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中华医学超声杂志(电子版) ›› 2021, Vol. 18 ›› Issue (03) : 272 -277. doi: 10.3877/cma.j.issn.1672-6448.2021.03.006

所属专题: 文献

浅表器官超声影像学

血管内乳头状内皮增生的高频超声表现
吴梦洁1, 孙浩然2, 胡彧1, 彭晓静1, 李奥1,()   
  1. 1. 210029 南京医科大学第一附属医院超声科
    2. 210029 南京医科大学第一附属医院病理科
  • 收稿日期:2020-02-16 出版日期:2021-03-01
  • 通信作者: 李奥

High frequency ultrasound features of intravascular papillary endothelial hyperplasia

Mengjie Wu1, Haoran Sun2, Yu Hu1, Xiaojing Peng1, Ao Li1,()   

  1. 1. Department of Ultrasound, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
    2. Department of Pathology, the First Affiliated Hospital, Nanjing Medical University, Nanjing 210029, China
  • Received:2020-02-16 Published:2021-03-01
  • Corresponding author: Ao Li
引用本文:

吴梦洁, 孙浩然, 胡彧, 彭晓静, 李奥. 血管内乳头状内皮增生的高频超声表现[J/OL]. 中华医学超声杂志(电子版), 2021, 18(03): 272-277.

Mengjie Wu, Haoran Sun, Yu Hu, Xiaojing Peng, Ao Li. High frequency ultrasound features of intravascular papillary endothelial hyperplasia[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2021, 18(03): 272-277.

目的

探讨血管内乳头状内皮增生(IPEH)的高频超声(包括二维及彩色多普勒血流)成像特征,帮助该病的诊断及鉴别诊断。

方法

收集2014年1月至2019年11月于南京医科大学第一附属医院经穿刺或手术病理证实的IPEH患者21例,回顾性分析患者的年龄、性别和临床病史。其中8例患者(年龄17~63岁,平均44.8岁,女性4例,男性4例)进行了术前高频超声检查,包括二维及彩色多普勒血流成像检查。2名肌肉骨骼超声医师对该8例IPEH患者的超声表现进行回顾性分析,包括病变位置、形状、大小、内部回声、异质性、血管分布,分析超声特征与病理的关系。

结果

8例IPEH灰阶超声表现为单发,平均大小23.5 mm,从皮下脂肪层至深筋膜层均可发生,呈边界清晰的不均质低回声,1例(12.5%)内部结构呈洋葱圈样改变,1例(12.5%)呈筛网状改变;彩色多普勒血流成像显示肿块内血流分级0级7例,仅1例(12.5%)肿块内可见血管穿行。病理诊断8例IPEH均为单纯型,均可见扩张血管腔内机化的血栓;典型病理表现为纤维血管轴心玻璃样变的乳头状内皮增生。所有患者均未复发。

结论

IPEH(单纯型)多为孤立性肿块,其超声表现为体积较小、椭圆形、边界清晰、不均匀低回声、不伴钙化、内部可有穿支血管、质偏软。检测到的起源血管的存在可能有助于区分IPEH和其他软组织肿块。高频超声成像检查可作为IPEH首选的检查方法。

Objective

To investigate the high frequency ultrasound features of intravascular papillary endothelial hyperplasia (IPEH), in order to assist the diagnosis and differential diagnosis of IPEH.

Methods

Twenty-one cases of histopathologically proven IPEH were collected from January 2014 to November 2019 at the First Affiliated Hospital, Nanjing Medical University. The age, gender, and clinical history of the patients were analyzed retrospectively. Among them, eight patients (age range, 17–63 years; mean age, 44.8 years; four females and four males) were examined by high frequency ultrasound (including B-mode ultrasonography and color Doppler flow imaging) before operation. Two musculoskeletal ultrasound doctors reviewed the ultrasound manifestations of the eight cases of IPEH, including the location, shape, size, echogenicity, heterogeneity, and vascularity. The correlations between the ultrasound and pathological features of the lesions were analyzed.

Results

The eight cases all manifested as a single mass, and the average size was 23.5 mm. They can occur from subcutaneous fat layer to deep fascia layer, and presented as a well-defined heterogeneous hypoechogenic mass. Among all the cases, one (12.5%) had an onion ring-like structure and one (12.5%) had a cribriform network-like structure. Seven cases were shown to have grade 0 blood flow on color Doppler flow imaging, and only one (12.5%) had an origin blood vessel passing through the mass. All of the eight cases were diagnosed as pure form by pathology, and thrombus was found in the vessels of all the cases. The typical pathological manifestation was papillary endothelial hyperplasia with hyaline change of fiber vascular axis. No recurrence occurred in all patients.

