脾硬化性血管瘤样结节性转化的临床病理观察

Clinicopathological features of sclerosing angiomatoid nodular transformation of spleen

关键词:  脾  硬化性血管瘤样结节性转化  形态学

Key words:  spleen  sclerosing angiomatoid nodular transformation  morphology

摘要:

［目的］探讨脾硬化性血管瘤样结节性转化（SANT）的临床病理特征及鉴别诊断。［方法］对1例SANT的临床资料、病理表现及免疫组化结果进行回顾性分析。［结果］本例SANT为影像学检查偶然发现，大体为孤立结节，无包膜，界限不清，切面为棕黄色细结节状，镜下可见大小不等的血管瘤样结节，单个或融合,结节内可见裂隙状、圆形、不规则形血管腔，内衬肥胖内皮细胞，血管间穿插分布梭形、卵圆形细胞，有多种炎细胞浸润。结节周围为向心性分布的平滑肌及胶原纤维，结节间为硬化的纤维间质，血管壁玻璃样变性。免疫组化显示结节内不同血管的免疫表型不同，所有血管CD31+，部分血管CD8+，部分血管CD34+，部分血管D68+。［结论］SANT是脾的一种良性非肿瘤性血管增生性病变，具有独特的病理组织学表现及免疫表型，行脾切除可治愈。

Abstract:

［Objective］To discuss the clinicopathological features and the differential diagnosis of sclerosing angiomatoid nodular transformation(SANT) of spleen.［Methods］We described clinical findings,pathological characteristics and immunophenotypes of a SANT case of spleen.［Results］The case was discovered incidentally through imaging.Grossly,a solitary ill- circumscribed mass without capsules was found,The red-brown multinodules seperated by white stroma in section surface.Microscopically,,multiple inconsistent singular or fused angiomatoid nodules were surrounded by concentric rings of collagen fibers and smooth muscles.There were slit-shaped,round,or irregular-shaped vascular spaces lined by plump endothelial cells in these nodules.There were interspersed spindly or ovoid cells and scattered various inflammatory cells among vessels.The stroma consist of band or large sheet of collagenous fibrosis with vessles in which walls hyaline degenerated.Immunohistochemical staining revealed different types of vessels in angiomatoid nodule which had corresponding immunophenotypes:all CD31+,partly CD34+,CD8+,or CD68+.［Conclusions］SANT is a benign nonneoplastic proliferative vascular lesion affecting spleen with characteristic histological and immunophenotypical appearances.The clinical prognosis is excellent following splenectomy.