摘要
目的:探讨肺活体组织检查肺上皮样血管内皮瘤(pulmonary epithelioid haemangioendothelioma,PEH)意义及鉴别诊断。方法:回顾分析4例肺穿刺活体组织检查诊断PEH患者的病理特点、免疫组织化学检查结果、临床及实验室检查结果。结果:4例PEH患者年龄30~61岁,男女比2∶2;影像学检查示肺内结节考虑为转移性癌,实验室检查未见明显异常。光镜下肿瘤细胞有上皮样及空泡样形态,空泡内偶见红细胞,瘤细胞呈条索状、小巢状,腺样结构及不规则状分布于淀粉样或玻璃样变间质中,瘤细胞未见核分裂相,肿瘤边缘区细胞丰富,呈息肉或肾小球样填塞于扩张的肺泡腔。肿瘤细胞表达CD31、CD34、第Ⅷ因子相关抗原(factorⅧrelated antigen,FⅧRAg)等血管内皮细胞标记,同时部分表达波形蛋白(vimentin)和细胞角蛋白(cytokeratin,CK)。结论:肺穿刺活体组织中,如果病变具有典型PEH形态学特征及免疫表型,同时又有临床及影像学支持,即可诊断PEH,应用多组抗体有助于PEH的诊断及鉴别诊断。
Objective:To explore the diagnosis and differential diagnosis of pulmonary epithelioid hemangioendothelioma(PEH) in lung biopsy specimens.Methods:A retrospective study was conducted by analyzing the pathological characteristics,immunohistochemical results,and the clinical and laboratory examination results of 4 cases being diagnosed as PEH.Results: The ages of the four cases ranged from 30 to 61 with gender ratio 2∶2(female∶male).Imaging findings showed pulmonary nodules considered as metastatic carcinoma,but laboratory examination showed no abnormalities.Under microscope,tumor cells appeared with epithelioid and vacuole morphology;sporadic red cells could be found in the vacuoles;tumor cells were distributed in amyloid stroma and hyaline stroma with cord-like,small nests,even adenoid or irregular structure.Tumor cells showed no mitosis;abundant cells were found in marginal zone and expansive alveolar cavity with polypoid or glomerular-like structure.The endothelial markers including CD31,CD34,factor Ⅷ related antigen(FⅧRAg) were expressed in tumor cells,with vimentin and cytokeratin(CK) partly expressed.Conclusions: In lung biopsy specimens,cases with typical morphological and immunophenotype characteristics in addition to clinical and radiology evidence can be diagnosed as PEH.Multiple antibodies are helpful in the diagnosis and differential diagnosis of PEH.
出处
《中国临床医学》
2013年第3期309-311,共3页
Chinese Journal of Clinical Medicine
关键词
肺
上皮样血管内皮瘤
活检
病理
鉴别诊断
Lung
Epithelioid hemangioendothelioma
Biopsy
Pathology
Differential diagnosis