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目的探讨脾硬化性血管瘤样结节性转化(SANT)的临床病理特征、诊断与鉴别诊断要点及治疗方法。方法对2例SANT的临床病理特征及免疫组化表达进行详细的观察并复习相关文献。结果 2例SANT的临床表现无特异性。组织学镜下见具有众多由环靶状纤维组织围绕的肉芽肿样结节,伴有结节间不同程度硬化的间质;肉芽肿样结节内细胞呈卵圆形、短梭形,胞质相对丰富,部分细胞胞质内可形成含红细胞的腔隙,细胞间还穿插有衬覆肥胖内皮细胞的枝芽状毛细血管及相对扩张的窦隙样血管腔隙。免疫组化示结节内不同血管样结构有3种不同的表达,结节内梭形、卵圆形细胞CD31、CD68和SMA呈不同程度(+),而CD21、S-100和EMA均(-)。术后随访,患者未发现病变复发和转移。结论 SANT是脾具有特征性改变的一种良性病变,过去易与脾炎性假瘤、错构瘤或血管瘤等相混淆。行脾切除术可治愈,预后良好。
Objective To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of splenic sclerosing hemangioma-like nodular transformation (SANT) and its treatment. Methods The clinicopathological characteristics and immunohistochemical expression of 2 cases of SANT were observed and reviewed. Results The clinical manifestations of 2 cases of SANT were nonspecific. Histoplasmic microscope, there are many granuloma-like nodules surrounded by target-like fibrous tissue, with interstitial interstitial sclerosis of varying degrees; granulomatous nodules were oval-shaped cells, short spindle-shaped cells Relatively rich in quality, some cells within the cytoplasm can form a cavity containing red blood cells interstitial cells interspersed with branches of budding capillary endothelial cells and the relative expansion of the sinusoid-like vascular lacuna. Immunohistochemistry revealed three different expressions of different vascular-like structures in the nodules. CD31, CD68 and SMA in the fusiform and oval cells in the nodules were all different (+), while CD21, S-100 and EMA -). After follow-up, no recurrence and metastasis were found in the patients. Conclusions SANT is a benign lesion of the spleen with characteristic changes that used to be confused with splenic inflammatory pseudotumor, hamartoma or hemangioma. Splenectomy can be cured, the prognosis is good.