Yoshioka Takashi, Muro Masahiko, Kumano Kenjiro, Yamashita Tetsumasa, Kurose Youhei, Kubo Shinichirou, Nojima Hiroki, Nakano Kanyu, Asami Shinya, Sasaki Hiroshi, Idani Hitoshi, Kin Hitoshi, Takakura Norihisa
Department of Surgery, Fukuyama City Hospital, Fukuyama, Japan.
Kyobu Geka. 2010 Jun;63(6):512-5.
A 72-year-old woman was reffered to our hospital for further examination of a tumor shadow in the left upper lung field which was detected in a mass screening chest X-ray. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a chest wall tumor located in the left 4th intercostal space. The lesion was suspected to be neurogenic tumor and CT-guided needle biopsy was performed. The tumor was consisted of spindle-shaped cells, but immunohistochemistry demonstrated no evidence of neurogenic tumor. As a possibility of malignant tumor could not denied, we performed tumor resection under video-assisted surgery. The lesion was not originated from nerves, but adhered to the intercostal muscle. Histologically, the tumor was consisted of spidle-shaped cells without atypia which sparsely proliferate in the myxoid stroma adjacent to intercostal muscle. In immunohistochemistry, tumor cells were positive for vimentin, and negative for desmin, S-100 protein, smooth muscle actin, CD34 and factor VIII. It was diagnosed as intramuscular myxoma. This histology in the intercostal muscle is extremely rare.
一名72岁女性因在大规模胸部X线筛查中发现左上肺野有肿瘤阴影而被转诊至我院进一步检查。计算机断层扫描（CT）和磁共振成像（MRI）显示胸壁肿瘤位于左第4肋间间隙。该病变疑似神经源性肿瘤，遂进行CT引导下针吸活检。肿瘤由梭形细胞组成，但免疫组织化学检查未发现神经源性肿瘤的证据。由于不能排除恶性肿瘤的可能性，我们在电视辅助手术下行肿瘤切除术。病变并非起源于神经，而是附着于肋间肌。组织学上，肿瘤由无异型性的梭形细胞组成，这些细胞在与肋间肌相邻的黏液样基质中稀疏增殖。免疫组织化学检查显示，肿瘤细胞波形蛋白阳性，结蛋白、S-100蛋白、平滑肌肌动蛋白、CD34和因子VIII阴性。诊断为肌内黏液瘤。这种发生于肋间肌的组织学表现极为罕见。
