Spaulding Reed, Koumoundouros Theodoros, Parker Joseph C
University of Louisville Hospital, Department of Anatomic Pathology, Louisville, KY 40202, USA.
Ann Clin Lab Sci. 2013 Spring;43(2):172-5.
Malignant Fibrous Histiocytoma was historically the most commonly diagnosed soft tissue sarcoma of adults. In 2002, the World Health Organization declassified malignant fibrous histiocytoma as a formal diagnostic entity. They recommended renaming the disease "Pleomorphic Undifferentiated Sarcoma". Current thoughts about the origin of this tumor are being debated. We report a case of a dedifferentiated liposarcoma that metastasized to the lung within one year. The histologic morphology of the metastasis was more aggressive than the primary lesion, and was consistent with a pleomorphic undifferentiated sarcoma. Following surgical resection of the metastatic pulmonary lesion, the patient never fully regained consciousness. He expired the day following his surgery. At autopsy, the patient was found to have died from a massive hemorrhagic stroke involving almost the entire left cerebrum. Tumor emboli from the pulmonary metastasis were seen in the left middle cerebral artery, causing the cerebral infarct. The embolic lesion was consistent with a pleomorphic undifferentiated sarcoma. This case illustrates the evolution that soft tissue sarcomas can undergo as they metastasize and become increasingly undifferentiated, and confirms the surgical risk of resecting such lesions.
恶性纤维组织细胞瘤在历史上是成人中最常被诊断出的软组织肉瘤。2002年，世界卫生组织不再将恶性纤维组织细胞瘤列为正式的诊断实体。他们建议将该疾病重新命名为“多形性未分化肉瘤”。目前关于这种肿瘤起源的观点仍在争论中。我们报告一例去分化脂肪肉瘤在一年内转移至肺部的病例。转移灶的组织形态学比原发灶更具侵袭性，与多形性未分化肉瘤一致。在手术切除肺部转移灶后，患者从未完全恢复意识。他在手术后第二天死亡。尸检发现，患者死于几乎累及整个左大脑的大面积出血性中风。在左大脑中动脉可见来自肺转移灶的肿瘤栓子，导致脑梗死。栓塞性病变与多形性未分化肉瘤一致。该病例说明了软组织肉瘤在转移过程中可能发生的演变，以及变得越来越未分化的情况，并证实了切除此类病变的手术风险。
