手指血管球瘤18例临床病理分析
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摘要
目的探讨血管球瘤(GT)的临床及病理学特征。方法回顾性分析手术切除并经病理确诊18例手指血管球瘤的临床资料、组织学形态及免疫组织化学染色结果,并复习相关文献。结果血管球瘤好发于甲下,疼痛具有特征性;光镜下肿瘤细胞形态一致,呈圆形、卵圆形,胞浆丰富红染、透亮,无明显异型性,血管丰富,瘤细胞围绕血管呈巢片状排列,间质可见黏液变、玻璃样变,含丰富的神经纤维和肥大细胞。免疫组织化学示18例样本中瘤细胞Vimentin、SMA (+),瘤细胞周围间质中神经纤维S-100(+);16例样本中血管CD34(+),5例样本CD117散在(+)。14例患者术后随访5个月至4年,其中2例复发,12例无复发及转移。结论血管球瘤多属于良性肿瘤,结合其特征性的疼痛特点、好发部位、病理学特点和免组标记可做出准确诊断。恶性血管球瘤诊断要慎重,疼痛可能与神经纤维有关。
Objective To investigate the clinical and pathological features of glomus tumor(GT).Methods The clinical data,histological morphology and immunohistochemical staining results in 18 cases of finger glomus tumor treated by operation excision were retrospectively analyzed,and the relevant literatures were reviewed.Results GT usually occurs under the nails with characteristic pain;the tumor cell morphology was conformity under microscope,showing the round and oval shape with abundant cytoplasm,red staining and transparence,without obvious atypia,the blood vessels were abundant,the tumor cells arranged as the nest sheet shape around the blood vessels.Myxoid change and hyaline degeneration were seen in the mesenchyma,and contained rich nerve fibers and mast cells.The immunohistochemistry showed that 18 samples were positive in tumor cell Vimentin,SMA(+)and nerve fiber S-100(+)in mecenchyma around the tumor cells;16 samples were positive in vessels CD34(+),and 5 samples were scattered positive(+)in CD117.Among them,14 cases were followed up for 5 months to 4 years after surgery,2 cases relapsed and 12 cases had no recurrence or metastasis.Conclusion GT is mostly benign tumor,its correct diagnosis can be taken by combining with characteristic pain,predilection site,pathologica features and immunohistochemical markers.The diagnosis of malignant GT should be careful,and the pain may be related to nerve fibers.
Objective To investigate the clinical and pathological features of glomus tumor(GT).Methods The clinical data,histological morphology and immunohistochemical staining results in 18 cases of finger glomus tumor treated by operation excision were retrospectively analyzed,and the relevant literatures were reviewed.Results GT usually occurs under the nails with characteristic pain;the tumor cell morphology was conformity under microscope,showing the round and oval shape with abundant cytoplasm,red staining and transparence,without obvious atypia,the blood vessels were abundant,the tumor cells arranged as the nest sheet shape around the blood vessels.Myxoid change and hyaline degeneration were seen in the mesenchyma,and contained rich nerve fibers and mast cells.The immunohistochemistry showed that 18 samples were positive in tumor cell Vimentin,SMA(+)and nerve fiber S-100(+)in mecenchyma around the tumor cells;16 samples were positive in vessels CD34(+),and 5 samples were scattered positive(+)in CD117.Among them,14 cases were followed up for 5 months to 4 years after surgery,2 cases relapsed and 12 cases had no recurrence or metastasis.Conclusion GT is mostly benign tumor,its correct diagnosis can be taken by combining with characteristic pain,predilection site,pathologica features and immunohistochemical markers.The diagnosis of malignant GT should be careful,and the pain may be related to nerve fibers.
引文
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[13]王黎明,李巧风,李秀翠,等.指腹血管球瘤的诊治[J].中华手外科杂志,2012,28(3):160-162.
[14]王培吉,张勇,赵家举,等.经甲床缘切口治疗手指末节血管球瘤[J].中华手外科杂志,2013,29(5):284-286.
[15]查国庆,牛晓锋,刘云江,等.37例指端血管球瘤的诊治[J].实用手外科杂志,2016,30(1):26-28.
[16]张宗康.71例血管球瘤临床分析[D].上海:复旦大学,2007:1-32.
[17]王彪,吕霞,田慧中,等.指甲下血管球瘤8例报告[J].中国矫形外科杂志,2005,13(7):556-557.
[18]洪光祥,王发斌,黄省秋,等.甲外血管球瘤[J].中华手外科杂志,1995,11:139-140.
[19]邓忠虎,王玉禄,周凤莲.血管球瘤长期误诊12例报告[J].中华手外科杂志,2002,18(1):247.
[2]SHEN S H,WANG J H,CHEN K K,et al.Retroperitoneal glomus tumor:CT and MRI appearance[J].Eur J Radiol Extra,2011,77(3):e79-83.
[3]GILL J,VAN VLIET C.Infiltrating glomus tumor of uncertain malignant potential arising in the kidney[J].Hum Pathol,2010,41(1):145-149.
[4]来茂德.病理学高级教程[M].北京:人民军医出版社,2013:3.
[5]SMILEVITCH D F,CHAPUT B,GROLLEAU J L,et al.Improvement in quality of 1ife after surgery for glomus tumors of the fingers[J].Chir Main,2014,33(5):330-335.
[6]谭湘黔.血管球瘤10例临床病理分析[J].治疗与观察,2015,1(2):362.
[7]MRAVIC M,LACHAUD G,NGUYEN A,et al.Clinical and Histopathological Diagnosis of Glomus Tumor An Institutional Experience of 138Cases[J].Int J Surg Pathol,2015,23(3):181-188.
[8]NAGATA K,HASHIZUME H,YAMADA H,et al.Long-term survival case of malignant glomus tumor mimicking “dumbbell-shaped”neurogenic tumor[J].Eur Spine J,2017,26(Suppl 1):42-46.
[9]范志娜,吴刚,袁建军,等.高频超声在甲下血管球瘤术前诊断中的价值[J].中华手外科杂志,2016,32(4):309-310.
[10]赖日权.对7种软组织肿瘤良、恶性诊断标准的探讨[J].诊断病理学杂志,2009,16(4):246-250.
[11]DEBNATH S C,ROY S K,KAIRY R R.Subungual glomus tumor-clinical presentation and treatment[J].Bangl J Plast Surg,2014,3(2):45-48.
[12]吴石奇,方冠毅,石小勇.8字缝合固定甲板在甲下血管球瘤手术中的应用[J].中华手外科杂志,2011,27(3):180.
[13]王黎明,李巧风,李秀翠,等.指腹血管球瘤的诊治[J].中华手外科杂志,2012,28(3):160-162.
[14]王培吉,张勇,赵家举,等.经甲床缘切口治疗手指末节血管球瘤[J].中华手外科杂志,2013,29(5):284-286.
[15]查国庆,牛晓锋,刘云江,等.37例指端血管球瘤的诊治[J].实用手外科杂志,2016,30(1):26-28.
[16]张宗康.71例血管球瘤临床分析[D].上海:复旦大学,2007:1-32.
[17]王彪,吕霞,田慧中,等.指甲下血管球瘤8例报告[J].中国矫形外科杂志,2005,13(7):556-557.
[18]洪光祥,王发斌,黄省秋,等.甲外血管球瘤[J].中华手外科杂志,1995,11:139-140.
[19]邓忠虎,王玉禄,周凤莲.血管球瘤长期误诊12例报告[J].中华手外科杂志,2002,18(1):247.