Kanner William A, Brill Louis B, Patterson James W, Wick Mark R
Department of Pathology, University of Virginia Health System, Charlottesville, VA 22908-0214, USA.
J Cutan Pathol. 2010 Jul;37(7):744-50. doi: 10.1111/j.1600-0560.2010.01534.x. Epub 2010 Feb 24.
Atypical fibroxanthoma (AFX) is a pleomorphic spindle cell lesion of the skin; it is considered in the differential diagnosis with spindle cell malignant melanoma (MM) and sarcomatoid carcinoma/spindle cell squamous cell carcinoma (SCC). An optimum approach has yet to fully emerge with respect to the immunohistochemical discrimination of these lesions.
Departmental archives from 1978 onwards were searched for clinicopathologically confirmed cases of AFX, MM and SCC. Immunostains for CD10, CD99 and p63 were performed in each case. Scored staining results were analyzed using Fisher's Exact Test.
Twenty-seven of 31 cases of AFX were positive for CD10, as compared with 3 of 22 SCCs and 0 of 20 MMs. CD10 positivity was preferentially associated with the diagnosis of AFX (p < 0.001). p63 reactivity was observed in 15/22 cases of SCCs, 5/31 AFXs and 1/20 MMs. CD99 reactivity was observed in 3/31 cases of AFX, 2/22 SCCs and 3/20 MMs.
CD10 positivity is relatively specific in this context for the diagnosis of AFX. Its utility is enhanced when only strong, diffuse membranocytoplasmic staining is considered as a positive result. In contrast to prior reports, p63 was not found to be highly sensitive for SCC. Similarly, CD99 showed no preferential staining of any single diagnostic group of lesions.
非典型纤维黄色瘤（AFX）是一种皮肤多形性梭形细胞病变；在鉴别诊断中需考虑与梭形细胞恶性黑色素瘤（MM）和肉瘤样癌/梭形细胞鳞状细胞癌（SCC）相鉴别。关于这些病变的免疫组化鉴别，尚未完全出现一种最佳方法。
检索自1978年起的科室档案，查找经临床病理确诊的AFX、MM和SCC病例。对每个病例进行CD10、CD99和p63免疫染色。使用Fisher精确检验分析评分后的染色结果。
31例AFX中有27例CD10呈阳性，相比之下，22例SCC中有3例阳性，20例MM中无阳性。CD10阳性与AFX的诊断优先相关（p<0.001）。在22例SCC中的15例、31例AFX中的5例和20例MM中的1例观察到p63反应性。在31例AFX中的3例、22例SCC中的2例和20例MM中的3例观察到CD99反应性。
在这种情况下，CD10阳性对AFX的诊断相对特异。当仅将强的、弥漫性的膜细胞质染色视为阳性结果时，其效用增强。与先前的报告相反，未发现p63对SCC具有高敏感性。同样，CD99在任何单一诊断组的病变中均未显示出优先染色。
