软组织肿瘤 病理学病例讨论 三课件.pptVIP

三、其它 Case 1. EX05-151 (04/S04470) Presented by P W AllenHistory Male aged 44 with a “curious” subcutaneous lump (size not stated) attached to the deep fascia in the right scapular area. The lesion appeared very well circumscribed with a condensed layer of fibro connective tissue peripherally Contributed by Dr J Evans, Nelson Hospital Laboratory, Nelson, New Zealand Diagnosis Spindle cell lipoma with minimal fat, subcutis attached to the deep fascia, right scapular area Spindle cell lipomaEnzinger and Harvey (1975) 114 cases from the AFIP Subcutaneous or dermal Mainly posterior neck, dorsal and shoulder areas Males 91% Mean age of 56 years (range 25 to 81 years) Spindle cell component may conceal lipomatous nature Previously misdiagnosed as subcutaneous liposarcomas or neural tumors Spindle cell lipoma S100 negative, CD34 positive Cytogenetics: anomalies in chromosomes 13 and 16 Cytogenetic changes different from those in lipomas and liposarcomas Spindle cell lipomaFanburg-Smith et al 18 cases of multiple spindle cell lipomas (7 familial) Clinically resembled multiple symmetric lipomatosis (Madelung’s disease) Case 2 (A 2 years old boy with a temporal bone lesion) Case History 两岁男孩，从8个月开始患有双侧中耳炎，并反复发作，左侧更为严重。 左耳频繁有脓性物质流出。 口服抗生素治疗，并行双侧鼓膜切开术及左中耳导管植入术。 随后出现左耳血性溢液，既而左耳突出。主诉间歇疼痛，无发热及寒颤。 父母听力基本正常。 CT和MRI示左侧颞骨肿物。行活检术。 Case History A 2 years-old boy with history of recurrent left (more severe) and right otitis media since 8 months. Frequent purulent discharge from left ear. Treated oral antibiotics, and bilateral myringotomy and tube placement in the left middle ear. Continued to have left side ear bloody otorrhea, and later developed left ear proptosis. Complain of intermittent pain. No fevers or chills. Hearing grossly normal per parents. CT and MRI revealed left temporal bone mass. Biopsy performed. Final Diagnosis Langerhan’s Cell Histiocytosis (Eosinophilic granuloma) Langerhan’s Cell Histiocytosis (Eosinophilic granuloma) Proliferation of Langerh