脾脏硬化性血管瘤样结节性转化2例报告及文献复习
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李明信 E-mail:lmxhsj@163.com

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Sclerosing angiomatoid nodular transformation of spleen: a report of two cases and literature review
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    摘要:

    目的:探讨脾脏硬化性血管瘤样结节性转化(SANT)的临床、病理、诊断与治疗。
    方法:对2例SANT的临床、病理特征及免疫组化表达及术后随访情况进行分析并复习文献。
    结果:显微镜下见肿物呈多个血管瘤样肉芽肿性结节,结节间为致密或黏液样变的纤维结缔组织,结节中瘤细胞呈卵圆形、短梭形,胞质丰富、可见分枝状及裂隙样不规则毛细血管,间质多量浆细胞、淋巴细胞浸润及红细胞外渗。细胞形态温和,无异型性,核分裂很少见。免疫表型复杂,无特征性表现。2例均行脾切除术治疗。术后随访6个月—1年余均无复发与转移。
    结论:SANT是一种罕见的具有特征性病理改变的良性增生性病变,临床上易与脾脏恶性肿瘤混淆,病理上易与炎性假瘤、错钩瘤等混淆,脾切除术是有效的治疗方法,预后良好。

    Abstract:

    Objective:To review the clinical manifestations, pathology, diagnosis, and therapy of sclerosing angiomatoid nodular transformation(SANT) of spleen.
    Methods:The clinical manifestations, pathology, expression of immunohistochemistry, and the  follow-up survey of 2 cases of SANT were  analyzed, and the related literature was reviewed.
    Results:The morphological features of SANT under microscope were as follows: Multiple angioloma-like granuloma  nodules were observed. The nodules appeared as compact or mucoid-degenerated fibrous connective tissue, and tumour cells in the nodules were orbicular-ovate or short spindle-shaped with rich cytoplasm. Cladodromous or crack-like irregular capillary vessels were detected. There were numerous plasmocytes, lymphocytes, and erythrocytes in the interstitium. The cell morphology was mild with no-atypia, and  nuclear division was rarely seen. There were no specific immunological characteristics. The two cases of SANT had no relapse or metastasis during the 6-months to 1-year follow-up after splenectomy.
    Conclusions:SANT is an infrequent hyperplatic and benign lesion of spleen which has a remarkably pathologic characteristic appearance. However, it might be mistdiagnosed clinically as other diseases, such as splenic cancer, inflammatory pseudotumor, hamartoma, etc. The effective therapy of SANT is splenectomy which has a good prognosis.

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李明信| 马建青| 廖秋林| 陈晓东| 陈育洪.脾脏硬化性血管瘤样结节性转化2例报告及文献复习[J].中国普通外科杂志,2010,19(11):1231-1233.
DOI:10.7659/j. issn.1005-6947.2010.11.018

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  • 收稿日期:2010-02-25
  • 最后修改日期:2010-08-11
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  • 在线发布日期: 2010-11-15