脾上皮样血管肉瘤 1例

患者 , 女 , 61岁 , 间歇性左上腹隐痛 1月余 , 于 2000年 10月 18日入院治疗 (住院号 : 288041). 查体 : 全身状况好 , 腹平坦 , 左上腹轻压痛 , 脾区轻微叩痛 . B超示脾占位 , 内有多个无回声暗区 ; CT示脾肿大 , 以脾后极更明显 , 外缘凹凸不平 , 可见多个较小的不规则类圆形低密度病灶 , 边界不清 . 强化 3 min后 , 脾脏显示出多个充盈缺损区 , 边缘清晰 . 临床诊断 : 脾脏恶性肿瘤 , 考虑为恶性淋巴瘤或血管肉瘤 . 2000年 10月 25日在全身麻醉下行脾切除手术 . 术后病理检查 (病理号 : 20008986): 切除全脾一个 , 大小为 12 cm× 8.5 cm× 4 cm, 切面见一大小为 3.5 cm× 5 cm× 4 cm的灰红色结节 , 呈分叶状 , 质软 , 可见出血及坏死区 ; 镜下见脾脏部分区域为瘤组织所代替 , 可见瘤细胞与脾血窦内皮细胞有移行 . 瘤细胞圆形、卵圆形 , 呈上皮样 , 胞体大 , 边界清楚 ; 胞浆丰富、嗜酸性 , 呈空泡状 , 偶见含有单个红细胞 ; 胞核大、淡染 , 核仁突出 , 多紧贴于核膜下 . 瘤组织中可见大量单核及多核瘤巨细胞 , 核分裂相约 15个 /10HPF. 瘤细胞弥漫呈片状排列 (图 1A), 局部见有裂隙状、管状及乳头状结构 . 瘤组织内有大片出血及坏死 , 间质有炎症细胞浸润 . 免疫组化染色 : CD34(+ )(图 1B), FVIII R(+ )(图 1C), Pan Keratin(+ ), CK8(+ ), EMA(+ ), Vimentin(+ ). 网状纤维染色 : 清晰显示大小不一的血管腔 , 瘤细胞分布成巢 , 巢周绕以网状纤维 . 病理诊断 : 脾上皮样血管肉瘤 .     

腹膜后血管平滑肌肉瘤1例

患者男，73a。于2001年3月5日开始发热，体温37．5℃左右，轻微咳嗽，无咳痰、咳血、呼吸困难、胸痛、心慌等症状。按上呼吸道感染处理，疗效不佳。1mo后，仍间断发热，出现肺部湿罗音。胸片提示：慢性支气管炎。于2001年4月26日以慢性支气管炎、肺部感染入住老年病科。血常规检查正常，B超检查提示：脾脏肿大，其余未见异常。     

乳房血管肉瘤1例

乳房血管肉瘤是起自乳房血管内皮细胞的恶性肿瘤。过去所用名称繁多,如良性转移性血管瘤、血管肉瘤,血管内皮肉瘤、成血管细胞瘤等。而以血管肉瘤的名称较为恰当,因其既阐明了肿瘤性质,又反映了肿瘤的组织起源,现报告1例并复习文献。病例报告女,25岁。停经7个月,发现左侧乳房无痛性肿物2个月。肿物初起如栗子大,稍活动,后逐渐长大,伴有刺痛,并向左肩部放射。曾多次诊为“纤维腺瘤”。检查:一般情况尚好。左乳房内外     

脾血管肉瘤1例(附文献复习)

脾血管肉瘤是一种较罕见的恶性肿瘤，文献报道约１００例犤１犦，本文报告１例。患者，男，５３岁。因上腹持续疼痛３个月入院。查体：左上腹压痛，左上腹扪及一约８cm×６cm大小包块，质硬、活动度差。手术见腹腔内有少许淡黄色腹水，肝表面有弥漫结节，脾脏肿大，约２０cm×２０cm×２０cm，行脾切除术，术后行肝动脉灌注化疗。病理检查：类圆形肿物，大小约１７cm×１６cm×１５cm，包膜完整，表面呈结节状，切面暗红，弥漫分布，灰白、暗褐色，直径１～３cm结节，质软。光镜见：肿瘤细胞呈梭形、多角形及类圆形，异型性明显，部分区域排…     

