肝脏细粒棘球蚴病13例临床病理学特征  

Hepatic echinococcus granulosus:a clinicopathological analysis of thirteen cases

作　　者：刘丽莎 郭卫平[2] 汪跃锋 董愉[3] 脱颖[3] 王晟[4] 万双 平措扎西 彭琳 李健[6] 韩安家[3] 刘大伟[3] Liu Lisha;Guo Weiping;Wang Yuefeng;Dong Yu;Tuo Ying;Wang Sheng;Wan Shuang;Phuntsok Tashi;Peng Lin;Li Jian;Han Anjia;Liu Dawei(Department of Pathology,Linzhi People′s Hospital,Linzhi 860000,China;Department of Gastroenterological Surgery,the Third Affiliated Hospital,Sun Yat-sen University,Guangzhou 510630,China;Department of Pathology,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Anesthesiology,Guangdong Provincial People′s Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China;Department of Laboratory,Linzhi People′s Hospital,Linzhi 860000,China;ENT.Department,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]西藏林芝市人民医院病理科,860000 [2]中山大学附属第三医院胃肠外科,广州510630 [3]中山大学附属第一医院病理科,广州510080 [4]广东省人民医院,广东省医学科学院麻醉科,广州510080 [5]西藏林芝市人民医院检验科,860000 [6]中山大学附属第一医院耳鼻喉科,广州510080

出　　处：《中华病理学杂志》2021年第6期650-654,共5页Chinese Journal of Pathology

基　　金：广东省自然科学基金(2017A030313817);国家自然科学基金(81974141,81371071)。

摘　　要：目的探讨肝细粒棘球蚴病(echinococcus granulosus)的临床特征、组织病理学特征以及诊断和鉴别诊断。方法收集2017年1月至2020年10月间就诊于西藏林芝市人民医院的13例肝细粒棘球蚴外科切除患者的病理标本,对其临床资料、B超表现、病理组织学形态特点以及免疫组织化学和组织化学染色特征进行回顾性分析。结果在13例肝细粒棘球蚴患者中女性8例,男性5例;发病年龄11~53岁,平均年龄32岁;肝右叶是主要的好发位置,占比为10/13;临床症状多为腹部胀痛(9/13)或症状不明显而在体检发现。根据世界卫生组织包虫病专家工作组(WHO-IWGE)彩超分类方案肝细粒棘球蚴分为6种类型,本组研究的13个病例中囊性病变(CL)型1例,囊性包虫病(CE)1型2例,CE2型4例,CE3型3例,CE4型3例。病理检查发现,肝细粒棘球蚴大小不一,直径2.7~13.5 cm,10/13的病例直径大于10 cm,大体上细粒棘球蚴囊壁外观为瓷白色凉皮样特点,可伴有不同程度的退变和坏死,显微镜下分为角皮层和胚层两层;囊内为棘球蚴液和数量不等的原头蚴。特殊染色显示细粒棘球蚴的内囊含有大量的弹力纤维和网状纤维,并清楚地显示角皮层特征性的平行的板层纹理结构和深染的原头蚴钩器等结构。免疫组织化学示外囊宿主免疫反应中的炎性细胞含数量不等的CD20和CD3阳性表达的B和T淋巴细胞、CD38阳性的浆细胞,部分病例可见明显CD68阳性的肉芽肿病变,同时发现少数B淋巴细胞灶性弱表达IgG和IgG4。结论细粒棘球蚴病是流行于西藏等牧区的人兽共患性寄生虫病,肝脏是其主要累及器官,其临床、B超和病理学特征很有研究必要。Objective To investigate the clinicopathologic characteristics of hepatic echinococcus granulosus(HEG).Methods Thirteen cases of HEG were collected from Linzhi People′s Hospital between January 2017 to October 2020,and their clinicopathologic features,ultrasound classification,immunophenotype and histochemical data were analyzed,retrospectively and the relevant literature was reviewed.Results Thirteen patients(5 male patients,8 female patients)were included in this cohort,and the mean age was 40 years.The most common clinical presentation was mild abdominal distention and pain(9/13).Based on WHO-IWGE ultrasound standardized classification,these cases were classified into 5 types,including type CL(1 case),type CE1(2 cases),type CE2(4 cases),type CE3(3 cases)and type CE4(3 cases).Gross examination revealed a solitary cyst localized in the liver,varying from 2.7 to 13.5 cm in diameter,and most of them(10/13)were more than 10 cm.Histopathologically,these cysts possessed a thin inner germinal layer and outer adventitial layer,and a central cavityfilled with a clear"hydatid"fluid.The germinal layer was continuous and generated brood capsules and protoscoleces.The laminated membranes were clearly demonstrated by elastic fiber and Gomori′s stains.Inside the"mother"cyst,there were a varying number of"daughter"vesicles of variable sizes.The inflammatory reaction around the cyst consisted of eosinophils,mononuclear cells immediately next to the cyst layer and sometimes formed granuloma and giant cells resembling the Langhan′s type giant cells.The lymphoid cells were positive for CD20 and CD3.The CD68 immunohistochemistry clearly demonstrated epithelioid cells of granuloma in two cases.Moreover,immunohistochemistry revealed plasma cells were locally positive for CD38,IgG and IgG4,but not meeting the criteria for IgG4 related lesion.Conclusions Hepatic echinococcus granulosus is a zoonotic parasitic disease prevalent in pastoral areas such as Tibet.It is important to understand its clinical features,ultrasound chara

关 键 词：肝疾病 寄生虫病 病理学 免疫组织化学 

分 类 号：R532.32[医药卫生—内科学] R575[医药卫生—临床医学]