Lu Linhui, Lao I Weng, Liu Xiaohang, Yu Lin, Wang Jian
Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China 200032.
Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China 200032.
Ann Diagn Pathol. 2015 Jun;19(3):180-5. doi: 10.1016/j.anndiagpath.2015.03.013. Epub 2015 Apr 6.
Our aim is to describe the largest series of nodular fasciitis (NF) with emphasis on the clinicopathologic and radiologic correlation. A total of 272 cases of NF were diagnosed between 2004 and 2014 at our institution. There were 160 males and 112 females with age ranging from newborn to 77 years (mean, 36 years). The upper extremity was the most common location (34%), followed by the head and neck region (24%), trunk (21%), and lower extremity (14%). By radiology, the lesion appeared as well-defined homogeneous mass with low or isodensity on computed tomography, homogenous hypointense or isointense on T1-weighted sequences, and heterogeneous intermediate-to-high signal on T2-weighted sequences. Although all cases were composed of short intersecting fascicles of uniform plump spindle cell, the cellularity and stromal components varied considerably between different cases. In intramuscular or deeply seated NFs, extension into adjacent skeletal muscles or structures was often noted. Immunohistochemically, all cases showed diffuse staining for smooth muscle actin and calponin, with consistent negativity for desmin, h-caldesmon, and β-catenin. Of patients with available followed up information, only 1 experienced local recurrence due to incomplete excision. Our comprehensive study further demonstrated that NF had a wide clinicopathologic spectrum. Correlation with the radiologic features may help pathologists in arriving at an accurate diagnosis.
我们的目的是描述最大系列的结节性筋膜炎（NF），重点在于临床病理与放射学的相关性。2004年至2014年期间，我们机构共诊断出272例NF。其中男性160例，女性112例，年龄从新生儿至77岁（平均36岁）。上肢是最常见的发病部位（34%），其次是头颈部（24%）、躯干（21%）和下肢（14%）。在放射学上，病变在计算机断层扫描上表现为边界清晰的均匀肿块，密度低或等密度，在T1加权序列上呈均匀低信号或等信号，在T2加权序列上呈不均匀的中高信号。尽管所有病例均由短而交叉的均匀丰满梭形细胞束组成，但不同病例之间的细胞密度和间质成分差异很大。在肌内或深部NF中，常可见病变延伸至相邻骨骼肌或结构。免疫组织化学检查显示，所有病例平滑肌肌动蛋白和钙调蛋白呈弥漫性染色，结蛋白、h-钙调蛋白和β-连环蛋白始终为阴性。在有随访信息的患者中，只有1例因切除不完全而出现局部复发。我们的综合研究进一步表明，NF具有广泛的临床病理谱。与放射学特征的相关性可能有助于病理学家做出准确诊断。
