【摘要】 目的　探讨滑膜肉瘤的形态特点和鉴别诊断。方法　收集原诊断为滑膜肉瘤的病例 66例、恶性周围神经鞘膜瘤 1 0例、纤维肉瘤 6例、平滑肌肉瘤 1 3例 ,进行形态学观察 ,并采用 1 0种抗体做免疫组化染色。结果　 66例原诊滑膜肉瘤的病例中 ,最终确诊为滑膜肉瘤者 2 7例 ,诊断准确率 40 .9%。最易误诊为滑膜肉瘤的肿瘤是恶性周围神经鞘膜瘤 ,占 31 .8%。 5例滑膜肉瘤最初误诊为其他梭形细胞肉瘤。组织学双向分化是其主要特点 ,分单相纤维型 ,双相型和低分化型 ,未见单相上皮型病例。免疫组化瘤细胞表达CK和 /或EMA ,同时vimentin阳性 ,S 1 0 0和PGP9.5也有一定阳性率。bcl 2蛋白阳性率高 ,多为弥漫性。其他几种梭形细胞肉瘤不表达CK和EMA ,bcl 2蛋白阳性率低或局灶阳性。结论　滑膜肉瘤是一种容易误诊的软组织肉瘤 ,免疫组化同时表达上皮性和间叶性标记。最易误诊的肿瘤是恶性周围神经鞘膜瘤。bcl 2蛋白检测对滑膜肉瘤鉴别诊断有一定帮助更多还原

【Abstract】 Objective To investigate the morphologic characteristics and differential diagnosis of synovial sarcoma. Methods Ninety five cases of spindle cell tumors that were previously diagnosed as synovial sarcoma, malignant peripheral nerve sheath tumor (MPNST), leiomyosarcoma and fibrosarcoma were retrieved, morphologically observed and immunohistochemically stained by 10 antibodies. Results Twenty seven out of 66 cases were diagosed as synovial sarcoma, which was 40.9% accuracy. Most of the cases mistaken as synovial sarcoma were MPNST that accounted for 31.8%. Five cases of true synovial sarcoma were previously diagnosed as other spindle cell sarcomas.Biphasic differentiation was one of the major characteristics. Histologically, synovial sarcoma could be divided into three types, monophasic fibrous, biphasic and poorly differentiated. No monophasic epithelial type of the tumor was found in this series.Immunohistochemically, the tumor cells were positive for cytokeratin and/or EMA and vimentin. S 100 protein and PGP9.5 positivities were focal or scattered in some cases. Most of the cases were positive for bcl 2 protein diffusely. No cytokeration or EMA positive cases were found and only a few or focal staining for bcl 2 were detected in other spindle cell sarcomas. Conclusions Synovial sarcoma is an easily misdiagnosed spindle cell sarcoma. Co expression of epithelial and mesenchymal markers existed in this tumor. MPNST is the most common tumor that might be misinterpreted as synovial sarcoma. Detection of bcl 2 protein may be helpful in the differential diagnosis of the tumor.更多还原