间皮性/单核细胞性偶发心脏赘生物3例临床病理观察  

Mesothelial/monocytic incidental cardiac excrescences:a clinicopathological analysis of three cases

作　　者：王彬[1] 沈恬 王劲松[1] 赵薇[1] 赵有财[1] 黄文斌[1] WANG Bin;SHEN Tian;WANG Jin-song;ZHAO Wei;ZHAO You-cai;HUANG Wen-bin(Depariment of Pathology,Nanjing Hospital(Nanjing First Hospital),Nanjing Medical Unioersity,Nanjing 210006,China)

机构地区：[1]南京医科大学附属南京医院(南京市第一医院)病理科,南京210006

出　　处：《诊断病理学杂志》2021年第9期721-725,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨间皮性/单核细胞性偶发心脏赘生物(MICE)的临床病理学特征、发病机制、鉴别诊断及预后。方法回顾性分析3例MICE病例,观察其临床和病理学特征,并结合文献进行复习。结果患者均为女性,年龄53~69岁,心脏彩超均提示"风湿性心脏病",其中1例超声示左心房内附壁血栓形成,2例于术中发现左房附壁血栓。组织学上,病变主要由片状分布的2种细胞组成,包埋于纤维素内,其间混杂大小不一的空泡和一些炎细胞。一种细胞呈多边形,细胞体积中等,大小较一致,胞质较丰富,细胞边界清楚,胞核卵圆形、深染,核染色质细腻,核仁不明显,偶见核沟,未见明确的核分裂象;另一种细胞较少,散在分布于第1种细胞之间,呈乳头状和假腺样分布,细胞呈立方形,胞质少,胞核卵圆形,核深染,但未见异型性和核分裂象。免疫组化显示多边形细胞表达CD68、CD163和CD31,立方形细胞表达CK、EMA、CK5/6、CR、D2-40,Ki-67增殖指数约2%~5%。结论MICE是一种少见的、反应性非肿瘤性病变,主要组织学特征为组织细胞和间皮细胞组成,免疫组织化学标记可有助于其诊断和鉴别诊断,预后良好,无复发和转移。Objective To explore the clinicopathological features,pathogenesis,differential diagnosis and prognosis of mesothelial/monocytic incidental cardiac excrescences(MICE).Methods The clinicopathological data of three MICE patients were retrospectively analyzed,and the relevant literature was reviewed.Results All the patients were female,aged 53-69 years.Color Doppler echocardiography revealed“rheumatic heart disease”.Left atrial mural thrombosis was found in 1 case and left atrial mural thrombus was found in 2 cases.Histologically,the lesions mainly consisted of two types of cells distributed in sheets,embedded in fibrinoid materials,mixed with vacuoles of different sizes and some inflammatory cells.One type of cells was polygonal,medium size and uniform in size,abundant cytoplasm,clear cell boundary,oval and hyperchromatic nuclei,fine chromatin,indistinct nucleoli,occasional groove,and no clear mitotic figures.The other type of cells was less and distributed among the first type of cells,showing papillary and pseudoglandular distribution.The cells were cuboidal,with less cytoplasm,rounded nuclei and hyperchromatic nuclei,but no atypia or mitotic figures were observed.Immunohistochemistry showed that polygonal cells expressed CD68,CD163 and CD31,while cube cells expressed CK,EMA,CK5/6,CR,D2-40;Ki-67 proliferation index was about 2%-5%.Conclusion MICE is a rare,reactive,non-neoplastic lesion characterized mainly by histocyte and mesothelial cell composition.Immunohistochemical markers are helpful for diagnosis and differential diagnosis,with a good prognosis and no recurrence or metastasis.

关 键 词：间皮性/单核细胞性偶发心脏赘生物 组织学特征 CD31 附壁血栓 

分 类 号：R732.1[医药卫生—肿瘤]