论文部分内容阅读
目的总结肝血管平滑肌脂肪瘤穿刺活检标本的组织病理学形态、免疫组化及诊断和鉴别诊断要点,探讨提高诊断准确率、降低误诊率的方法。方法对9例肝血管平滑肌脂肪瘤穿刺活检病例进行临床病理与免疫组化观察。结果 9例肝血管平滑肌脂肪瘤中女性8例,男性1例,年龄25～62岁,中位年龄43岁;肿瘤直径2～10 cm;5例为肌瘤型,3例为混合型,1例为脂肪瘤型;其中8例HMB45(+),1例HMB45(-)但melan A(+)。仅1例术前影像学诊断考虑为肝血管平滑肌脂肪瘤,而未行免疫组化检测、仅依靠光镜观察,有4例得出正确的病理诊断。结论肝血管平滑肌脂肪瘤的组织形态变化多样,穿刺活检标本更易误诊或漏诊,确切的病理诊断还需借助于免疫组化,尤其是HMB45和melan A对鉴别诊断有重要意义。
Objective To summarize the histopathological features, immunohistochemistry, and the main points of diagnosis and differential diagnosis in the biopsy specimen of hepatic steatosis of lipoma, and to explore ways to improve the diagnostic accuracy and reduce the misdiagnosis rate. Methods Nine cases of hepatic angiomyolipoma biopsy were observed by clinicopathological and immunohistochemical methods. Results Among the 9 cases of hepatic angiomyolipoma, 8 were female and 1 was male, aged from 25 to 62 years with a median age of 43 years. The diameter of the tumor was from 2 to 10 cm. Five were myoma and three were mixed. Cases of lipoma type; of which 8 cases of HMB45 (+), 1 case of HMB45 (-) but melan A (+). Only 1 case of preoperative imaging diagnosis of hepatic angiomyolipoma, without immunohistochemical detection, only rely on light microscopy, 4 cases come to the correct pathological diagnosis. Conclusions The histological changes of hepatic angiomyolipoma are diverse and the biopsy specimens are more likely to be misdiagnosed or missed. The exact pathological diagnosis is also based on immunohistochemistry. In particular, HMB45 and melan A are important for differential diagnosis.