• 成都軍區(qū)總醫(yī)院（成都，610083）1 病理科，2 皮膚科;

【摘要】　目的　 探討老年人頭面部脈管肉瘤的臨床病理學(xué)特征。　方法　 1996年-2008年對5例老年人頭面部脈管肉瘤的臨床資料、病理形態(tài)學(xué)、免疫組織化學(xué)染色進(jìn)行觀察，并對其中4例進(jìn)行了隨訪。　結(jié)果　 臨床表現(xiàn)主要是頭面部發(fā)生的瘀斑、潰瘍或結(jié)節(jié)狀病變。腫瘤細(xì)胞圍繞皮膚附件周圍排列成交通狀吻合的血竇網(wǎng)，襯覆有異型性的內(nèi)皮細(xì)胞，有的區(qū)域內(nèi)皮細(xì)胞形成乳頭狀突起。腫瘤組織內(nèi)有不同程度的彌漫性出血。腫瘤細(xì)胞表達(dá)CD34、CD31、Fli-1和FⅧ，部分表達(dá)CD117和CK8/18。經(jīng)隨訪3例3年內(nèi)死亡，1例帶瘤存活1年余，1例失訪。　結(jié)論　 老年人頭面部脈管肉瘤組織形態(tài)多樣，預(yù)后較差，及時(shí)診治十分重要。需要與其他皮膚良性血管病變和低分化癌、惡性黑色素瘤、惡性梭形細(xì)胞腫瘤、Kaposi肉瘤等鑒別。
【Abstract】　Objective　 To explore the clinicopathological features of cutaneous angiosarcoma on the scalp and face in elder patients.　Methods　 The clinical data of five elder patients with cutaneous angiosarcoma on the scalp and face from 1996 to 2008 were retrospectively analyzed. The patients underwent the light microscopy, pathomorphological examination, and immunohistochemistry. Four patients were followed up.　Results　 Most clinical manifestation was dusky irregular erythematous plaques which were often ulcerated. The tumor was composed of asymmetric collection of angulated and irregular vascular spaces infiltrating between collagen bundles. Endothelial cells attaching to the vascular spaces had hyperchromatic irregular nuclei and prominent nucleoli. Hemorrhage was another histologic feature. Positive expression of CD34,CD31,Fli-1 and FⅧ were found in tumor cells, and expression of CD117 and CK8/18 was found in some of the patients. In the follow-up duration, three patients died in three years, and one failed to be followed up.　Conclusion　 Cutaneous angiosarcoma of the scalp and face has various histomorphology and poor prognosis, which should be diagnosed and treated in time. It should be distinguished from benign cutaneous hemangioma, poorly differentiated carcinoma, malignant melanoma and malignant spindle cell tumor.

引用本文： 陳易華,劉太華,簡燚,范嚴(yán)嚴(yán). 老年人頭面部脈管肉瘤的臨床病理分析. 華西醫(yī)學(xué), 2010, 25(12): 2171-2173. doi: 復(fù)制

1. 　Glickstein J, Sebelik ME, Lu Q. Cutaneous angiosarcoma of the head and neck: a case presentation and review of the literature [J]. Ear Nose Throat J, 2006, 85(10): 672-674.
2. 　Juan Rosai. Rosai & Ackerman 外科病理學(xué)[M]. 9版. 回允中, 譯. 北京: 北京大學(xué)醫(yī)學(xué)出版社, 2006: 195-196.
3. 　Spillane EL, Xia Y, Turiansky GW. Atypical cutaneous presentation of Waldenstrm macroglobulinemia: an extensive erythematous patch mimicking an angiosarcoma[J]. Cutis, 2008, 81(1): 67-68.
4. 　Requena L, Santonja C, Stutz N, et al. Pseudolymphomatous cutaneous angiosarcoma: a rare variant of cutaneous angiosarcoma readily mistaken for cutaneous lymphoma [J]. Am J Dermatopathol, 2007, 29(4): 342-350.
5. 　Brightman LA, Demierre MF, Byers HR. Macrophage-rich epithelioid angiosarcoma mimicking malignant melanoma [J]. J Cutan Pathol, 2006, 33(1): 38-42.
6. 　Deyrup AT, McKenney JK, Tighiouart M, et al. Sporadic cutaneous angiosarcomas: a proposal for risk stratification based on 69 cases [J]. Am J Surg Pathol, 2008, 32(1): 72-77.
7. 　沈亞麗, 羅柱, 王辛, 等. 頭面部血管肉瘤3例報(bào)道并文獻(xiàn)復(fù)習(xí)[J]. 華西醫(yī)學(xué), 2007, 22(4): 713-714.
8. 　Demartelaere SL, Roberts D, Burgess MA, et al. Neoadjuvant chemotherapy-specific and overall treatment outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement[J]. Head Neck, 2008, 30(5): 639-646.
9. 　Nagano T, Yamada Y, Ikeda T, et al. Docetaxel: a therapeutic option in the treatment of cutaneous angiosarcoma: report of 9 patients [J]. Cancer, 2007, 110(3): 648-651.
  1. 1. 　Glickstein J, Sebelik ME, Lu Q. Cutaneous angiosarcoma of the head and neck: a case presentation and review of the literature [J]. Ear Nose Throat J, 2006, 85(10): 672-674.
  2. 2. 　Juan Rosai. Rosai & Ackerman 外科病理學(xué)[M]. 9版. 回允中, 譯. 北京: 北京大學(xué)醫(yī)學(xué)出版社, 2006: 195-196.
  3. 3. 　Spillane EL, Xia Y, Turiansky GW. Atypical cutaneous presentation of Waldenstrm macroglobulinemia: an extensive erythematous patch mimicking an angiosarcoma[J]. Cutis, 2008, 81(1): 67-68.
  4. 4. 　Requena L, Santonja C, Stutz N, et al. Pseudolymphomatous cutaneous angiosarcoma: a rare variant of cutaneous angiosarcoma readily mistaken for cutaneous lymphoma [J]. Am J Dermatopathol, 2007, 29(4): 342-350.
  5. 5. 　Brightman LA, Demierre MF, Byers HR. Macrophage-rich epithelioid angiosarcoma mimicking malignant melanoma [J]. J Cutan Pathol, 2006, 33(1): 38-42.
  6. 6. 　Deyrup AT, McKenney JK, Tighiouart M, et al. Sporadic cutaneous angiosarcomas: a proposal for risk stratification based on 69 cases [J]. Am J Surg Pathol, 2008, 32(1): 72-77.
  7. 7. 　沈亞麗, 羅柱, 王辛, 等. 頭面部血管肉瘤3例報(bào)道并文獻(xiàn)復(fù)習(xí)[J]. 華西醫(yī)學(xué), 2007, 22(4): 713-714.
  8. 8. 　Demartelaere SL, Roberts D, Burgess MA, et al. Neoadjuvant chemotherapy-specific and overall treatment outcomes in patients with cutaneous angiosarcoma of the face with periorbital involvement[J]. Head Neck, 2008, 30(5): 639-646.
  9. 9. 　Nagano T, Yamada Y, Ikeda T, et al. Docetaxel: a therapeutic option in the treatment of cutaneous angiosarcoma: report of 9 patients [J]. Cancer, 2007, 110(3): 648-651.