甲下外生性骨疣的临床病理特征

Clinicopathologic features of subungual exostosis

目的探讨甲下外生性骨疣的临床病理特征。方法收集上海市第六人民医院病理科经手术切除和病理证实的甲下外生性骨疣，对患者作临床资料、大体观察记录及镜下HE切片形态学的复习整理。结果2000～2006年间累计22例甲下外生性骨疣，男性11例、女性11例。发病年龄8～67岁，中位发病年龄25．7岁，低于20岁者占13例（59％）。原发足趾者为19例（86．36％），手指者为3例（13．64％）。在19例足趾中，左侧13例，右侧5例，双侧1例；足拇趾14例（63．63％）。X线表现为致密钙化的骨赘生物附着于趾（指）骨远端，但病变松质骨和正常髓腔松质骨之间没有延续，骨疣基底部骨皮质无缺损。镜下显示典型的分层结构（由上往下依次为）：纤维层（相当于骨膜），增生活跃的纤维母细胞层，纤维软骨层，软骨化骨区域。结论甲下外生性骨疣是一类少见的好发于青少年手足骨的良性骨软骨增生性病变。病理诊断应把握其特征性的影像学和镜下HE形态学表现，并注意与其他骨软骨增生性病变，特别是骨软骨瘤的鉴别。准确的诊断有助于指导病人的治疗和对预后的评估。

Purpose To investigate the clinicopathologic features of subungual exostosis. Methods Archival subungual exostosis was retrieved in the Department of Pathology, Shanghai 6th People＇s Hospital. Clinical history, gross records, and HE slides were collected and reviewed. Results In total 22 cases of subungual exostosis between 2000 and 2006, there were 11 men and 11 women with median age of 25.7 years. Ages younger than 20 years old were seen in 13 cases （59%）. The lesions located in foot digits were 19 cases （86.36%）, and in fingers were 3 cases （ 13.64% ）. Among 19 foot lesions, 13 on left side, 5 on right side, and 1 involving both sides. Lesions on the great toe accounted for 14 cases （63.63%）. X-ray revealed dense mineralized lesion attaching to the surface of the distal phalanx, with no medullary connection between the normal bone digit and lesion, nor cortical defect at the base of the lesion. Microscopically, subungual exostosis demonstrated well-arranged zones of proliferation and development （from the outer surface to the inner base） ： fibrous zone, representing periosteum; active fibroblast proliferation zone; fibrocartilage zone; trabecular bone formation zone. Conclusion Subungual exostosis is a type of uncommon benign neoplastic lesion, often occurring on hand and foot bone of teenagers. In the routine practice, it should be differentiated from other lesions of osteochondromatous proliferation, especially osteochondroma. Accurate diagnosis, based upon its characteristics on imaging and microscopic appearance, is important for clinical management.