肝血管平滑肌脂肪瘤23例临床病理特征分析

肝癌电子杂志 ›› 2020, Vol. 7 ›› Issue (2): 21-27.

肝血管平滑肌脂肪瘤23例临床病理特征分析

李卓¹, 王黎明², 张海峰¹, 张宏图¹, 石素胜¹, 鲁海珍^1,*

1 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院病理科,北京 100021;
2 国家癌症中心/国家肿瘤临床医学研究中心/中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京 100021

收稿日期:2020-03-27 出版日期:2020-06-30 发布日期:2020-07-23
通讯作者: ^* 鲁海珍 E-mail: haizhen_lu@qq.com
作者简介:李卓,主治医师,中国医学科学院北京协和医学院肿瘤医院病理科。

Clinicopathological charateristics analysis for 23 cases of hepatic angiomyolipoma

Li Zhuo¹, Wang Liming², Zhang Haifeng¹, Zhang Hongtu¹, Shi Susheng¹, Lu Haizhen^1,*

1 Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China;
2 Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China

Received:2020-03-27 Online:2020-06-30 Published:2020-07-23

摘要/Abstract

摘要： 目的: 分析肝血管平滑肌脂肪瘤（hepatic angiomyolipoma,HAML）的临床病理特征、免疫表型、诊断、鉴别诊断及预后。方法: 回顾性分析中国医学科学院北京协和医学院肿瘤医院2010年12月至2019年12月外科手术切除治疗的HAML病例23例,总结患者性别、年龄分布、病史及临床症状、发病部位、肿瘤大小、大体表现、镜下组织学特征及免疫组织化学染色结果等临床病理特征。结果: 本研究23例HAML患者男性5例,女性18例,平均年龄46.8（27~66）岁。23例中的5例伴乙型肝炎病毒感染,20例进行了血清学AFP及CEA检测,均在正常范围内。术前临床结合影像诊断仅5例考虑HAML,其余15例考虑肝细胞癌,2例考虑肝血管瘤,另1例考虑肝细胞腺瘤,体现出HAML术前诊断的困难。23例HAML中的18例（78.3%）含有上皮样成分。全部23例均呈免疫组化HMB45阳性表达（阳性率100%）;SMA免疫组化检测结果呈22例阳性（95.7%阳性率）;22例的上皮标志物表达均呈阴性。23例患者除1例为外院HAML术后复发病例外,随访期间均未见复发及远处器官转移。结论: HAML是间叶源性肿瘤,联合应用HMB45及SMA进行免疫组化检测具有确诊的价值。HAML较肾AML具有上皮样成分更常见的特点。但经外科手术治愈后的HAML总体预后良好,我们因此推测上皮样成分对其预后无明显影响。

关键词: 上皮样, 血管平滑肌脂肪瘤, HMB45

Abstract: Objective: The aim of the study was to investigate the clinicopathologic characteristics, immunohistochemical results, diagnosis, differential diagnosis and prognosis of hepatic angiomyolipoma (HAML).Methods: The 23 surgically excisional cases of HAML were collected and systematically analyzed in Cancer Hospital, Chinese Academy of Medical Sciences from December 2010 to December 2019. The clinical and pathological characteristics, including gender, age distribution, former medical history, symptoms, tumor location, size, gross and microscopic morphological features and immunohistochemical results were reviewed in the study.Results: There were 5 males and 18 females, with a median age of 46.8 years (range 27~66 years). The results of serological examination showed 5 cases of HAML patients with the infection of Hepatitis B virus. The test results of AFP and CEA in 20 cases were within the normal range. Only 5 cases of the 23 HAML were correctly diagnosed before the operations, with the other 15 cases diagnosed as hepatic carcinoma, 2 cases as hepatic hemangioma and 1 case as hepatic adenoma. There were 18 cases 78.3% out of the 23 HAML cases with epithelial components in our study. The immunohistochemical results of 23 cases showed the positive percentage ratio of HMB45 as 100%, SMA as 95.7% and 0 for the epithelial markers respectively. Except for only one case with the recurrence with the history of former operation from another hospital, no recurrence or metastasis in the other 22 cases was observed in our study.Conclusions: HAML was a type of mesenchymal neoplasm. The combined application of HMB45 and SMA immunohistochemical examination was proved to be essential for the correct diagnosis of HAML. Although there was higher existence of epithelial components in HAML than in renal counterpart, the favorable prognosis was still observed depending on the completely surgical resection in this study. Thus we assume that the epithelial components in HAML would not change its clinical outcome.

Key words: Epithelioid, Angiomyolipoma, HMB45

李卓, 王黎明, 张海峰, 张宏图, 石素胜, 鲁海珍. 肝血管平滑肌脂肪瘤23例临床病理特征分析[J]. 肝癌电子杂志, 2020, 7(2): 21-27.

Li Zhuo, Wang Liming, Zhang Haifeng, Zhang Hongtu, Shi Susheng, Lu Haizhen. Clinicopathological charateristics analysis for 23 cases of hepatic angiomyolipoma[J]. Electronic Journal of Liver Tumor, 2020, 7(2): 21-27.

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