皮肤血管肉瘤的临床表现、皮肤镜特征及误诊分析  

Analysis of Clinical Manifestations,Dermoscopic Features and Misdiagnosis of Cutaneous Angiosarcoma

作　　者：陈文静[1] 丁媛[1] 于世荣[1] 张德志[1] 吴曹英[1] 刘建勇[1] 金东旭 康晓静[1] CHEN Wenjing;DING Yuan;YU Shirong;ZHANG Dezhi;WU Caoying;LIU Jianyong;JIN Dongxu;KANG Xiaojing(Department of Dermatology and Venereology,People′s Hospital of Xinjiang Uygur Autonomous Region,Xinjiang Clinical Research Center for Dermatology and Venereology,Xinjiang Key Laboratory of Dermatology Research,Urumqi 830001,China)

机构地区：[1]新疆维吾尔自治区人民医院皮肤性病科,新疆皮肤性病临床医学研究中心,新疆皮肤病研究重点实验室(XJYS1707),新疆乌鲁木齐830001

出　　处：《中国皮肤性病学杂志》2024年第12期1341-1347,共7页The Chinese Journal of Dermatovenereology

基　　金：国家自然科学基金项目(82060502)。

摘　　要：目的探讨皮肤血管肉瘤(cutaneous angiosarcoma,CAS)的临床表现、皮肤镜特征及临床误诊情况。方法回顾性分析2015年1月—2023年12月在新疆维吾尔自治区人民医院皮肤科就诊并经组织病理检查确诊的11例CAS患者的病史、临床表现、皮肤镜特征、组织病理资料及误诊情况。结果11例CAS患者中,男6例(54.55%),女5例(45.45%),确诊时患者年龄57~83岁,平均(70.32±12.16)岁;病程1~15个月,平均(6.45±7.84)个月。皮损位于头皮9例,面部1例,躯干1例。主要临床表现为:紫红、暗红或蓝黑色斑片、斑块、结节,可伴有溃疡、出血及渗液。皮肤镜表现:多种颜色的渐变,可见多形性血管,部分病例同时可见白色条纹及溃疡形成。病变发生于头皮的患者局部混有大小基本一致的圆形或卵圆形“黄土块样结构”。组织病理:肿瘤均位于真皮和皮下脂肪组织,边界不清,胶原纤维间可见裂隙样的管腔结构,部分管腔相互交通,形成不同程度的胶原分割现象,血管内皮细胞核异型,可见核分裂象。内皮细胞均表达CD31、ERG和Fli-1,CD34阳性率为81.82%。11例中7例(63.64%)为中高分化,4例(36.36%)为低分化。系统检查中1例伴有淋巴结转移、1例伴有肠道转移。首诊误诊为带状疱疹1例、皮肤感染1例、转移癌1例、鳞状细胞癌1例,淋巴瘤1例,性质待定6例。结论皮肤血管肉瘤临床极易造成误诊,诊断主要依靠组织病理学形态以及免疫组织化学染色,皮肤镜表现具有特征性。Objective To explore the clinical manifestations,dermoscopic features,and clinnical misdiagnosis of cutaneous angiosarcoma(CAS).Methods A retrospective analysis was conducted on the medical history,clinical manifestations,dermoscopic features,histopathological data,and misdiagnosis of 11 patients with cutaneous angiosarcoma diagnosed by skin biopsy in the Dermatology Department of the People′s Hospital of Xinjiang Uygur Autonomous Region from January 2015 to December 2023.Results Among the 11 CAS patients,there were 6 males(54.55)and 5 females(45.45),ranging from 57 to 83 years old.The average age was(70.32±12.16)years old at diagnosis.The duration of the disease ranged from 1 to 15 months,with an average of(6.45±7.54)months.Nine cases′skin lesions were on the scalp,one case′s on the face,and one on the trunk.The main clinical manifestations showed purplish-red,dark red,or blue-black patches,plaques,or nodules,accompanied by ulceration,bleeding,and exudation.Dermoscopic features showed various colors of gradients,pleomorphic vascular structures,white streaks and ulceration in some cases.The local areas were mixed with circular or oval"yellow clay-like structures"of basically uniform size in patients with lesions occurring on the scalp.Histopathologically,the tumors were located in the dermis and subcutaneous adipose tissue,with unclear boundaries.Cracked-like tubular structures were visible between collagen fibers,with some tubules communicating with each other,forming varying degrees of collagen division phenomena.Endothelial cell nuclei showed pleomorphism and mitotic figures were visible.Endothelial cells were positive for CD31,ERG,and Fli-1,with a CD34 positivity rate of 81.82.Among the 11 cases,7 cases(63.64)were moderate to well-differentiated,4 cases(36.36)were poorly differentiated.And during the systemic examination,one patient had lymph node metastasis and one had intestinal metastasis.The initial misdiagnosis included herpes zoster(1 case),skin infection(1 case),metastatic carcinoma(1 case),squ

关 键 词：血管肉瘤 皮肤镜 临床表现 误诊 

分 类 号：R739.5[医药卫生—肿瘤]