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论著:肺硬化性血管瘤的临床特征分析
Clinical Features of Pulmonary Sclerosing Hemangioma
郭卫刚 范虹 张毅 张永星 王群 葛棣
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作者单位:复旦大学附属中山医院胸外科
中文关键字:肺;硬化性血管瘤;影像学;病理学;外科治疗
英文关键字:Lung; Pulmonary sclerosing hemangioma; Imaging findings; Histopathology
中文摘要:目的:探讨肺硬化性血管瘤的影像学表现、病理特征、外科治疗手段及预后。方法:回顾分析复旦大学附属中山医院1999 年1月—2012年1月已行手术且病理证实的68例肺硬化性血管瘤的临床资料。结果:68例患者中男7例,女61例(89.7%),年龄17~74岁,平均(43.4±12.3)岁。体检发现无症状的患者为38例(55.9%)。胸部X线示边缘光整的圆形或类圆形阴影;CT平扫表现为类圆形结节,边缘清楚,密度均匀,增强扫描见明显强化,也可观察到血管贴边征和空气新月征。组织学上有实变、乳头状、硬化性和血管瘤样等4 种结构,多为2~3种结构的混合型,肿瘤由圆形间质细胞和表面立方形细胞两种组成,免疫组织化学提示肿瘤表达表面活性物质蛋白A、细胞角蛋白7、上皮膜抗原和甲状腺转录因子1等。68例患者术后均无严重并发症发生,随访3个月~10年,患者无复发、转移。结论:肺硬化性血管瘤术前诊断困难,其影像学和组织学表现有一定的特征,免疫组织化学提示肿瘤为上皮来源。手术切除是治疗本病的有效方法并能明确诊断,免疫组织化学有助于诊断和鉴别诊断。胸腔镜行楔形切除和肺叶切除是此病目前首选的手术方法。
英文摘要:Objective: To investigate the imaging findings, histopathological features, surgical treatment and prognosis of pulmonary sclerosing hemangioma(PSH). Methods:Clinical data of 68 cases with postoperative pathologically proven PSH in Zhongshan Hospital, Fudan University between January 1999 and January 2012 were analyzed retrospectively. Results: Among the 68 cases, 7 were males, 61 were females(89.7%). The age of them ranged from 17 to 74 years(43.4±12.3 years). 38(55.9%) cases of PSH were found in routine physical examination and those patients were free of symptoms. The lesions presented as round or nearly round shaped well defined shadow on chest X ray. On CT, the lesions presented as nearly round shaped mass or nodule, well defined, homogeneous density, homogeneous and heterogeneous enhancement after contrast administration. The characteristic air trapping zone and vessels at its periphery could be observed. Pathological morphology demonstrated that surface cuboidal cells and round mesenchymal cells formed four types of migratory structures, including solid, papillary, sclerotic and hemorrhagic pattern. The mixed type made of two or three structures was more common than the other types. Immunohistochemisty results showed that PSH expressed surfactant protein A(SPA), cytokeratin 7(CK 7), epithelial membrane antigen(EMA) and thyroid transcription factor 1 (TTF 1). All patients underwent operation and had no severe complications. There was no recurrence or metastasis during the postoperative follow up of 3 months to 10 years. Conclusions: It is difficult to diagnose PSH before operation. There were some characteristic features in imaging findings and histopathology of PSH. Immunohistochemical findings demonstrated that PSH might originate from epithelium. Prognosis and diagnosis can be achieved through surgical treatment, and immunohistochemisty plays an important role in the diagnosis and differential diagnosis. Limited resection and lobectomy by video assisted minimally surgery are good choice for PSH.
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