Thrombus and encapsulated hematoma in cerebral cavernous malformations
Thrombus and encapsulated hematoma in cerebral cavernous malformations
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DOI：
10.1007/s00401-005-0994-8
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发表时间：
2005-05-01
影响因子：
12.7
通讯作者：
Kawano, T
中科院分区：
文献类型：
--
作者：
Abe, M;Fukudome, K;Kawano, T
血栓、包裹性血肿和肉芽组织常见于脑海绵状畸形(CCM)。我们研究了这些组织学变化在CCM反复出血和病变生长中所起的作用，检查了20名患者的手术标本。免疫组织化学研究包括血栓调节蛋白(TM)和内皮细胞蛋白C受体(EPCR)这两种重要的凝血调节因子。包裹性血肿患者可见含有血液降解产物的厚厚的胶囊。在这些厚厚的囊膜外可见一簇簇的正弦血管。4例无包膜血肿可见肉芽组织伴炎性浸润物和毛细血管。20例中有15例可见窦状血管内有机化血栓。凝血因子VIII相关抗原染色显示机化血栓内及周围、增厚的血管壁内及血肿囊内外两侧均有大量毛细血管。TM和EPCR在这些毛细血管内皮细胞中呈阳性表达，而在病变周围的脑毛细血管内皮细胞中均为阴性。我们的研究表明，血栓形成的窦状血管可以通过壁内大量毛细血管的反复出血而逐渐扩张，形成包裹性血肿，而增厚的管壁外的毛细血管可以成为窦状血管。脑微静脉内血栓形成可能是CCM的病因之一。
Thrombi, encapsulated hematomas, and granulation tissue are frequently seen in cerebral cavernous malformations (CCMs). We investigated the role that these histological changes play in repeated hemorrhages in CCMs as well as lesion growth, examining specimens of CCMs surgically harvested from 20 patients. The immunohistochemical study included thrombomodulin (TM) and endothelial cell protein C receptor (EPCR), which are important regulators of blood coagulation. Thick capsules, which contained blood degradation product, were seen in cases with encapsulated hematomas. Clusters of sinusoidal vessels were found outside of these thick capsules. Granulation tissue with inflammatory infiltrates and capillaries was seen in 4 cases with non-capsulated hematomas. Organizing thrombi were seen in sinusoidal vessels in 15 out of 20 cases. Factor VIII-related antigen staining demonstrated numerous capillaries in and around organizing thrombi and within the thickened vessel walls as well as in both the inner and outer sides of the hematoma capsule. TM and EPCR were positive in the endothelial cells of these capillaries, whereas they were negative in those of capillaries in the brain surrounding the lesions. Our study suggests that thrombosed sinusoidal blood vessels could gradually expand by repeated bleeding from numerous capillaries inside the wall and become encapsulated hematomas, and capillaries outside the thickened vessel wall could become sinusoidal blood vessels. Thrombosis within cerebral venules could be one of the causal factors of CCMs.