Oyama Yuzo, Furukawa-Kubota Riko, Kadowaki Hiroko, Wada Junnpei, Kawamura Kazuhiro, Miura Takashi, Daa Tsutomu
The Departments of Pathology, Oita City Medical Association's Almeida Memorial Hospital, Oita City, Japan.
The Department of Diagnostic Pathology, Faculty of Medicine, Oita University, 1-1, Idaigaoka, Hasama-Machi, Yufu, 879-5593, Japan.
Med Mol Morphol. 2025 Aug 9. doi: 10.1007/s00795-025-00445-z.
This report presents the sixth case of chest wall epithelioid sarcoma (ES) in a 71-year-old Japanese man. The patient was incidentally diagnosed with a soft tissue tumor between the eighth and ninth ribs, presenting with an associated bone fracture and osteolytic change. Marginal resection followed by chest wall reconstruction was performed for a definitive diagnosis. Histopathological examination revealed multinodular growth associated with collagenous stroma, mimicking a necrotizing granulomatous process. Various tumor cells were observed, including epithelioid, spindle-shaped, and rhabdoid cells. Immunohistochemical analysis, conducted on trimmed tumor samples without decalcification, revealed positivity for cytokeratin AE1/AE3, vimentin, and CD34, as well as negativity for CK7, CK20, CD31, calretinin, and D2-40. INI expression was completely absent in tumor cells. The patient was diagnosed with ES. The chest wall is an unusual location for ES, and its diagnosis requires differentiation from other epithelioid neoplasms. This case highlights the importance of trimming tumor samples before decalcification to preserve antigenicity and ensure accurate immunohistochemistry analysis.
本报告介绍了一名71岁日本男性胸壁上皮样肉瘤（ES）的第六例病例。该患者偶然被诊断出第八和第九肋骨之间存在软组织肿瘤，并伴有相关的骨折和溶骨性改变。为明确诊断，进行了边缘切除并随后进行胸壁重建。组织病理学检查显示多结节生长并伴有胶原性基质，类似坏死性肉芽肿过程。观察到各种肿瘤细胞，包括上皮样、梭形和横纹肌样细胞。对未经脱钙的修整肿瘤样本进行免疫组织化学分析，结果显示细胞角蛋白AE1/AE3、波形蛋白和CD34呈阳性，而CK7、CK20、CD31、钙视网膜蛋白和D2-40呈阴性。肿瘤细胞中完全不存在INI表达。该患者被诊断为ES。胸壁是ES的一个不寻常发病部位，其诊断需要与其他上皮样肿瘤相鉴别。本病例强调了在脱钙前修整肿瘤样本以保留抗原性并确保准确免疫组织化学分析的重要性。
