肝脏炎症型血管平滑肌脂肪瘤临床病理分析  

Clinicopathological analysis of hepatic inflammatory angiomyolipoma

作　　者：石怀银[1] 韦立新[1] 孙璐[1] 邰艳红[1] 王玉兰[1] 郭爱桃[1] 赵景民[2] 

机构地区：[1]解放军总医院病理科,北京100853 [2]解放军302医院病理诊断与研究中心,北京100039

出　　处：《解放军医学杂志》2011年第1期83-85,共3页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨肝脏炎症型血管平滑肌脂肪瘤的组织学形态、免疫组织化学特点、鉴别诊断以及预后。方法回顾性分析5例肝脏炎症型血管平滑肌脂肪瘤患者的临床病理资料并进行随访分析,选择典型蜡块做免疫组织化学染色观察。结果 5例患者中男1例,女4例,年龄21～48岁。3例肿瘤位于肝左叶,2例位于肝右叶。肿瘤直径5.5～10.0cm,平均7.5cm。大体观察见肿瘤切面呈灰白色,境界清楚,无出血、坏死及囊性变。光镜下见肿瘤由梭形及上皮样肌细胞、不规则的厚壁血管、不同比例的脂肪组织构成,背景中均见大量的炎细胞浸润,炎细胞包括淋巴细胞、浆细胞和组织细胞;肿瘤细胞异型性不明显,核分裂象少见,无出血、坏死及囊性变。免疫组织化学染色示肿瘤细胞HMB-45阳性(5/5),Melan-A阳性(5/5),SMA阳性(5/5),Vimentin阳性(5/5),而CD21、CD35、CK18、CK19、Hepatocyteparaffin-1、AFP、EMA、CK均为阴性。5例患者均行局部肿瘤切除术,术后随访3～9年均无复发。结论肝脏炎症型血管平滑肌脂肪瘤是血管平滑肌脂肪瘤的一种亚型,其生物学行为与经典的血管平滑肌脂肪瘤相同,呈良性经过。Objective To explore the histological morphous,immunohistochemical and clinical features,differential diagnosis and prognosis of hepatic inflammatory angiomyolipoma（AML）.Methods The clinical and pathological data of 5 patients with inflammatory hepatic AML were retrospectively analyzed followed by follow-up.The typical tissue was observed by immunohistochemical staining.Results Five patients（1 male and 4 females） aged from 21 to 48 years.Tumors were situated in left lobe of liver in 3 patients,and in right lobe in 2 patients.The tumors had a diameter of 5.5-10.0cm averaged 7.5cm.Generally,the tumors were grey-white on cut surface,without hemorrhage,necrosis and cystic degeneration.Microscopically,the tumors were consisted of spindle and epithelioid myocytes,irregular thick-walled blood vessels and adipose tissue in different proportion.A prominent infiltration of inflammatory cells,including lymphocytes,plasmocytes and histiocytes,in the background was noted in all cases.No obvious atypia and mitotic figure,and no hemorrhage,necrosis and cystic degeneration were noted in the tumor cells.It was immunohistochemically revealed that the tumor cells of all the 5 patients were positive in HMB-45,Melan-A,SMA and Vimentin,while negative in CD21,CD35,CK18,CK19,hepatocyte paraffin-1,AFP,EMA and CK.All the patients were undergone local hepatectomy without recurrence during a 3 to 9 years follow-up.Conclusion Inflammatory hepatic AML is one of the sub-types of AML,demonstrating a similar benign biologic behavior with classical AML.

关 键 词：肝肿瘤 血管肌脂瘤 病理学 临床 

分 类 号：R735.702.2[医药卫生—肿瘤]