Mentzel T, Goodlad J R, Smith M A, Fletcher C D
Department of Pathology, University of Jena, Germany.
Mod Pathol. 1997 Apr;10(4):334-40.
We describe the clinicopathologic features of four cases of ancient hematoma occurring in the tensor fascia lata and perifascial tissue that clinically and radiologically mimicked aggressive soft tissue neoplasms. The lesions arose in three men and one woman, aged between 31 and 61 years. In three cases, an injury to the affected site had been noted 18 months, 19 years, and 20 years beforehand, respectively. At presentation, these deep-seated and enlarging lesions were highly suggestive of soft tissue sarcomas. Three lesions were treated by excision of an intramuscular or perifascial mass; in one case, repeated incomplete excisions were performed. Grossly, in three cases a well-circumscribed, fusiform mass with a soft cystic center and a fibrous pseudocapsule was described. Histologically, blood clot, fibrin, and predominant amorphous debris were seen in the central cavities; in three cases, the fibrous pseudocapsule contained clumped, eosinophilic, amorphous debris surrounded by a prominent xanthogranulomatous inflammatory infiltrate with numerous, multinucleated, foreign body-type, giant cells. Additionally, cholesterol clefts, areas of hemorrhage and dystrophic calcification, hemosiderin deposits, and cellular scar tissue were seen. Follow-up information revealed no evidence of recurrence or secondary infection in the three cases treated by local or wide excision; in the case in which incomplete excision was performed, continuous symptomatic growth was noted. Pathologic features of ancient hematomas are similar, if not identical, to those hematomas described previously as calcific myonecrosis, chronic expanding hematoma or posttraumatic cyst of soft tissues; we propose instead the term ancient hematoma. The reason for the commonly very long delay between the initiating trauma and presentation is uncertain.
我们描述了4例发生于阔筋膜张肌和筋膜周围组织的陈旧性血肿的临床病理特征，这些血肿在临床和放射学上酷似侵袭性软组织肿瘤。病变发生于3名男性和1名女性，年龄在31至61岁之间。3例中，分别于发病前18个月、19年和20年记录到患部有损伤。就诊时，这些深部且不断增大的病变高度提示为软组织肉瘤。3例病变通过切除肌内或筋膜周围肿块进行治疗；1例进行了多次不完全切除。大体上，3例描述为边界清楚的梭形肿块，中心为软囊性，有纤维性假包膜。组织学上，中央腔内可见血凝块、纤维蛋白和主要为无定形碎片；3例中，纤维性假包膜内含有聚集的嗜酸性无定形碎片，周围有显著的黄色肉芽肿性炎性浸润，伴有大量多核异物型巨细胞。此外，可见胆固醇裂隙、出血和营养不良性钙化区域、含铁血黄素沉积及细胞性瘢痕组织。随访信息显示，经局部或广泛切除治疗的3例无复发或继发感染迹象；进行不完全切除的病例中，病变持续有症状性生长。陈旧性血肿的病理特征即使不完全相同，也与先前描述的钙化性肌坏死、慢性扩展性血肿或软组织创伤后囊肿相似；我们建议采用“陈旧性血肿”这一术语。起始创伤与就诊之间通常间隔很长时间的原因尚不确定。
