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例1,女,26岁。于3个月前突然咳嗽,咯白色泡沫带血丝样痰,查体及各项实验室检查均未见异常。痰未发现瘤细胞,X线摄胸片示右肺下叶背段和后基底段有一8cm×8cm巨块肿块,边缘锐利,密度均匀。手术切除右肺下叶,右肺门淋巴结不大,肉眼观察肿物8cm×7cm×8cm,中等硬,切面为灰白色,质脆。镜下:肿瘤由上皮和间叶成分组成,相互间无移行,上皮成分癌细胞排列呈条索状、巢状,与周围间质分界清楚,癌细胞大小不一,呈圆形,卵圆形或多边形;胞浆丰富,胞核与细胞形态相对应,染色质粗大,可见核仁核分裂相常见。间叶成分瘤细胞呈梭形,胞浆边界不清,可见较多胶原纤维;胞核胖梭形,呈中度异形,瘤细胞呈弥散或束状排列,穿插瘤巢之间;网浆后见瘤细胞周围有网状纤维围绕。病理诊为:肺癌肉瘤(鳞状上皮癌与纤维肉瘤)。
Example 1, female, 26 years old. Suddenly coughing three months ago, a slightly white foam with blood-like sputum, and no abnormalities in physical examinations and laboratory tests. No tumor cells were found. X-ray chest radiographs showed an 8cm x 8cm massive mass in the dorsal and posterior basal segments of the right lower lobe with sharp edges and uniform density. Surgical removal of the right lower lobe, the right hilar lymph node is not large, naked eye mass observed 8cm × 7cm × 8cm, moderate hard, cut surface is gray, crisp. Microscopically, the tumor consists of epithelial and mesenchymal components with no transitions between each other. The epithelial components of the cancer cells are arranged in cords and nests, and the surrounding mesenchyme is clearly demarcated. The cancer cells are of different sizes and are round and oval. Or polygonal; abundant cytoplasm, nucleus and cell morphology corresponding to large chromatin, visible nucleolar mitosis is common. The mesenchymal tumor cells were spindle-shaped, with unclear cytoplasmic borders and more collagen fibers; nucleus fat spindle-shaped, moderately shaped; tumor cells diffuse or bundled, interspersed with tumor nests; Seen around the tumor cells are surrounded by reticular fibers. Pathological diagnosis: lung sarcoma (squamous cell carcinoma and fibrosarcoma).