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． 2007年6月,38(6):871 - 7。
doi: 10.1016 / j.humpath.2006.11.017。 EPUB 2007 3月12日。

肺部血栓紊乱术：一个机构中200个连续肺血栓性术病例的临床病理学研究

琼伯纳德1， eunhee s yi.
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肺部血栓紊乱术：一个机构中200个连续肺血栓性术病例的临床病理学研究

琼伯纳德et al。 哼哼． 2007年6月．

摘要

到目前为止，大约有2000名患者在加州大学圣地亚哥分校接受了肺血栓内膜切除术(PTE)。我们回顾了从2004年6月到2006年2月连续200例PTE的临床病理表现，重点是慢性血栓栓塞性疾病的组织病理学谱。检查所有病例的病理报告和组织学切片。相关的临床资料来自手术报告和医疗记录。研究组2例(男1例，女1例)为肺动脉肉瘤，1例为睾丸生殖细胞肿瘤转移瘤栓。2例患者(均为女性)组织学表现为动脉炎，但临床无明显系统性血管炎。其余195名患有慢性血栓栓塞疾病的PTE患者包括97名女性和98名男性，平均年龄分别为52岁(17-83岁)和51岁(16-82岁)。191例行双侧PTE, 4例行单侧PTE(左、右各2例)。在195例患者中，38.5%有深静脉血栓形成史，16.4%有凝血异常。从总体上看，男性PTE标本的体积大于女性，男性和女性的右侧PTE标本体积均大于左侧PTE标本体积。 Microscopically, the thrombi were recent fibrinous clot in 0.8%, mixed fibrinous and organizing in 45%, and old organized in 54.2% of specimens. Inflammation within the thrombi was usually mild but moderate and severe inflammation was found in 13.4% and 1.3% of specimens, respectively. Exuberant epithelioid granulomas were seen within the thrombi in one patient who had a history of sarcoidosis. Collections of foamy histiocytes and/or cholesterol clefts were found in 45%, and calcification was present in 11.5% of specimens. One case revealed diffuse myofibroblastic proliferation in a highly inflammatory background containing numerous plasma cells, reminiscent of inflammatory myofibroblastic tumor. In summary, pathology of PTE specimens in our study group encompassed remodeling of thrombi at various stages with variable degrees of inflammation and cellularity, granulomas associated with sarcoidosis, a rare case showing features of inflammatory myofibroblastic tumor, primary or metastatic malignancy, and isolated pulmonary arteritis.

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