羊水栓塞的病理诊断

Pathologic diagnosis of amnionic fluid embolism

目的 探讨羊水栓塞病人病理诊断的有关问题。方法 通过HE染色、胆色素和黏液组织化学染色以及CD34、cy tokeratin(H)、HCG β免疫组化染色 ,对死于围产期的 13例尸检资料及 1例抢救成功的外检资料进行回顾性分析。 结果尸检中明确诊断为羊水栓塞的 5例 ,在其HE染色的肺组织切片中小血管及毛细血管内都看到了长梭形 ,三五成团或散在分布的鳞状上皮 ,其中 4例观察到胎粪小体的存在 ,经胆色素染色证实 ,3例观察到黏液 ,2例经黏液染色证实。 1例外检诊断为羊水栓塞抢救成功的病例在子宫小血管及毛细血管内也看到了鳞状上皮 ,并经免疫组化标记证实。其他 8例病例 ,无 1例观察到明确羊水成分 ,其中 6例在肺小血管内发现红染、丝状细胞团 ,但量少且无其他羊水成分证据 ,cytokeratin(H)全部阴性 ,CD34染色有 3例阳性 ,3例在肺血管或子宫血管内看到了大细胞 ,HCG染色均为阴性。结论 羊水栓塞的病理诊断应该以HE切片结合病史及临床表现为主 ,特殊染色及免疫组化染色可以辅助诊断 ,但不应完全依赖于特殊染色及免疫组化染色。

Purpose To explore the pathologic diagnosis of amnionic fluid embolism. Methods The 13 autopsy cases died in perinatal stage and 1 survived clinical case diagnosed AFE in recent 10 years were studied using HE staining, porphobilin staining , mucus staining and immuohistochemistry staining.Results Five of 13 died cases were diagnosed AFE by autopsy. Squamous epithelium could be found in all 5 AFE, meconium in 4 cases and mucus in 3 cases, whearas no one in 8 other cases. Of the 5 AFE cases, 4 were positive for cytokeratin, 3 for porphobilin staining and 2 for mucus staining. Squamous epithelium could be found immuohistochemically in the survived cases too. Conclusions The pathologic diagnosis of amnionic fluid embolism rely on HE staining and clinical symptom, porphobilin staining , mucus staining and immuohistochemistry staining are useful in diagnosis, but can not be relied on absolutely.