Division of General Radiology, Department of Radiology, Medical University of Graz, Graz, Austria.
Diagnostic and Research Institute of Pathology, Medical University of Graz, Graz, Austria.
Int J Surg Pathol. 2020 Sep;28(6):672-677. doi: 10.1177/1066896920908054. Epub 2020 Feb 23.
. Nodular fasciitis (NF) is a self-limiting, benign mesenchymal neoplasm of fibroblastic/myofibroblastic origin. Due to the fast growth, cellularity, and frequently observed high mitotic count, it is commonly misdiagnosed as a sarcoma, often resulting in overtreatment. Intraarticular examples of NF are extremely rare. Radiologically, NF can mimic fibroma of the tendon sheath, tenosynovial giant cell tumor, and synovial chondromatosis. Histology can vary from hypercellular, mitotically active lesions to fibrotic, less cellular ones, and can, therefore, mimic other benign and low-grade malignant neoplasms. Recently, the fusion has been found in up to 92% of NF. . In this article, we report a case of a 38-year-old patient with an intraarticular lesion, radiologically suspicious of tenosynovial giant cell tumor. Histology demonstrated a spindle cell lesion composed of fibroblasts/myofibroblasts embedded in a highly collagenous/hyalinized stroma, partly arranged in short fascicles. Extravasated erythrocytes and rare mitotic figures were present. Immunohistochemically, tumor cells expressed smooth muscle actin and were negative for desmin, β-catenin, CD34, and SOX10. These findings rendered the diagnosis of NF. Molecular analysis using next-generation sequencing (Archer FusionPlex Sarcoma Panel) revealed gene rearrangement involving and supporting the diagnosis of NF in the knee joint. . Radiological and histological features of NF can overlap with other benign and low-grade malignant lesion. Identification of the gene rearrangements or finding of the fusion, especially in core needle biopsies and in the lesions occurring at unusual sites, can result in adequate therapeutic approach avoiding overtreatment.
结节性筋膜炎(NF)是一种自限性、良性的间叶性肿瘤,来源于成纤维细胞/肌纤维母细胞。由于其快速生长、细胞丰富且有较高的有丝分裂计数,常被误诊为肉瘤,导致过度治疗。关节内的 NF 极为罕见。影像学上,NF 可类似于腱鞘纤维瘤、腱鞘巨细胞瘤和滑膜软骨瘤病。组织学上,NF 可以从细胞丰富、有丝分裂活跃的病变到纤维性、细胞较少的病变,因此可以模拟其他良性和低度恶性肿瘤。最近,高达 92%的 NF 中发现了 融合。在本文中,我们报告了一例 38 岁患者,关节内病变,影像学上怀疑为腱鞘巨细胞瘤。组织学显示梭形细胞病变,由成纤维细胞/肌纤维母细胞组成,嵌入高度胶原化/玻璃样化的基质中,部分排列成短束。存在渗出的红细胞和罕见的有丝分裂象。免疫组化显示肿瘤细胞表达平滑肌肌动蛋白,而 desmin、β-catenin、CD34 和 SOX10 阴性。这些发现提示 NF 的诊断。使用下一代测序(Archer FusionPlex Sarcoma Panel)进行的分子分析显示涉及 和 的基因重排,支持膝关节 NF 的诊断。NF 的影像学和组织学特征可能与其他良性和低度恶性病变重叠。识别基因重排或发现 融合,特别是在常规活检和不常见部位的病变中,可以采取适当的治疗方法,避免过度治疗。
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