肝海綿狀血管瘤臨床特點(diǎn)及病理分析

王懸峰 張建東 肖海

摘要：目的? 探討肝海綿狀血管瘤的臨床病理特征。方法? 收集2014年1月～2017年4月我院存檔的25例肝海綿狀血管瘤石蠟標(biāo)本，行HE染色后觀察其病理形態(tài)，并結(jié)合患者病史和影像學(xué)資料總結(jié)肝海綿狀血管瘤的臨床病理特征。結(jié)果? 共25例肝海綿狀血管瘤標(biāo)本，其中女性18例，男性7例;病灶位于左肝葉10例，右肝葉12例，左、右肝葉均有者3例，分布無(wú)明顯規(guī)律;血管瘤單發(fā)20例，多發(fā)5例;病灶最大徑4～10 cm。CT平掃表現(xiàn)為肝實(shí)質(zhì)內(nèi)圓形、類圓形或不規(guī)則形低密度影，邊緣尚清楚;動(dòng)脈期呈結(jié)節(jié)狀強(qiáng)化;門靜脈期強(qiáng)化向心性強(qiáng)化;平衡期和延遲期腫瘤持續(xù)向心性強(qiáng)化，且強(qiáng)化程度減低。MRI表現(xiàn)為T1WI呈均勻低信號(hào)，T2WI呈均勻高信號(hào)，病灶邊緣清晰。肝海綿狀血管瘤表現(xiàn)為質(zhì)地柔軟的腫物，切面無(wú)包膜，呈腔隙狀;病變與周圍肝組織分界清楚，由大量不規(guī)則形擴(kuò)張的血管組成，管腔大小、形狀不一。結(jié)論? 肝海綿狀血管瘤臨床表現(xiàn)不明顯，以女性多見，單發(fā)為主;病變主要由大小不等的異常血管腔組成，管腔內(nèi)襯單層扁平內(nèi)皮細(xì)胞，周圍環(huán)繞纖維組織。

關(guān)鍵詞：海綿狀血管瘤;病理組織學(xué);脈管性疾病

Abstract：Objective? To explore the clinicopathological features of hepatic cavernous hemangioma.Methods? 25 specimens of hepatic cavernous hemangioma were collected from January 2014 to April 2017. The pathological morphology was observed after HE staining. The clinical and clinical data of patients with hepatic cavernous hemangioma were summarized. Pathological features.Results? A total of 25 specimens of hepatic cavernous hemangioma， including 18 females and 7 males; the lesions were located in the left hepatic lobe in 10 cases， the right hepatic lobe in 12 cases， and the left and right hepatic lobe in 3 cases， with no obvious distribution; There were 20 cases of single tumor and 5 cases of multiple cases. The maximum diameter of the lesion was 4～10 cm. CT plain scan showed a round， round or irregular low-density shadow in the liver parenchyma with clear edges; nodular enhancement in the arterial phase; intensive cardiac enhancement in the portal vein; continuous centripetal in the balanced and delayed phases Strengthened and reduced in intensity. MRI showed a uniform low signal on T1WI， a uniform high signal on T2WI， and a clear edge of the lesion. The hepatic cavernous hemangioma is characterized by a soft mass of the tumor. The cut surface has no capsule and is lacunar. The lesion is clearly separated from the surrounding liver tissue. It consists of a large number of irregularly shaped vessels， and the lumen size and shape are different.Conclusion? The clinical manifestations of hepatic cavernous hemangioma are not obvious. They are more common in women and single-shot. The lesions are mainly composed of abnormal vascular cavities of different sizes. The lumen is lined with a single layer of flat endothelial cells surrounded by fibrous tissue.

Key words：Cavernous hemangioma;Histopathology;Vascular disease

肝海綿狀血管瘤（hepatic cavernous hemangioma，HCH）是肝臟常見的良性腫瘤，也是肝血管瘤中最常見的類型之一，發(fā)生率在0.4%～20%不等，占肝良性腫瘤的70%左右[1]。大多數(shù)肝海綿狀血管瘤體積較小且不引起明顯的臨床癥狀，僅在體檢時(shí)偶然發(fā)現(xiàn)，但部分肝海綿狀血管瘤因不斷增大而引起上腹部疼痛不適[2]。目前關(guān)于肝海綿狀血管瘤臨床和組織病理形態(tài)的研究較少，本文結(jié)合臨床資料回顧性觀察和分析我院25例肝海綿狀血管瘤的病理形態(tài)，旨在探討肝海綿狀血管瘤的臨床病理形態(tài)特征，并提高人們對(duì)肝海綿狀血管瘤的認(rèn)識(shí)。

綜上所述，肝海綿狀血管瘤是非腫瘤性先天性發(fā)育畸形，病變主要由大小不等的異常血管管腔組成，管腔內(nèi)襯單層扁平內(nèi)皮細(xì)胞，周圍環(huán)繞豐富的纖維組織。當(dāng)病灶中見明顯的纖維化和玻璃樣變性時(shí)，在臨床上易誤診為其他占位性病變，需聯(lián)合應(yīng)用超聲、CT和MRI等影像學(xué)方法并結(jié)合臨床表現(xiàn)一般可診斷，明確診斷需結(jié)合組織學(xué)形態(tài)，手術(shù)完整切除瘤體能有效治療。

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收稿日期：2019-4-15;修回日期：2019-4-25

編輯/杜帆