肺硬化性血管瘤的诊断及研究现状.doc

肺硬化性血管瘤的诊断及研究现状 　　作者：薛娣,魏中华,邵睿　　作者单位：江苏大学附属人民医院病理科，江苏 镇江 　　【摘要】目的探讨肺硬化性血管瘤(SHL)的组成成分及组织起源，提高对其临床病理特征的认识。方法：综合分析15例SHL临床特点，免疫组化及病理形态学特征。结果：SHL主要由圆形细胞和表面立方细胞两种细胞类型组成，组织结构多样，主要表现为实性区，乳头区，出血区和硬化区四种结构，大部分实性区圆形瘤细胞对上皮抗原(EMA)，甲状腺转录因子(TTF-1)及波形蛋白(vimentin)阳性，也有部分圆形瘤细胞对神经元特异性希醇化酶(NSE)、突触素(SYN)、雌激素受体(ER)和孕激素受体(PR)呈阳性反应，EMA、TTF-1和表面活性蛋白(SP-B)对乳头表面立方细胞呈阳性反应。结论：实性的圆形细胞和乳头表面立方细胞均为SHL 的肿瘤细胞，可能起源于原始的未分化的呼吸道上皮。 　　【关键词】 肺硬化性血管瘤;病理特征;免疫组化;鉴别诊断 　　Diagnostic and study status of sclerosing hemangioma of the lung 　　XUE Di, WEI Zhong-hua, SHAO Rui (Department of Pathology, the Affiliated Peoples Hospital of Jiangsu University, Zhenjiang 212000, China) 　　Abstract:Objective To investigate the composition and histogenesis of sclerosing hemangioma of the lung (SHL), in order to elevate the recognition of clinicopathological feathers of SHL.Method The clinicopathlogical and immunohistochemical feathers were reviewed in 15 cases of SHL. Results SHL has a characteristic architecture composed of round cell and surface cubic cell. It has a variety of tissular structure, mainly expression with four regions that contains solid regions, papillary regions, angiomatoid regions and sclerosing regions. The expression of round cells about EMA, TTF-1, vimentin is positive and the expression of round cells about NSE, SYN, ER, PR is positive partly. As far as EMA, TTF-1 and SP-B are concered, the expression of surface cubic cell is positive. Conclusion Both solid round cells and surface cubic cells are neoplastic. SHL is a tumor that probably originates from the epithelial cell of primary respiratory tract. 　　Key Words:Sclerosing hemangioma of the lung; Pathological feathers; Immunohistochemistry; Differential diagnosis 　　肺硬化性血管瘤(SHL)是一种少见的肺部良性肿瘤，于1956年由Liebow和Hubll首先报道，在WHO肺肿瘤分类中，先后将其归在瘤样病变(1981)和杂类肿瘤(1999，2004)中。对其形态表现虽已有不少报道，但对其来源和性质一直有争议，现将笔者在工作中遇到的15例病例结合文献及研究现状予以讨论，旨在提高对SHL的认识。 　　1 资料与方法 　　1.1 一般资料：搜集镇江市第一人民医院2000年～2007年间外科手术肺切除标本15例。 　　1.2 方法：全部标本经冰冻切片初步诊断，再行常规10