大腿：大腿：上皮样血管肉瘤？讨论病例【91360.软组织714】

刘伟

一公里生命
病例(形态)分享第457例
Thigh, older patient



周泉
PHE


一公里生命
Further history:


Patient is immunosuppressed (for autoimmune condition).


No history of malignancy.


Clinical diagnosis: ?inflammatory or ?lymphoma



一公里生命
Diagnosis  
Cutaneous (epithelioid) angiosarcoma


一公里 生命
1/This tumour had more traditional features in other areas
2/ Cutaneous angiosarcoma usually only occurs in the following 3 settings: Idiopathic AS of the head and neck (usually elderly) Lymphedema-associated AS Postirradiation AS
3/ AS occurring outside of these settings might have a worse prognosis (see article below).
4/ ERG, CD31 and FLI1 useful stains, but cytokeratin can be positive (~50%) as can EMA (~25%).
5/ Cutaneous AS can have a wide range of appearances from haemangioma like to solid sarcoma/carcinoma like (i.e. poorly dif/epithelioid)!
6/ For latter cases, metastatic carcinoma, melanoma, epithelioid sarcoma and lymphoma are all DDx
7/ Cases caused by chronic immunosuppression have been reported.
8/ Lastly, cases of AS caused by such things as foreign bodies and orthopedic joint prostheses have been reported.


一公里生命
我当时看HE第一想到的也是PHE
感觉肿瘤背景里有中性粒的感觉
神奇的东方树叶
缺少强嗜酸性肌样胞质



KK
上皮样血管内皮细胞瘤和上皮样血管肉瘤怎么鉴别诊断？
头三张图，我还可以是个上皮样血管内皮细胞瘤呢

有没有更客观一点的指标，比如核分裂像什么的？
实际病例中有些病例很难用三个一鉴别
注：病例来自网络，版权归原作者仅供学习