Ito M, Matsunaga K, Sano K, Sakaguchi N, Hotchi M
Department of Pathology, Shinshu University School of Medicine, Matsumoto, Nagano, Japan.
Pathol Int. 1999 Feb;49(2):175-9. doi: 10.1046/j.1440-1827.1999.00842.x.
Intravascular fasciitis is a very unusual variant of nodular fasciitis. A unique case of this lesion occurring in the proximal portion of the superficial vein of the forearm in an otherwise healthy 26-year-old man is reported. The intravascular polypoid lesion grew longitudinally along the vascular lumen, was loosely attached to the intimal layer, and was partly anchored beyond the internal elastic lamina into the medial smooth muscle layer. However, extravascular involvement was absent. The histological features were identical to those observed in ordinary cellular nodular fasciitis. Because of its myofibroblastic phenotype exhibited by highly proliferative spindle cells, certain intimomedial myofibroblasts are thought to be the indigenous source of this unique fibroproliferative lesion. Unless the diagnosis of intravascular fasciitis is considered and appropriate differential markers examined, it may be confused with other intravascular lesions, such as intravascular leiomyoma, intravenous pyogenic granuloma, organized thrombus and, even, fibromuscular dysplasia if it arises in the arteries. A simple excision is considered curable. Even so, two recurrent cases have been documented to date.
血管内筋膜炎是结节性筋膜炎一种非常罕见的变异类型。本文报道了一例发生在一名26岁健康男性前臂浅静脉近端的该病变独特病例。血管内息肉样病变沿血管腔纵向生长，松散附着于内膜层，部分锚定在内弹力层之外并深入到中膜平滑肌层。然而，未发现血管外受累情况。其组织学特征与普通细胞性结节性筋膜炎中观察到的特征相同。由于其由高度增殖的梭形细胞表现出的肌成纤维细胞表型，某些内膜中层肌成纤维细胞被认为是这种独特的纤维增生性病变的原发来源。除非考虑血管内筋膜炎的诊断并检查适当的鉴别标志物，否则它可能会与其他血管内病变混淆，如血管内平滑肌瘤、静脉化脓性肉芽肿、机化血栓，甚至如果发生在动脉中还会与纤维肌发育异常混淆。单纯切除被认为可治愈。即便如此，迄今为止已有两例复发病例记录在案。
