Montgomery E A, Meis J M
Department of Soft Tissue Pathology, Armed Forces Institute of Pathology, Washington, D.C.
Am J Surg Pathol. 1991 Oct;15(10):942-8.
Although nodular fasciitis (NF) is a well recognized pseudosarcomatous proliferation, it continues to cause diagnostic problems. We reviewed the clinical, histologic and immunohistochemical features of 53 lesions from 30 male and 23 female patients, ages 8-76 years, that involved the upper and lower extremities, trunk, and head and neck. Sizes ranged from 0.6 to 6.5 cm. The morphologic spectrum was broad, including the classic pattern of delicate fibroblasts suspended in a myxoid matrix, granulation tissue-like areas, solid and whorled myofibroblastic proliferations with multinucleated cells, mucoid cysts, and so-called "ancient" forms with dense, refractile strands of keloid-like collagen. Nodular fasciitis was correctly diagnosed in 23 cases (43%); a sarcoma was diagnosed in 11 (21%). A characteristic immunohistochemical profile emerged wherein 49 of 53 cases stained for smooth-muscle and muscle-specific actins, vimentin, and KP1 (a histiocyte marker), indicating dual myofibroblastic and histiocytic differentiation. None of the lesions expressed keratin, S-100 protein, or desmin. Knowledge of the immunohistochemical profile of nodular fasciitis and its overlap with certain sarcomas can decrease the likelihood of misdiagnosis.
尽管结节性筋膜炎（NF）是一种已被充分认识的假肉瘤性增生，但它仍会引发诊断难题。我们回顾了30例男性和23例女性患者（年龄8至76岁）的53个病变的临床、组织学和免疫组化特征，这些病变累及上下肢、躯干以及头颈部。大小范围为0.6至6.5厘米。形态学谱较广，包括经典模式，即纤细的成纤维细胞悬浮于黏液样基质中、肉芽组织样区域、伴有多核细胞的实性及涡状肌成纤维细胞增生、黏液囊肿以及具有致密、折光性的瘢痕疙瘩样胶原束的所谓“陈旧”形式。结节性筋膜炎在23例（43%）中得到正确诊断；11例（21%）被诊断为肉瘤。出现了一种特征性的免疫组化表现，其中53例中有49例平滑肌和肌肉特异性肌动蛋白、波形蛋白及KP1（一种组织细胞标志物）染色阳性，表明具有双相肌成纤维细胞和组织细胞分化。所有病变均未表达角蛋白、S - 蛋白或结蛋白。了解结节性筋膜炎的免疫组化表现及其与某些肉瘤的重叠情况可降低误诊的可能性。
