Hasegawa T, Seki K, Yang P, Hirose T, Hizawa K
First Department of Pathology, School of Medicine, University of Tokushima, Japan.
Pathol Int. 1994 Jan;44(1):66-72. doi: 10.1111/j.1440-1827.1994.tb02587.x.
Angioleiomyoma is a solitary subcutaneous tumor characterized by pain in about half of patients with this tumor, and the pathogenesis of this pain has been a cause of much debate. To clarify the mechanism of pain and cytoskeletal property of tumor cells, 50 angioleiomyomas were studied clinicopathologically and immunohistochemically. The tumors occurred preferentially on the extremities, particularly the lower leg (46%), and the female to male ratio was 1.9:1. They were classified into three histological subtypes: (i) solid (30 cases); (ii) venous (15 cases); and (iii) cavernous (five cases). The pain and/or tenderness were present in 26 out of 49 patients (52%), in which small nerve fibers immunoreactive for S-100 protein and PGP9.5 were identified within the capsule of 20 tumors (77%) and the tumor stroma of 18 (69%), irrespective of the histological subtypes. In 24 patients where the pain was absent or unknown, nerves were observed within the capsule of 19 tumors (79%) and tumor parenchyma of 10 (42%). Many cells in all 50 tumors were positive for alpha-smooth muscle actin, and a relatively large number of cells in many tumors were positive for vimentin, desmin and collagen type IV. Also, cytokeratin (CAM5.2) reactivity was scattered in a few cells of four tumors. From these findings, the peculiar pain of angioleiomyomas could be mediated by the nerve fibers especially located within the tumor parenchyma. Although the expression of intermediate filaments in angioleiomyomas was heterogeneous, the overall cytoskeletal features were of smooth muscle cell differentiation.
血管平滑肌瘤是一种孤立性皮下肿瘤，约半数患者伴有疼痛，其疼痛的发病机制一直是诸多争论的焦点。为阐明疼痛机制及肿瘤细胞的细胞骨架特性，对50例血管平滑肌瘤进行了临床病理及免疫组织化学研究。肿瘤好发于四肢，尤其是小腿（46%），男女比例为1.9:1。它们分为三种组织学亚型：（i）实性（30例）；（ii）静脉型（15例）；（iii）海绵状（5例）。49例患者中有26例（52%）存在疼痛和/或压痛，其中20例肿瘤（77%）的包膜内及18例肿瘤（69%）的肿瘤间质中可识别出对S-100蛋白和PGP9.5呈免疫反应性的小神经纤维，与组织学亚型无关。在24例无疼痛或疼痛情况不明的患者中，19例肿瘤（79%）的包膜内及10例肿瘤（42%）的肿瘤实质内观察到神经。所有50例肿瘤中的许多细胞α-平滑肌肌动蛋白呈阳性，许多肿瘤中有相对大量的细胞波形蛋白、结蛋白和IV型胶原呈阳性。此外，细胞角蛋白（CAM5.2）反应性在4例肿瘤的少数细胞中呈散在分布。基于这些发现，血管平滑肌瘤的特殊疼痛可能由尤其位于肿瘤实质内的神经纤维介导。尽管血管平滑肌瘤中间丝的表达具有异质性，但整体细胞骨架特征为平滑肌细胞分化。
