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目的探讨伴有组织细胞样分化的心黏液瘤的病理学特点及鉴别诊断。方法报道1例伴有组织细胞样分化的心黏液瘤,进行组织学及免疫组化标记研究,并复习相关文献。结果患者男性,56岁。活动后呼吸困难伴心悸。超声发现右心房肿块。镜下肿瘤组织呈短条索状或实性巢样排列,大部分区域缺乏黏液样基质。肿瘤细胞呈组织细胞样,核圆形、卵圆形,染色质空泡状,有明显小核仁,缺乏核分裂。免疫组化:瘤细胞vimentin和calretinin(+),SMA、actin(sarcomeric)和S-100灶状(+),desmin、myoglobin、HMB45、melan-A、CDla、CD21、CD23、CD35、F、CD68、CD117、CK(AE1/AE3)、CK5/6、EMA、mesothelial和WT-1(-)。结论伴有组织细胞样分化的心黏液瘤为一种特殊类型,与经典型心黏液瘤相比具有独特的组织学特征,需与上皮样血管内皮瘤及炎性肌纤维母细胞瘤相鉴别。
Objective To investigate the pathological features and differential diagnosis of cardiac myxoma with histiocytic differentiation. Methods One case of cardiac myxoma with histocytoid differentiation was reported. The histological and immunohistochemical studies were performed and the related literatures were reviewed. Results The patient was male, 56 years old. Breathing difficulties with heart palpitations after activity. Right atrium was found by ultrasound. Microscopic tumor tissue was short-cords or solid nest-like arrangement, the majority of areas lack of myxoid matrix. Tumor cells were organized cell-like, nuclear round, oval, chromatin vacuolar, with obvious small nucleoli, the lack of nuclear fission. Immunohistochemistry: The expressions of vimentin and calretinin (+), SMA, actin (sarcomeric) and S-100, desmin, myoglobin, HMB45, melan-A, CDla, CD21, CD23, CD35, CD68, CD117, CK (AE1 / AE3), CK5 / 6, EMA, mesothelial and WT-1 (-). Conclusions Cardiac myxoma with histiocytic differentiation is a special type that has unique histological features compared with classical cardiac myxoma and needs to be differentiated from epithelioid hemangioendothelioma and inflammatory myofibroblastoma.