肠道旺炽性血管增生3例临床病理分析及文献复习

Clinicopathological features with intestinal florid vascular proliferation:report of three cases and review of literature

目的探讨旺炽性血管增生(FVP)的临床病理特点、诊断及鉴别诊断。方法分析3例FVP临床资料,观察其组织学形态及免疫组化特征,并复习相关文献。结果3例患者均为男性,中位年龄58岁(31~65岁),均为无明显诱因下出现腹部疼痛不适,影像学检查提示肠占位合并肠套叠和肠梗阻。3例均行手术切除,病变黏膜表面缺血、溃疡合并黏膜脱垂及纤维化。镜下见增生的血管呈小叶状分布,自黏膜层延伸至浆膜层,增生血管穿插于黏膜肌及固有肌层之间,血管大小不等,分化良好,无相互吻合现象,部分管壁增厚,内皮细胞形态温和或轻度异型,核分裂象罕见。免疫组化染色显示Vimentin、CD34、CD31、F-Ⅷ血管内皮阳性,SMA血管周围平滑肌阳性,Ki-67增殖指数较低。结论FVP是一种罕见的良性假瘤样血管增生性病变,在完全的手术切除后不会复发。但因其类似其他良性或恶性的血管病变或肿瘤,容易造成误诊,所以正确认识并诊断该疾病非常重要。

Objective To explore the clinicopathological features,diagnosis and differential diagnosis of florid vascular proliferation(FVP).Methods Three cases of florid vascular proliferation were studied with analysis of clinical data,histological morphology,immunohistochemical features and review of related literatures.Results All 3 patients were male with a median age of 58 years(31-65 years).The patients presented with abdominal pain and discomfort without obvious inducement,and imaging examination suggested intestinal occupying complicated with intussusception and intestinal obstruction.All 3 cases underwent surgical resection,and the mucosal surface was ischemia,ulcer complicated with mucosal prolapse and fibrosis.Microscopically,proliferated vessels were lobulated,extending from mucosa to muscularis and serosa.The vessels interspersed the muscularis of intestinal tract.These vessels were different in size,well differentiated,without mutual anastomosis,partial tube wall thickened,the morphology of endothelial cells was mild or mild atypia,and mitosis was rare.Immunohistochemical staining showed positive vimentin,CD34,CD31,and F-Ⅷin vascular endothelium,positive SMA in perivascular smooth muscle,and low Ki-67 proliferation index.Conclusion FVP is a rare benign pseudotumor lesion that does not recur after complete surgical resection.However,as it is similar to other benign or malignant vascular lesions or tumors,it is easy to cause misdiagnosis,and therefore it is very important to correctly understand and diagnose this disease.