Kilpatrick S E, Koplyay P D, Ward W G, Richards F
Department of Pathology, Bowman Gray School of Medicine of Wake Forest University, Winston-Salem, North Carolina, USA.
Diagn Cytopathol. 1998 Jul 1;19(1):38-43. doi: 10.1002/(sici)1097-0339(199807)19:1<38::aid-dc8>3.0.co;2-k.
We retrospectively reviewed two fine-needle aspiration biopsy (FNAB) specimens from two patients with histologically confirmed epithelioid hemangioendothelioma (EH). Both patients were men, ages 79 and 39 years; their primary tumors arose in the soft tissues of the mediastinum and within the proximal tibia, respectively. The former patient had symptoms of superior vena cava syndrome; multicentric intraosseous lesions involved the proximal tibia of the latter patient. All cytologic smears were hypercellular and composed of mostly disassociated single cells and small aggregates of ovoid to polygonal-shaped epithelioid cells. Nuclei were variable, ranging from ovoid and reniform to round and polylobated and surrounded by an abundant amount of dense cytoplasm. Binucleated epithelioid neoplastic cells were frequent. Nuclear pleomorphism ranged from slight to moderate, and small solitary to multiple nucleoli were identified within the majority of tumor cells. Rare neoplastic cells with a single, sharply demarcated intracytoplasmic vacuole and intranuclear cytoplasmic pseudoinclusions were observed in the smears of one tumor. Metachromatic stromal fragments, probably representing hyalinized chondromyxoid stroma, were seen in the other tumor. Neither case was recognized initially on FNAB as EH. Immunohistochemically, sections from the surgical biopsy specimens of both cases showed diffuse and strong immunopositivity for the endothelial marker CD31. Although the cytomorphology of EH appears distinct, clinicoradiologic correlation is essential, and immunohistochemistry may be helpful to avoid misdiagnoses.
我们回顾性分析了2例经组织学确诊为上皮样血管内皮瘤（EH）患者的细针穿刺活检（FNAB）标本。2例均为男性，年龄分别为79岁和39岁；其原发性肿瘤分别起源于纵隔软组织和胫骨近端。前1例患者有上腔静脉综合征症状；后1例患者有多中心骨内病变累及胫骨近端。所有细胞学涂片细胞丰富，主要由散在的单个细胞和卵圆形至多边形上皮样细胞小聚集体组成。细胞核形态各异，从卵圆形、肾形到圆形及多叶形，周围有大量致密细胞质。双核上皮样肿瘤细胞常见。核异型性从轻度到中度，大多数肿瘤细胞内可见小的单个至多个核仁。在1例肿瘤的涂片中观察到罕见的肿瘤细胞，其胞质内有单个、界限清晰的空泡及核内胞质假包涵体。在另1例肿瘤中可见异染性间质碎片，可能代表透明变性的软骨黏液样间质。2例最初在FNAB时均未诊断为EH。免疫组化方面，2例手术活检标本切片对内皮标志物CD31均呈弥漫性强免疫阳性。尽管EH的细胞形态学表现独特，但临床影像学相关性至关重要，免疫组化可能有助于避免误诊。
