老年人头面部血管肉瘤2例  

Two cases of cutaneous angiosarcoma on the scalp and face in the elderly

作　　者：王一鑫 于腾 WANG Yixin;YU Teng(Shenzhen Hospital(Fu Tian)of Guangzhou University of Chinese Medicine,Shenzhen 518000,China)

机构地区：[1]广州中医药大学深圳医院(福田),广东深圳518000

出　　处：《皮肤性病诊疗学杂志》2024年第7期496-501,共6页Journal of Diagnosis and Therapy on Dermato-venereology

摘　　要：报告老年人头面部血管肉瘤2例。患者1,89岁,因头皮及右面部紫红色斑伴溃疡2个月就诊。皮肤科检查:头顶、额部及右侧面部皮肤泛发紫红色水肿性斑片,边界欠清,皮肤紧绷发亮,压之凹陷;头顶及右额颞部各散在一处溃疡结痂,头顶溃疡结痂呈圆形,约2 cm×3 cm,痂黑且厚,边缘肿胀隆起;右额颞部溃疡约4 cm×6 cm,形状不规则,中央结痂,边缘黑紫,其上方散在一黄豆大小黑色结痂。皮损组织病理检查:大部分为坏死组织,组织边缘真皮见异型细胞,似管腔样排列。免疫组化:CD31(+)、CD34(+)、ERG(+)、HHV8灶性弱阳性、P53突变型、Ki-67(约30%+)、CK(-)、CEA(-)。诊断:血管肉瘤。患者及家属拒绝进一步诊治,患者已死亡。患者2,女,81岁,因右侧头面部暗红色斑2个月就诊。皮肤科检查:右侧头面部紫红色斑,融合成片,其上散在多个紫红色丘疹、结节。皮损组织病理检查:棘层稍增厚,真皮全层弥漫性增生内皮细胞浸润,分割胶原,具有异形性,部分区域形成裂隙和管腔,内含红细胞。免疫组化:CD31(+)、CD34(+)、D240(+)、ERG(+)、Ki-67(约35%+)、S100(-)、HMB45(-)、CK(-)。诊断:头面部血管肉瘤。患者转至肿瘤科放疗化疗,后随访已死亡。Two cases of cutaneous angiosarcoma of the scalp and face in the elderly are reported.Case 1 was an 89 years old man with ulcerated edematous,erythematous plagues on the scalp and right face for 2 months.Dermatological examination showed that ulcerated edematous,erythematous patches on the crown,forehead,and right face,with unclear boundaries.The involved skin was tight,shiny,and depressed under pressure.Ulcers and scabs were present on the crown(sized 2 cm×3 cm)and frontotemporal region(sized 4 cm×6 cm).Histopathology showed necrosis and atypical cells arranged in luminal pattern around lesion in the dermis.Immunohistochemistry showed CD31(+),CD34(+),ERG(+),HHV8 focal weak positive,P53 mutation,Ki-67(30%+),CK(-),and CEA(-).Diagnosis:angiosarcoma.The patient and his family refused further diagnosis and treatment,and the patient passed away.Case 2 was an 81 years old female with dark erythema on the right scalp and face for 2 months.Dermatological examination revealed purple patch covered with purple papules and nodules on the right scalp and face.Skin histopathology showed slight thickening of the spinous layers,diffuse proliferation of endothelial cells in the dermis,segmentation of collagen,and atypia.Fissures and vascular lumens containing erythrocytes were also observed in the dermis.Immunohistochemistry:CD31(+),CD34(+),D240(+),ERG(+),Ki-67(≈35%+),S100(-),HMB45(-),and CK(-).Diagnosis:angiosarcoma of the scalp and face.The patient was transferred to the oncology department for radiotherapy and chemotherapy,and passed away during follow-up.

关 键 词：血管肉瘤 头面部 

分 类 号：R739.5[医药卫生—肿瘤]