Nsour Esra, Al Khader Ali, Al-Tarawneh Bushra
Department of Pathology, Al Hussein Salt Hospital, Ministry of Health, Al-Salt, Jordan.
Al-Balqa Applied University, Al-Salt, Jordan.
SAGE Open Med Case Rep. 2020 Dec 18;8:2050313X20981177. doi: 10.1177/2050313X20981177. eCollection 2020.
Small cell carcinoma is a malignant neuroendocrine tumor with aggressive clinical behavior. Histologically, the tumor is characterized by the proliferation of small, round, blue cells. Here, we present the case of a 50-year-old man with a 1-month history of enlarging chest wall mass. Microscopic examination of the lesion revealed a highly cellular neoplasm composed of closely packed, atypical spindle cells with scant cytoplasm, inconspicuous nucleoli, and brisk mitotic activity. The hemangiopericytoma-like vascular pattern was prominent. Areas showing a fibrosarcoma-like fascicular pattern were also observed. The tumor was immunohistochemically positive for TTF1, synaptophysin, and chromogranin, confirming small cell carcinoma. Further investigations revealed a lung origin and widespread metastases. The tumor in this case closely mimicked synovial sarcoma or malignant peripheral nerve sheath tumor. Small cell carcinoma demonstrates a hemangiopericytoma-like pattern that can mimic sarcoma histologically. This is a serious pitfall that can significantly affect the speed of diagnosis and management.
小细胞癌是一种具有侵袭性临床行为的恶性神经内分泌肿瘤。在组织学上，该肿瘤的特征是小的、圆形的蓝色细胞增殖。在此，我们报告一例50岁男性病例，其胸壁肿物增大1个月。对病变进行显微镜检查发现，肿瘤细胞高度密集，由紧密排列的非典型梭形细胞组成，胞质稀少，核仁不明显，有活跃的有丝分裂活动。血管外皮细胞瘤样血管模式显著。还观察到呈纤维肉瘤样束状模式的区域。肿瘤免疫组化TTF1、突触素和嗜铬粒蛋白呈阳性，确诊为小细胞癌。进一步检查发现肿瘤起源于肺且有广泛转移。该病例中的肿瘤与滑膜肉瘤或恶性外周神经鞘瘤极为相似。小细胞癌表现出血管外皮细胞瘤样模式，在组织学上可类似肉瘤。这是一个严重的陷阱，可显著影响诊断和治疗的速度。
