脾脏组织细胞肉瘤1例

A Case Report: Histiocytic Sarcoma of the Spleen

摘要: 本文报道一例67岁女性脾组织细胞肉瘤患者的影像学及病理学特征，旨在提高对该罕见病的认识和诊断。患者因体检发现脾占位伴左腰部隐痛就诊。腹部CT表现为脾内巨大混杂密度肿块，增强后边缘及分隔呈进行性强化，术前影像易误诊为良性肿瘤。最终经脾切除术后的病理学检查确诊：镜下见显著异型性的梭形/上皮样细胞，免疫组化显示CD68、CD163弥漫强阳性，Ki-67指数达30%。本例说明，脾组织细胞肉瘤的CT表现虽可提示恶性，但缺乏特异性，极易误诊，病理学及免疫组化是确诊该病的金标准。

Abstract: This article presents the imaging and pathological features of a case of splenic histiocytic sarcoma in a 67-year-old female to enhance recognition of this rare entity. The patient presented with a splenic mass discovered incidentally during a physical examination, accompanied by dull pain in the left lumbar region. Abdominal CT revealed a large, heterogeneous-density mass within the spleen, which demonstrated progressive enhancement of the periphery and internal septa on post-contrast images; these imaging findings were prone to preoperative misdiagnosis as a benign tumor. The diagnosis was confirmed by pathological examination following splenectomy, which revealed spindle/epithelioid cells with significant atypia. Immunohistochemistry showed diffuse and strong positivity for CD68 and CD163, with a Ki-67 proliferation index of 30%. This case illustrates that while CT findings of splenic histiocytic sarcoma may suggest malignancy, they are non-specific and carry a high risk of misdiagnosis. Pathological examination combined with immunohistochemical analysis remains the gold standard for definitive diagnosis.