滑膜脂肪瘤病的临床病理诊断

Synovial lipomatosis: two cases report and review of literature

目的探讨滑膜脂肪瘤病的临床病理学特征与鉴别诊断。方法报道2例关节滑膜脂肪瘤病,对其进行临床病理学分析并文献复习。结果 1例发生在膝关节,1例发生在髋关节,主要临床症状都是关节疼痛和肿胀,实验室检查无明显异常,其中1例MRI显示关节腔积液,滑膜呈棕榈叶状增生、肥厚。组织学检查显示2例滑膜组织呈绒毛状增生,部分绒毛被覆的滑膜细胞有不同程度增生,绒毛上皮下可见灶性或弥漫的成熟脂肪细胞浸润,少至中量的淋巴细胞、浆细胞及扩张充血的毛细血管在两例都能看到。结论滑膜脂肪瘤病是一种罕见的病因不明的良性关节内病变,对于临床上出现关节疼痛,缓慢发展的关节肿胀以及持续的关节积液的病例,要想到该病的可能,尤其是膝关节,确诊依赖病理组织学诊断。

Objective To investigate the clinicopathologic features and differential diagnosis of synovial lipomatosis .Methods Two cases of synovial lipomatosis were reported ,and the related literatures were reviewed as well .Results Two cases of synovial li-pomatosis were diagnosed on histopathology from year 2010 to 2013,with one in the knee joint and another in the hip joint .Pain and swelling of the joint were major complaints .No abnormality was detected in any laboratory tests .MRI showed joint effusion and the syno-vium suprapatellar bursas remarkably thickened ,like palm leaves in a case .On histopathological examination ,two cases showed villous proliferation of the synovium with focal and diffuse infiltration by mature adipocytes ,amild-to-moderate chronic inflammatory cells infil-trate and congested capillaries were present in two cases .Conclusion Synovial lipomatosis is a rare benign intra-articular lesion of un-known etiology .It should be considered in patients with slowly progressive joint pain and swelling ,persistent joint effusion ,especially the knee,and histopathology is mandatory for a conclusive diagnosis of synovial lipomatosis .