肝上皮样血管内皮瘤的临床病理观察

Clincopathological analysis of hepatic epithelioid hemangioendothelioma

目的探讨肝上皮样血管内皮瘤(EH)的临床病理特点、鉴别诊断及预后。方法观察4例肝EH的组织形态学特点并行免疫组化检测,并结合相关文献进行分析。结果 EH镜下肿瘤细胞为上皮样、梭形或多角形,呈条索状、小巢状生长,或在血管内呈乳头状生长,部分瘤细胞胞质空泡化,内含红细胞;核分裂像罕见,瘤细胞胞质丰富,嗜酸性,胞界不清,间质黏液样变或玻璃样变。免疫组化染色显示肿瘤细胞CD31、CD34、Vim阳性。结论肝EH是一种少见的低度恶性的血管源性肿瘤,影像学易误诊,需依靠病理形态学及免疫组化确诊。

Objective To investigate the clinicopathotogical characteristics, differential diagnosis and prognosis of hepatic epithelioid hemangioendothelioma（EH）. Methods The morphological characteristics of 4 cases of hepatic EH were observed. The immunohistochemical approach and literature review were employed. Results The tumor cells were epithelioid, spindle or polygonal- shaped and exhibited cord-like, small nests or intravascular papillary growth pattern. Some tumor cells formed empty cytoplasmic vacu- oles, of which contained red blood cell fragments. The tumor cells showed rare mitotic figures, abundant eosinophilic cytoplasm and unclear cell-cell boundaries with mesenchymal mucus or hyaline appearance. The tumor cells were positive for CD31, CD34 and Vim. Conclusion Hepatic EH is a rare, low-grade, malignant neoplasm of vascular origin that may be easily misdiagnosed by imaging. Pathological morphology and immunohistochemistry are needed to facilitate the identification and diagnosis.