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目的正确鉴别体表软组织深部的增殖期婴幼儿血管瘤(Infantile hemangioma,IH)和卡波西样血管内皮瘤(Kaporsiform Hemangioendothelioma,KHE)是选择合适治疗方案的重要条件。从多方面比较增殖期IH和KHE的病理特征,为更准确地鉴别诊断这两种疾病提供依据。方法在2001年1月至2009年6月期间,收集21例增殖期IH和12例KHE标本。采用HE染色、透射电镜和免疫组化染色等方法,比较增殖期IH和KHE的病理结构和抗原标记(D2-40和Glut1)的表达。结果 HE染色显示,增殖期IH有众多毛细血管丛,新生毛细血管壁内可见扁平状周细胞;KHE由肿瘤结节组成,结节中心是大量狭缝状管腔,结节边缘可见毛细血管。在电镜下观察,增殖期IH的毛细血管壁基底膜呈多层板状结构,基底膜内有周细胞;KHE的狭缝状管腔和毛细血管壁基底膜仅有数层,且不连续,基底膜内也可见周细胞。增殖期IH肿瘤内皮细胞不表达D2-40,强烈表达Glut1;而KHE仅表达D2-40,不表达Glut1。结论增殖期IH的病理结构与KHE有明显差别。D2-40和Glut1可以作为鉴别增殖期IH和KHE的可靠抗原标记。
Objective To correctly identify infantile hemangioma (IH) and Kaposi-like hemangioendothelioma (KHE) in the deep part of body surface soft tissue is an important condition for the selection of appropriate treatment. To compare the pathological features of proliferative phase IH and KHE in many aspects and provide the basis for more accurate differential diagnosis of these two diseases. Methods Between January 2001 and June 2009, 21 cases of proliferative phase IH and 12 cases of KHE were collected. The pathological structures of IH and KHE during proliferative phase and the expression of antigen markers (D2-40 and Glut1) were compared by HE staining, transmission electron microscopy and immunohistochemical staining. Results Hematoxylin-eosin staining showed that there were numerous capillary plexuses in proliferating phase IH and flat pericytes in nascent capillaries. KHE was composed of tumor nodules, and the center of nodules was a large number of slit-shaped lumens with capillaries at the edge of nodules. Under electron microscope, the proliferating IH capillary wall basement membrane was multilayer plate-like structure, the basement membrane within the week cells; KHE slit-shaped lumen and capillary wall basement membrane only a few layers, and not continuous, the basement Peripheral membrane can also be seen in the membrane. Proliferating phase IH tumor endothelial cells did not express D2-40, strongly expressed Glut1; while KHE only expressed D2-40, did not express Glut1. Conclusions The pathological structure of IH during proliferative phase is obviously different from that of KHE. D2-40 and Glut1 can be used as reliable antigens to identify IH and KHE during proliferative phase.