Lindberg G M, Maitra A, Gokaslan S T, Saboorian M H, Albores-Saavedra J
Department of Pathology, University of Texas Southwestern Medical Center, Dallas 75235, USA.
Cancer. 1999 Apr 25;87(2):75-82.
Although the histologic features of the recently described low grade fibromyxoid sarcoma are well established, to the authors' knowledge there are no reports in the literature describing the cytologic features of this tumor by fine-needle aspiration. Recognition of this lesion is important because of its indolent but metastasizing nature.
The authors retrospectively reviewed their surgical pathology files for cases of low grade fibromyxoid sarcoma with a preoperative fine-needle aspiration biopsy (FNAB); three such cases were found. Immunohistochemical studies were performed in all three tumors, ultrastructural examination was performed in two tumors, and fresh tissue for cytogenetic analysis was obtained in one tumor.
All FNABs showed similar features. The aspirates were relatively hypocellular with an abundant myxoid background; the neoplastic cells contained oval to spindle shaped nuclei with minimal pleomorphism. No capillaries or areas of fibrous tissue were identified. Cytogenetic study of one case revealed no chromosomal abnormalities. The histologic findings were characteristic for this lesion. By immunohistochemistry the tumor cells showed diffuse and strong reactivity for vimentin only; at the ultrastructural level the neoplastic spindle cells had characteristics of fibroblasts.
The cytologic features of low grade fibromyxoid sarcoma are not specific enough for a definitive diagnosis based on FNAB alone; however, correlating the cytologic and clinical findings can narrow the range of diagnosis. The differential diagnosis includes other myxoid lesions, in particular superficial or intramuscular myxoma and myxofibrosarcoma. In addition, the immunohistochemical and ultrastructural findings support a fibroblastic origin for this neoplasm.
尽管最近描述的低度纤维黏液样肉瘤的组织学特征已明确，但据作者所知，文献中尚无通过细针穿刺描述该肿瘤细胞学特征的报道。认识到这种病变很重要，因为它具有惰性但会转移的特性。
作者回顾性分析了其手术病理档案中术前进行过细针穿刺活检（FNAB）的低度纤维黏液样肉瘤病例；共发现3例。对所有3例肿瘤均进行了免疫组织化学研究，对其中2例进行了超微结构检查，并对1例肿瘤获取了新鲜组织进行细胞遗传学分析。
所有FNAB均显示出相似特征。穿刺物细胞相对较少，有丰富的黏液样背景；肿瘤细胞的核呈椭圆形至梭形，异型性极小。未发现毛细血管或纤维组织区域。1例的细胞遗传学研究未发现染色体异常。组织学表现为此病变的特征性表现。免疫组织化学显示肿瘤细胞仅对波形蛋白呈弥漫性强反应；在超微结构水平，肿瘤梭形细胞具有成纤维细胞的特征。
低度纤维黏液样肉瘤的细胞学特征单独基于FNAB不足以做出明确诊断；然而，将细胞学和临床发现相结合可缩小诊断范围。鉴别诊断包括其他黏液样病变，特别是浅表或肌内黏液瘤和黏液纤维肉瘤。此外，免疫组织化学和超微结构发现支持该肿瘤起源于成纤维细胞。
