老年人头面部脉管肉瘤的临床病理分析

【】　目的　探讨老年人头面部脉管肉瘤的临床病理学特征。　方法　1996年-2008年对5例老年人头面部脉管肉瘤的临床资料、病理形态学、免疫组织化学染色进行观察，并对其中4例进行了随访。　结果　临床表现主要是头面部发生的瘀斑、溃疡或结节状病变。肿瘤细胞围绕皮肤附件周围排列成交通状吻合的血窦网，衬覆有异型性的内皮细胞，有的区域内皮细胞形成乳头状突起。肿瘤组织内有不同程度的弥漫性出血。肿瘤细胞表达CD34、CD31、Fli-1和FⅧ，部分表达CD117和CK8/18。经随访3例3年内死亡，1例带瘤存活1年余，1例失访。　结论　老年人头面部脉管肉瘤组织形态多样，预后较差，及时诊治十分重要。需要与其他皮肤良性血管病变和低分化癌、恶性黑色素瘤、恶性梭形细胞肿瘤、Kaposi肉瘤等鉴别。？【Abstract】　Objective　Toexploretheclinicopathologicalfeaturesofcutaneousangiosarcomaonthescalpandfaceinelderpatients.　Methods　Theclinicaldataoffiveelderpatientswithcutaneousangiosarcomaonthescalpandfacefrom1996to2008wereretrospectivelyanalyzed.Thepatientsunderwentthelightmicroscopy,pathomorphologicalexamination,andimmunohistochemistry.Fourpatientswerefollowedup.　Results　Mostclinicalmanifestationwasduskyirregularerythematousplaqueswhichwereoftenulcerated.Thetumorwascomposedofasymmetriccollectionofangulatedandirregularvascularspacesinfiltratingbetweencollagenbundles.Endothelialcellsattachingtothevascularspaceshadhyperchromaticirregularnucleiandprominentnucleoli.Hemorrhagewasanotherhistologicfeature.PositiveexpressionofCD34,CD31,Fli-1andFⅧwerefoundintumorcells,andexpressionofCD117andCK8/18wasfoundinsomeofthepatients.Inthefollow-upduration,threepatientsdiedinthreeyears,andonefailedtobefollowedup.　Conclusion　Cutaneousangiosarcomaofthescalpandfacehasvarioushistomorphologyandpoorprognosis,whichshouldbediagnosedandtreatedintime.Itshouldbedistinguishedfrombenigncutaneoushemangioma,poorlydifferentiatedcarcinoma,malignantmelanomaandmalignantspindlecelltumor.