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目的通过分析肺硬化性血管瘤(PSH)临床病理特点,提高快速冷冻诊断中的准确性。方法对21例经手术切除PSH的冷冻及常规切片进行回顾性病理特征分析,其中包括3例在快速冷冻中误诊为PSH的其他病变。7例PSH标本行免疫组化标记观察。结果镜下肿物边界清楚,呈推挤状生长。出血区和实性结构在冷冻及常规切片中出现比率高((100%和95%),硬化性结构其次(57%和76%),而乳头状结构约为(38%和52%)。10例冷冻及常规切片中未出现乳头状结构,9例未出现硬化性结构。但间质常出现泡沫细胞、淋巴细胞、胆固醇结晶、钙化。PSH主要由2型细胞构成,表面细胞主要被覆于乳头状结构表面及管状分布于实性结构间质,而圆细胞主要分布于实性结构区和乳头状区间质中。表面细胞napsin-A、TTF-1、EMA和CK(+),而圆细胞TTF-1、EMA和PR(+)。圆细胞Ki-67阳性率为5%~10%,较表面细胞(1%~2%)高。当表面上皮细胞在冷冻切片中有明显异型性时,易误诊为腺癌;而周围型肺腺癌或类癌伴有出血时,易误诊为PSH。结论 PSH在冷冻或常规切片中多显示不同比例的出血、实性、硬化、乳头4种混合结构及间质炎症,出现明显异型性细胞易误诊。
Objective To improve the accuracy of rapid freezing diagnosis by analyzing the clinicopathological features of pulmonary sclerosing hemangioma (PSH). Methods Retrospective pathological features of 21 cases of PSH were analyzed retrospectively, including 3 other cases which were misdiagnosed as PSH during rapid freezing. Seven cases of PSH specimens were observed by immunohistochemistry. The results of microscopic tumor clear boundary, a push-like growth. Bleeding areas and solid structures were found to be high (100% and 95%) in frozen and routine sections, sclerotic structures (57% and 76%), and papillary structures (38% and 52%). There were no papillary structures in 10 cases of frozen and conventional sections, and no sclerosing structures in 9 cases, but foam cells, lymphocytes, cholesterol crystals and calcification appeared frequently in the interstitium.PSH mainly consisted of type 2 cells, Papillary structures and tubules are distributed in the interstitial structure of solid, while the round cells are mainly distributed in the stroma and papillary interstitial surface cells, napsin-A, TTF-1, EMA and CK (+) The positive rate of round cell Ki-67 was 5% ~ 10%, which was higher than that of the surface cells (1% ~ 2%). When the surface epithelial cells were obviously abnormal in frozen section Often, it is easily misdiagnosed as adenocarcinoma.While peripheral pulmonary adenocarcinoma or carcinoid carcinomas with hemorrhage are easily misdiagnosed as PSH.Conclusion PSH showed more or less different rates of bleeding, solidification, and papilla 4 in frozen or conventional sections Mixed structure and interstitial inflammation, there is obvious atypia cells easily misdiagnosed.