增生性筋膜炎临床病理分析

Clinicopathologic features of proliferative fasciitis

目的:探讨增生性筋膜炎的临床病理特点。方法:例1为男性患者,74岁,发现右颌下区包块1周;例2为女性患者,71岁,发现左颈部包块1周,迅速长大3 d。观察2例增生性筋膜炎的组织学及免疫表型并复习相关文献。结果:2例患者镜下见肿块由大量形态不规则的梭形细胞组成,呈致密区与疏松区交替排列。致密区中梭形细胞排列成编织状、席纹状。疏松区梭形细胞呈束带状排列于胶原和黏液样间质为主的间质中,其间可见神经节样大细胞。免疫组织化学显示:例1梭形细胞的波形蛋白(vimentin)、平滑肌肌动蛋白(smooth muscle actin,SMA)、钙调蛋白结合蛋白和肌动蛋白结合蛋白呈阳性表达,不表达可溶蛋白-100(soluble protein-100,S-100)和细胞分化簇(cluster of differenation 34,CD34);例2梭形细胞的vimentin和SMA呈阳性表达,不表达细胞角蛋白(cytokeratin,CK)、S-100、人黑色素相关抗体(human melanoma-related antibody 45,HMB45)和CD34,两例Ki-67阳性率均低于2%。结论:增生性筋膜炎是一种罕见的良性增生性病变,手术切除是主要治疗手段。因其临床及病理特征,易被误诊为恶性肿瘤而予以后续的放射治疗和化学治疗,故应加强对该病的认识,避免误诊和漏诊。

Objective：To explore the clinicopathologic features of proliferative fasciitis（PF）.Methods：Case 1 was a 74-yearold man with a nodular for 1 week in the right submandibular region.Case 2 was a 71-year-old woman with a nodular for 1 week in the left neck region,which enlarged rapidly during the past 3 days.The histological and immunological phenotype in the 2 patients with PF was studied and the related literatures were reviewed.Results：Macroscopically,the tumor was composed of variable spindle cells in condense or in loose region.Spindle cells in condense region were braided and storiform.In loose region,the strapped spindle cells were embedded in collagen and myxoid stroma,which arranged in zone,and the ganglion-like cells were observed in some areas.Immunochistochemically,the staining of vimentin,smooth muscle actin（SMA）,caldesmon and calpoinin was positive in the spindle cells,and the staining of soluble protein-100（S-100） and cluster of differenation 34（CD34） was negative in the Case 1.Meanwhile,the staining of vimentin and SMA was positive in the spindle cells,and the staining of cytokeratin（CK）,S-100,human melanoma-related antibody 45（HMB45） and CD34 was negative in the Case 2.The positive rate of Ki-67 was below 2% in the two patients.Conclusion：PF is a rare benign lesion,and surgical operation is main treatment.Because of its clinical and pathological features,the PF is misdiagnose with the malignant tumor and accepts radiotherapy and chemotherapy,so it is important to improve our knowledge and diagnosis ability.