Kyorin University School of Medicine, Tokyo, Japan.
Pathol Res Pract. 2010 Dec 15;206(12):839-45. doi: 10.1016/j.prp.2010.05.014. Epub 2010 Jul 4.
We present a case of aortic intramural hematoma, a variant of aortic dissection, with metastatic carcinoma invasion within the aortic wall and pseudolumen. An elderly male patient with a history of controlled hypertension initially experienced chest pain. A computed tomographic scan revealed aortic intramural hematoma; thus, conservative therapy was performed. One and a half months later, tumors in both adrenal glands and the lumbar vertebra were discovered. The primary site was not identified, and the patient died following septic shock 1 month later. An autopsy revealed intramural hematoma throughout the aorta, as well as systemic metastases of adrenocortical carcinoma with invasion into the aortic wall and formation of a pseudolumen accompanied by disruption of the vasa vasorum. As far as we know, this is the second case of aortic dissection associated with metastatic carcinoma. The highly aggressive nature of the tumor cells was demonstrated by high mitotic ratio and Ki-67 labeling index. The tumor was also positive for matrix metalloproteinase-12, thus suggesting disruption of the aortic media.
我们报告了一例主动脉壁内血肿，这是主动脉夹层的一种变体，其主动脉壁内有转移性癌浸润和假腔。一名患有高血压病史的老年男性患者最初出现胸痛。计算机断层扫描显示主动脉壁内血肿，因此进行了保守治疗。一个半月后，发现双侧肾上腺和腰椎有肿瘤。原发灶未确定，1 个月后患者死于感染性休克。尸检显示主动脉壁内血肿，以及伴有侵犯主动脉壁和形成假腔的伴发性肾上腺皮质癌的全身转移，伴滋养血管破裂。据我们所知，这是第二例与转移性癌相关的主动脉夹层病例。肿瘤细胞具有很高的有丝分裂率和 Ki-67 标记指数，显示出高度侵袭性。肿瘤还对基质金属蛋白酶-12 呈阳性，因此提示主动脉中层破裂。
