甲下外生性骨疣的临床病理分析

Clinicopathologic analysis of subungual exostosis

目的阐述甲下外生性骨疣的临床、影像、病理特征。方法收集中国医科大学附属盛京医院2006年1月～2011年12月甲下外生性骨疣14例进行分析,并参阅文献。结果 14例患者平均年龄13岁,11例位于拇趾,病程2个月～3年,临床上出现甲下或甲旁的结节、疼痛、感染、趾甲异常。X线多表现为趾骨远端的骨性突起,基底与趾骨相连,大小0.5～1.2厘米。组织学上,表现为基底的成熟骨组织表面被覆纤维软骨。有随访结果的6例中1例术后1年复发。结论甲下外生性骨疣有典型的临床、影像、病理特点。手术时应确认肿物和甲床的关系,做到既将肿物完全切除以防止复发,同时又保护甲床,对甲床进行精确的修复以尽量避免指甲变形或丧失。

Objective To study the clinicopathologic features and behavior of subungual exotosis. Methods We performed a retrospective analysis of 14 cases diagnosed as subungual exotosis between January 2006 and December 2011. Results The average age of the 14 cases at diagnosis of subungual exotosis was 13 years. 11 of the 14 cases occurred on the distal phalanx beneath or beside the nail of great toe. Radiography revealed a calcifying projection firmly attached to the underlying distal phalanx. Histologically, subungual exostosis was composed of a mature trabecular bone base with a proliferating fibrocartilaginous cap. Conclusion Subungual exostosis has distinctive clinical, radiographic, and pathological features. Perioperative confirmation of the attachment of the tumor to the nail matrix can help the clinician to design and perform the removal cautiously, so the tumor can be excised completely and the nail plate can be meticulously repaired.