心脏黏液瘤23例临床病理特征分析

Analysis of clinicopathologic features of 23 cases of cardiac myxoma

目的探讨心脏黏液瘤(cardiac myxoma,CM)的临床病理特征、病因及组织起源,为其防治提供理论依据。方法收集23例CM临床病理资料,应用HE、AB/PAS特染、免疫组化标记及电镜分析其组织病理特征,并复习相关文献。结果23例CM中,男性7例,女性16例,男女比为1∶2.3,平均年龄56.7岁;23例中左心房占21例;12例无明显症状,因体检或其它手术术前检查发现,11例患者既往有糖尿病或高血压或栓塞病史。瘤体大体呈淡黄色、切面为黏液半透明状伴明显出血。镜下为大量嗜酸性基质,AB染色显示淡蓝色,其间散在分布梭形或星芒状肿瘤细胞。免疫组化vimentin、CD34、CD31、Calretinin、HBME-1等间质、间皮及血管源性标记阳性为主。透视电镜显示肿瘤细胞具有原始多潜能间充质细胞特征。21例获得随访患者均无复发。结论CM罕见,推测起源于原始多潜能间充质细胞,既往有糖尿病、高血压、栓塞等高凝状态心血管疾病可能是其诱因之一,定期超声检查,能早期发现,确诊需要结合组织病理及免疫组化标记,散发性CM几乎均为良性,很少复发,预后很好。

Purpose To explore the clinicopathological characteristics,etiology and tissue origin of cardiac myxoma(CM),and to provide evidence for its prevention and treatment.Methods The clinical data of 23 patients with CM were retrospectively summarized and analyzed.The pathological features were analyzed by HE staining,AB/PAS special staining,immunohistochemical markers and electron microscopy,and the relevant literatures were reviewed.Results Among the 23 cases of CM,there were 7 males and 16 females.The proportion was 1∶2.3,and the average age was 56.7 years.The left atrium accounted for 21 cases,among those 12 cases had no obvious symptoms.As a result of physical examination or other preoperative examinations,11 patients had a history of diabetes,hypertension or embolism.The tumors were pale yellow with translucent mucus and obvious bleeding.A large number of eosinophilic stroma was seen under the microscope,and AB showed a pale blue color with scattered spindle-shaped or star-shaped tumor cells.Immunohistochemical markers such as vimentin,CD34,CD31,Calretinin,and HBME-1 were mainly positive for mesenchymal,mesothelial and vascular derived markers.Transmission electron microscopy showed that tumor cells had the characteristics of primitive multipotent mesenchymal cells.None of the patients relapse by telephone followed up.Conclusion CM is a rare tumor.It is speculated that it originated from primordial pluripotent mesenchymal cells.Previous cardiovascular diseases such as diabetes,high blood pressure and embolism may be one of the predisposing factors.Regular ultrasound examination can be detected early.Histopathology and immunohistochemical examinations are needed.Sporadic CMs are almost benign,rarely recur,and have a good prognosis.