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Cytology of soft tissue tumors: Cytological classification of soft tissue tumors 有关软组织肿瘤的细胞学：软组织肿瘤在细胞学上的分类 Manoj Kumar Choudhuri （名字） Department of Pathology, B S Medical College, Bankura, West Bengal, India BS医学院，病理学系，印度西孟加拉Bankura Depending on existing knowledge, classification of any disease changes from time to time, as is the case with soft tissue tumors. The WHO classification of soft tissue tumors was first published in 1969 and was revised twice in 1994 and 2002. 根据现存的知识，对於”疾病的变化”所做的分类，一直随时间在改变。对软组织肿瘤所做的分类就是这样一个例子。世界卫生组织(WHO)对软组织肿瘤所做的分类，最先发表於1969年，并分别於1994与2002年做过修订。 Following are some of the major changes that have taken place in the latest classification: [1],[2] 以下是”最新分类’上出现的一些主要改变。 Fibroblastic tumor / so-called fibrohistiocytic tumor : The most striking change in this group is that malignant fibrous histiocytoma has lost its glory and has been relegated to an "undifferentiated pleomorphic sarcoma." Myxoid fibrous histiocytoma has been replaced with "myxofibrosarcoma," which represents the most common soft tissue sarcoma in elderly individuals. 纤维组织母细胞肿瘤／即所谓的纤维组繊球性肿瘤(fibrohistiocytic tumor)： 这个群组最显著的改变在於，恶性纤维所构成的组织细胞瘤已经不像过去那样意义非凡，现已被贬为一种”未分化多形性肉瘤(undifferentiated pleomorphic sarcoma)”。 粘液样纤维构成的组织细胞瘤(myxoid fibrous histiocytoma)已经被黏液纤维肉瘤(myxofibrosarcoma)所取代，这是老年人最常见的软组织肉瘤。 Smooth muscle tumor and skeletal muscle tumors : There has been no significant change in this group. 平滑肌肿瘤与骨骼肌肿瘤：这个群组并未有明显的改变。 Adipocytic tumors : A well differentiated liposarcoma has no malignant potential, thus, "atypical lipomatous tumor" is the preferred term when the tumors arise at extremities and other surgically amenable sites. However, the term, "well differentiated liposarcoma" is reserved for tumors arising in the retroperitoneum and mediastinum. Incomplete resection results in local recurrence even in the absence of dedifferentiation. Myolipoma and chondroid lipoma are two new entities included in the recent classification. 脂肪细胞肿瘤：是一种不具恶性潜能的分化良好型脂肪肉瘤，因此，不典型脂肪瘤样肿瘤(atypical lipomatous tumor)这个名称被采用，因为肿瘤发生在身体末端如四肢，以及其它适合外科手术的地方。然而，分化良好型脂肪肉瘤(well differentiated liposarcoma)这个名称，则是被用於发生在后腹腔与纵膈腔的肿瘤。即使在没有”失分化”的情况下，切除不完整将导致局部性再发。肌脂瘤(myolipoma)与软骨样脂肪瘤(chondroid lipoma)是新加入分类中的两个种类。 Pericytic tumors : Some tumors previously categorized as hemangiopericytomas are indistinguishable from "solitary fibrous tumors." However, sinonasal hemangiopericytomas appear to be truly pericytic lesions. Large groups of pericytic / perivascular tumors have been renamed as "myopericytomas". 周细胞肿瘤：一些先前被归类为血管外皮细胞瘤(hemangiopericytoma)的肿瘤，与孤立性纤维性肿瘤(solitary fibrous tumor)的区分不是很明显。然而，鼻腔鼻窦血管外皮细胞瘤(sinonasal emangiopericytomas)看似真正周细胞的损害。 周细胞的大群组已被更名为肌周细胞瘤(myopericytomas)。 Vascular tumors : Spindle cell haemangioendotheliomas have been renamed as "spindle cell hemangiomas." 血管肿瘤：纺锤体细胞血管内皮瘤(Spindle cell haemangioendothelioma)已被更名为纺锤体细胞血管瘤(spindle cell hemangiomas)。 All of us appreciate that diagnosis by fine needle aspiration depends on pattern recognition. Thus, cytological classification of soft tissue tumors is based on the principal pattern. Immunocytochemistry has been increasingly used in the recent past for further categorization of the lesions. 藉细针吸取所做的诊断，是依赖於对形态(pattern)的辨识。因此，细胞学对软组织肿瘤的分类，就是根据”主要形态”(pattern)所建立的。免疫细胞化学於最近已经逐渐被使用在更进一步的器官损害之范畴内。 Soft tissue tumors are classified into five groups [3] on the basis of their cytological results: 根据细胞学上的结果，软组织肿瘤被分为五个群组： Pleomorphic pattern : The aspirate is richly cellular and there is a marked variation in cell size and shape. Nuclear pleomorphism is striking and some of the tumor cells show large nucleoli; bizzare tumor giant cells can be detected. Pleomorphic liposarcomas, pleomorphic undifferentiated sarcomas, and pleomorphic rhabdomyosarcomas belong to this group. 多形性形态：抽吸(aspirate)完全是细胞的，并且在细胞尺寸与形状上有非常大的差异。细胞核多形性很突出，并且有些肿瘤细胞显示有大细胞核；可侦测到怪异肿瘤巨大细胞。多形性脂肪肉瘤，多形性未分化肉瘤以及多形性横纹肌肉瘤都属於这个群组。 Spindle cell pattern : Spindle cells are shed as fascicles. A typical spindle cell has fusiform or ovoid nuclei; the cytoplasm is tapered, unipolar, or bipolar; mitotic figures are variable. Fibrosarcomas and leiomyosarcomas present with this classical spindle cell pattern. 纺锤体细胞形态：纺锤体细胞褪为丛团。典型的纺锤细胞呈纺绽状，或者卵圆形细胞核。该细胞质一端宽一端较细，单极的，或双极的；有丝分裂的外观是易变的。纤维肉瘤与子宫肌肉瘤出现典形的纺锤细胞形态。