(Greek epi-on, atop + thele of pacifiers + eidos a look; sarcoma) — a malignant tumor of soft tissues.
As nosological form E. the page was allocated for the first time in 1970 by Entsinger (F. M of Enzinger). The tumor meets seldom, to a crust, time in world medical literature is described apprx. 300 observations. Most of scientists consider that E. the page has a sino-vialno-histiocytic origin, however there are opinions on its fibroblastichesky or histiocytic nature.
AA. the page comes to light preferential at men (more than 70% of patients), hl. obr. aged from 20 up to 40 years. The brush and a forearm are surprised generally (apprx. 60% of all cases of epithelioid sarcoma). AA. the page usually is located subcutaneously and is connected with tendinous and fascial educations, sometimes burgeons in skin that is followed by an ulceration. At a deep arrangement of a tumor the focal atrophy (uzura) of a bone can be observed. Occurs at a part of patients mul-titsentrichny E. page, i.e. the tumor arising at the same time in several sites.
Macroscopically the tumor usually represents accurately delimited dense lobular or a multinodular look education, grayish-yellow or grayish-pink color on a section. In most cases diameter of a tumor does not exceed lV2 — 2 cm though can reach 20 cm and more. Microscopically E. page it is formed by the polygonal eosinophial epithelial-like or extended fibroblastopodob-ny cells, to-rye tend to create a set of small knots, it is frequent with the central focuses of a necrosis. Sometimes cells are located palisadoobrazno around necrotic fields that gives to these sites looking alike a granuloma (see). On the periphery of tumor cells signs of a hyalinosis are noted (see). Polymorphism of cells is not expressed: are found two-more often -
nuclear cells, it is extremely rare — multinuclear. In cells of a tumor figures of a mitosis meet. Occasionally in a tumor are noted ossification (see Ossificates) and deposits of salts of calcium (see Calcification). For E. page the tendency to invasive growth along sinews and fastion is characteristic, the tumor can burgeon in vessels, destroy bones. Innidiation preferential hematogenous; it is observed more than in half of cases. The most often hematogenous metastasises are found in lungs, skin and bones, is more rare — in limf, nodes.
Wedge, symptomatology scanty. In most cases to the first and the main the wedge, a symptom is detection of a swelling, napr, in the field of a brush or a forearm. Sometimes in this area pain is noted. Symptoms of a disease can be observed on an extent from several months to 20 years and more.
314 EPITHELIAL CELLS
Treatment operational. At solitary defeats make broad excision of a tumor, and in cases of its distribution on other fabric structures (bones, vessels, nerves, etc.), multitsentrichny defeat or numerous recuring — amputation of an extremity. The possibility of use in treatment E is studied. page of radiation therapy and antineoplastic means.
Against the background of a long course of a disease the final forecast, as a rule, adverse. Since emergence of the first symptoms of a disease before detection of metastasises of a tumor can pass from several months to 18 years. After broad excision of a tumor a recurrence, quite often repeated is observed. After amputation of an extremity a recurrence in a stump is possible. Frequency of a recurrence, according to various researchers, fluctuates from 63 to 85%.
Bibliography: Pathoanatomical diagnosis of tumors of the person, under the editorship of
N. A. Krayevsky, etc., page 109, M.,
1982; Smolyannikov A. V. About epithelioid sarcoma, Arkh. patol., t. 40, century 2, page 8, 1978; E nzinger F.M. Epithelioid sarcoma, Cancer, v. 26, p. 1029, 1970; Prat J., Woodruff J. M. a. M a with o v e R. C. Epithelioid sarcoma, ibid., V. 41, p. 1472, 1978.
V. M. Blinov.