原发性胸膜上皮样血管肉瘤2例临床病理分析
摘要
目的探讨原发性胸膜上皮样血管肉瘤(epithelioid angiosarcoma, EAS)的临床病理学特征、鉴别诊断、治疗及预后。方法收集2例原发性胸膜EAS的临床病理资料,并复习相关文献。结果 2例患者男、女性各1例,年龄分别为47、45岁,均以呼吸系统症状就诊。影像学发现左侧胸膜增厚或包块。镜检见异型上皮样细胞及含红细胞的空泡状瘤细胞,胞质嗜伊红色或透明,胞核圆形空泡状或不规则形,核仁增大,局部见梭形瘤细胞,核分裂象5～12/HPF,坏死多少不等。瘤组织排列呈实性巢片状、条索状、窦隙状脉管样及乳头状。免疫表型:肿瘤细胞vimentin、CD31、ERG弥漫阳性,CD34阴性,Ki-67增殖指数为40%～60%。患者未行放、化疗,均于确诊后短期内死亡。结论原发性胸膜EAS十分罕见,其高度恶性、预后差,临床表现缺乏特征性,易误诊,组织病理学检查可确诊,需与转移癌、恶性间皮瘤、上皮样血管内皮瘤、黑色素瘤及大细胞淋巴瘤鉴别。
引文
[1] Zhang S,Zheng Y,Liu W,et al.Primary epithelioid angiosarcoma of the pleura:a case report and review of literature[J].Int J Clin Exp Pathol,2015,8(2):2153-2158.
[2] Weiss S W,Ishak K G,Dail D H,et al.Epithelioid hemangioendothelioma and related lesions[J].Semin Diagn Pathol,1986,3(4):259-287.
[3] Quesada A,Quesada J,Khalil K,et al.Morphoproteomic study of primary pleural angiosarcoma of lymphangioendothelial lineage:a case report[J].Ann Clin Lab Sci,2013,43(3):317-322.
[4] Chen C,Wu Y,Chou T,et al.Pleural angiosarcoma mimicking pleural haematoma[J].Interact Cardiovasc Thorac Surg,2013,17(5):886-888.
[5] Cabibi D,Pipitone G,Porcasi R,et al.Pleural epithelioid angiosarcoma with lymphatic differentiation arisen after radiometabolic therapy for thyroid carcinoma:immunohistochemical findings and review of the literature[J].Diagn Pathol,2017,12(1):60.
[6] Wang L,Lao I,Yu L,et al.Clinicopathological features and prognostic factors in angiosarcoma:a retrospective analysis of 200 patients from a single Chinese medical institute[J].Oncol Lett,2017,14(5):5370-5378.
[7] Kao Y C,Chow J M,Wang K M,et al.Primary pleural angiosarcoma as a mimicker of mesothelioma:a case report[J].Diagno Pathol,2011,6:130.
[8] Wu J,Li X,Liu X.Epithelioid angiosarcoma:a clinicopathological study of 16 Chinese cases[J].Int J Clin Exp Pathol,2015,8(4):3901-3909.
[9] 张海芳,李德本,张新华,等.骨原发性上皮样血管肉瘤2例报道并文献复习[J].临床与实验病理学杂志,2012,28(5):546-550.
[10] Folpe A L,Chand E M,Goldblum J R,et al.Expression of Fli-1,a nuclear transcription factor,distinguishes vascular neoplasms from potential mimics[J].Am J Surg Pathol,2001,25(8):1061-1066.
[11] Miettinen M,Wang Z,Paetau,et al.ERG transcription factor as an immunohistochemical marker for vascular endothelial tumors and prostatic carcinoma[J].Am J Clin Pathol,2011,35(3):432-441.
[12] Kimura M,Ito H,Furuta T,et al.Pyothorax-associated angiosarcoma of the pleura with metastasis to the brain[J].Pathol Int,2003,53(8):547-551.
[13] Zhang P,Livolsi V A,Brooks J J.Malignant epithelioid vascular tumors of the pleura:report of a series and literature review[J].Hum Pathol,2000,31(1):29-34.
[14] 张娜,王志敢,朱德茂,等.肺胸区上皮样血管内皮瘤2例临床病理观察[J].临床与实验病理学杂志,2017,33(4):450-452.
[15] Wada M,Horinaka M,Yasuda S,et al.PDK1 is a potential therapeutic target against angiosarcoma cells[J].J Dermatol Sci,2015,78(1):44-50.
[2] Weiss S W,Ishak K G,Dail D H,et al.Epithelioid hemangioendothelioma and related lesions[J].Semin Diagn Pathol,1986,3(4):259-287.
[3] Quesada A,Quesada J,Khalil K,et al.Morphoproteomic study of primary pleural angiosarcoma of lymphangioendothelial lineage:a case report[J].Ann Clin Lab Sci,2013,43(3):317-322.
[4] Chen C,Wu Y,Chou T,et al.Pleural angiosarcoma mimicking pleural haematoma[J].Interact Cardiovasc Thorac Surg,2013,17(5):886-888.
[5] Cabibi D,Pipitone G,Porcasi R,et al.Pleural epithelioid angiosarcoma with lymphatic differentiation arisen after radiometabolic therapy for thyroid carcinoma:immunohistochemical findings and review of the literature[J].Diagn Pathol,2017,12(1):60.
[6] Wang L,Lao I,Yu L,et al.Clinicopathological features and prognostic factors in angiosarcoma:a retrospective analysis of 200 patients from a single Chinese medical institute[J].Oncol Lett,2017,14(5):5370-5378.
[7] Kao Y C,Chow J M,Wang K M,et al.Primary pleural angiosarcoma as a mimicker of mesothelioma:a case report[J].Diagno Pathol,2011,6:130.
[8] Wu J,Li X,Liu X.Epithelioid angiosarcoma:a clinicopathological study of 16 Chinese cases[J].Int J Clin Exp Pathol,2015,8(4):3901-3909.
[9] 张海芳,李德本,张新华,等.骨原发性上皮样血管肉瘤2例报道并文献复习[J].临床与实验病理学杂志,2012,28(5):546-550.
[10] Folpe A L,Chand E M,Goldblum J R,et al.Expression of Fli-1,a nuclear transcription factor,distinguishes vascular neoplasms from potential mimics[J].Am J Surg Pathol,2001,25(8):1061-1066.
[11] Miettinen M,Wang Z,Paetau,et al.ERG transcription factor as an immunohistochemical marker for vascular endothelial tumors and prostatic carcinoma[J].Am J Clin Pathol,2011,35(3):432-441.
[12] Kimura M,Ito H,Furuta T,et al.Pyothorax-associated angiosarcoma of the pleura with metastasis to the brain[J].Pathol Int,2003,53(8):547-551.
[13] Zhang P,Livolsi V A,Brooks J J.Malignant epithelioid vascular tumors of the pleura:report of a series and literature review[J].Hum Pathol,2000,31(1):29-34.
[14] 张娜,王志敢,朱德茂,等.肺胸区上皮样血管内皮瘤2例临床病理观察[J].临床与实验病理学杂志,2017,33(4):450-452.
[15] Wada M,Horinaka M,Yasuda S,et al.PDK1 is a potential therapeutic target against angiosarcoma cells[J].J Dermatol Sci,2015,78(1):44-50.