吻合状血管瘤临床病理特征分析  

Clinicopathological characteristics of anastomosing hemangioma

作　　者：施登超 尹霞 徐德 SHI Deng-chao;YIN Xia;XU De(Department of Pathology,Central Hospital of Panzhihua City,Panzhihua 617000,China;Department of Pathology,the Affiliated Hospital of Panzhihua Collgeg,Panzhihua 617000,China)

机构地区：[1]攀枝花市中心医院病理科,四川攀枝花617000 [2]攀枝花学院附属医院病理科,四川攀枝花617000

出　　处：《诊断病理学杂志》2025年第2期166-170,共5页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨吻合状血管瘤(AH)的临床病理学特征、诊断及鉴别诊断。方法收集4例AH,回顾性分析其临床特征、组织形态学、免疫表型及预后,并复习相关文献。结果患者男性3例,女性1例,年龄42-58岁(中位年龄54岁)。发病部位:肾脏2例,肾上腺1例,腹膜后1例。肿瘤最大径1.6 cm-4.0 cm(平均2.6 cm)。4例均为体检偶然发现。影像学显示界限清楚的圆形或类圆形占位性病变,例1同时伴发对侧肾脏占位(病理诊断为透明细胞肾细胞癌)。病理组织学显示肿瘤与周围组织分界清楚,例4可见纤维性包膜。肿瘤由显著增生的小血管组成,血管腔相互吻合呈交织状,衬覆单层扁平至靴钉样内皮细胞,无或轻微细胞异型性,未见核分裂象。其中3例见纤维素性血栓;2例见髓外造血。免疫表型:血管内皮细胞弥漫表达CD34、CD31、ERG,Ki-67增殖指数1%-3%。4例术后随访时间6-60个月(平均33个月),均无复发或转移证据。结论AH是一种罕见的良性血管肿瘤,因其血管广泛吻合的特点极易被误诊为高分化血管肉瘤。提高对它的准确认识可避免误诊或过诊发生。Objective To explore the clinicopathological characteristics,diagnosis and differential diagnosis of anastomosing hemangioma(AH).Methods Four cases of AH were collected.The clinical featuers,histomorphology,immunohistochemistry and prognosis were analyzed and the relevant literature was reviewed.Results Patients consisted of 3 men and 1 woman with ages ranging from 42 years to 58 years.Locations included the kidney,adrenal gland and retroperitoneal.The tumors measured in maximum diameter from 1.6 cm to 4.0 cm.All cases were found accidentally during physical examination.Imaging showed well-defined space-occupying lesions,and case 1 was accompanied by a space-occupying lesion of contralateral kidney(pathological diagnosis was clear cell renal cell carcinoma).Histopathological examination showed that the tumor had a clear boundary with surrounding tissues,and a fibrous capsule was visible in case 4.The tumor were composed of significantly proliferated anastomosing small blood vessels,lined with a single layer of flat to hobnail endothelial cells,without or slight atypia and no mitotic figures.Fibrinous thrombus was seen in three cases and extramedullary hematopoiesis was observed in two cases.Immunohistochemical study showed that the vascular endothelial cells were diffuse positive for CD34,CD31 and ERG,and Ki-67 proliferative index was 1%~3%.Follow-up information(range from 6 to 60 months,with mean 33 months)showed that no evidence of local recurrence or metastasis were identified in four cases.Conclusion Anastomosing hemangioma is a rare benign vascular tumor easily misdiagnosed as highly differentiated angiosarcoma due to its characteristics of extensive vascular anastomosis.Improving the understanding of its pathogenesis and diagnostic features can help avoid misdiagnoses.

关 键 词：吻合状血管瘤 血管肉瘤 免疫组化染色 诊断 鉴别 

分 类 号：R365[医药卫生—病理学]