肺硬化性血管瘤的影像征象与病理分析

Imaging Features and Pathological Analysis of Pulmonary Sclerosing Hemangioma

目的探讨肺硬化性血管瘤的影像学表现及病理学特征。资料与方法回顾性分析10例经病理确诊为肺硬化性血管瘤患者的胸片及CT图像,并对其影像表现与病理组织学特征进行分析。结果 10例患者均行胸片检查,9例单发,1例多发(3个病灶),共12个病灶。其中7例行CT平扫及增强扫描,共9个病灶。平片上病灶短径平均为(1.8±0.6)cm,未见钙化、毛刺、空洞等征象。CT病灶位于胸膜下,大小为1.7cm×1.9cm,5例可见浅分叶,2例可见小块状钙化灶,3例见周围血管包绕征,4例可见周围有肺气肿带包绕,所有结节均未见毛刺、空洞及空泡征,无胸膜牵拉征,肺门纵隔无淋巴结增大,无胸腔积液。平扫CT均值为(45.6±10.0)Hu,增强后可见不均匀强化,有明显强化区及未强化区,主要与病理组织成分相关;强化区域CT均值为(105.6±12.7)Hu,绝对增强均值为(60.0±13.8)Hu。病理上均包含血管瘤样区、乳头区、实变区和硬化区,按不同比例混合存在。免疫组化显示:Vim(+++),CK(++),EMA(+),部分CD34、NSE(+)。结论肺硬化性血管瘤影像学表现较具特征性,术前若作出正确诊断,多数患者可避免手术。

Purpose To explore the imaging and pathologic features of pulmonary sclerosing hemangioma.Material and Methods X-ray and CT images of 10 cases with pathology confirmed pulmonary sclerosing hemangioma were retrospectively analyzed.Results All the 10 patients had chest X-ray with 9 cases showing single lesion,and 1 case showing multiple lesions（n =3）.Seven cases（9 lesions） also underwent contrast enhanced CT scan.On plain film the average diameter of all 12 lesions was（1.8±0.6） cm without calcification,spiculation or cavities.On CT films,the lesions were subpleural with mean size of 1.7 cm×1.9 cm.There were 5 cases with lobulation,2 cases with patchy calcification,3 cases with peripheral vascular wrapping,and 4 cases with adjacent emphysema.There was no spiculation,cavity,pleural retraction,mediastinal adenopathy or pleural effusion.The average CT attenuation of the lesions was（45.6±10.0） Hu with heterogeneous enhancement after contrast.The average CT enhancement was（105.6±12.7） Hu,with the absolute enhancement of（60.0±13.8） Hu.On pathology the tumor showed mixed hemangioma-like,papillary,consolidation and sclerotic areas.Immunohistochemistry study showed Vim（＋＋＋）,CK（＋＋）,EMA（＋） with partial CD34 and NSE（＋）.Conclusion The imaging features of pulmonary sclerosing hemangioma is characteristic.Accurate diagnosis will make most patients avoid surgery.