心脏瓣膜原发性肿瘤和瘤样病变的临床病理分析

目的分析原发于心脏瓣膜的肿瘤和瘤样病变的病理特征.方法从384例心脏原发肿瘤中收集瓣膜肿瘤的病理资料,加做免疫组化染色,分析其病理特征和临床意义.结果共检出瓣膜肿瘤和瘤样病变10例,占心脏肿瘤的2.60%.8例位于二尖瓣,1例三尖瓣,1例肺动脉瓣.病理类型有乳头状纤维弹力瘤1例,再发粘液瘤1例,脂肪瘤1例,畸胎瘤1例,海绵状血管瘤1例,钙化性假瘤2例,血囊肿1例,间叶肉瘤2例.肿物直径0.3 cm～3 cm,外观形态多样.临床可出现心力衰竭、偏瘫和晕厥.肿瘤的外形及有无瘤蒂不是良恶性的鉴别点.2例恶性肿瘤临床误诊.10例中7例外科做了瓣膜置换术.结论瓣膜肿瘤较易影响瓣膜功能,且易脱落引起栓塞,建议临床一旦发现应及时手术.由于其良恶性肉眼较难判别,术中冰冻切片检查对临床处理有较大的参考价值.

Pathological Characteristics and Clinical Significance of Primary Tumors and Tumor-Like Lesions on Cardiac Valves

Objective: To investigate the histopathological characteristics and clinical significance of primary tumors on the heart valves. Methods: We reviewed data from 384 cases of primary cardiac tumors recorded from 1976 to 2000. Among them 10 cases of valve tumors were found and their location, gross appearance and histopathological patterns were examined. Immunohisto- chemical marking were done in 2 cases. Results: The prevalence of valve tumor was 2.60%. Eight located at mitral valve and another two at tricuspid, pul- monary valves, respectively. Their clinical symptoms included heart failure, hemiplegia, syncope. Histopathologically they were papillary fibroelastoma, myxoma, lipoma, teratoma, calcifying pseudoneoplasms, blood cyst, carvinous hemoangioma and undifferentiated sarcomas. The valve tumors looked like papillary and sea anemone appearance whatever they were malig- nant or benign. Clinical misdiagnosis was made in 2 cases of malignant tumors. The valves were replaced in 7 out of 10. Conclusions: Valve tumors are liable to cause embolism compared with non-valve tumors. It is hard to differentiate their biological behavior only by its gross appearance. Our results suggest that it is advisable to make frozen section during such oper- ation.