原发性脾血管肉瘤1例报道

原发性脾血管肉瘤 (angiosarcoma)罕见 ,由Ianghans在1 879年首先报到[1 ] ,经检索国内至今共报道 40余例。我院于 2 0 0 1年诊治 1例。临床资料患者男 ,59岁。发现左上腹渐增性包块 1月余 ,伴持续性胀痛。查体 :腹平软 ,无腹壁静脉曲张。肝肋下未触及 ,脾肋缘下 6cm ,质稍硬 ,肝区叩痛阴性 ,脾区叩痛阳性 ,移动性浊音阴性。CT :脾脏肿大 ,脾内见大小不等多发实性及低密度性混杂影 ,注射造影剂后实性部分轻度强化 ,低密度区无增强。肝内见多个大小不等的低密度病灶 ,无强化。CT诊断 :脾脏占位性病变 ,肝脏弥漫转移。手术所见 :肝色泽正常 …     

肝血管内皮细胞肉瘤1例

肝血管内皮细胞肉瘤１例王洪波１朱昌栋２吕琳１王丛笑１１病例介绍患者，男，４０岁，农民，因上腹胀痛７个月，加重３个月于１９９７年１月６日入院。７月前无明显诱因出现上腹痛，呈胀痛、钝痛，无规律性间断发作，可自行缓解，与活动体位无关，出汗较多，尤以夜间为重...     

脾原发性血管肉瘤伴肝转移1例

 患者女，63岁，5周前无明显诱因出现腹痛，以左侧季肋下为著，无发热，自行热敷后略缓解，近1个月腹痛加重，疼痛呈持续性，1个月来消瘦明显。查体：一般状态尚可，腹部平坦，触诊脾大，达左侧肋缘下3指，左侧季肋下及剑突下压痛（+），无反跳痛及肌紧张，无移动性浊音。超声检查所见：（1）肝脏大小正常，被膜尚光整，右叶内可见几个等回声结节，边界欠清晰，较大的为3.0cm×3.0cm，内部回声均匀，肝尾状叶可探及3.7cm×3.8cm囊实混合性包块，边界清晰，以囊性为主，囊内可见强回声条索状分隔及弱点样回声浮动，余肝脏实质回声尚均匀，管状结构走行清晰，肝内外胆管及门静脉未见扩张；（2）脾脏形态失常，上极内可见多个大小不等的略强回声团块，边界尚清晰，内部回声不均匀，可见低回声区，下极脾脏轮廓不规整，内部回声明显不均匀，可见多个大小不等的囊实混合性团块，较大的8.2cm×10.8cm，以囊性为主，边界欠清晰，团块内可探及星点血流信号。超声提示：（1）肝内多发实性占位；（2）肝尾状叶囊实性占位；（3）脾脏多发实性占位并部分囊性变，脾脏肿瘤破裂可能性大。CT检查提示：（1）肝内多发占位；（2）脾内及脾脏前缘多发占位。实验室检查：WBC 9.7×109/L；RBC 3.54×1012/L；Hb 106g/L；PLT 239×109/L；Hct 31%。 术中所见：肝脏隔面可触及多个大小不等的结节，大者约2.5cm×3cm，于肝尾状叶可探及一大小约为3.5cm×3.5cm×3.5cm囊实混合性占位，伴出血，脾脏形态不整，于上下极均可探及大小约8cm×7cm×7cm囊实混合性占位伴出血坏死，与胃后壁、结肠脾曲粘连侵润严重。切除组织的病理结果：免疫组化：CK（-），AFP（-），CEA（-），CK7（-），CK20（-），Vim（+），CD68-，CD34+，CD31+，F-8血管及少许瘤细胞（+）。诊断：脾血管肉瘤侵及肝尾状叶。 讨论：脾脏为造血器官，血运极为丰富，故脾脏肿瘤较为少见，文献报道其发病率低于0.1%，原发性脾脏恶性肿瘤则更罕见，占各种肿瘤的比例不足1%。1879年，Lanhans首次报道国内脾脏原发性血管肉瘤，迄今为止，文献报道的约140余例。血管肉瘤是一种血管内皮细胞来源的恶性肿瘤，该病恶性程度高，预后差，53%的患者中数生存期为11个月，49%发生转移，20%局部复发，最常见的发病部位有皮肤软组织及内脏器官，如肝、脾等，该病的早期发现和手术治疗是唯一提高生存率的方法，而影像学检查是脾脏占位性病变的主要诊断方法，其中超声检查无创、无痛、简便、可重复，因此，超声检查应作为脾脏肿瘤诊断的首选方法。 参考文献 1 Lam KY，Tang V.Metastatic tumors to　the spleen:a 25-year clinicopathologic study.Arch Pathol Lab Med,2000,124(4):526. 2 吴福生，董秀志，腾理送，等.脾脏占位性病变，中国普通外科杂志,2002,11(9)：725.     

