12例中国汉族人艾滋病相关型皮肤Kaposi肉瘤临床病理特征及治疗分析  

Clinicopathological features and treatment of 12 cases of AIDS-related cutaneous Kaposi sarcoma in Chinese Han people

作　　者：赖英荣[1] 胡荣欣[2] 卢斯汉[2] 郑晓克[1] 杨诗聪[1] 

机构地区：[1]中山大学附属第一医院病理科,广东广州510080 [2]广州市第八人民医院皮肤性病和艾滋病科,广东广州510060

出　　处：《中国病理生理杂志》2013年第11期2092-2096,共5页Chinese Journal of Pathophysiology

基　　金：广东省科技计划(No.2011B080702007)

摘　　要：目的:观察12例汉族人艾滋病(AIDS)相关型皮肤Kaposi肉瘤患者的临床、病理学特点及免疫学表型,探讨其有效治理的方法及预后因素。方法:回顾分析12例汉族人AIDS相关型皮肤Kaposi肉瘤患者临床、病理学特征及免疫学表型。结果:12例汉族人AIDS相关型皮肤Kaposi肉瘤患者HIV均阳性;12例患者的皮损主要表现为暗红或紫黑色的丘疹、斑块;病理表现为真皮内见片状或弥漫分布的棱形细胞浸润,增生活跃的血管多呈裂隙状,组织间隙见红细胞渗出,含铁血黄素沉积,有炎症细胞浸润;免疫组化结果如下:T细胞UCHL1(+),局部CD31(+),增生的血管内皮细胞factorⅧ(+),血管壁HHF-35(+),vimentin(+++),S-100蛋白(-),6例梭形细胞CD34(+++),1例梭形细胞CD34(-)。12例患者均使用高效抗反转录病毒治疗(HAART),4例皮损局限者手术切除,局部辅以微波,预后良好;另2例皮损局限者辅以微波治疗,皮损消退;6例全身泛发皮损者,其中5例辅以微波、1例联合化疗,5例患者的皮损缓解,1例死亡。结论:12例汉族人AIDS相关型皮肤Kaposi肉瘤患者与其他人群的AIDS相关型皮肤Kaposi肉瘤患者的临床、组织病理学及免疫学表现无明显差异。HAART是治疗AIDS相关型皮肤Kaposi肉瘤的必要手段。早期患者肉瘤直径小于2 cm,可给予手术切除肿物,微波治疗;肿物直径大于2 cm,可给予化疗和微波治疗。AIM ： To explore the effective treatment and prognostic factors of 12 cases of acquired immunodeficiency syndrome （AIDS）-related cutaneous Kaposi sarcoma （KS） in Chinese Han people. METHODS： The clinicopathological characteristics and immune phenotypes of the 12 patients with AIDS-related cutaneous KS were analyzed retrospectively. RESULTS： The 12 cases of AIDS-related cutaneous KS were human immunodeficiency virus （HIV）-positive. Most skin lesions of the 12 patients presented as purple and solid papules or plaques. Skin biopsy showed the diffuse or sheetlike infiltration of spindle cells, the active proliferation of slit-like blood vessels, the extravasation of erythrocytes, the deposition of hemosiderin, and the infiltration of inflammatory cells. The results of immunohistochemistry were as follows ： T-cell ubiquitin C-terminal hydroxylase L1 （UCHL1） （ ＋ ）, local CD31 （ ＋ ）, endothelial cell factor VIII （ ＋ ）, HHF- 35 （ ＋ ） in the vessel wall, vimentin （ ＋ ）, S-100 protein （ - ）, spindle cell CD34 （ ＋ ＋ ＋ ） in 6 cases and CD34 （ - ） in 1 case. The 12 patients were all treated with highly active antiretroviral therapy （HAART）. Four patients with small sarcoma were treated with surgery and microwave therapy, and the prognosis is good. Two patients with greater sarcoma were treated microwave therapy, and most skin lesions disappeared. In 6 patients with widely-distributed sarcoma, 5 cases were given microwave and 1 case was given microwave and chemotherapy, and then 5 cases gained significant efficacy and 1 case died. CONCLUSION： The clinicopathological characteristics and immune phenotypes of the 12 cases of AIDS-related cutaneous KS in Chinese Han people are similar to those in other people. HAART is necessary for the treatment of AIDS-related cutaneous KS. The patients in the early stage with the sarcoma smaller than 2 cm in diameter should be treated with surgery and microwave therapy, and the patients with the sarcoma greater than 2

关 键 词：获得性免疫缺陷综合征 KAPOSI肉瘤 高效抗反转录病毒治疗 

分 类 号：R512.91[医药卫生—内科学]