直肠血管肉瘤1例

Clinical and pathological features of angiosarcoma of the rectum:a report of one case

目的:探讨胃肠道血管肉瘤的临床病理特征及鉴别诊断及治疗预后.方法:在光学显微镜下对直肠血管肉瘤进行组织形态学观察,并借助免疫组织化学进一步对血管肉瘤的特点进行分析.由于累及直肠的血管肉瘤极为罕见,本研究对相关的文献资料进行回顾分析与总结.结果:累及直肠的血管肉瘤可以首先累及外膜或者先侵犯直肠黏膜.大体上为灰褐色结节状,伴有广泛的出血坏死,切面呈多彩状;显微镜下组织学表现为肿瘤细胞弥漫分布,形成大小不等互相吻合的管腔,免疫组织化学显示瘤细胞表达CD31和Vimentin等血管和间叶分化.肿瘤高度恶行.本例患者术后5mo死亡.结论:血管肉瘤,特别是深部软组织及胃肠道的血管肉瘤,具有高度侵袭性并且快速转移,预后很差.在临床病理实践中,必须首先与常见的发生于该部位恶性肿瘤如癌,恶性黑色素瘤鉴别.

AIM： To describe the clinical and pathological features of angiosarcoma of the rectum and to explore the differential diagnosis, treatment and prognosis of the disease. METHODS： The typical histomorphological features of angiosarcoma of the rectum were observed under a light microscope. The diagnosis was confirmed by immunohistochemistry. Considering that angiosarcoma involving the rectum is quite rare, we reviewed the related literature and gave a detailed description of the disease. RESULTS： Swelling of the lymph nodes was the first clinical manifestation of angiosarcoma of the rectum. Postoperative examination showed that it was a grey-brown nodular tumor in the rectum. The characteristic histological appearance of the lesions featuring angiosarcoma of the rectum was irregular neoplastic vascular channels that intercommunicate with each other in a sinusoidal fashion. Angiosarcoma cells were immunohistochemically positive for CD31 and vimentin. CONCLUSION： Angiosarcinoma of the rectum is a rare type of malignant tumor with very poor prognosis and high metastatic rate. It should be differentiated from melanoma or carcinoma involving the same region.