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[儿童肾外恶性横纹肌样瘤:8例临床病理分析]

[Extrarenal malignant rhabdoid tumor of childhood: a clinicopathologic analysis of 8 cases].

作者信息

Wang Han, Ma Yangyang, Li Jiaheng, Zhang Dawen, Wu Baoyu, Fang Cheng, Chen Lian

机构信息

Department of Pathology, Children's Hospital, Fudan University, Shanghai 201102, China.

E-mail:

出版信息

Zhonghua Bing Li Xue Za Zhi. 2014 Dec;43(12):805-8.

Abstract

OBJECTIVE

To study the clinicopathologic characteristics of extrarenal malignant rhabdoid tumor (E-MRT) with emphasis on diagnosis and differential diagnosis.

METHODS

The clinical and pathologic data of 8 E-MRT cases were reviewed. The outcome was analyzed.

RESULTS

There were four males and four females. The age at presentation ranged from 3 days to 8 years (mean, 2.6 years; median, 3 years). The tumors were located in the extremities (n = 1), head and neck (n = 2), trunk (n = 2), cervical cord (n = 1), liver (n = 1) and retroperitoneum (n = 1). Histologically, the tumors were composed of a diffuse proliferation of rounded or polygonal cells with eccentric nuclei, prominent nucleoli, and glassy eosinophilic cytoplasm containing hyaline-like inclusion bodies, arranged in sheets and nests. Cellular atypia was easily observed and mitotic activity was high. Necrotic and hemorrhagic areas were abundant. On immunohistochemistry, the tumor cells expressed vimentin and epithelial marker such as EMA, AE1/AE3, and CAM5.2. The absence of INI1 protein expression was a distinctive feature. Follow-up of all eight cases revealed five deaths in one year and the other three were disease-free at last follow-up of one month, three months and seven months.

CONCLUSIONS

E-MRT is a rare and highly aggressive tumor of infancy and childhood. Recurrence and distant metastasis was common and the 5-year survival rate is low. Increased awareness of the clinocopathologic features and immunophenotypes of E-MRT is helpful for correct diagnosis and effective treatment.

摘要

目的

研究肾外恶性横纹肌样瘤(E-MRT)的临床病理特征,重点在于诊断和鉴别诊断。

方法

回顾8例E-MRT病例的临床和病理资料,并分析其预后。

结果

男性4例,女性4例。发病年龄为3天至8岁(平均2.6岁;中位数3岁)。肿瘤位于四肢(1例)、头颈部(2例)、躯干(2例)、颈髓(1例)、肝脏(1例)和腹膜后(1例)。组织学上,肿瘤由圆形或多边形细胞弥漫性增生组成,细胞核偏位,核仁明显,胞质呈玻璃样嗜酸性,含有透明样包涵体,呈片状和巢状排列。细胞异型性易于观察,有丝分裂活性高。坏死和出血区域多见。免疫组化显示,肿瘤细胞表达波形蛋白和上皮标志物如EMA、AE1/AE3和CAM5.2。INI1蛋白表达缺失是其显著特征。8例患者随访显示,1年内5例死亡,其余3例在最后一次随访时分别为1个月、3个月和7个月,均无疾病复发。

结论

E-MRT是婴幼儿期罕见且侵袭性很强的肿瘤。复发和远处转移常见,5年生存率低。提高对E-MRT临床病理特征和免疫表型的认识有助于正确诊断和有效治疗。

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