脾血管肉瘤并发脾破裂1例

1 病案摘要 患者女,54岁。2004年12月3日晚餐后约2小时在家看电视时突感左上腹持续性隐痛,无放射,腹痛随体位改变而加剧,伴恶心、呕吐胃内容物2次,无咖啡样液体,无畏寒发热,无腹胀腹泻。当晚未予任何处理。次日10时许腹痛未缓解乃步行来我院检查并收入院治疗。已绝经6年。     

颈部血管肉瘤1例

1资料患者女性,56岁,因发现颈部斑块3年,确诊颈部血管肉瘤10个月入院,患者2010年发现颈部发际处可见褐色片状斑,夹杂白斑,逐渐迁延至双耳部及颈项部,伴颈部皮肤瘙痒,后自觉表情僵硬,四肢冰凉,外院诊断为＂系统性硬皮病＂,予强的松等药治疗,效果不佳。10个月前行颈部皮肤活检病理示：梭形细胞肿瘤,倾向血管源性,细胞中度异型,核分裂相易见,血管丰富,免疫组化：CD31（＋）,CD34（＋）,F8（＋）,SMA（-）,Ki-67（＋）（20%）,确诊血管肉瘤。查体：表情僵硬,激素面容。     

睾丸原发性上皮样血管肉瘤1例报告

1　病例报告患者男性 ,74岁。左侧睾丸无明显诱因肿大胀痛 40天 ,于2 0 0 1年 5月 2 1日入院治疗。体检 :左侧睾丸肿大 ,大小为6 .2ｃｍ× 3.8ｃｍ× 3.8ｃｍ ,质硬 ,表面溃烂 ,且可触及多个结节 ;右侧睾丸无明显异常 ;阴囊肿胀 ,鞘膜无积液 ;腹股沟区未触及肿大淋巴结。实验室检查 :血红蛋白明显降低 ,白细胞升高 ,血沉加快。临床诊断为睾丸恶性肿瘤 ,故于 2 0 0 1年 5月 2 5日行睾丸全切除术。病理检查 :巨检 :左侧睾丸大小为 6 .0ｃｍ× 5 .0ｃｍ× 4.5ｃｍ ,表面破溃 ,切面广泛出血 ,中央区见多个大小不等的浅黄色结节 ,结节大的为 1.2…     

Spleen Rupture Due to Primary Angiosarcoma: A Case Report

A case of a 79-year-old female with rupture of the spleen due to primary angiosarcoma is presented. Symptoms were non-specific. Diagnosis was based on histology postoperatively. Primary angiosarcoma of the spleen is a very rare and aggressive neoplasm with a high metastatic rate and almost uniformly fatal. Due to small number of reported cases, there are no guidelines concerning adjuvant or palliative treatment or any beneficial protocols of chemotherapy or radiotherapy up to date. Splenectomy prior to rupture seems to have a positive impact on long-term survival.     

