骨化性肌炎15例的临床病理学分析  

Myositis ossificans ： a clinicopathologic analysis of 15 cases

作　　者：孟淑琴[1] 孙晓淇[1] 宫丽华[1] 黄啸原[1] 席越[1] 

机构地区：[1]北京积水潭医院病理科,100035

出　　处：《中华病理学杂志》2008年第10期665-669,共5页Chinese Journal of Pathology

摘　　要：目的探讨骨化性肌炎的临床病理学特征、诊断及鉴别诊断的意义。方法通过收集骨化性肌炎15例的临床及影像学资料，光镜观察及免疫组织化学EnVision法（波形蛋白、S-100蛋白、结蛋白、平滑肌肌动蛋白、骨连接素、Ki-67染色），分析其临床、影像学、病理学特征及免疫表型。结果15例骨化性肌炎中发病年龄12～46岁，平均年龄31岁，男11例，女4例。发生在长骨皮质外，骨膜下及深部软组织占13例，1例位于髂部，1例位于手掌；15例中8例有明确外伤史，2例有手术史，1例不清楚，4例否认有外伤史。组织学上相应的10例穿刺及8例大体标本分带倾向不明显，均为较活跃的肿瘤样成骨表现，另5例穿刺标本及7例手术大体标本都可观察到较明确的骨化性肌炎分带状结构。术后随诊1年，2例复发。免疫组织化学染色波形蛋白、结蛋白、肌动蛋白及骨连接素均呈不同程度阳性；S-100蛋白2例阳性；Ki-67增殖指数5例为10％，其余为1％。结论骨化性肌炎同骨表面骨肉瘤鉴别诊断在于临床、影像及病理三者结合。Objective To study the clinicopathologic features, diagnosis and differential diagnosis of myositis ossificans （MO）. Methods The clinical features, radiologic results and pathologic findings of 15 cases of MO （including biopsy and surgical specimens ） were analyzed. The hematoxylin and eosin sections were reviewed under light microscope. Immunohistochemical staining for S-100 protein, vimentin, desmin, actin and osteonectin was performed. Results The age of the patients ranged from 12 to 46 years. The male-to-female ratio was 11 ： 4. Thirteen cases were located in the parosteum of long bone or subperiosteal soft tissue. The remaining two cases occurred in iliac region and palm, respectively. Five patients had history of injury, while 2 patients had operation before. Four patients bad no history of trauma and the remaining one had unknown clinical history. Histologically, zonation pattern was not conspicuous in 10 biopsy cases and 8 corresponding surgical specimens. On the other hand, zonation pattern was observed in 5 biopsy cases and 7 corresponding surgical specimens. Follow up revealed relapses in two patients. Immunohistochemical study showed various degree of positivity for vimentin, desmin, actin and osteonectin. S-100 protein was focally positive in 2 of the cases. The Ki-67 index varied from 1% to 10%. Conclusion Correct diagnosis of MO relies on correlation of clinical features, radiologic examination and pathologic findings.

关 键 词：骨疾病 肌炎 骨化性 诊断 鉴别 

分 类 号：R686[医药卫生—骨科学]