两例肺穿刺活检诊断上皮样血管内皮瘤的病理形态与免疫组织化学表型特征分析  

Analysis of pathological morphology and immunohistochemical phenotypic characteristics of two cases of epithelioid hemangioendothelioma diagnosed by lung biopsy

作　　者：徐励 陈芳芳 何惠华[1] 任家材 袁静萍[1] 李文华 Xu Li;Chen Fangfang;He Huihua;Ren Jiacai;Yuan Jingping;Li Wenhua(Department of Pathology,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Pathology,Yidu People’s Hospital,Yidu 443300,China)

机构地区：[1]武汉大学人民医院病理科,武汉430060 [2]宜都市人民医院病理科,宜都443300

出　　处：《中国组织化学与细胞化学杂志》2024年第6期579-582,597,共5页Chinese Journal of Histochemistry and Cytochemistry

摘　　要：目的探讨肺穿刺活检小标本诊断上皮样血管内皮瘤的病理形态、免疫表型特征。方法收集武汉大学人民医院病理科2021年6月至2023年12月穿刺活检诊断肺上皮样血管内皮瘤2例(男女各一,年龄分别为55岁和70岁),对穿刺标本进一步进行免疫组化检测,并电话随访。结果肺部CT提示多发散在实性结节。病理显示:肿瘤呈结节状或息肉增生,突向肺泡腔内。1例未见明显软骨样基质,另1例有较多黏液软骨样基质。肿瘤细胞呈上皮样或多角状,巢片状或条索状排列,细胞核小呈卵圆形,部分细胞内可见空泡,空泡内含红细胞。1例可见成熟血管腔,另一例无明显血管结构。免疫组化显示:肿瘤细胞CD31、CD34、ERG、Fli-1均阳性,EMA、CK7、D2-40、TFE-3、napsin A、P40、TTF-1均阴性,Ki-67增殖指数分别为30%和10%。结论肺上皮样血管内皮瘤为罕见恶性肿瘤,易误诊为转移癌或肺腺癌。尽管病理形态具有一定特征性,但穿刺活检诊断具有较大难度,需结合免疫组化进行确诊。Objective To investigate the pathological morphology and immunophenotypic characteristics of epithelioid hemangioendothelioma diagnosed by lung biopsy specimens.Methods Two cases of lung epithelioid hemangioendothelioma(one male,one female,aged 55 and 70 years,respectively)diagnosed by lung biopsy at the Pathology Department of Wuhan University People’s Hospital between June 2021 and December 2023 were collected.Immunohistochemical analysis was performed on the biopsy specimens,and follow-up was conducted via telephone.Results Lung CT revealed multiple scattered solid nodules.Pathology showed tumors with nodular or polypoid growth,protruding into the alveolar cavity.One case lacked distinct cartilage-like stroma,while the other exhibited abundant mucinous cartilage-like stroma.Tumor cells were either epithelioid or polygonal,arranged in nests or cords.The nuclei were small and oval,with some cells showing vacuoles containing red blood cells.One case showed mature vascular lumens,while the other lacked distinct vascular structures.Immunohistochemistry revealed positivity for CD31,CD34,ERG,and Fli-1 in tumor cells,while EMA,CK7,D2-40,TFE-3,napsin A,P40,and TTF-1 were negative.Ki-67 proliferation indices were 30%and 10%,respectively.Conclusion Lung epithelioid hemangioendothelioma is a rare malignant tumor that is easily misdiagnosed as metastatic cancer or lung adenocarcinoma.Although its pathological morphology has certain characteristic features,the diagnosis based on biopsy specimens can be challenging and requires the use of immunohistochemistry for confirmation.

关 键 词：穿刺活检 上皮样血管内皮瘤 免疫组织化学表型 

分 类 号：R365[医药卫生—病理学]