Goldblum J R, Tuthill R J
Department of Anatomic Pathology, Cleveland Clinic Foundation, OH 44195, USA.
Am J Dermatopathol. 1997 Apr;19(2):147-53. doi: 10.1097/00000372-199704000-00008.
The histologic distinction between dermatofibrosarcoma protuberans (DFSP) and the fibrous type of benign fibrous histiocytoma (dermatofibroma, DF) may be extremely difficult. In this study, we evaluated the extent and pattern of immunoreactivity of both CD34 and factor XIIIa in a large number of DFSPs and DFs in order to determine the utility of these markers in their distinction. Using histologic criteria alone, the authors independently evaluated and agreed upon 30 cases of DF and 24 cases of DFSP, and a representative section was stained with antibodies to both factor XIIIa and CD34. Immunopositivity was evaluated semiquantitatively and assigned a score from 0 to 5. CD34 immunoreactivity was seen in 22 (92%) of 24 DFSPs (mean CD34 score, 4.60 +/- 0.3). Only 12 (40%) of 30 DFs showed CD34 immunopositivity (mean CD34 score, 0.6 +/- 0.1). Factor XIIIa was seen in 29 (97%) of 30 DFs (mean factor-XIIIa score, 4.1 +/- 0.3). In contrast, 18 (75%) of 24 DFSPs stained for factor XIIIa (mean factor-XIIIa score, 1.3 +/- 0.2), but in most of these cases the factor-XIIIa-positive cells were felt to be entrapped nonneoplastic dermal dendrocytes. Thus, an immunoprofile using antibodies to CD34 and factor XIIIa is capable of distinguishing between DFSP and the fibrous type of DF in the vast majority of cases, as long as there is recognition that there may be some CD34-positive cells in DFs, as well as some factor-XIIIa-positive cells in DFSPs.
隆突性皮肤纤维肉瘤（DFSP）与纤维型良性纤维组织细胞瘤（皮肤纤维瘤，DF）之间的组织学鉴别可能极其困难。在本研究中，我们评估了大量DFSP和DF中CD34和因子ⅩⅢa的免疫反应程度和模式，以确定这些标志物在鉴别诊断中的效用。仅根据组织学标准，作者独立评估并认可了30例DF和24例DFSP，并对一个代表性切片用因子ⅩⅢa和CD34抗体进行染色。对免疫阳性进行半定量评估，并赋予0至5分的评分。24例DFSP中有22例（92%）可见CD34免疫反应（平均CD34评分，4.60±0.3）。30例DF中仅12例（40%）显示CD34免疫阳性（平均CD34评分，0.6±0.1）。30例DF中有29例（97%）可见因子ⅩⅢa（平均因子ⅩⅢa评分，4.1±0.3）。相比之下，24例DFSP中有18例（75%）因子ⅩⅢa染色阳性（平均因子ⅩⅢa评分，1.3±0.2），但在大多数这些病例中，因子ⅩⅢa阳性细胞被认为是陷入的非肿瘤性真皮树突状细胞。因此，只要认识到DF中可能存在一些CD34阳性细胞以及DFSP中可能存在一些因子ⅩⅢa阳性细胞，使用CD34和因子ⅩⅢa抗体的免疫表型在绝大多数病例中能够区分DFSP和纤维型DF。
