Schütte H E, van der Heul R O
Department of Radiology, University Hospital Rotterdam-Dijkzigt, The Netherlands.
J Belge Radiol. 1992 Aug;75(4):297-302.
One hundred and thirteen cases in the files of the Netherlands Committee on Bone Tumors were diagnosed as heterotopic soft tissue ossification. Myositis ossificans was diagnosed in 62, ossifying hematoma in 21, and pseudomalignant osseous tumor of soft tissues in 30 cases. Antecedent trauma was present in 37%, 46% and 7%, respectively. Myositis ossificans arose in the large muscle groups of the thighs and upper arms; when closely related to the shaft of a bone, periosteal reactions were more outspoken. Pseudomalignant osseous tumor of soft tissues was located in the hands, feet, and pelvis, some cases were not in muscle groups and some were almost periosteal. Ossifying hematoma was located in the upper and lower legs and usually in close relation to bone. The three entities belong to the same kind of reactive mesenchymal proliferative process. The radiologic and histologic patterns are reflections of whether the lesions are closely localized to bone shafts or in soft tissues, e.g. in muscles and therefore the term "reactive mesenchymal proliferation" is preferred to myositis ossificans, pseudomalignant osseous tumor of soft tissues and ossifying hematoma. Diagnostic problems are encountered in early phases when cellularity, mitotic activity, and infiltrative spread suggest malignancy. Recognition of these reactions in early phases is important to avoid mutilating surgery.
荷兰骨肿瘤委员会档案中的113例病例被诊断为异位软组织骨化。其中62例诊断为骨化性肌炎，21例为骨化性血肿，30例为软组织假恶性骨肿瘤。既往创伤分别见于37%、46%和7%的病例。骨化性肌炎发生于大腿和上臂的大肌群；当与骨干密切相关时，骨膜反应更为明显。软组织假恶性骨肿瘤位于手、足和骨盆，部分病例不在肌群中，部分病例几乎位于骨膜处。骨化性血肿位于小腿和大腿，通常与骨密切相关。这三种病变属于同一种反应性间充质增生过程。放射学和组织学表现反映了病变是紧密局限于骨干还是位于软组织，如肌肉中，因此，相对于骨化性肌炎、软组织假恶性骨肿瘤和骨化性血肿，“反应性间充质增生”这一术语更为可取。在早期阶段，当细胞增多、有丝分裂活性和浸润性扩散提示恶性时，会遇到诊断问题。早期识别这些反应对于避免致残性手术很重要。
