Pathology Department, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, México.
Ann Hepatol. 2011 Jul-Sep;10(3):365-9.
Well established complications of essential thrombocythemia are multiple thrombohemorrhagic phenomena in various abdominal organs. We describe the case of a 22 year old man with essential thrombocythemia and thrombosis of the mesenteric and splenic veins as well as cavernomatous transformation of the portal vein. The patient also had a splenic infarction and a subphrenic hematoma. Additionally, he developed signs and symptoms of acute cholecystitis which in turn led to an open cholecystectomy. The gallbladder had a markedly thickened wall due to multiple recent and recanalized thrombi predominantly in subserosal veins. Only a few arteries were occluded by thrombi. A marked vascular proliferation in the subserosal connective tissue mimicking a hemangioma was most likely the result of collateral circulation. There was also a mild acute and chronic inflammatory infiltrate and edema in the lamina propria of the gallbladder. Hyperplasia of interstitial cells of Cajal in the lamina propria and between smooth muscle cells and proliferation of nerve trunks in the subserosal connective tissue adjacent to the thrombosed veins and arteries was also noted. To our knowledge this unique gallbladder thrombotic complication of essential thrombocythemia has not been previously reported.
原发性血小板增多症的公认并发症是多种腹部器官的血栓-出血现象。我们描述了一例 22 岁原发性血小板增多症患者，肠系膜和脾静脉血栓形成，门静脉海绵样变性。该患者还伴有脾梗死和膈下血肿。此外，他出现了急性胆囊炎的症状和体征，进而导致行胆囊切开术。胆囊壁明显增厚，有多个新近再通的血栓，主要位于胆囊黏膜下静脉。只有少数动脉被血栓阻塞。胆囊黏膜下结缔组织中的明显血管增生类似于血管瘤，可能是侧支循环的结果。胆囊固有层也有轻度急性和慢性炎症浸润和水肿。固有层和邻近血栓形成的动静脉的平滑肌细胞之间的 Cajal 间质细胞增生和神经束的增生也被注意到。据我们所知，这种原发性血小板增多症的胆囊血栓性并发症以前尚未报道过。
