肺硬化性血管瘤临床病理与影像学对照研究

Sclerotic hemangioma of lung:clinical pathology and imaging features

目的分析肺硬化性血管瘤(SHL)的病理组织学特点,以及与影像学之间的关系,为临床诊断及选择治疗方案提供依据。方法运用苏木素-伊红(HE)染色及多种抗体免疫组织化学标记分析15例SHL的组织学构型与蛋白表达,并与影像学进行对照。结果①SHL主要有3种组织学构型:血管瘤样、乳头状和实性片状,多为3种类型混合存在,且常合并有硬化。有两种细胞(实性细胞和被覆细胞),免疫组织化学共同表达MCK、EMA、Vimentin,部分病例表达CgA、Syn、S-100蛋白,不表达Ⅷ因子、CD34、CD68、Calretinin。②影像学(X线及CT)表现为肺部单发、圆形、卵圆形,边界清楚的结节,无分叶及毛刺,CT平扫病变密度较均匀,与肌肉密度相仿。③使用秩相关统计学分析,被覆细胞的Vimentin蛋白表达与CT值相关(P<0.05),Spearman's rho相关系数为0.554。结论①SHL是一种来源于肺泡上皮的良性肿瘤。②影像学大多为单发圆形、类圆形肿物或结节,边缘光整,CT增强后强化程度与其病理组织构型有关。③CT增强值是否大于20Hu不能作为判断SHL良恶性的标准。

Objective To analyze the histopathologic features of sclerotic hemangioma of lung （SHL） and their relationship with imaging, in order to provide evidence for clinical diagnosis and selection of therapeutic regimen. Methods H.E. staining and immunohistochemistry of multiple antibody were applied to analyze histological morphology and protein expressions in 15 cases of SHL. The findings were compared with imaging. Results ① There were three main histological patterns in SHL, including hemorrhagic pattern, papillary pattern and solid pattern. These patterns were often mixed and with concomitant sclerosis. There were two cell types, including sheets of round ceils and surface cells, which expressed MCK, EMA and Vimentin generally, some expressed CgA, Syn and S-100, while VIII factor, CD34, CD68, Calretinin were usually negative. ② Imaging studies showed solitary pulmonary masses, round or ovoid in shape, well-demarcated, with no lobulation or marginal spiking. CT scan showed that the masses were with even density comparable to muscle. ③ Rank correlation indicated that vimentin expression in surface ceils was correlated with CT value （P〈0.05, correlation coefficient = 0.554）. Conclusion ① SHL is a type of benign tumor derived from alveolar epithelium. ② By imaging, the tumor usually appears as solitary pulmonary masses, round or ovoid in shape, and well demarcated. CT enhancement was shown to be associated with histopathologic pattern of SHL. ③ Enhanced CT value of 20 Hu may not be convincing as a threshold in diagnosing benign or malignant tumors.