Lui P C W, Luk I S C, Lee C K L, Lui Y H, Leung C Y, Choi C H
Department of Pathology, United Christian Hospital, 130 Hip Wo Street, Kwun Tong, Hong Kong.
J Clin Pathol. 2004 Feb;57(2):155-8. doi: 10.1136/jcp.2003.11965.
Myospherulosis is a rare condition characterised by sac-like structures containing spheroid bodies in cysts or cystic spaces in the tissue. This condition has not previously been reported in the liver. The association with previous portal vein embolisation using a mixture of butyl 2-cyanoacrylate and ethiodised oil and the proposed mechanism of pathogenesis are discussed.
Samples from 8 patients treated by hepatectomy after portal vein embolisation using a mixture of butyl 2-cyanoacrylate and ethiodised oil were retrieved from the archives of the United Christian Hospital, Hong Kong. The histological specimens were reviewed. A panel of histochemical and immunohistochemical stains was used.
All cases showed hepatic myospherulosis within the veins. The veins were denuded of endothelium, which was replaced by granulation tissue and fibrous tissue with a lymphoplasmacytic infiltrate. Foreign body-type giant cells (six cases) and eosinophilic infiltrates (seven cases) were noted in most cases. Both parent bodies and endobodies were stained red by Papanicolaou and Masson's trichrome and stained blue by solochrome cyanine. The endobodies showed immunoreactivity towards glycophorin A. They were negative for Alcian blue, periodic acid Schiff, Grocott, and Ziehl-Neelsen stains.
The endobodies of myospherulosis may be misdiagnosed as fungi or algae by the unwary. The clinical history, intravascular location, lack of staining with periodic acid Schiff and Grocott stains, and positive glycophorin A staining are generally sufficient for a confident diagnosis of myospherulosis.
肌球孢子菌病是一种罕见病症，其特征为组织中的囊肿或囊状间隙内存在含有球状体的囊样结构。此前肝脏中尚未有该病症的报道。本文讨论了其与先前使用丁基-2-氰基丙烯酸酯和碘化油混合物进行门静脉栓塞的关联以及推测的发病机制。
从香港联合医院的档案中获取了8例使用丁基-2-氰基丙烯酸酯和碘化油混合物进行门静脉栓塞后接受肝切除术患者的样本。对组织学标本进行回顾，并使用了一组组织化学和免疫组织化学染色。
所有病例均显示静脉内存在肝肌球孢子菌病。静脉内皮剥脱，被肉芽组织和纤维组织取代，并伴有淋巴浆细胞浸润。大多数病例中可见异物型巨细胞（6例）和嗜酸性浸润（7例）。母球体和内球体经巴氏染色和马森三色染色均呈红色，经铬花青染色呈蓝色。内球体对血型糖蛋白A呈免疫反应性。阿尔辛蓝、过碘酸希夫、格罗科特和齐尔-尼尔森染色均为阴性。
粗心的人可能会将肌球孢子菌病的内球体误诊为真菌或藻类。临床病史、血管内位置、过碘酸希夫和格罗科特染色阴性以及血型糖蛋白A染色阳性通常足以确诊肌球孢子菌病。
