Raab S S, Silverman J F, McLeod D L, Benning T L, Geisinger K R
Department of Pathology and Laboratory Medicine, East Carolina University School of Medicine, Greenville, North Carolina 27858-4354.
Acta Cytol. 1993 May-Jun;37(3):323-8.
Fibromatoses form a spectrum of clinicopathologic entities characterized by the infiltrative proliferation of fibroblasts that lack malignant cytologic features. Fibromatoses present as nodular soft tissue masses almost anywhere in the body and thus are often amenable to fine needle aspiration (FNA). This report describes the FNA cytologic findings of fibromatosis in six patients ranging in age from 7 1/2 weeks to 36 years. Two of the lesions arose in the abdominal wall (musculoaponeurotic fibromatosis or extra-abdominal desmoid), and one each involved the plantar surface (Ledderhose's disease), the shoulder and the sternocleidomastoid muscle (Fibromatosis coli). The FNA of the shoulder was initially interpreted as nodular fasciitis due to the clinical presentation of a rapidly growing mass; an aspirate from the deep musculoaponeurotic region was believed to reveal a low grade sarcoma. The FNA diagnosis of musculoaponeurotic fibromatosis in a patient with familial polyposis coli suggested the diagnosis of Gardner's syndrome. Cytologically the aspirates consisted of groups of loosely cohesive, bland-appearing, spindle-shaped cells having oval to elongated nuclei and cytoplasmic tags. Individual spindle cells and rare inflammatory cells were also present. The aspirate of fibromatosis coli also contained degenerating skeletal muscle cells. Tissue confirmation was obtained in four cases. We believe that FNA is a useful procedure for the initial and recurrent diagnosis of fibromatoses and in the separation of fibromatoses from other benign and malignant soft tissue lesions. A discussion of other entities that enter into the cytologic differential diagnosis, such as mesenchymal repair, fasciitis and spindle cell types of sarcoma, is presented. From our experience we believe that the clinicopathologic features can suggest the diagnosis of fibromatosis, but histologic confirmation is recommended.
纤维瘤病是一系列临床病理实体，其特征为成纤维细胞呈浸润性增殖，且缺乏恶性细胞学特征。纤维瘤病表现为身体几乎任何部位的结节状软组织肿块，因此通常适合细针穿刺抽吸活检（FNA）。本报告描述了6例年龄从7.5周至36岁的纤维瘤病患者的FNA细胞学检查结果。其中2个病变发生在腹壁（肌筋膜纤维瘤病或腹外硬纤维瘤），另外1个分别累及足底（莱德霍斯病）、肩部和胸锁乳突肌（结肠纤维瘤病）。肩部病变的FNA最初因快速生长肿块的临床表现而被诊断为结节性筋膜炎；来自深部肌筋膜区域的抽吸物被认为显示为低级别肉瘤。1例家族性腺瘤性息肉病患者的肌筋膜纤维瘤病FNA诊断提示了加德纳综合征的诊断。细胞学上，抽吸物由成组的松散黏附、外观温和的梭形细胞组成，这些细胞具有椭圆形至细长形核以及胞质突起。也存在单个梭形细胞和罕见的炎性细胞。结肠纤维瘤病的抽吸物中还含有退变的骨骼肌细胞。4例获得了组织学确诊。我们认为FNA对于纤维瘤病的初次和复发性诊断以及将纤维瘤病与其他良性和恶性软组织病变区分开来是一种有用的方法。本文还讨论了其他参与细胞学鉴别诊断的实体，如间充质修复、筋膜炎和肉瘤的梭形细胞类型。根据我们的经验，我们认为临床病理特征可提示纤维瘤病的诊断，但建议进行组织学确诊。
