组织学和生物学检测对小儿血管瘤临床治疗价值的探讨

Biological characters and clinical significance of hemangioma in children

目的通过对小儿血管瘤标本的组织形态学观察和生物学特性测定,探讨血管瘤分类、分期的诊断指标,为临床选择治疗方案提供客观依据。方法①采用苏木素伊红染色(HE)法,根据镜下组织形态学特点进行分类及分期;②采用甲苯氨蓝染色法进行肥大细胞数测定;③采用免疫组化(SP)法,测定血管瘤组织中增殖细胞核抗原(PCNA)、血管内皮细胞生成因子(VEGF)和碱性成纤维细胞生长因子(bFGF)在血管瘤与血管畸形中的表达。结果①增生期血管瘤(55例)内皮细胞增殖活跃,形成细胞团;消退期血管瘤(7例)内皮细胞减少,可见呈岛状分布的脂肪和纤维组织;血管畸形(40例)为毛细血管、小动脉、静脉的异常扩张,内皮细胞无异常增殖;②增生期血管瘤肥大细胞计数为33.30±18.66,高于消退期的26.16±19.09(P<0.05),二者均明显高于血管畸形的7.27±13.01(P<0.01);③PCNA在增生和消退期血管瘤标本中表达的阳性率分别为100%和42.9%,血管畸形仅为22.5%,组间有非常显著性差异(P<0.01)。VEGF在三种组织中表达的阳性率分别为89.6%、42.9%和5%,组间有非常显著性差异(P<0.01)。bFGF在三种组织中表达的阳性率分别为89.6%、100%和25.1%,血管瘤与血管畸形组间有非常显著性差异(P<0.01)。结论肥大细胞可能与血管瘤组织纤维变性及导致血管瘤自然消退有关。PCNA、VEGF与bFGF是判断血管内皮细胞增殖与否的较准确与实用的指标,可作为诊断增生期血管瘤、消退期血管瘤,抑或血管畸形的重要参考。

Objective To investigate the histology and biological characters of hemangioma and vascular malformation in 95 children, and explore the clinical dignosis, classification and stage. Methods Hematorylin-Eosin （HE） staining was used to classify. Toluidine blue stained slides was used to count mast cells. Immunohistiochemistry was used to determine the expression of proliferating cell nuclear antigen（PCNA）, vascular endothelial growth factor （VEGF） and basic fibroblast grower factor（bFGF） in hemangioma and vascular malformation. Results Proliferating phase（55 cases）： increased endothelia cells activity with the formation of syncytial masses with and without lumens. Involuted phase（7 cases）： diminished cellularity with islands of fatty deposits intermingled with fibrous tissue. The hyperplasia of endothelia cells was not evident. Vascular malformations（40 cases） was predominant dilatation of venous, capillary vessel and arteriolar. The mast cell counts of the proliferating phase（33.30±18.66） was higher than those of the involuted phase（26.16±19.09, P〈 0.05） . The mast cell counts of hemangiomas were higher than vascular malformations（7.27±13.01, P〈0.01）. The PCNA- positive rates in proliferative hemangiomas, involuting hemangiomas, vascular malformations were 100%, 42.9%, 22.5% respectively. There was a significant difference between the three pathologies（P〈0.01） and between each pair of pathologies （P〈0.01）. The VEGF-positive rates in proliferative hemangiomas, involuting hemangiomas, vascular malformations were 89.6%, 42.9%, 5% respectively. There was significant difference between the three pathologies（P〈0.01）, bFPF-positive rates were 89.6%, 100% and 25.1% respectively. There was a significant difference between hemangiomas and vascular malformations. Conclusions Mast cells may accelerate regression of hemangiomas. PCNA, VEGF and bFGF are effective targets to distinguish proliferative hemangiomas, involuting hemangiomas and vascular malformations.This is helpful to decide the appropriate treatment.