足趾纤维骨性假瘤病理形态及免疫组化研究

The Pathological Morphology and Immunohistiochemistry Study of the Fibro-osseous Pseudotumor in Toe

目的 :对 1例罕见的足趾纤维骨性假瘤进行病理形态及免疫组化研究。方法 :标本采用常规石蜡切片、HE染色及ABC法免疫组化染色 ,光镜观察。结果 :本例在显微镜下最显著的特点为在多量增生及玻变的纤维结缔组织及成束的纤维母细胞中有多量散在小梁状的、条索状的及斑片状的分化较成熟的骨样组织。在骨样组织之间可见岛状的及片状的组织细胞样细胞浸润 ,并可见散在分布的破骨细胞样多核巨细胞及成片的泡沫状细胞。病变内细胞表达Vimentin阳性、上皮细胞性能标记、肌源性标记、神经内分泌标记及F8因子等阴性。结论 :本例手术中见肿块将屈趾肌腱包裹在内 ,镜下见病变内有多量组织细胞样细胞浸润和不规则狭长裂隙 ,支持其起始部位肌腱和腱鞘 ,因而好发生于指、趾。可能本病在早期细胞成份较丰富 ,增生较活跃 ,可有不同程度的异型性和核分裂 ,而到晚期则以致密区域为主 ,随着胶原纤维的不断增多 ,细胞成份则趋于减少且分化成熟 ,而异型性及核分裂则趋于消失。本病应与骨旁骨肉瘤、骨化性肌炎、钙化性腱膜纤维瘤、骨母细胞瘤、腱鞘巨细胞瘤及结节性筋膜炎等相鉴别。

Objective:To investigate the pathological morphology and immunohistiochemistry characteristics of a rare case of fibro-osseous pseudotumor in toe. Methods:The routine paraffin slides were cut, stained with H.E and stained immunochemically with ABC method. Then the slides were observed under optical microscope.Results:The most remarkable morphological characteristics of the lesion under microscope were that in large amount of proliferative and hyaline degenerative fibrous connective tissue, there were many of trabeculae, cords and patches of relatively mature osteoid. Among the osteoid, there were islands and sheets of histiocytolike cells infiltration and scattered osteoclastlike multinuclear giant cells and sheets of foam cells. In immunohistiochemically stained slides, except for Vimentin, the cells in the lesion expressed the epithelial, muscles and neuroendocrine marks and F8 factor negative. Conclusion:It could be seen in operation that the masses wrapped up the tendon and tendon sheaths of flexor digitorum and under microscope there were islands and sheets of histocytolike cells infiltration and long irregular narrow cracks, which indicated that the primary location of the lesion may be tendon and tendon sheaths so that the lesion was prevalent in digits. It was likely that during the early period in the lesion the cells were rich, actively proliferative and showed some degree atypia and mitosis and in later period the lesion tended to be compact, along with the continous increase of collagen, the cell component tended to decrease and differentiate maturely, and the cellular atypia and mitosis tended to disappear.The differential diagnosis should be made for the lesion with parosteal sarcoma, myositis ossificans calcifying aponeurotic fibroma,osteoblastoma, giant cell tumor of tendon sheath and nodular fascitis.