Wick M R, Fitzgibbon J, Swanson P E
Lauren V. Ackerman Laboratory of Surgical Pathology, Washington University School of Medicine, St Louis, MO.
Semin Diagn Pathol. 1993 May;10(2):148-58.
Cutaneous sarcomas and sarcoma-like lesions pose special problems for pathologists. These lesions manifest a great deal of clinical and histological overlap, and they may be virtually impossible to separate from one another on conventional microscopy. Spindle-cell squamous carcinoma (SCSC), sarcomatoid malignant melanoma (SCMM), and fibrohistiocytic tumors, such as "atypical fibroxanthoma" (AFX) and superficial malignant fibrous histiocytoma (SMFH), comprise the group of neoplasms in this category that pose the greatest diagnostic difficulty. All may or may not show attachments between dermal tumor cells and the overlying epidermis; all may be composed of varying proportions of fusiform and pleomorphic cells; and all may demonstrate the presence of "divergent" differentiation into bone, cartilage, or myogenous tissues. Electron microscopy and immunohistology usually are required to identify these tumors with certainty. The usefulness in doing so is supported by differing biological behaviors in this context. SCMM shows the greatest tendency for recurrence and metastasis, followed in relative order by SMFH, SCSC, and AFX.
皮肤肉瘤和肉瘤样病变给病理学家带来了特殊的问题。这些病变在临床和组织学上有大量重叠，在传统显微镜下几乎不可能将它们彼此区分开来。梭形细胞鳞状细胞癌（SCSC）、肉瘤样恶性黑色素瘤（SCMM）以及纤维组织细胞肿瘤，如“非典型纤维黄色瘤”（AFX）和浅表性恶性纤维组织细胞瘤（SMFH），构成了这一类中诊断难度最大的肿瘤群体。所有这些肿瘤可能显示或不显示真皮肿瘤细胞与上方表皮之间的连接；都可能由不同比例的梭形细胞和多形性细胞组成；并且都可能表现出向骨、软骨或肌源性组织的“异向”分化。通常需要电子显微镜检查和免疫组织学检查才能确切识别这些肿瘤。在这种情况下，不同的生物学行为支持了这样做的实用性。SCMM复发和转移的倾向最大，其次依次是SMFH、SCSC和AFX。
