外科理论与实践 ›› 2022, Vol. 27 ›› Issue (06): 500-505.doi: 10.16139/j.1007-9610.2022.06.04
王坚(
)
收稿日期:2022-09-26
出版日期:2022-11-25
发布日期:2023-01-30
通讯作者:
王坚，E-mail:
WANG Jian()
Received:2022-09-26
Online:2022-11-25
Published:2023-01-30
中图分类号:
王坚. 腹膜后肿瘤的病理诊断与鉴别诊断[J]. 外科理论与实践, 2022, 27(06): 500-505.
WANG Jian. Retroperitoneal tumor: pathological diagnosis and differential diagnosis[J]. Journal of Surgery Concepts & Practice, 2022, 27(06): 500-505.
表1
SFT转移风险分层模型
| 风险因素 | 评分（分） | 5年；10年无转移率 |
|---|---|---|
| 年龄（岁） | ||
| <55 | 0 | |
| ≥55 | 1 | |
| 肿瘤直径（cm） | ||
| <5 | 0 | |
| 5~<10 | 1 | |
| 10~<15 | 2 | |
| ≥15 | 3 | |
| 核分裂相（/10高倍视野） | ||
| 0 | 0 | |
| 1~3 | 1 | |
| ≥4 | 2 | |
| 肿瘤坏死 | ||
| <10% | 0 | |
| ≥10% | 1 | |
| 风险分层 | 合计 | |
| 低 | 0~3 | 100% |
| 中 | 4~5 | 69%；50% |
| 高 | 6~7 | 0；0 |
表2
推荐的IgG4相关性动脉周围炎/腹膜后纤维化的诊断标准
| A：项目 1. 影像学检查异常 a. 包绕腹主动脉和分支的低密度增厚或软组织肿块 b. 肾盂壁软组织肿块和（或）包绕输尿管 c. 盆腔和椎旁软组织肿块 2. 血清IgG4升高（>1.35 g/L） 3. 组织学 a.（i）, （ii）, （iii）/（iv） b.（i）, （ii） （i）明显的淋巴细胞和浆细胞浸润和纤维化 （ii）IgG4+浆细胞浸润 （iii）席纹状纤维化 手术标本：IgG4阳性细胞>30个/HPF，IgG4/IgG>40% 活检标本：IgG4阳性细胞>10个/HPF，IgG4/IgG>40% （iv）闭塞性静脉炎 4. 其他器官累及 采用综合诊断标准或器官特异性诊断标准，下列器官有诊断明确的IgG4相关性疾病：眼、唾液腺、胰腺、胆管、肾脏或肺 B：诊断 确诊：1（a/b/c）+3a；或1（a/b/c）+2+4 可能诊断：1（a/b/c）+3b；或1（a/b/c）+4；或3a 可疑诊断：1（a/b/c）+2；或3b |
表3
INPC预后分组
| 诊断时年龄 | 组织学亚型 | MKI | 预后分组 |
|---|---|---|---|
| <18个月 | 未分化型 | 任何 | 差 |
| 差分化型 | 低或中 | 好 | |
| 分化型 | 低或中 | 好 | |
| 任何亚型 | 高 | 差 | |
| 18个月~5岁 | 未分化型 | 任何 | 差 |
| 差分化型 | 任何 | 差 | |
| 分化型 | 低 | 好 | |
| 任何亚型 | 高 | 差 | |
| >5岁 | 任何亚型 | 任何 | 差 |
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