血管平滑肌肉瘤的临床病理特征及超声表现  

Ultrasound Features and Histopathological Characteristics of Vascular Leiomyosarcomas

作　　者：纪佳琦 梁蕾[1] 谭莉[2] Ji Jiaqi;Liang Lei;Tan Li(Aerospace Center Hospital,Beijing,100730,China)

机构地区：[1]航天中心医院,北京100730 [2]中国医学科学院北京协和医院,北京100730

出　　处：《中国初级卫生保健》2024年第8期108-110,共3页Chinese Primary Health Care

摘　　要：目的:总结血管平滑肌肉瘤的超声表现及病理特征,以期提高临床及超声医师对该病的认识,减少误诊误治病例出现。方法:选择2003—2020年北京协和医院手术病理证实为血管平滑肌肉瘤并有完整超声记录的患者共17例,分析其超声声像图表现及临床病理特征。结果:17例患者中,下腔静脉平滑肌肉瘤10例,上腔静脉平滑肌肉瘤1例,肺动脉平滑肌肉瘤3例,肾动脉平滑肌肉瘤1例,髂静脉平滑肌肉瘤1例,大隐静脉平滑肌肉瘤1例;有胸背部或腹部疼痛症状9例,有腹部或下肢水肿症状5例,无明显症状3例。超声检查结果显示,17例患者血管平滑肌肉瘤病变最大径为2.3~16.2cm,平均为(7.1±1.1)cm,其中低回声14例,中高回声2例,无回声1例;形态不规则15例,形态规则2例;边界清15例,边界欠清2例;侵及血管外组织器官9例,局限于血管内8例。彩色多普勒血流成像结果显示,11例有血供,6例无血供。手术标本肉眼检查多为灰粉或灰黄不整形结节样实性肿物,最大径平均为(8.1±1.8)cm。手术病理结果显示血管来源肿物,考虑梭形细胞肿瘤,结合免疫组化结果,符合血管内平滑肌肉瘤诊断。结论:血管平滑肌肉瘤超声声像图多表现为形态不规则、边界清的低回声、有血供肿物,常可侵犯血管外组织器官,多表现为疼痛、水肿等临床症状。手术病理及免疫组化结果可明确诊断。OBJECTIVE To summarize the ultrasound features and histopathological characteristics of vascular leiomyosarcomas.METHODS From January 2003 to December 2020,17 patients diagnosed with vascular leiomyosarcomas by surgical pathology and with complete ultrasound records in Peking Union Medical College Hospital were analyzed.The ultrasonographic and clinicopatholog⁃ical features of the patients were analyzed.RESULTS Among them,there were 10 cases of inferior vena cava leiomyosarcoma,1 case of superior vena cava leiomyosarcoma,3 cases of pulmonary artery leiomyosarcoma,1 case of renal artery leiomyosarcoma,1 case of iliac vein leiomyosarcoma and 1 case of great saphenous vein leiomyosarcoma.9 patients had chest and back pain or abdomi⁃nal pain,5 patients had abdominal or lower limb edema symptoms,and 3 patients had no obvious symptoms.Ultrasonography showed that the maximum diameter of the lesions ranged from 2 to 16 cm,with an average of 7.1±1.1 cm.Among them,14 cases were hypoechogenicity,2 were isoechogenicity,and 1 was anechoic.15 cases had irregular shape and 2 cases had regular shape.The boundary was well-defined in 15 cases and 2 cases were ill-defined.Extravascular tissue and organs invasion were found in 9 cases and another 8 cases were constrained in vascularity.Color Doppler flow imaging showed that 11 cases had blood supply and 6 showed no blood supply.The surgical specimens were mostly gray,pink and yellow unplastic nodular solid masses with an average maximum diameter of 8.1±1.8 cm.Postoperative pathology showed the lesion origin from vascularity with spindle cell tumor,and combining with immunohistochemistry,vascular leiomyosarcomas could be diagnosed.CONCLUSION Vascular leiomyosarcomas is usually characterized by irregular shape,constrained with clear boundary and blood supply masses.Lesions often invade extravascu⁃lar tissues and organs,and patients often had pain and edema.Surgical pathology and immunohistochemistry can help to confirm the diagnosis.

关 键 词：血管肉瘤 超声检查 病理学 

分 类 号：R73[医药卫生—肿瘤]