成人小肠原发性淋巴管瘤临床病理分析  

Clinicopathological features of the lymphangioma of small intestine

作　　者：夏迪[1,2] 陆珍凤[1] 周军[1] 周晓军[1] 印洪林[1] 

机构地区：[1]南京军区南京总医院病理科,南京210002 [2]江苏省丹阳市人民医院病理科

出　　处：《诊断病理学杂志》2014年第5期260-262,266,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的 探讨小肠原发性淋巴管瘤临床病理特征,为该类肿瘤的诊断和治疗提供临床病理研究资料.方法 复习3例成人小肠原发性淋巴管瘤临床资料,对肿瘤切除标本进行组织学和免疫组织化学标记检查,结合文献讨论该类肿瘤的临床病理特征.结果 3例均为成人,其中男性2例,女性1例,年龄34～47岁.临床首发症状同为下消化道不同程度的出血和黑便,但腹部查体均未见明显异常.临床诊断：炎性肠病.病理组织学检查显示肿瘤病变位于小肠黏膜下及肠系膜内,淋巴管呈不规则丛状囊性扩张,形态不一,肿瘤性淋巴管有不连续平滑肌围绕,壁内衬扁平上皮,腔内含淋巴液,间质内见散在淋巴细胞浸润.其中1例合并小肠系膜分叶状毛细血管瘤.免疫组织化学标记示淋巴管瘤内皮细胞CD31、D2-40和FⅧ（＋）,CD34、SMA、EMA和CKpan（-）.结论 小肠淋巴管瘤临床十分少见,临床首发症状以下消化道出血为特征,病理上病变可以累及小肠壁黏膜全层、肌层和肠系膜,呈蔓状分布并发分叶状毛细血管瘤.治疗首选切除肿瘤性肠段.Purpose To investigate the clinicopathologic characteristics of lymphangioma of small intestine to provide the pathological data for the diagnosis and treatment of the lesions. Methods Three cases of lymphangioma of small intestine in adults were analyzed by means of morphological and immunohistochemical examinations with review of the literature. Results Three cases were adults, including 2 males and 1 female, with age range from 34 -47 years. The first clinical symptoms were varying degree of lower gastrointestinal bleeding and melena, but the abdominal examination showed no obvious abnormalities. So the three cases were initially diagnosed as inflammatory bowel disease. Microscopically, all the cases represented irregularly expanded lymphatics within intestinal mucosa and mesentery, of which the lumens contained lymph and varied in diameter, were covered by lining epithelia, partly surrounded by incontinuous smooth muscles, with interstitial lymphocytic infiltrates. One patient presented with lobular capillary hemangioma in small bowel mesentery. lmmunohistochemically, vascular epithelia were positive for CD31, D2 -40, FⅧAg, but negative for CD34, SMA, EMA, and CKpan. Conclusion The lymphangioma of small intestine is rare. Pathologically, it is characterized by the early symptom of lower gastrointestinal hemorrhage involved in the entire wall of mucosa, muscular layer and mesentery. Surgical removal of the damaged intestine tract is an optimal choice.

关 键 词：淋巴管瘤 小肠 免疫组化 成人 

分 类 号：R735.32[医药卫生—肿瘤]