39例结节性筋膜炎临床病理分析

Clinicopathologic Analysis of 39 Cases with Nodular Fasciitis

目的 :探讨结节性筋膜炎 (NDF)的临床病理特点及鉴别诊断要点。方法 :用光镜、免疫组化方法观察 3 9例NDF病理组织学特点 ,分析其临床资料 ,并文献复习。结果 :临床上有两个重要的特点即结节生长迅速、体积小 ,且境界不清。光镜下NDF的特点是 :疏松的粘液样基质中有丰富的增生活跃核肥硕的梭形细胞 ,基质常有小裂隙形成 ;有丰富的新生的毛细血管、红细胞外渗和少量的炎性细胞 ;间质中可有少量胶原带。根据组织学可以分为三型 :粘液型 ( 13例 ) ,肉芽肿型 ( 2 0例 ) ,纤维瘤型 ( 6例 )。免疫组化标记显示梭形细胞对Vimentin和Actin呈阳性反应。结论 :NDF是一种少见的肌纤维母细胞增生性良性瘤样病变 ,在病理形态学上具有多态性 ,熟悉其临床和组织学特点对避免误诊为恶性软组织肉瘤具有重要意义。

Objective: To investigate the clinicopathologic characteristic of nodular fasciitis(NDF) and differential diagnosis. Methods: 39 cases of NDF were observed by light microscopy and immunohistochemistry and their clinical date were reviewed. Results: 39 cases showed two important characteristics of rapidly growth and small volume node without marked circumscription. Histological characteristic was richly marked proliferative spindle cell with hypertrophic nucleus in loose mucous stroma accompanyed with small fissure and richly new capillary?erythocyte exudation, and a small number of inflammatory cell. A small number of collagenosis zone in stroma was found. According to histopathological classification,they was divided into mucoid type (13 cases);granulation type (20 cases), and fibroma type (6 cases). Immunohistochemically, spindle cell were vimentin and actin positive. Conclusion: NDF is a infrequent benign tumorlike leision of myoblastoma proliferation with histopatholgical polymormhisms. Recognizing this entity is important to avoid confusion with malignant soft tissue sarcomas.