Zhang Liuzhe, Kobayashi Hiroshi, Ikegami Masachika, Ohki Takahiro, Shinoda Yusuke, Tanaka Sakae, Kawano Hirotaka
Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Teikyo University, 2-11-1, Kaga, Itabashi-ku, Tokyo 173-8606, Japan.
Int J Surg Case Rep. 2020;69:96-100. doi: 10.1016/j.ijscr.2020.03.039. Epub 2020 Apr 1.
Calcifying aponeurotic fibroma is an uncommon type of tumor that primarily occurs in the distal extremities of young children. It usually appears as a slow-growing and asymptomatic soft-tissue mass and rarely causes complications, such as joint contractures.
We present a case of calcifying aponeurotic fibroma that caused knee contracture and leg length inequality, in which the affected leg was longer than the other. On the patient's first visit to our hospital at 8 years of age, a solid nodule was palpable at the medial distal area of her right thigh. Magnetic resonance imaging showed a T1WI-low, fs-T2WI-slightly high 60-mm lesion on the vastus intermedius muscle with enhancement caused by a gadolinium agent. Tumor resection surgery, which was preceded by an incisional biopsy that resulted in calcifying aponeurotic fibroma, improved the knee's range of motion (extension-flexion improved from 0-80° to 0-120°). For the remaining leg length inequality of 35 mm, epiphyseal arrest surgery is planned.
Very infrequently, calcifying aponeurotic fibroma can cause infant knee contracture and leg length inequality. These symptoms were seemingly caused, respectively, by fascia adhesion and by increased blood flow around the metaphysis. Timely diagnosis and appropriate surgical intervention may improve functional prognosis in affected patients.
钙化性腱膜纤维瘤是一种罕见的肿瘤类型，主要发生于幼儿的四肢远端。它通常表现为生长缓慢且无症状的软组织肿块，很少引起诸如关节挛缩等并发症。
我们报告一例钙化性腱膜纤维瘤病例，该病例导致膝关节挛缩和腿长不等，患侧腿比另一侧长。患者8岁首次来我院就诊时，在其右大腿远端内侧可触及一个实性结节。磁共振成像显示在股中间肌上有一个大小为60毫米的病变，T1加权像呈低信号，脂肪抑制T2加权像呈稍高信号，钆剂增强。在进行肿瘤切除手术之前先进行了切开活检，结果确诊为钙化性腱膜纤维瘤，术后膝关节活动范围得到改善（屈伸角度从0-80°改善至0-120°）。对于剩余35毫米的腿长不等问题，计划进行骨骺阻滞手术。
钙化性腱膜纤维瘤极少会导致婴儿膝关节挛缩和腿长不等。这些症状似乎分别是由筋膜粘连和干骺端周围血流增加引起的。及时诊断和适当的手术干预可能会改善受影响患者的功能预后。
