Gastric epithelioid leiomyoma and leiomyosarcoma (leiomyoblastoma)
Gastric epithelioid leiomyoma and leiomyosarcoma (leiomyoblastoma)
复制标题
胃上皮样平滑肌瘤和平滑肌肉瘤（平滑肌母细胞瘤）
作者：
H. Appelman;E. B. Helwig
本文研究了127例来自美国武装部队病理研究所（AFIP）的胃壁上皮样平滑肌瘤（平滑肌母细胞瘤）手术标本的生物学行为、形态发生和组织学特征。这些肿瘤主要影响中年男性，通常表现为上消化道出血或消化性溃疡样症状。它们由圆形上皮样细胞和梭形细胞的混合物组成，其中许多细胞质透明。细胞被纤细的网状纤维包裹。在某些肿瘤中存在周上皮或血管球样结构提示可能与血管平滑肌瘤、血管球瘤和"周细胞瘤"有关。上皮样平滑肌瘤是一种良性肿瘤，通常发生在胃的中端和远端，尤其是前壁。显微镜下可见大的上皮样细胞和少见的核分裂象。在103例上皮样平滑肌瘤中，只有1例转移，因此为生物学恶性。上皮样平滑肌肉瘤好发于胃近端，也好发于远端，尤其是后壁。上皮样平滑肌肉瘤的两种组织学类型与良性上皮样平滑肌瘤的区别在于细胞体积小，偶见较高的核分裂计数。肉瘤的一种变体是平滑肌瘤的小细胞漫画。另一种是间变性，与细胞周围的网状纤维和肺泡排列的损失有关。上皮样平滑肌瘤是最常见的胃肉瘤类型。它们是侵袭性肿瘤; 63%转移，通常在诊断后2年内。
A series of 127 surgical specimens of epithelioid leiomyomatous tumors (leiomyoblastomas) of the gastric wall from the files of the Armed Forces Institute of Pathology (AFIP) were studied as to biologic behavior, morphogenesis, and histologic features of value in distinguishing benign and malignant variants. These tumors affect middle‐aged men primarily and usually present with upper gastrointestinal bleeding or peptic ulcer‐like symptoms. They are composed of a mixture of round epithelioid and spindle cells, many of which have clear cytoplasm. The cells are ensheathed by delicate reticular fibers. The presence of a perithelial or glomoid pattern in some tumors suggests a possible relationship to angiomyoma, glomus tumors, and “pericytoma” The epithelioid leiomyoma, the benign form, often arises in the mid‐ and distal stomach, especially on the anterior wall. Microscopically, it is recognized by the presence of large epithelioid cells and infrequent mitotic figures. Of 103 epithelioid leiomyomas, only one metastasized and thus was biologically malignant. The epithelioid leiomyosarcoma often arises in the proximal stomach and also distally, especially on the posterior wall. Two histologic types of epithelioid leiomyosarcoma are distinguished from the benign epithelioid leiomyoma by the small size of the cells and occasional higher mitotic counts. One sarcoma variant is a small cell caricature of the leiomyoma. The other is more anaplastic, associated with a loss of reticular fibers surrounding the cells and an alveolar arrangement. Epithelioid leiomyosarcomas are the most common type of gastric sarcoma. They are aggressive neoplasms; 63% metastasized, usually within 2 years after diagnosis.