摘要目的 探讨Erdheim?Chester病(ECD)合并朗格汉斯细胞组织细胞增生症(LCH)的临床病理学特征、免疫组织化学及BRAF V600E基因突变状态.方法 收集北京协和医院2015年2月至2018年9月诊断的4例ECD合并LCH进行组织形态学、免疫组织化学及BRAF V600E基因检测,并随访及复习相关文献.结果 男性2例,女性2例,发病年龄7～55岁(平均32.5岁).病理组织学:病变有两种区域,一是病变细胞呈泡沫样组织细胞样,伴有纤维母细胞增生,可见散在分布的多核巨细胞,间质炎性细胞浸润,二是组织细胞浸润,可见核沟,间质见较多嗜酸性粒细胞浸润.免疫表型:第二种区域细胞呈S?100蛋白、CD1a、CD207/Langerin、cyclin D1阳性;2种区域细胞共同阳性表达CD68、CD163、Braf.Ki?67阳性指数约为1%～10%.分子病理检测:3例(3/4)检测到BRAF V600E基因突变.结论 ECD合并LCH属于罕见的组织细胞发生的肿瘤,具有一定的组织学特征.诊断主要依靠影像学、病理形态学、免疫组织化学标记及BRAF V600E基因检测.

abstractsObjective To investigate the clinicpathological and molecular features of Erdheim?Chester disease (ECD) as well langerhans cell histiocytosis (LCH). Methods The clinical, histopathological, molecular findings, immunophenotype, treatment and prognosis in 4 cases of ECD combined LCH were evaluated from February 2015 to September 2018 with review of the relevant literature. Results 2 cases were male, and 2 were female, aged from 7-55 years. Microscopically, there were two different areas, in the first area, the lesions were composed of foamy histiocytes, spindle?shaped fibroblasts, scattered multinucleated giant cells. Lymphocytes, plasma cells, and giant cells were also found. In the other, the lesions were composed of histiocytes with obvious nuclear groove, associated with a variable number of eosinophils, lymphocytes and plasma cells. Immunephenotype, In the second area, histiocytes were positive for CD1a (4/4), S?100 (4/4),CD207/Langerin (4/4), cyclin D1(4/4), and in the two different area, the histiocytes were positive for CD68, CD163, Braf. Ki?67 positive index 1%-10% BRAF V600E gene mutation was detected in three cases. Conclusion ECD combined LCH was a very rare histiocytosis tumor and its correct diagnosis relies on histopathologic features, immunohistochemical staining, and BRAF V600E gene detection.