Cummings T J, George T M, Fuchs H E, McLendon R E
Department of Pathology, Duke University Medical Center, Durham, NC 27710, USA.
Clin Neuropathol. 2004 Jan-Feb;23(1):34-43.
Extracranial subcutaneous masses involving the scalp and/or skull in young children are uncommon lesions that get excised by the neurosurgeon. Although the most common reported lesion is the dermoid cyst, our experience suggests that the spectrum of pathology in these lesions can present diagnostic challenges to the pathologist.
We reviewed 30 consecutive extracranial masses from 29 patients between July 1998 and June 2003.
Hematoxylin and eosin-stained sections were reviewed in all cases, and immunohistochemistry was performed in select cases.
Twenty-three were within the scalp, 5 involved the scalp and skull and 2 were within the limits of the inner and outer tables of the skull. There were 8 dermoid cysts, 2 epidermoid cysts, 6 post-traumatic lesions including 3 calcified cephalhematomas and 3 pseudocysts, 5 vascular lesions including 3 capillary hemangiomas, 1 venous angioma and 1 lymphangioma, 2 cases of cranial fasciitis and 1 case each of benign teratoma, deep granuloma annulare, benign fibrous histiocytoma, congenital melanocytic nevus, hamartoma with ectopic meningothelial elements, cutaneous hyalinised ectopic meningioma and a meningocele with a fibrohistiocytic reaction. No lesions have recurred or exhibited malignant features.
Surgical pathologists and neuropathologists should be aware that the differential diagnosis of "lumps and bumps on babie's heads" is quite varied and can be histologically challenging.
小儿颅外皮下肿物累及头皮和/或颅骨是神经外科医生需切除的罕见病变。尽管报道最多的病变是皮样囊肿，但我们的经验表明，这些病变的病理谱可能给病理学家带来诊断挑战。
我们回顾了1998年7月至2003年6月期间29例患者的30例连续颅外肿物。
所有病例均复查苏木精-伊红染色切片，部分病例进行免疫组化检查。
23例位于头皮内，5例累及头皮和颅骨，2例位于颅骨内外板范围内。包括8例皮样囊肿、2例表皮样囊肿、6例创伤后病变（包括3例钙化性头颅血肿和3例假囊肿）、5例血管性病变（包括3例毛细血管瘤、1例静脉血管瘤和1例淋巴管瘤）、2例颅骨筋膜炎，以及各1例良性畸胎瘤、深部环状肉芽肿、良性纤维组织细胞瘤、先天性黑素细胞痣、伴有异位脑膜内皮成分的错构瘤、皮肤透明变性异位脑膜瘤和伴有纤维组织细胞反应的脑脊膜膨出。无病变复发或表现出恶性特征。
外科病理学家和神经病理学家应意识到，婴儿头部“肿块”的鉴别诊断差异很大，在组织学上具有挑战性。