Conclusion

IPEH (pure form) is usually an isolated mass. On ultrasound, it is always characterized by a small, well-defined, oval, soft, inhomogeneous and hypoechoic soft tissue mass without calcification. The presence of detectable origin vessel may be help to distinguish the lesion from other soft tissue masses. High frequency ultrasound imaging is the first choice for IPEH.

表1 8例血管内乳头状内皮增生患者临床特征
表2 8例血管内乳头状内皮增生患者灰阶声像图特征
图1 血管内乳头状内皮增生患者灰阶图像表现。图a示肿块位于脂肪层;图b示肿块位于肌层;图c示肿块内部结构呈洋葱圈样;图d示肿块内部结构呈筛网状
表3 8例血管内乳头状内皮增生患者彩色多普勒超声图像特征
图2 血管内乳头状内皮增生患者彩色多普勒血流成像。图a示血流分级0级;图b示血流分级为Ⅱ级
图3 中倍视野显示血管内乳头状内皮增生典型的病理特征。图a所示为纤维血管轴心,玻璃样变的乳头状内皮增生,图b显示扩张的血管内血栓,部分机化后再通
1
Hashimoto H, Daimaru Y, Enjoji M. Intravascular papillary endothelial hyperplasia-a clinicopathologic study of 91 cases [J]. Am J Dermatopathol, 1983, 5(6): 539-546.
2
Masson P. Hemangioendotheliome vegetant intra-vasculaire [J]. Bull Soc Anat Paris, 1926, 93: 517-523.
3
Clearkin KP, Enzinger FM. Intravascular papillary endothelial hyperplasia [J]. Arch Pathol Lab Med, 1976, 100(8): 441-444.
4
Adler DD, Carson PL, Rubin JM, et al. Doppler ultrasound color flow imaging in the study of breast cancer: preliminary findings [J]. Ultrasound Med Biol, 1990, 16(6): 553-559.
5
Akdur NC, Donmez M, Gozel S, et al. Intravascular papillary endothelial hyperplasia: histomorphological and immunohistochemical features [J]. Diagn Pathol, 2013, 8: 167-172.
6
Weiss SW, Goldblum JR. Enzinger & Weiss's soft tissue tumors [M]. Philadelphia: Mosby, 2008: 633-679.
7
Lee SJ, Choo HJ, Park JS, et al. Imaging findings of intravascular papillary endothelial hyperplasia presenting in extremities: correlation with pathological findings [J]. Skeletal Radiol, 2010, 39(8): 783-789.
8
Craig KA, Escobar E, Inwards CY, et al. Imaging characteristics of intravascular papillary endothelial hyperplasia [J]. Skeletal Radiol, 2016, 45(11): 1467-1472.
9
Lysyy O, Schwartz I, Kolander Y, et al. Sonographic features of intravascular papillary endothelial hyperplasia (Masson's tumor) in the forearm [J]. J Clin Ultrasound, 2011, 39(5): 301-303.
10
Kim OH, Kim YM, Choo HJ, et al. Subcutaneous intravascular papillary endothelial hyperplasia: ultrasound features and pathological correlation [J]. Skeletal Radiol, 2016, 45(2): 227-233.
11
Schwartz SA, Taljanovic MS, Harrigal CL, et al. Intravascular papillary endothelial hyperplasia sonographic appearance with histopathologic correlation [J]. J Ultrasound Med, 2008, 27(11): 1651-1653.
12
Tarallo M, Spagnoli AM, Fino P, et al. Masson's tumor: a soft tissue tumor simulating a tendon cyst [J]. G Chri, 2012, 33(1-2): 34-37.
13
Clifford PD, Temple HT, Jorda M, et al. Intravascular papillary endothelial hyperplasia (Masson's tumor) presenting as a triceps mass [J]. Skeletal Radiol, 2004, 33(7): 421-425.
14
蒋洁, 陈文, 崔立刚, 等. 软组织血管平滑肌瘤的声像图特征 [J]. 中国超声医学杂志, 2014, 30(10): 937-939.
15
赵新美, 项霞青, 吴春燕, 等. 肢体腱鞘巨细胞瘤的高频超声表现 [J]. 中国医学影像学杂志, 2013, 21(2): 107-109.
16
Elder DE, Elenitsas R, Bernett L, et al. Lever's histopathology of the skin [M]. Philadelphia: Lippincott Williams & Wilkins, 2008: 483-484.
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