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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2021, Vol. 10 ›› Issue (01) : 87 -92. doi: 10.3877/cma.j.issn.2095-3232.2021.01.019

所属专题： 文献；

临床研究

肝脏孤立性纤维瘤临床病理特征及手术疗效并文献复习
牟怡平1, 王瑞涛1,†(), 侯惠莲1, 刘昌1   
  1. 1. 710061　西安交通大学第一附属医院肝胆外科
  • 收稿日期:2020-11-06 出版日期:2021-02-10
  • 通信作者: 王瑞涛
  • 基金资助:
    西安交通大学教学改革研究项目(17YB03); 西安交通大学医学部本科教学改革研究项目(XJJG202018)

Clinicopathological characteristics and surgical efficacy of liver solitary fibrous tumor and literature review

Yiping Mou1, Ruitao Wang1,†(), Huilian Hou1, Chang Liu1   

  1. 1. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, China
  • Received:2020-11-06 Published:2021-02-10
  • Corresponding author: Ruitao Wang
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牟怡平, 王瑞涛, 侯惠莲, 刘昌. 肝脏孤立性纤维瘤临床病理特征及手术疗效并文献复习[J]. 中华肝脏外科手术学电子杂志, 2021, 10(01): 87-92.

Yiping Mou, Ruitao Wang, Huilian Hou, Chang Liu. Clinicopathological characteristics and surgical efficacy of liver solitary fibrous tumor and literature review[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(01): 87-92.

目的

探讨肝脏孤立性纤维瘤（SFT）的临床病理特点及手术疗效。

方法

回顾性分析2001年1月至2018年12月在西安交通大学第一附属医院接受根治性切除术的2例肝脏SFT患者，以及检索文献纳入49例肝脏SFT患者临床资料。本院2例患者均签署知情同意书，符合医学伦理学规定。分析纳入病例的一般情况、临床表现、组织学类型，采用免疫组化染色检测肿瘤Vim、CD34、CD99、desmin、Bcl-2和STAT6表达，总结其临床病理特征和手术疗效。

结果

共51例经病理确诊且有随访资料的肝脏SFT病例纳入研究。其中男23例，女28例；平均年龄（52±3）岁；临床表现为腹胀11例，低血糖7例，腹痛4例，癫痫1例，28例无明显临床症状。肿瘤均为单发且有完整包膜，血供丰富，质地韧，界限较清楚，剖面多为黄色。肿瘤直径（15.4±2.3） cm。组织学表现为瘤细胞多呈梭形或卵圆形，排列不规则，疏密不均，细胞核呈卵圆形，核仁小，瘤细胞间大量胶原纤维。免疫组化结果示CD34阳性率为94%（48/51），Vim为77%（39/51），Bcl-2为55% （28/51）。本组患者中位生存时间17.4个月，无复发病例报道。

结论

肝脏SFT临床少见，早期无明显症状，病灶较大时引起腹胀、腹痛，可伴有低血糖。病理检查是确诊的金标准，根治性切除是首选治疗方法，手术切除配合规律复查随访疗效确切。

关键词: 肝肿瘤, 孤立性纤维瘤, 病理状态, 体征和症状, 预后
Objective

To investigate the clinicopathological characteristics and surgical efficacy of liver solitary fibrous tumor (SFT).

Methods

Clinical data of 2 patients diagnosed with liver SFT who underwent radical resection in the First Affiliated Hospital of Xi'an Jiaotong University from January 2001 to December 2018 were retrospectively analyzed. In addition, 49 cases with liver SFT were included by literature searching. The informed consents of 2 patients of our hospital were obtained and the local ethical committee approval was received. Baseline data, clinical manifestations and histological types of the patients were analyzed. The expression levels of Vim, CD34, CD99, desmin, Bcl-2 and STAT6 of tumors were detected by immunohistochemical staining. Clinicopathological characteristics and surgical efficacy were summarized.

Results

A total of 51 patients pathologically diagnosed with liver SFT and complete follow-up data were included in this study. 23 cases were male and 28 female, aged (52±3) years on average. The clinical manifestations included abdominal distension in 11 cases, hypoglycemia in 7 cases, abdominal pain in 4 cases, epilepsy in 1 case, and no obvious clinical symptoms were observed in 28 cases. All the tumors were solitary with complete capsule, abundant blood supply, tough texture, clear boundary and yellow cross-section. The tumor diameter was (15.4±2.3) cm. Histological manifestations were spindle-shaped or ovoid tumor cells, irregular arrangement and uneven density, ovoid nucleus, small nucleoli, and a large amount of collagen fibers between tumor cells. Immunohistochemical staining revealed that the positive rate of CD34 was 94% (48/51), 77% (39/51) for Vim and 55% (28/51) for Bcl-2. The median survival time of patients in this group was 17.4 months. No recurrence was reported.

Conclusions

Liver SFT is rarely seen in clinical practice. No evident symptom is noted in the early stage. Large lesions may cause abdominal distension and pain, accompanied by hypoglycemia. Pathological examination is the gold standard for diagnosis. Radical resection is the primary choice of treatment. Surgical resection combined with regular follow-up yield exact clinical efficacy.

Key words: Liver neoplasms, Solitary fibrous tumors, Pathological conditions, signs and symptoms, Prognosis
图1 一例孤立性肝纤维瘤患者肝脏CT图
图2 一例孤立性肝纤维瘤患者肿瘤切除标本
图3 一例孤立性肝纤维瘤细胞HE及免疫组化染色（×200）
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