靶样含铁血黄素沉积性血管瘤10例临床、组织病理及免疫组化分析  

Clinical,histopathological and immunohistochemical analysis of targetoid hemosiderotic hemangioma:a report of 10 cases

作　　者：余音[1] 张颖[1] 卢阳[1] 江阳[1] 冯林[1] YU Yin;ZHANG Ying;LU Yang;JIANG Yang;FENG Lin(Department of Dermatology,Chongqing Hospital of Traditional Chinese Medicine,Chongqing 400010,China)

机构地区：[1]重庆市中医院皮肤科,重庆400010

出　　处：《临床皮肤科杂志》2022年第7期389-393,共5页Journal of Clinical Dermatology

摘　　要：目的:总结靶样含铁血黄素沉积性血管瘤(THH)的临床、组织病理及免疫组化特点。方法:对该院皮肤科门诊2014年1月-2018年12月经临床及组织病理确诊为THH的10例患者的临床、组织病理及免疫组化资料进行回顾性分析。结果:10例THH患者中,男女各5例(50%),发病年龄9~30岁,平均20.60±6.33岁;其中21~30岁者7例(70%)。发病部位最多见于躯干(7例,70%),其次为下肢(2例,20%)及上肢(1例,10%);临床均表现为红黑色丘疹伴外周紫红色晕。临床诊断为血管瘤者最多见(4例,40%),正确诊断者3例(30%),另有诊断为色素痣、汗孔瘤及化脓性肉芽肿者(各1例,10%)。皮损组织病理均可见真皮浅层小血管楔形增生、扩张,部分内皮细胞似鞋钉样突向管腔,真皮浅层可见红细胞外溢。免疫组化显示全部患者CD31呈强阳性表达,8例患者(80%)肿瘤胚胎性抗原M2A(D2-40)呈阳性表达,7例患者(70%)血管内皮细胞生长因子受体(VGEFR)-3呈阳性表达,1例患者(10%)CD34呈局灶性、弱阳性表达,仅1例患者抑癌基因Wilms tumor 1(WT-1)呈可疑阳性表达。全部患者均经外科手术切除,随访2年均未见复发。结论:THH多见于青少年,好发于躯干,表现为红黑色丘疹伴外周紫红色晕,组织病理表现为真皮浅层小血管增生,血管内皮细胞鞋钉样突向管腔,伴红细胞外溢。免疫组化示CD31均表达,D2-40、VGEFR-3大部分表达,CD34、WT-1仅1例表达。Objective: To summarize the clinical, histopathological and immunohistochemical features of targetoid hemosiderotic hemangioma(THH). Methods: The clinical manifestation, histopathological and immunohistochemical features of 10 patients with THH diagnosed in our department from January 2014 to December 2018 were retrospectively analyzed. Results: Among the 10 patients, 5 were males(50%) and 5 were females(50%), and the onset age ranged from 9 to 30 years old, with an average onset age of 20.60±6.33 years. And 7(70%) patients presented with lesions on the trunk, 2(20%) on lower limbs,and 1(10%) on upper limbs. All patients presented with reddish black papule, surrounded by purplish red halo. The clinical diagnostic rate was 30%. The most common misdiagnosis was angioma(4 patients, 40%), and other misdiagnosis included melanocytic nevus, poroma, and pyogenic granuloma(1 patient respectively, 10%). Histopathology showed wedge-shaped hyperplasia and expansion of small vessels in the superficial and middle dermis, endothelial cells protruding into the lumen like hobnails, and overflow of red blood cells. Immunohistochemistry revealed all the 10 cases(100%) were strongly positive for CD31, 8(80%) were positive for D2-40, 7(70%) were positive for VGEFR-3, 1(10%) was weakly and focally positive for CD34, and 1(10%) was suspected positive for WT-1. All cases were resected surgically and no recurrence was found during the 2-year follow-up. Conclusion: THH is commonly seen on the trunk of young people, appearing as reddish black papule surrounded by purplish red halo. The histopathologic features of THH include hyperplasia of small vessels in the superficial and middle dermis, hobnail cells, and overflow of red blood cells. Immunohistochemistry showed that all cases were strongly positive for CD31, most cases were positive for D2-40 and VGEFR-3, while 1 case was weakly and focally positive for CD34 and 1 case was suspected positive for WT-1.

关 键 词：靶样含铁血黄素沉积性血管瘤 临床表现 组织病理 免疫组化 

分 类 号：R732.2[医药卫生—肿瘤]