诊断学理论与实践

诊断学理论与实践 ›› 2019, Vol. 18 ›› Issue (05): 560-564.doi: 10.16150/j.1671-2870.2019.05.014

• 论著 • 上一篇    下一篇

脾脏硬化性血管瘤样结节性转化8例临床病理分析及文献复习

王建军, 陈雅, 樊祥山, 牛丰南()   

  1. 南京大学医学院附属鼓楼医院病理科,江苏 南京 210008
  • 收稿日期:2019-06-25 出版日期:2019-10-25 发布日期:2019-10-25
  • 通讯作者: 牛丰南 E-mail:alison2009@126.com
  • 基金资助:
    国家自然科学基金面上项目(81671113);江苏省青年医学人才项目(QNRC2016026)

Sclerosing angiomatoid nodular transformation of spleen: clinicopathological analysis and literature review

WANG Jianjun, CHEN Ya, FAN Xiangshan, NIU Fengnan()   

  1. Department of Pathology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Jiangsu Nanjing 210008, China
  • Received:2019-06-25 Online:2019-10-25 Published:2019-10-25
  • Contact: NIU Fengnan E-mail:alison2009@126.com

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摘要：

目的：探讨脾脏硬化性血管瘤样结节性转化（sclerosing angiomatoid nodular transformation of spleen,SANT）患者的临床病理特征。方法：收集2010年至2019年本院诊断为脾脏SANT的8例患者,对其病理组织行常规病理、免疫组化染色检查,并结合其临床症状、影像学表现及病理特点进行分析和总结。结果：8例患者中男性、女性各4例,年龄为3~67岁不等,5例患者无明显的临床症状,2例表现为腹痛,1例左上腹部扪及一包块。B超检查提示脾脏占位;进一步行CT检查,发现脾脏内存在类圆形低密度肿块,且增强后无明显强化。手术中可见肿块最大径为1.5~11.0 cm,边界尚清,无包膜。肿块切面呈灰褐色,实性,近中央区可见灰白色纤维条索分隔形成星芒状瘢痕。病理组织切片经HE染色后,在光镜下可见纤维增生硬化背景中散在多个大小不一的血管瘤样结节,结节内血管腔不规则扩张,腔内可见多量红细胞;结节间为纤维性分隔或排列成同心圆状的梭形细胞包绕。免疫组化检测显示,结节病变区血管内皮细胞的CD31、CD34、CD8表达有所差异,周围梭形细胞CD68、SMA表达灶状阳性。8例患者随访2~104个月均无复发。结论：脾脏SANT属于良性增生性瘤样病变,本研究中男女患者比例无差异,且大部分患者无明确的临床症状,少部分可表现为腹痛,增强CT图像上其多显示为低密度、无明显强化的肿块。脾脏SANT通过行脾脏切除手术即可治愈,术后病理组织学和免疫组化染色是确诊该病的重要方法。

关键词: 脾脏, 硬化性血管瘤样结节性转化, 临床病理分析, 鉴别诊断

Abstract:

Objective: To explore the clinicopathological characteristics of sclerosing angiomatoid nodular transformation (SANT) of spleen. Methods Eight cases diagnosed with SANT of spleenin our hospital from 2010 to 2019 were enrolled. Routine pathology and immunohistochemical staining were performed. The clinical symptoms, imaging examination and pathological features of SANT of spleen were analyzed respectively. Results Among the 8 cases, there were 4 males and 4 females, aged from 3 to 67 years old. Five cases had no obvious clinic symptoms, two cases showed abdominal pain.One case had a mass in the left upper abdomen. B-ultrasound showed occupying lesions in the spleen. Further examination revealed a round-shaped low-density mass in the spleen by CT scan, and there was no obvious enhancement under contrast-enhanced CT. The maximum diameter of the tumor was 1.5 cm-11.0 cm with relatively clear boundaries. The section of the mass was gray-brownin color and solid, and the gray-white fiber strips near the section center were divided to form a star-shaped scar. HE staining showed there were many angiomatoid-like nodules scattered in the background of fibroproliferative sclerosis. The vascular lumen in the nodules was irregularly dilated, and there werelots of red blood cells in the lumen. The nodules were fibrously separated or arranged in concentric circles. The spindle cells were wrapped around. Immunohistochemistry revealed that the expressions of CD31, CD34 and CD8 in vascular endothelial cells were varied in nodular lesions. The surrounding spindle cells were positive for CD68, and focally positive for SMA. No recurrence or metastasis was found during 2 to 104 months of follow-up. Conclusions SANT is currently considered as a benign proliferative neoplastic lesion. There is no significant difference in ratio between men and women. Most patients have no obvious clinical manifestations, few of them are characterized by abdomen pain. CT scan usually shows a low-density tumor with no obvious enhancement under contrast-enhanced CT. Surgical resection is the primary treatment for SANT. Postoperative pathological and immunohistochemical staining are important methods for the final diagnosis.

Key words: Sclerosing angiomatoid nodular transformation, Spleen, Clinicopathological analysis, Differential diagnosis

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