脾脏硬化性血管瘤样结节性转化病理形态观察  

Sclerosing angiomatoid nodular transformation of spleen

作　　者：滕晓东[1] 余心如[1] 王桂华 许林杰[1] 来茂德[3] 

机构地区：[1]浙江大学医学院附属第一医院病理科,杭州310003 [2]浙江省嘉兴市第二人民医院病理科 [3]浙江大学医学院病理学与病理生理学系

出　　处：《中华病理学杂志》2007年第2期118-121,共4页Chinese Journal of Pathology

摘　　要：目的探讨脾脏硬化性血管瘤样结节性转化的临床病理表现及诊断、鉴别诊断。方法对4例脾脏硬化性血管瘤样结节性转化进行常规 HE 及免疫组织化学(EnVision 法)观察并结合文献讨论。结果脾脏硬化性血管瘤样结节性转化的最大特征是在纤维硬化间质中形成多个血管瘤样结节。结节为单个或多个融合,周围为增生纤维组织包绕。结节中央可见裂隙样或不规则形或略为扩张的血管腔构成,内衬肿胀的内皮细胞。血管腔隙之间为梭形细胞和卵圆形细胞。免疫组织化学显示结节内为 CD34阳性表达的小血管及少量 CD8阳性表达的窦性腔隙,CD31阳性表达的内皮细胞数量多,并构成复杂的网状结构,局灶性内衬细胞 CD68亦为阳性,平滑肌肌动蛋白阳性细胞成簇分布在血管腔隙之间,结节间梭形细胞局灶性肌动蛋白阳性,但结蛋白、CD21、CD35阴性。结论脾脏硬化性血管瘤样结节性转化是一种少见的良性病变,有其特征的临床病理表现,应注意与脾脏其他类型肿瘤及瘤样病变鉴别。Objective To study the clinicopathologic features of sclerosing angiomatoid nodular transformation of spleen and its differential diagnosis. Methods The clinicopathologic characteristics and immunophenotype of 4 cases of sclerosing angiomatoid nodular transformation of spleen were studied. Results Histologically, all cases were characterized by multiple angiomatoid nodules of various sizes in a fibrosclerotic stroma. The nodules were round and sometimes convoluted. They were composed of slit-like, irregnlar-shaped or slightly dilated vascular spaces lined by plump endothelial cells and interspersed with a population of spindly or ovoid cells. Immunohistochemical study showed a heterogeneous staining pattern, with the lining cells of the small capillaries expressing CD34 and those of the sinusoid-like structures expressing CD8. CD31 highlighted both the lining cells and interspersed cells, resulting in a complex meshwork. The lining cells were also focally positive for CD68. Smooth muscle actin revealed conglomerates of spindly shaped cells around and between the vascular channels. These spindly shaped cells in the intervening stroma were focally positive for actin, but negative for desmin, CD21 and CD35. Conclusions Sclerosing angiomatoid nodular transformation is a rarely encountered benign lesion of the spleen, which should be distinguished from other angiomatoid tumors and tumor-like lesions.

关 键 词：脾疾病 血管瘤 诊断 鉴别 免疫组织化学 

分 类 号：R733.2[医药卫生—肿瘤]