吕国庆 甘继瑶 周斌

[摘要] 目的 探讨腱鞘巨细胞瘤的临床病理特征，对其鉴别诊断进行探讨。 方法 收集47例腱鞘巨细胞瘤，根据临床病理学特点、形态学观察及免疫组化染色进行分析。 结果 47例腱鞘巨细胞瘤患者中男15例（31.9%），女32例（68.1%），男女比为1：2.1，平均年龄43岁，≥31岁者35例（74.5%），发生于手部29例（61.7%）、足部18例（38.3%）。肿瘤细胞由数量不等的中等大小滑膜样多形性单核细胞、破骨样多核巨细胞、泡沫样吞噬细胞组成，伴有不同程度的胶原化，另见散在及灶性炎细胞浸润，部分组织细胞内有含铁血黄素颗粒存在。 结论 腱鞘巨细胞瘤是一种起源于腱鞘和关节滑膜层的良性病变，为较少见的纤维组织细胞肿瘤，免疫组化检查可作为诊断及鉴别诊断的重要参考依据。

[关键词] 腱鞘巨细胞瘤；临床病理；鉴别诊断

[中图分类号] R738[文献标识码] B[文章编号] 1673—9701（2012）25—0073—02

Giant cell tumor of tendon sheath：A clinicopathological analysis of 47 cases

LV GuoqingGAN JiyaoZHOU Bin

Department of Pathology，Changji Prefecture Peoples Hospital in Xinjiang Uygur Autonomous Region，Changji 831100，China

[Abstract] Objective To study the clinicopathological features of Giant cell tumor of tendon Sheath and discuss its differential diagnosis. Methods The clinical and pathological characteristics of 47 cases of Giant cell tumor of tendon sheath were selected and paraffin—embedded sections histochemical staining and immunohistochemical staining. Results Male in 47 cases of tendon sheath giant cell tumor of 15 cases（31.9%）， female 32 cases（68.1%）， male to female ratio was 1：2.1. The patients average age at diagnosis were 43 years， ≥ 31 years of age in 35 cases（74.5%）， occur in the hand in 29 cases（61.7%）， in the foot in 18 cases（38.3%）. Tumor cells by varying amounts of synovial samples of medium—size pleomorphic mononuclear cells ， osteoclast—like multinucleated giant cells， foamy phagocytic cells， and with varying degrees of collagen， the other can be seen scattered and focal inflammation cell infiltration ， hemosiderin granules in some of the tissue cells. Conclusion Tenosynovial giant cell tumor that originated in the benign lesions of the tendon sheath and synovial layer， rare cell tumor of fibrous tissue ， immunohistochemistry can be used as important reference for the diagnosis and differential diagnosis .

[Key words] Giant cell tumor of tendon sheath；Clinical pathology；Differential diagnosis

腱鞘巨细胞瘤是一种起源于腱鞘和关节滑膜层的良性病变，好发于手指及足部腱鞘滑膜组织或小关节，也可发生于臀、腕、踝和肩等部位，是临床较少见的纤维组织细胞肿瘤。我们收集47例腱鞘巨细胞瘤，并重点探讨其病理形态学特点、诊断及鉴别诊断问题，现报道如下。

1 资料与方法

1.1 一般资料

收集我院病理科2003～2012年47例患者活检的病理资料。年龄18～69岁，平均43.0岁，其中男15例（31.9%），女32例（68.1%），男女比为1：2.1。其中<30岁12例（25.5%），>31岁者35例（74.5%）。47例中发生于手部29例（61.7%）、足部18例（38.3%），手部发生率明显多于足部，手部以手指发生较常见。临床主要表现为局部生长缓慢、无痛性包块、无自觉症状，多数患者为偶然发现。……