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目的通过对小儿血管瘤标本的组织形态学观察和生物学特性测定,探讨血管瘤分类、分期的诊断指标,为临床选择治疗方案提供客观依据。方法①采用苏木素伊红染色(HE)法,根据镜下组织形态学特点进行分类及分期;②采用甲苯氨蓝染色法进行肥大细胞数测定;③采用免疫组化(SP)法,测定血管瘤组织中增殖细胞核抗原(PCNA)、血管内皮细胞生成因子(VEGF)和碱性成纤维细胞生长因子(bFGF)在血管瘤与血管畸形中的表达。结果①增生期血管瘤(55例)内皮细胞增殖活跃,形成细胞团;消退期血管瘤(7例)内皮细胞减少,可见呈岛状分布的脂肪和纤维组织;血管畸形(40例)为毛细血管、小动脉、静脉的异常扩张,内皮细胞无异常增殖;②增生期血管瘤肥大细胞计数为33.30±18.66,高于消退期的26.16±19.09(P<0.05),二者均明显高于血管畸形的7.27±13.01(P<0.01);③PCNA在增生和消退期血管瘤标本中表达的阳性率分别为100%和42.9%,血管畸形仅为22.5%,组间有非常显著性差异(P<0.01)。VEGF在三种组织中表达的阳性率分别为89.6%、42.9%和5%,组间有非常显著性差异(P<0.01)。bFGF在三种组织中表达的阳性率分别为89.6%、100%和25.1%,血管瘤与血管畸形组间有非常显著性差异(P<0.01)。结论肥大细胞可能与血管瘤组织纤维变性及导致血管瘤自然消退有关。PCNA、VEGF与bFGF是判断血管内皮细胞增殖与否的较准确与实用的指标,可作为诊断增生期血管瘤、消退期血管瘤,抑或血管畸形的重要参考。
Objective To investigate the classification and staging of hemangiomas by means of histomorphological observation and biological characterization of pediatric hemangiomas and provide an objective basis for the clinical choice of treatment. Methods ① Hematoxylin and eosin staining (HE) method was used to classify and staging the tumor cells according to microscopic histological features; (2) The number of mast cells was determined by toluidine blue stain; (3) Immunohistochemistry (SP) Expression of proliferating cell nuclear antigen (PCNA), vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) in hemangiomas and vascular malformations. Results ① In proliferating hemangiomas (55 cases), the endothelial cells proliferated actively and formed cell mass. Endothelium of hemangiomas in remission stage decreased (7 cases), showing island-shaped distribution of fat and fibrous tissue. Vascular malformations (40 cases) Abnormal proliferation of blood vessels, arterioles and veins, no abnormal proliferation of endothelial cells; ② The number of mast cells in proliferative hemangioma was 33.30 ± 18.66, which was higher than that of remission (26.16 ± 19.09, P <0.05), both of which were significantly higher than that of blood vessels (7.27 ± 13.01) (P <0.01). The positive rates of PCNA expression in proliferating and resolving hemangiomas were 100% and 42.9%, respectively. The vascular malformations were only 22.5% (P < 0.01). The positive rates of VEGF expression in the three tissues were 89.6%, 42.9% and 5%, respectively, with significant difference (P <0.01). The positive rates of bFGF expression in the three tissues were 89.6%, 100% and 25.1%, respectively. There was a significant difference between the two groups (P <0.01). Conclusion Mast cells may be related to fibrosis of hemangiomas and the natural regression of hemangiomas. PCNA, VEGF and bFGF are more accurate and practical indicators to judge the proliferation of vascular endothelial cells, which can be used as an important reference for diagnosing proliferative hemangiomas, regression hemangiomas, or vascular malformations.