59例肺硬化性血管瘤的临床病理分析  

Clinicopathological analysis of 59 patients with pulmonary sclerosing hemangioma

作　　者：殷清华[1,2] 申丽丽[1] 闫广宁[1] 辛榕[1] 段光杰[1] 姚小红[1] 郭德玉[1] 

机构地区：[1]第三军医大学西南医院病理学研究所,重庆400038 [2]长寿区人民医院病理科,重庆401220

出　　处：《第三军医大学学报》2013年第11期1156-1159,共4页Journal of Third Military Medical University

摘　　要：目的探讨肺硬化性血管瘤的临床病理特征,寻找其诊断和鉴别诊断的方法。方法回顾性分析2005年1月至2012年12月第三军医大学西南医院病理学研究所病理诊断为肺硬化性血管瘤的59例病例的临床影像学特征、组织学及免疫组织化学染色特点。结果男性5例,女性54例,年龄15～79岁,平均49岁。左肺24例,右肺33例,双肺2例。临床表现咳嗽合并痰中带血13例,胸痛3例,发热1例,其余42例无明显症状。影像学检查病变结节单发56例,多发3例,结节直径最小0.8cm,最大为10cm。临床诊断为肺癌20例,肺硬化性血管瘤15例,炎性假瘤4例,肺结核3例,错构瘤2例,肺转移癌2例,感染1例,其他诊断12例。组织学显示肺硬化性血管瘤细胞成分及组织结构复杂,肿瘤实质由上皮样细胞及卵圆形细胞构成,组织结构可见实性区、乳头区、血管瘤样区及硬化区,间质可发生黏液变性及钙化。免疫组化染色结果显示:上皮样细胞及卵圆形细胞均表达TTF-1及EMA,上皮样细胞表达CK,卵圆形细胞表达Vimentin,部分表达CD56、Syn。结论肺硬化性血管瘤是常发生于中年女性,可能是起源于呼吸道的原始多潜能干细胞的少见肿瘤,多表现为孤立性肺结节,临床极易误诊为肺癌,病理常规切片辅以免疫组织化学检查是诊断和鉴别诊断的有效方法。Objective To investigate the clinicopathological characteristics of pulmonary sclerosing hemangioma （PSH）, and explore the methods for diagnosis and differential diagnosis of PSH. Methods Clinical manifestations and histological and immunohistochemical features of 59 patients with PSH were retrospectively analyzed. Results There were 54 female patients including 24 patients with PSH on the left lung, 33 patients with PSH on the right lung, and 2 patients with PSH on bilateral lungs. They were aged from 15-79 with an average of 49. Clinical manifestation showed cough with blood-tinged sputum in 13 patients, chest pain in 3 patients, fever in 1 patient, and no obvious symptoms in 42 patients. Imaging examination showed 56 patients with single nodule and 3 patients with multiple nodules, and the diameter the nodules ranged from 0.8 cm to 10 cm. Twenty patients were diagnosed as lung cancer, 15 patients as PSH, 4 patients as inflammatory pseudotumor, 3 patients as pulmonary tuberculosis, 2 patients as hamartoma, 2 patients as pulmonary metastatic carcinoma, 1 patient as infection, and 12 patients as other diagnoses. The tumor tissues were composed by epitheloid cells and oval cells, and four histological patterns were observed including solid area, papillary area, sclerotic area, and hemangioma-like area. Immunohistochemical staining revealed that the epithelioid cells expressed TTF-1, CK and EMA, while the oval cells expressed TTF-1, vimentin and EMA as well as partial expression of CD56 and Syn. Conclusion PSH is a rare tumor that is particularly prevalent in isolated lung nodules in middle-aged women and may originate from primitive respiratory multipotent stem cells. It is usually misdiagnosed as lung cancer. Histological section combined with immunohistochemical inspection is effective for differential diagnosis of PSH.

关 键 词：肺 硬化性血管瘤 免疫组化 

分 类 号：R446.8[医药卫生—诊断学] R732.2[医药卫生—临床医学]