Sarangarajan R, Dehner L P
Lauren V. Ackerman Laboratory of Surgical Pathology, Barnes-Jewish Hospital, Washington University Medical Center, St Louis, MO 63110, USA.
Hum Pathol. 1999 Jan;30(1):87-92. doi: 10.1016/s0046-8177(99)90306-4.
Fasciitis of various types constitutes a distinctive category of soft tissue lesions whose microscopic features are known for their potential to evoke a pathological diagnosis of one or another type of sarcoma. Nodular fasciitis is the archetype of this group of "fibrous tumors." Cranial fasciitis is considered a nonneoplastic lesion similar to nodular fasciitis, which is seen almost exclusively in infants and children and has unique clinicopathologic features. The current study documents our experience with fibrous-myofibroblastic proliferations in extracranial sites, mainly in the head and neck region of young children, whose histological features resemble those of cranial fasciitis. These lesions were composed of loosely arranged spindle to stellate cells in a myxoid background. One patient in the study had both cranial and extracranial involvement. Some histological overlap between nodular fasciitis and cranial-extracranial fasciitis was noted, but the latter lesion tended to be more uniform in appearance than nodular fasciitis with its fascicular, spindle cell features and variability in histological patterns within the same lesion, unlike the more consistently uniform myxoid appearance of the cranial and extracranial lesions. Immunohistochemically, the spindle cells of the extracranial lesions and the one case of cranial fasciitis co-expressed vimentin and smooth muscle actin. The extracranial lesions had a predilection for children in the first year of life with all cases occurring at or before 2 years of age, unlike nodular fasciitis, which is rarely seen in the first 4 to 5 years of life. The cranial and extracranial fasciitides should be differentiated from the fibromatoses that tend to locally recur, unlike the nonrecurring behavior of these lesions in common with the other types of fasciitis.
各种类型的筋膜炎构成了一类独特的软组织病变，其微观特征以可能引发一种或另一种肉瘤的病理诊断而闻名。结节性筋膜炎是这类“纤维性肿瘤”的原型。颅骨筋膜炎被认为是一种与结节性筋膜炎相似的非肿瘤性病变，几乎仅见于婴儿和儿童，具有独特的临床病理特征。本研究记录了我们对颅外部位纤维-肌成纤维细胞增生的经验，主要发生在幼儿的头颈部，其组织学特征与颅骨筋膜炎相似。这些病变由黏液样背景中松散排列的梭形至星状细胞组成。研究中的一名患者同时有颅骨和颅外受累。结节性筋膜炎与颅内外筋膜炎之间存在一些组织学重叠，但后者在外观上往往比结节性筋膜炎更均匀，结节性筋膜炎具有束状、梭形细胞特征，且同一病变内组织学模式存在变异性，这与颅内外病变更一致的均匀黏液样外观不同。免疫组化方面，颅外病变的梭形细胞和一例颅骨筋膜炎病例共表达波形蛋白和平滑肌肌动蛋白。颅外病变好发于1岁以内的儿童，所有病例均发生在2岁或2岁之前，这与结节性筋膜炎不同，后者在生命的最初4至5年很少见。颅骨和颅外筋膜炎应与倾向于局部复发的纤维瘤病相鉴别，而这些病变与其他类型的筋膜炎一样不具有复发行为。
