肺硬化性血管瘤的临床病理及免疫表型特点分析

Histopathological characteristics and immuophenotype of pulmonary sclerosing hemangioma

目的探讨肺硬化性血管瘤（PSH）的临床病理及免疫表型特点。方法对28例PSH手术切除标本作组织病理学检查，并用免疫组化SP法对标本进行vimentin、ER、PR、TTF-1、CK、EMA、CD34、Syn、CgA、Calretinin、Ki-67标记，观察其表达情况。结果PSH由实性、乳头状、硬化性和血管瘤样区组成，主要的两种细胞为立方状或柱状表面上皮细胞和圆形间质细胞。乳头、实性区裂隙及血管瘤样区表面衬覆有立方或柱状上皮细胞，乳头间隙及实性细胞区为圆形或多角形胞质浅染的细胞。立方或柱状表面上皮细胞表达广谱CK、TTF-1、EMA，圆形间质细胞表达EMA、TTF-1、PR、vimentin；两种细胞均无间皮及血管内皮标记的表达，个别病例两种细胞不同程度散在表达Syn、CgA。结论PSH是一种肺内少见的肿瘤，组织学形态呈多样性，主要以混合型结构为主。免疫组织化学染色在诊断与鉴别诊断中有重要作用。

Objective To review the histopathological characteristics and immuophenotype of pulmonary sclerosing hemangioma （PSH）. Methods The histopathological examination was performed in 28 cases of PSH and the expression of vimentin, ER, PR, TTF-1, CK, CD34, Syn, CgA, Calretinin and Ki-67 were detected with immunohistochemical methods. Results PSH demonstrated the histological characters with variable proportions of solid,papillary,sclerotic and hemangioma-like patterns. Cuboidal or columnar cells covered the papillary and cleft-side spaces in solid areas whereas solid areas and stalk of papillary projections were composed of uniform round or polygonal pale cells. The cuboidal or columnar cells were positive for CK, TTF-1 and EMA. The round or polygonal pale cells expressed EMA, TTF-I, PR and vimentin. Neither of these two type cells expressed mesothelial and vascular endothelial markers. Sporadic expression of Syn and CgA was observed in a few cases. Conclusion PSH is a rare lung tumor,with various histological appearance. The mixed-type is more common than other types. Immunohistochemistry is important for diagnosis and differential diagnosis of this type of tumor.