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[ Erdheim-Chester病的临床与病理特征]

[Clinical and pathologic characteristics of Erdheim-Chester disease].

作者信息

Lu Tao, Cao Xinxin, Luo Yufeng, Cai Huacong, Zhang Wei, Zhong Dingrong

机构信息

Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China.

E-mail:

出版信息

Zhonghua Bing Li Xue Za Zhi. 2014 Dec;43(12):809-13.

Abstract

OBJECTIVE

To explore the clinicopathologic features, immunophenotype, differential diagnosis and gene mutation status of the Erdheim-Chester disease (ECD).

METHODS

Clinical and pathologic findings of 3 ECD cases were examined by gross, microscopic, immunohistochemical methods and BRAF V600E mutation. Related literatures were reviewed.

RESULTS

Two male patients and one female patient presented clinically with multiple skin nodules, bone pain and bony lesions by imaging study. Microscopically, the lesions were composed of spindle-shaped fibroblasts, foamy histiocytes and scattered Touton-type giant cells embedded in reactive fibrous tissue. Lymphocytes, plasma cells, and multinucleated giant cells were also found. Immunohistochemically, all histiocytes were positive for CD68, none of which expressed CD1a, although 2 cases focally expressed weak S-100 stain. In 2 cases,BRAF V600E mutation was detected.

CONCLUSIONS

ECD is a rare disease of xanthogranulomatous histiocytosis.Its diagnosis relies on pathological and immunohistochemical findings, but correlation with clinical information, especially radiographic findings should be performed.No effective treatment of the disease is currently available.

摘要

目的

探讨 Erdheim-Chester 病(ECD)的临床病理特征、免疫表型、鉴别诊断及基因突变状态。

方法

采用大体、显微镜、免疫组织化学方法及 BRAF V600E 突变检测 3 例 ECD 病例的临床及病理表现。并复习相关文献。

结果

2 例男性患者和 1 例女性患者临床上均表现为多发皮肤结节、骨痛及影像学检查显示的骨病变。显微镜下,病变由梭形成纤维细胞、泡沫状组织细胞及散在的 Touton 型巨细胞组成,包埋于反应性纤维组织中。还发现淋巴细胞、浆细胞及多核巨细胞。免疫组织化学显示,所有组织细胞 CD68 均呈阳性,均不表达 CD1a,尽管 2 例病例灶性弱表达 S-100 染色。2 例病例检测到 BRAF V600E 突变。

结论

ECD 是一种罕见的黄色肉芽肿性组织细胞增多症。其诊断依赖于病理及免疫组织化学结果,但应结合临床信息,尤其是影像学表现。目前尚无有效的治疗方法。

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