Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA.
Cytopathology. 2023 Sep;34(5):472-478. doi: 10.1111/cyt.13248. Epub 2023 May 19.
Pleomorphic dermal sarcoma (PDS) is an uncommon cutaneous mesenchymal neoplasm. It is cytomorphologically identical to atypical fibroxanthoma (AFX), but differs due to its invasion beyond the dermis. We undertook an examination of our experience with fine needle aspiration (FNA) biopsy cytology of PDS.
Our cytopathology files were searched for examples of PDS with concomitant histopathological verification. FNA biopsy smears and cell collection were performed using standard techniques.
Seven cases of PDS were retrieved from four different patients (M:F, 1:1; age range: 63-88 years; mean age = 78 years). All patients (57%) presented with a primary tumour with one having an FNA biopsy of two local recurrences and a single distant metastasis. Five aspirates were from the extremities and two from the head/neck. Tumours ranged from 1.0 to 3.5 cm (mean, 2.2 cm). Specific cytological diagnoses were pleomorphic spindle/epithelioid sarcoma (3 cases), PDS (2), AFX (1), and atypical myofibroblastic lesion, query nodular fasciitis (1). Immunohistochemical (IHC) staining from FNA-generated cell blocks in two cases showed non-specific staining with vimentin in both cases; positive CD10, CD68, and INI-1 staining in one case; and smooth muscle actin expression in the other. Multiple negative stains were performed in both of these cases to exclude malignant melanoma, carcinoma, and specific forms of sarcoma. Cytopathology consisted of a mixture of spindle, epithelioid, and bizarre pleomorphic cells.
Coupled with ancillary IHC stains, FNA biopsy can help recognise PDS as a sarcomatous cutaneous neoplasm, but is unable to distinguish PDS from AFX.
多形性真皮肉瘤（PDS）是一种罕见的皮肤间叶性肿瘤。它在细胞学形态上与非典型纤维黄色瘤（AFX）相同，但由于其侵犯真皮以外而有所不同。我们对 PDS 的细针抽吸（FNA）活检细胞学检查经验进行了检查。
我们的细胞病理学档案中搜索了伴有组织病理学验证的 PDS 病例。使用标准技术进行 FNA 活检涂片和细胞采集。
从四位不同的患者中检索到了七例 PDS 病例（M：F，1：1；年龄范围：63-88 岁；平均年龄=78 岁）。所有患者（57%）均表现为原发性肿瘤，其中一例有两个局部复发和一个远处转移的 FNA 活检。五个抽吸物来自四肢，两个来自头/颈部。肿瘤大小从 1.0 到 3.5 厘米（平均为 2.2 厘米）。特定的细胞学诊断为多形性梭形/上皮样肉瘤（3 例）、PDS（2 例）、AFX（1 例）和非特异性肌纤维母细胞病变，疑为结节性筋膜炎（1 例）。在两个病例中，从 FNA 生成的细胞块进行免疫组织化学（IHC）染色，在两个病例中均显示出波形蛋白的非特异性染色；在一个病例中，CD10、CD68 和 INI-1 染色阳性；另一个病例中平滑肌肌动蛋白表达阳性。在这两个病例中进行了多种阴性染色以排除恶性黑色素瘤、癌和特定类型的肉瘤。细胞学检查包括梭形、上皮样和奇异的多形性细胞的混合物。
结合辅助 IHC 染色，FNA 活检可以帮助识别 PDS 为肉瘤性皮肤肿瘤，但无法区分 PDS 与 AFX。
