软组织结节性筋膜炎的细针吸取细胞学诊断

Diagnosis of nodular fascitis in soft tissue by fine needle aspiration cytology

目的对13例结节性筋膜炎进行细针吸取细胞学检查,并结合病史分析不同时期的细胞学形态特点,以取得诊断与鉴别诊断的经验。方法13例均有术后病理组织学对照,光镜观察其细胞学特点及形态表现,与组织学对比分析;并与黏液性脂肪肉瘤、恶性纤维组织细胞瘤、皮肤转移腺癌及炎性肌纤维母细胞瘤等的细胞学特点相对照。结果13例中男性8例,女性5例;发生于上肢6例,胸壁1例,颈部1例,背部2例,下肢3例。在疾病不同的发展阶段可见不同的细胞学构象,但基本图像以从幼稚到较成熟的纤维母细胞增生为主,病变的不同阶段纤维母细胞以不同比例混杂出现,可见核分裂,但无病理性核分裂及凝固性坏死是其与各种肉瘤区分的要点。结论细胞学穿刺对结节性筋膜炎的中、晚期改变诊断较准确,但在早期病变中误诊率较高,需密切结合病史及部位。

Objective To investigate the cytologic features of nodular fascitis （NF） in different phase in order to increase the experience in the diagnosis and differential diagnosis, as comparied with those of myxoid liposarcoma, malignant fibrous hisfiocytoma （MFH）, skin metastasis carcinoma and inflammatory myofibroblastoma. Methods 13 cases of NF were diagnozed by fine needle aspiration cytology （FNAC）. There were 8 males and 5 females. The lesions located in the upper limbs in 6 cases,1 in chest wall, 1 in the neck, 2 in the backs and 3 in lower limbs. Different cytologic features were found in different stage of the disease. Different number of fibroblasts always existed and mixed with other cell component. The major changes were myofibroblast hyperplusia from infantility to mature. No abnormal mitosis and coagulative necrosis found in the lesion was the main points for differential diagnosis from sarcomas. Conclusion The diagnosis of NF can be correctly achieved by FNAC in the intermediate and advanced stages, but misdiagnosis rate is increased in its early stage. In order to improve the correct rate, we must integrate closely the disease history and sites while making diagnosis.