脾表皮样囊肿临床病理特征分析  

Splenic epidermoid cyst:a clinicopathological analysis

作　　者：刘建兰 成志强 贾桂静 胡锦涛 Liu Jianlan;Cheng Zhiqiang;Jia Guijing;Hu Jintao(Department of Pathology,Shenzhen People′s Hospital(The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,China;Department of Radiology,Shenzhen People′s Hospital(The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020,China)

机构地区：[1]广东省深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)病理科,518020 [2]广东省深圳市人民医院(暨南大学第二临床医学院,南方科技大学第一附属医院)放射科,518020

出　　处：《实用医技杂志》2022年第2期144-147,I0001,共5页Journal of Practical Medical Techniques

摘　　要：目的探讨发生于脾脏的表皮样囊肿(SEC)临床病理特征、诊断、鉴别诊断、治疗及预后。方法收集2017—2020年深圳市人民医院4例SEC患者的临床病理资料及随访资料,对其病理形态特点及免疫组织化学进行观察分析,并复习相关文献。结果4例患者均为女性,发病年龄19~34岁,平均(22±3)岁。2例为体检时偶然发现,无明显症状,2例表现为左上腹胀痛不适。3例血清肿瘤标志物糖类抗原(CA)19-9水平升高,1例正常。4例均行脾全切术。大体检查肿瘤最大径6~13 cm,平均(8.8±1.5)cm。2例表现为单房囊性,2例表现为多房囊性,囊壁尚光滑,部分囊壁粗糙,灰黄,质稍硬。4例镜下形态相似,囊壁被覆分化成熟的鳞状上皮,可见角化物。其中2例部分囊壁衬覆上皮脱落,可见组织细胞反应,胆固醇结晶形成,钙盐沉积。免疫组织化学:4例CEA、P63均阳性。3例CA19-9阳性,1例为阴性。结论SEC是脾脏的一种罕见的良性病变,儿童和青壮年多发,女性多见。患者常无症状,当囊肿较大时,可出现临床症状或破裂、出血及感染等并发症,需及时手术治疗。Objective To discuss the clinicopathological characteristics,diagnosis and differential diagnosis,and prognosis of splenic epidermoid cyst(SEC).Methods Clinicopathological and follow-up data of four SEC patients diagnosed in Shenzhen people′s Hospital were collected from 2017 to 2020.The morphology and immunophenotype of these cases were analyzed,and relevant literatures were reviewed.Results The four patients were all female.The ages of the patients ranged from 19 to 34 years with a mean age of(22±3)years.Two cases were discovered incidentally during physical examination with no obvious symptoms and the other two cases complained of left upper abdomen pain.The serum tumor marker carbohydrate antigen(CA)19-9 was elevated in 3 cases,and normal in 1 case.All the patients underwent a splenectomy.Grossly,the tumor size ranged from 6 to 13 cm with a mean size of(8.8±1.5)cm.Two patients developed unilocular cysts and two developed multilocular cysts.The inner lining of cyst was smooth,whereas partially rough,grayish yellow,and slightly hard.Histologically,the 4 cases were similar.The cystic wall was covered with well differentiated squamous epithelium.In two cases,the epithelial lining of the capsular wall was focally denuded with infiltration of histiocytes,formation of cholesterol crystals,and deposition of calcium.Immunohistochemically,carcinoembryonic antigen(CEA)and P63 were positive in all 4 cases.CA19-9 was positive in 3 cases and negative in1 case.Conclusion SEC is a rare benign splenic lesion that is predisposed to occur in children and young females.The patients are usually asymptomatic,however,when the cyst is large enough to produce clinical symptoms or complications such as rupture,bleeding,and infection,surgical treatment is required immediately.

关 键 词：脾 表皮囊肿 病理学 临床 

分 类 号：R733.2[医药卫生—肿瘤]