McDermott M B, Glasner S D, Nielsen P L, Dehner L P
Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes Hospital, MO 63110, USA.
Am J Surg Pathol. 1996 Feb;20(2):148-55. doi: 10.1097/00000478-199602000-00002.
Normal-appearing tissues in non-native sites constitute one of the more common morphologic expressions of abnormal development. The presence of pancreas in the wall or on the serosa of the small intestine and adrenal cortical tissue in a hernia sac are two familiar examples of heterotopias. We report our experience of mature glial tissues in the soft tissues of six children who were between the ages of 4.5 months and 2 years when they presented with a solitary mass on the chest wall (three cases), scalp (two cases) and gluteal region (one case). These tumors were all characterized by pale-staining fibrillary foci of mature neuroglia, which were intensely immunoreactive for glial fibrillary acidic protein in each case. One of the two scalp lesions was accompanied by a nodule of cartilage and a meshwork of pseudovascular spaces, which were decorated with antibodies to vimentin and epithelial membrane antigen consistent with meningothelial tissue. The histogenesis of the neuroglial tissue in the gluteal region and scalp was, respectively, on the basis of a recurrence of a sacrococcygeal teratoma in the former case and sequestered encephaloceles in the last two cases. A facile explanation for the occurrence of neuroglial tissue in the soft tissue of the chest wall in the remaining three cases was less than obvious as none of the patients had accompanying neurologic or anatomic defects and all were in a nonmidline location. These three cases of soft tissue gliomatosis of the chest wall are similar to an earlier example in the recent literature whose histogenesis was as enigmatic as it proved to be in our three cases. Although the histologic and immunohistochemical features of these six cases were very similar in each instance, their origin varied from a recurrent sacrococcygeal teratoma and sequestered encephaloceles to essentially unknown.
非原位出现的外观正常的组织是异常发育较常见的形态学表现之一。小肠壁内或浆膜上存在胰腺以及疝囊内出现肾上腺皮质组织是异位的两个常见例子。我们报告了6例儿童软组织中成熟神经胶质组织的情况，这些儿童就诊时年龄在4.5个月至2岁之间，分别在胸壁（3例）、头皮（2例）和臀区（1例）出现孤立性肿块。这些肿瘤均以成熟神经胶质细胞的淡染纤维灶为特征，每例对胶质纤维酸性蛋白均有强烈免疫反应。头皮的2个病变中有1个伴有软骨结节和假血管间隙网，用波形蛋白和上皮膜抗原抗体染色显示与脑膜内皮组织一致。臀区和头皮的神经胶质组织的组织发生，前者是基于骶尾部畸胎瘤复发，后两例是基于隐蔽性脑膨出。其余3例胸壁软组织中神经胶质组织的出现原因不太明显，因为这些患者均无伴随的神经或解剖缺陷，且均位于非中线位置。这3例胸壁软组织胶质瘤病与近期文献中一个较早的例子相似，其组织发生和我们这3例一样神秘莫测。尽管这6例的组织学和免疫组化特征在每个病例中都非常相似，但其起源各不相同，从骶尾部畸胎瘤复发、隐蔽性脑膨出到基本不明。
