先天性血管瘤40例临床病理学特征研究  

Clinicopathological features of congenital hemangioma:a study of 40 cases

作　　者：梁栋[1] 周博 李娜[1] 孔令非[3] 刘秋雨[3] 丁胭脂 牛会林 朱晓爽[5] 朱好辉[6] Liang Dong;Zhou Bo;Li Na;Kong Lingfei;Liu Qiuyu;Ding Yanzhi;Niu Huilin;Zhu Xiaoshuang;Zhu Haohui(Department of Breast Surgery,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Pathology,Weishi People′s Hospital,Kaifeng 475000,China;Department of Pathology,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Pathology,Guangzhou Women and Children′s Medical Center,Guangzhou 510623,China;Department of Hemangioma,Henan Provincial People′s Hospital,Zhengzhou 450003,China;Department of Ultrasonography,Henan Provincial People′s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院河南大学人民医院乳腺外科,郑州450003 [2]开封市尉氏县人民医院病理科,开封475000 [3]河南省人民医院病理科,郑州450003 [4]广州市妇女儿童医疗中心病理科,广州510623 [5]河南省人民医院血管瘤科,河南省血管瘤(畸形)诊疗中心,郑州450003 [6]河南省人民医院超声科,郑州450003

出　　处：《中华病理学杂志》2022年第3期202-206,共5页Chinese Journal of Pathology

摘　　要：目的探讨先天性血管瘤(congenital hemangioma,CH)临床及病理学特征、诊断及鉴别诊断。方法回顾性收集河南省人民医院2017年1月至2020年12月确诊CH病例40例,分析临床及病理学资料,采用免疫组织化学法检测相关指标,并复习文献。结果40例CH中,男性24例,女性16例,发病部位有头面颈部(11例)、四肢(14例)、躯干(15例)。临床主要表现为出生时即发现,呈缓慢生长的无痛性斑块或肿块,较大者隆起于皮肤表面,多呈青紫色或鲜红色,周围可见白色晕环。低倍镜下见肿瘤组织界限尚清,呈分叶状结构生长,小叶内可见大小不等新生血管腔形成,血管内皮细胞呈立方样或钉突样形态,小叶内可见星状引流血管,1例快速消退型CH可见髓外造血现象;小叶之间可见多少不等迂曲扩张畸形血管腔,部分不消退型CH以畸形血管为主,分叶状结构不明显。免疫组织化学示血管内皮细胞呈CD31、CD34、ERG强阳性,D2-40和葡萄糖转运蛋白-1阴性。结论CH是一种良性的先天性血管肿瘤,形态学呈特征性分叶状生长,间质可见畸形血管;病理诊断常需与婴儿性血管瘤、化脓性肉芽肿、卡波西型血管内皮瘤以及脉管畸形相鉴别。Objective To investigate the clinical and pathologic features,diagnosis and differential diagnosis of congenital hemangioma(CH).Methods Forty cases of CH were diagnosed from January 2017 to December 2020 in Henan Provincial People′s Hospital.The clinical and pathological and immunohistochemical data were analyzed,with review of literature.Results There were 24 male and 16 female patients.The lesions were located in the head,neck(11 cases),limbs(14 cases),and trunk(15 cases).The clinical manifestations were congenital painless plaques or masses,the larger ones protruded on the skin surface,mostly dusky purple or bright red,with surrounding white halos.Under low magnification,the tumor was lobular and well demarcated,composed of neo-microvascular lumen of different sizes.The vascular endothelial cells were cuboidal or hobnail in appearance,forming stellar drainage vessels within the lobules.Extra-medullary hematopoiesis was seen in one case of rapidly involuting CH;there were different number of tortuous and dilated vascular lumen between the lobular structures,and some non-involuting CH cases were vascular malformations,which were devoid of lobulated structures.Immunohistochemistry showed that endothelial cells were strongly positive for CD31,CD34 and ERG,while D2-40 and GLUT-1 were negative.Conclusions CH is a benign congenital vascular tumor with characteristic lobulated growth and abnormal blood vessels in the stroma.Pathological diagnosis often needs to be differentiated from infantile hemangioma,pyogenic granuloma,kaposiform hemangioendothelioma and vascular malformation.

关 键 词：软组织肿瘤 血管瘤 诊断 鉴别 

分 类 号：R732.2[医药卫生—肿瘤]