文章摘要

鼻腔畸胎癌肉瘤1例及文献复习

作者: 1梁玉梅
1 解放军总医院第八医学中心病理科,北京 100091
通讯: 梁玉梅 Email: liangyumei309@126.com
DOI: 10.3978/j.issn.2095-6959.2019.12.035

摘要

报告1例鼻腔畸胎癌肉瘤(teratocarcinosarcoma,TCS)患者,分析其临床病理特征并复习相关文献,为其诊断与治疗总结经验。患者,男,54岁,因鼻塞、涕中带血入院,查体见右鼻腔占位性病变,行手术治疗。镜下见肿瘤由上皮源性及间叶源性2种成分组成,上皮成分中见鳞状上皮、纤毛柱状上皮及神经上皮,神经上皮呈巢团状排列,可见菊形团。部分鳞状上皮细胞胞质透亮,可见鳞状上皮细胞与柱状上皮细胞的移行;局部见鳞状细胞癌成分。间叶成分主要由丰富的梭形细胞构成,细胞异型性明显,间质内富于血管,局灶可见软骨形成。免疫组织化学示上皮成分中嗜铬素呈细胞质内点状阳性,CD56,NSE弱阳性,部分上皮细胞CKpan阳性,同时表达CK5/6及p63,提示鳞状细胞分化;间叶源性成分中仅Vimentin阳性表达。结合形态学及免疫组织化学表型符合鼻腔TCS,伴有鳞状细胞癌成分,肿瘤局部累及骨骼肌。术后患者行放射治疗,随访30个月未见肿瘤复发及转移。鼻腔TCS为罕见的鼻腔恶性肿瘤,须积极治疗;其诊断主要依靠组织病理学,特征性的组织结构及免疫组织化学表型有利于疾病的诊断。
关键词: 畸胎癌肉瘤;鼻腔;恶性肿瘤

Teratocarcinosarcoma of the nasal cavity: A case report and literature review

Authors: 1LIANG Yumei
1 Department of Pathology, 8th Medical Center of Chinese PLA General Hospital, Beijing 100091, China

CorrespondingAuthor: LIANG Yumei Email: liangyumei309@126.com

DOI: 10.3978/j.issn.2095-6959.2019.12.035

Abstract

To analyze the clinicopathological features of teratocarcinosarcoma of the nasal cavity, we presented a case of 54-year-old man and reviewed the literatures. A 54-year-old man presented to an outside institution with a 2-week history of nasal obstruction and epistaxis. A polypoid mass was found in his right nasal cavity. He subsequently underwent endoscopic sinus surgery. Histopathologic examination identified the malignant tumor was composed by two parts, one showing the histological features of carcinoma, the other with the features of sarcoma. There were nests of cells like neuroepithelium cells with scanty cytoplasm, inconspicuous nucleoli. Areas of nonkeratinizing squamous epithelium were found, there were also glandular structures lined by benign-appearing epithelium. Despite the epithelium component, the spindle cells showed the features of sarcoma with the apparent atypia and high mitosis index of 14/10 HPF. Benign cartilage and ciliated epithelium were also found in the tumor which revealed the features of teratoma of this malignant tumor. By immunohistochemistry, the epithelial components were positive with CK. NSE was positive in the neuroepithelium with focal positive pattern, so was CgA with a dotted positive pattern. The spindle cells were only positive with vimentin. A diagnosis of teratocarcinosarcoma was made. The patient accepted radio therapy after the surgery and was event-free in the next 30 months in follow-up. Teratocarcinosarcoma is a rare malignant tumor of nasal cavity which is needed aggressive therapy. The diagnosis depends on histopathology, the characteristic morphologic features and typical immunohistochemical phenotype can facilitate the diagnosis.
Keywords: teratocarcinosarcoma; nasal cavity; malignant tumor