增生性筋膜炎3例临床病理分析

Proliferative fasciitis:a clinicopathological analysis of 3 cases

目的探讨增生性筋膜炎的临床病理学特点。方法对3例增生性筋膜炎的临床资料、影像学、病理形态学及免疫组化结果进行分析,并结合相关文献进行复习。结果 3例患者均为女性,平均年龄54岁。肿块发生部位分别在肩胛区、臀部及前臂。临床表现均为短期内出现迅速增大的软组织肿块,伴压痛。MRI示肌肉筋膜层出现软组织肿块,界限欠清,沿筋膜层向肌内生长。镜下均可见纤维组织瘢痕样增生伴慢性炎症细胞浸润,肌间散在一些神经节细胞样或横纹肌样大细胞,胞质丰富,呈嗜碱性,并可见少量横纹肌组织因受到压迫而萎缩。免疫组化示vimentin、calponin和SMA均(+)。3例随访8个月～21年均未见复发。结论增生性筋膜炎是一种发生在肌筋膜的纤维母细胞增生性病变,此种特殊性纤维母细胞可因外伤或其他诱因而迅速增生。对迅速增大的软组织肿块,若MRI上发现肿块位于肌筋膜层时,应考虑增生性筋膜炎的可能。

Objective To discuss the clinicopathological features of proliferative fasciitis.Methods The clinical characteristics,radiologic-pathologic patterns and immunophenotypic features were studied in three cases of proliferative fasciitis,with review of related literatures.Results Three cases were female,with an average age of 54 years.A mass located in scapular area,hip and forearm,respectively.Clinical manifestations were short-term rapid enlargement of a painless soft tissue mass with tenderness.MRI showed that musculoaponeurotic layer appeared a soft tissue mass,clear margin,but along the fascia layer to intramuscular growth.Microscopically,the lesion showed fibrous scar hyperplasia with chronic inflammatory cell infiltration,and some scattered ganglion-like cells or myoid large cells with rich,basophilic cytoplasm,and nearby striated muscular atrophy.Immunohistochemical staining showed that the lesion was positive for vimentin,calponin and SMA.3 cases were followed up for 8 months to 21 years,without recurrence.Conclusion Proliferative fasciitis is a fibroblast hyperplastic lesion in muscle fascia,characterized by rapid proliferation of a special fibroblast due to trauma or other causes.It is easily misdiagnosed as a malignant tumor.If MRI shows a mass lesion in the musculoaponeurotic layer,proliferative fasciitis should be considered.