Primary Renal Angiosarcoma: One Case Report and Literatures Review

Introduction Angiosarcomas are rare highly malignant neoplasm that make up less than 2% of all soft-tissue sarcomas.Only 40 renal cases have been described[1].     

A Primary Epithelioid Angiosarcoma Arising in a Bilharzial Urinary Bladder: A Reappraisal and Case Report

Background: Angiosarcoma (AS) of the urinary bladder is a very rare and aggressive malignancy with a dismal outcome. Case report: Here, we report a primary epithelioid angiosarcoma (EAS) of the urinary bladder in a forty-nine-year-old male patient who presented with severe hematuria. Cystoscopic examination revealed hemorrhagic ulcerated bladder mucosa but no definite mass lesions. Intractable hematuria raised the initial clinical impression of idiopathic hemorrhagic cystitis. Analysis of the cystoscopic biopsy revealed features of old bilharzial cystitis, markedly atypical epithelioid endothelial cells arranged as primitive anastomosing vascular structures and expressing vascular markers. The diagnosis of EAS was established. The patient developed intractable severe hematuria, and a radical cystoprostatectomy was performed. The patient was started on chemotherapy but suddenly developed widespread distant metastasis (liver, lung, suprarenal glands, and lymph nodes) and succumbed to death two months after the surgery. Conclusion: To the best of these authors’ knowledge, we presented the first report of primary EAS arising in a bilharzial bladder. The relevant studies were discussed.     

Metastatic Angiosarcoma of the Kidney: A Case Report with Treatment Approach and Review of the Literature

Abstract

Angiosarcomas are rare soft tissue malignancies. Typically they originate from the skin of the scalp or face, whereas visceral sarcomas are very rare. We report the case of a 67-year-old man affected by a large angiosarcoma of the kidney. After surgical removal, a rapid peritoneal, visceral and cutaneous diffusion developed. Palliative chemotherapy, based on anthracycline and ifosfamide, which are normally used to treat all other high-grade spindle cell sarcomas, was totally inactive. On the basis of these results and of the biological characteristics of these rare neoplasms it is mandatory to develop other therapeutic approaches. Antiangiogenetic agents are of interest for this disease due to the peculiar origin of the cells of these sarcomas.     

Unexplained Hemopericardium as a Presenting Feature of Primary Cardiac Angiosarcoma: A Case Report and a Review of the Diagnostic Dilemma

This report describes a patient diagnosed with a cardiac angiosarcoma. The patient presented with cardiac tamponade. A pericardiocentesis revealed a bloody effusion, but cytology was nondiagnostic and a chest computed tomography showed only mediastinal lymphadenopathy. His pericardial effusion recurred 3 weeks later, at which time he was found to have a large right atrial mass which proved to be a cardiac angiosarcoma. This case report underscores the difficulties encountered in the diagnosis of cardiac angiosarcoma.     

A Case of Colon Cancer Metastasizing to the Spleen

A case of colon cancer metastasizing to the spleen is reported.The patient was a 43-year-old man who was laparotomized underthe diagnosis of colon cancer. The tumor of the transverse colonshowed a small ulcer and polypoid projections. Poorly differentiatedadenocarcinoma was noted in the mucosa. Marked tumor metastasiswas found in the parenchyma of the spleen and the peripancreatic,portohepatic, mesenteric and periaortic lymph nodes. The literatureon the incidence and mechanism of metastasis to the spleen wasreviewed, and mtastasis to the spleen was found to be not infrequentat a late or advanced stage of cancer.