Flemming P, Lang H, Georgii A
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover.
Verh Dtsch Ges Pathol. 1995;79:116-9.
Primary mesenchymal tumors of the liver are rarely observed. Histopathological diagnosis can be very difficult, in needle biopsies especially. This is a great difference to epithelial tumors of the liver. The frequency of their occurrence within surgical pathology will increase in the near future, since image analysis and improvement of liver surgery technics raise their recruiting.
A total of 1102 primary liver tumors were evaluated from the files of this laboratory between 1981 and 1993, reclassified histologically and in cases of mesenchymal tumors compared with clinical data and course.
208/1102 (19%) mesenchymal tumors were revealed. When 177 cavernous hemangiomas were omitted for its choristomatous character and unproblematically diagnostic approach, a substantial group of 31/1102 (3%) mesenchymal tumors does remain. These were classified as: epithelioid hemangioendotheliomas (EHE) (8/31), angiosarcomas (7/31) infantile hemangioendotheliomas (5/31), mesenchymal hamartomas (5/31), angiomyolipomas (3/31), malignant mesenchymomas (2/31) and schwannoma (1/31). Among other misdiagnoses, 3 of hemangiopericytoma are remarkable, since they had to be reclassified as metastases from adult granulosa cell tumor of the ovary and meningeoma respectively. The histological distinction of EHE's is discussed versus angiosarcoma, since therapy and prognosis are different.
These results reconfirm that mesenchymal neoplasms of the liver in adults are usually angiomatous differentiated. Diagnostic approach to probably mesenchymal derived masses of the liver does often request additional information from immunostaining and image analysis, especially when based on needle biopsies. Metastases are to be considered in this procedure. Primary pericytomas were not reconfirmed among this total of 1102 primary liver tumors.
肝脏原发性间叶性肿瘤很少见。组织病理学诊断可能非常困难，尤其是在针吸活检中。这与肝脏上皮性肿瘤有很大不同。由于图像分析和肝脏手术技术的改进提高了其检出率，在不久的将来，它们在外科病理学中的发生率将会增加。
1981年至1993年间，从本实验室档案中评估了总共1102例原发性肝肿瘤，进行组织学重新分类，并将间叶性肿瘤病例与临床数据及病程进行比较。
发现208/1102（19%）为间叶性肿瘤。当因海绵状血管瘤具有错构瘤性质且诊断方法简单而将177例排除后，仍有一组数量可观的31/1102（3%）间叶性肿瘤。这些肿瘤分类如下：上皮样血管内皮瘤（EHE）（8/31）、血管肉瘤（7/31）、婴儿血管内皮瘤（5/31）、间叶性错构瘤（5/31）、血管平滑肌脂肪瘤（3/31）、恶性间叶瘤（2/31）和神经鞘瘤（1/31）。在其他误诊病例中，3例血管外皮细胞瘤值得注意，因为它们分别不得不重新分类为卵巢成人颗粒细胞瘤和脑膜瘤的转移瘤。由于治疗方法和预后不同，讨论了EHE与血管肉瘤的组织学鉴别。
这些结果再次证实，成人肝脏间叶性肿瘤通常为血管瘤样分化。对于可能源自间叶组织的肝脏肿块，诊断方法通常需要免疫染色和图像分析提供的额外信息，尤其是基于针吸活检时。在此过程中应考虑转移瘤。在这1102例原发性肝肿瘤中未再次确认原发性血管外皮细胞瘤。
