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目的探讨胃原发性浆细胞瘤病理学特征及其诊断、治疗。方法对1例胃原发性浆细胞瘤行组织病理学形态观察及免疫组化检测,并结合相关文献进行讨论。结果肿瘤位于胃体部,大小6 cm×5 cm×3 cm,周边散在息肉样肿块,最大者直径6 cm。镜检:肿瘤由具有浆细胞特征的瘤细胞构成,多为成熟的浆细胞,细胞呈圆形或卵圆形,染色质呈车轮状排列,在显微镜高倍视野下可见双核、多核,核分裂象1~2个/HPF,肿瘤细胞弥漫片状排列并侵及胃壁全层。免疫组化PAX-5、CD138、CD38、Pan-CK、EMA、CD30、MUM-1、vimentin和CD10(+);Kappa、Lambda、EBV、EBER、CK7、CD5、CD20、CD56、CD79α、CD4、CD8、CD45、CD43、CD68、S-100、melan-A、HMB45、CD34、CD117、DOG-1、CEA、bcl-6、PAX-8、CD3、ALK、granzyme B和TIA为(-);Ki-67增殖指数80%;D2-40显示脉管内瘤栓形成。结论胃原发性浆细胞瘤较罕见,有关病例报道较少,因缺乏特异性临床表现及影像学依据,极易被误诊,明确诊断依赖于病理学检查,免疫组化有助于鉴别诊断。
Objective To investigate the pathological features of gastric primary plasmacytoma and its diagnosis and treatment. Methods One case of gastric primary plasmacytoma was observed by histopathology and immunohistochemistry, and the related literature was discussed. Results The tumor was located in the body of the body with a size of 6 cm × 5 cm × 3 cm. The periphery was surrounded by a polypoid mass with a maximum diameter of 6 cm. Microscopic examination: The tumor consists of tumor cells with plasma cell features, mostly mature plasma cells, cells were round or oval, chromatin was arranged in a wheel shape, visible in the microscope under high power double-nuclei, multi-nuclear, mitotic 1 ~ 2 / HPF, tumor cells diffuse flaky arrangement and invasion of the full-thickness gastric wall. Kappa, Lambda, EBV, EBER, CK7, CD5, CD20, CD56, CD79a, CD4, CD8 CD45 CD43 CD68 S-100 melan-A HMB45 CD34 CD117 DOG-1 CEA bcl-6 PAX-8 CD3 ALK granzyme B and TIA were (-); Ki -67 proliferation index of 80%; D2-40 shows intravascular tumor thrombus formation. Conclusion Gastric primary plasmacytoma is rare and few cases are reported. Due to the lack of specific clinical manifestations and imaging evidence, it is easily misdiagnosed, and the diagnosis is dependent on pathological examination. Immunohistochemistry is helpful for the differential diagnosis.