Matsukuma Susumu, Koga Ayano, Takeo Hiroaki, Kato Kimi, Mori Kazuma, Sato Kimiya
Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo, Japan.
Health Care Center, Japan Self-Defense Forces Central Hospital, Tokyo, Japan.
Histopathology. 2016 Aug;69(2):307-14. doi: 10.1111/his.12938. Epub 2016 Mar 4.
To elucidate the histopathological findings of classical Lambl excrescences (LEs) and non-exophytic LEs (non-ex LEs) without excrescent papillary features.
We examined 126 aortic valves (AVs) and revealed LEs (non-ex and/or classical), non-ex LEs and classical LEs in 106, 78 and 88 AVs, respectively. The detection of non-ex LEs was challenging, but elastica van Gieson stain highlighted their presence. Non-ex and classical LEs chiefly involved the ventricular regions, favoured posterior cusps and coexisted in the same areas of 31 AVs. A possible transformation of classical LEs into non-ex LEs was suggested histologically in 39 AVs. Non-ex LEs were associated with age of >70 years (P < 0.001) and marked deformity (P = 0.007). Classical LEs were associated inversely with marked deformity (P < 0.001), but not with age of >70 years. Compared with age- and sex-matched control AVs, non-ex LEs and marked deformity in dysfunctional AVs were more common (P = 0.037 and P < 0.001, respectively), but classical LEs were less common (P = 0.021).
Non-ex LEs have subtle features but are a common form of LEs, and seem to develop from classical LEs. AV dysfunction-related marked deformity can promote non-ex LEs.
阐明无赘生物乳头特征的经典兰布尔赘生物（LEs）和非外生性LEs（非外生性LEs）的组织病理学表现。
我们检查了126个主动脉瓣（AVs），分别在106个、78个和88个AVs中发现了LEs（非外生性和/或经典型）、非外生性LEs和经典型LEs。非外生性LEs的检测具有挑战性，但弹性纤维染色突出了它们的存在。非外生性和经典型LEs主要累及心室区域，更常见于后叶，并在31个AVs的相同区域共存。在39个AVs中，组织学上提示经典型LEs可能转变为非外生性LEs。非外生性LEs与年龄>70岁（P<0.001）和明显畸形（P = 0.007）相关。经典型LEs与明显畸形呈负相关（P<0.001），但与年龄>70岁无关。与年龄和性别匹配的对照AVs相比，功能障碍性AVs中的非外生性LEs和明显畸形更常见（分别为P = 0.037和P<0.001），但经典型LEs较少见（P = 0.021）。
非外生性LEs具有细微特征，但却是LEs的常见形式，似乎由经典型LEs发展而来。与AV功能障碍相关的明显畸形可促进非外生性LEs的形成。
