Papillard-Maréchal S, Brisse H J, Pannier S, Ilharreborde B, Philippe-Chomette P, Irtan S, Thevenin-Lemoine C, Cellier C, Freneaux P, Klijanienko J, Orbach D
Service de pédiatrie générale, hôpital Ambroise-Paré, 92100 Boulogne-Billancourt, France.
Département de radiologie, institut Curie, 75005 Paris, France.
Arch Pediatr. 2015 Jan;22(1):14-23. doi: 10.1016/j.arcped.2014.10.007. Epub 2014 Nov 4.
Pseudotumoral soft tissue masses in children and adolescents are a frequent reason for consultation and a diagnostic dilemma. Soft tissue malignancies are relatively uncommon, unlike the large number of benign lesions that may be seen in the superficial tissue and that can be diagnosed with clinical characteristics.
This retrospective study concerns 161 children and adolescents less than 20 years old, referred for a soft tissue mass between 2007 and 2011. It describes their epidemiology, clinical characteristics, and course of care to validate a diagnostic strategy for such masses.
Final diagnoses were malignant tumors (44%), benign tumors (32%), and pseudotumoral lesions (24%). Clinical features were similar between these three groups except for age and tumor location, with more benign thoracic masses in younger children. Clinical and radiological association led to an accurate diagnosis for 50% of benign masses and with cytological analysis contribution in 79% of benign tumors and 86% of pseudotumoral lesions. Malignant tumors were suspected in only 39% of cases with radiological exams and in 89% after fine-needle aspiration, an essential additional diagnostic tool. Final diagnoses were formally established through simple standard clinical and radiological evaluation in 19 patients (11.8%; benign tumors, seven patients; malformations, eight patients; post-traumatic lesions, two patients; infection and inflammation, one patient each); ultrasound exam in five patients (3.1%; hemangioendotheliomas, two patients, fascial dehiscence, hemangioma, and vascular malformation, one patient each); MRI in four patients (2.5%; three vascular malformations and one lipoma); CT in two cases (1.2%; vascular malformation and myositis ossificans), and radiological examinations associated with cell aspiration in 15 cases (9.3%; ten benign tumors and five malignant tumors).
A multidisciplinary approach should be requested from oncological, radiological, and pathologic experts to optimize soft tissue mass management as soon as initial investigations start. The authors advise a diagnostic strategy for children with pseudotumoral soft tissue masses.
儿童和青少年的假性肿瘤性软组织肿块是会诊的常见原因及诊断难题。软组织恶性肿瘤相对少见，与之不同的是，大量良性病变可见于浅表组织，可根据临床特征进行诊断。
这项回顾性研究涉及2007年至2011年间因软组织肿块前来就诊的161名20岁以下儿童和青少年。研究描述了他们的流行病学、临床特征及治疗过程，以验证针对此类肿块的诊断策略。
最终诊断为恶性肿瘤（44%）、良性肿瘤（32%）和假性肿瘤病变（24%）。除年龄和肿瘤位置外，这三组的临床特征相似，年幼儿童的良性胸部肿块更多。临床与放射学联合检查对50%的良性肿块可做出准确诊断，细胞学分析对79%的良性肿瘤和86%的假性肿瘤病变有诊断帮助。仅39%的病例通过放射学检查怀疑为恶性肿瘤，而在细针穿刺后这一比例为89%，细针穿刺是一项重要的辅助诊断工具。通过简单的标准临床和放射学评估正式确诊的有19例患者（11.8%；良性肿瘤7例；畸形8例；创伤后病变2例；感染和炎症各1例）；超声检查确诊5例患者（3.1%；血管内皮瘤2例，筋膜裂开、血管瘤和血管畸形各1例）；MRI确诊4例患者（2.5%；3例血管畸形和1例脂肪瘤）；CT确诊2例（1.2%；血管畸形和骨化性肌炎），15例（9.3%）通过放射学检查与细胞抽吸联合确诊（10例良性肿瘤和5例恶性肿瘤）。
一旦开始初步检查，应要求肿瘤学、放射学和病理学专家采用多学科方法，以优化软组织肿块的管理。作者为患有假性肿瘤性软组织肿块的儿童建议了一种诊断策略。
