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首页> 外文期刊>Diagnostic cytopathology >Metastatic Alveolar Soft Part Sarcoma of the Lung Metastatic Alveolar Soft Part Sarcoma of the Lung-A Morphologic Pitfall on Cytology and Aberrant CD10 Expression on Histology
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Metastatic Alveolar Soft Part Sarcoma of the Lung Metastatic Alveolar Soft Part Sarcoma of the Lung-A Morphologic Pitfall on Cytology and Aberrant CD10 Expression on Histology

机译：肺转移性肺泡软部分肉瘤肺转移性肺泡软部分肉瘤-细胞学形态学缺陷和组织学异常CD10表达

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Alveolar soft part sarcoma (ASPS) is a rare aggressive soft tissue sarcoma of young adults, typically arising in the deep soft tissue of lower extremities. Although cytomorphology is characteristic enough for an accurate diagnosis in typical clinical scenarios, problems arise when it occurs in older patients, atypical sites, or in primary evaluation at metastatic sites. A 48-year-old smoker presented with breathlessness and headache for 2 months. Imaging showed a heterogeneous enhancing lesion of 6 cm x 6 cm in right middle lobe of lung, smaller miliary nodules in bilateral lungs, multiple bilateral cerebral lesions, and a mass of 3 cm x 3 cm in the left thigh. Primary lung carcinoma with brain and thigh metastases was the clinical diagnosis. Fine-needle aspiration smears of the lung lesion showed cohesive fragments of large cells with a prominent traversing branching capillary network and discohesion at periphery resulting in a pseudo-papillary appearance. Tumor cells had fine granular to vacuolated cytoplasm, frayed borders, and prominent nucleoli. Trucut biopsy from the same showed a tumor arranged in nests composed of large polygonal cells, immunopositive for CD10. Possibility of metastatic renal cell carcinoma (RCC) was offered. Abdominal imaging was, however, normal. Core biopsy from thigh showed a similar tumor, immunonegative for epithelial markers, with cytoplasmic periodic-acid-schiff positive rhomboid crystals, clinching the final diagnosis of ASPS with lung and brain metastases. There is considerable morphological and immunohistochemical overlap between ASPS and RCC. Bare nuclei on air dried smears, binucleation, metachromatic basement membrane material are subtle pointers toward ASPS. (C) 2015 Wiley Periodicals, Inc.
机译：肺泡软部分肉瘤（ASPS）是年轻人罕见的侵略性软组织肉瘤，通常发生在下肢的深部软组织中。尽管细胞形态学的特征足以在典型的临床情况下进行准确的诊断，但是当它发生在老年患者，非典型部位或转移部位的初步评估中时，就会出现问题。一名48岁的吸烟者出现呼吸困难和头痛2个月。影像学检查显示，肺右中叶有6 cm x 6 cm的异质性增强病灶，双侧肺中有较小的粟粒状结节，双侧多发性脑部病变，左大腿有3 cm x 3 cm的肿块。原发性肺癌伴脑和大腿转移是临床诊断。肺部病变的细针穿刺涂片显示大细胞的凝聚性碎片，具有明显的横越的分支毛细血管网和周围的空腹，导致假乳头状外观。肿瘤细胞具有细小的颗粒至空泡的细胞质，磨损的边界和突出的核仁。来自同一组织的Trucut活检显示，肿瘤排列在由大型多边形细胞组成的巢中，对CD10免疫阳性。提供了转移性肾细胞癌（RCC）的可能性。但是，腹部成像正常。大腿的核心活检显示类似的肿瘤，上皮标记免疫阴性，胞质高碘酸-希夫阳性菱形晶体，最终确定了患有肺和脑转移的ASPS。 ASPS和RCC之间存在大量的形态学和免疫组化重叠。空气干涂片，双核化，变色基底膜材料上的裸核是对ASPS的细微指示。 （C）2015威利期刊公司

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