具有Bland组织学特征的肉瘤样间皮瘤:诊断中的一个潜在缺陷。

IF 0.1 Q4 PATHOLOGY
Allen P Burke, Naomi Hardy, Rachel Fanaroff, Teklu Legesse
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引用次数: 0

摘要

肉瘤样间皮瘤在小的活检标本上诊断可能很有挑战性,因为有限的材料可能会阻碍对侵袭的明确评估,并且病变细胞的细胞学可能相对平淡,没有间皮标记物表达。我们报告了一例患者,他出现胸腔积液,随后进行了胸膜活检,结果显示轻度黏液样背景下的纺锤体细胞增殖平淡、均匀。几乎没有胶原蛋白;无胸壁、软组织或脂肪;间皮标志物为阴性。免疫组化显示细胞的泛细胞角蛋白和GATA3阳性,原位杂交显示CDKN2A纯合缺失的“阴性”结果;然而,有一个等位基因的部分(杂合)丢失。基于这些发现,对非典型梭形细胞增殖进行了诊断。几个月后,患者进行了重复的胸膜活检,结果显示多刺细胞具有更多的多形性,侵犯胸壁的区域,CDKN2A也有相同的部分丢失,与肉瘤样间皮瘤一致。该病例强调了小活检标本存在的挑战,事实上,肉瘤样间皮瘤可能相对平淡,出现局灶性多形性,CDKN2A的杂合缺失应被视为指示肿瘤过程的阳性结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Sarcomatoid Mesothelioma with Bland Histologic Features: A Potential Pitfall in Diagnosis.

Sarcomatoid Mesothelioma with Bland Histologic Features: A Potential Pitfall in Diagnosis.

Sarcomatoid mesotheliomas can be challenging to diagnose on small biopsy specimens, where limited material may preclude definitive assessment of invasion and lesional cells can have relatively bland cytology with no mesothelial marker expression. We report a case of a patient who presented with a pleural effusion and had subsequent pleural biopsy that showed a bland, uniform spindle cell proliferation in a mildly myxoid background. There was little if any collagen; no chest wall, soft tissue, or fat; and mesothelial markers were negative. The cells were positive for pancytokeratin and GATA3 by immunohistochemistry, and in situ hybridization showed a "negative" result for homozygous loss of CDKN2A; however, there was partial (heterozygous) loss of one allele. A diagnosis of atypical spindle cell proliferation was made based on these findings. Several months later, the patient had a repeat pleural biopsy that showed spindled cells with more pleomorphism, areas of invasion into the chest wall, and the same partial loss of CDKN2A, consistent with a sarcomatoid mesothelioma. This case underscores the challenges present on small biopsy specimens, the fact that sarcomatoid mesotheliomas can be relatively bland appearing with focal pleomorphism, and that heterozygous loss of CDKN2A should be considered a positive result indicative of a neoplastic process.

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