腱鞘纤维瘤39例临床病理学分析  

Clinicopathological study of fibroma of tendon sheath

作　　者：毛荣军[1] 樊长姝[2] 杨克非[3] 郭莉[4] 谢乐[1] 房惠琼[1] 李启明[1] 

机构地区：[1]广州中医药大学附属佛山市中医院病理科,佛山528300 [2]广州中医药大学附属佛山市中医院影像中心,佛山528300 [3]广州中医药大学附属佛山市中医院手外科,佛山528300 [4]中山大学附属佛山市第一人民医院病理科,佛山528300

出　　处：《临床与实验病理学杂志》2012年第5期533-538,共6页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨腱鞘纤维瘤(fibroma of tendon sheath,FTS)的临床病理学特征。方法对39例FTS的临床表现、影像学及病理学特征进行观察。结果男性24例(61.54%),女性15例(38.46%),男女比为1.6∶1,年龄5～69岁,平均34.56岁。74.36%的病例累及上肢,尤以掌指部为主。临床上,66.67%病例表现为局部无痛性缓慢生长的肿块,33.33%病例伴局部压痛、肿痛症状。10.26%病例曾有局部外伤史,患者术后复发率为14.29%。以MRI为代表的影像学成像显示病变与肌腱、腱鞘或关节囊紧密相连。大体上,病变包膜纤薄或无包膜。镜下病变呈分叶状,每个小叶由稀疏散在的纤维母细胞、裂隙状血管腔隙和大量玻璃样变胶原间质所组成。部分病变形态多样,局部与促结缔组织增生性纤维母细胞瘤、纤维组织细胞瘤或纤维瘤病、结节性筋膜炎及微静脉型血管瘤病变相似。免疫组化示所有成分均表达vimentin,部分梭形及星形细胞表达α-SMA、calponin及CD163,少数病变局灶弱阳性表达β-catenin(胞质)、CD68、MSA及h-Caldesmon,裂隙状腔隙内衬扁平细胞表达CD34、CD31及FⅧRAg,提示为血管性腔隙。结论 FTS是一种相对少见的发生于肌腱、腱鞘或关节滑囊的良性纤维母/肌纤维母细胞增生性病变。典型的FTS多发生于青年人及成年人,以男性居多,好发于上肢,掌指部占多数,少数病变切除后可复发。Purpose To study the clinicopathological features of fibroma of tendon sheath（FTS）. Methods 39 cases of FTS were an- alyzed by the clinical manifestations, imaging features and histopathological characteristics. Results Of 39 cases, 24 （61.54%）were male and 15（38.46% ）were female, male-female ratio is 16 ： 1. The ages of all the patients at the time of the first surgical procedure ranged from 5 to 69 years, with a average of 34. 56 years and with a peak incidence at 20 - 60 years of age. All of the lesions arose in the extremities and in 74. 36% of cases the lesion involved the upper extremity which the hands and fingersbeing the most commonly in- volved sites. Clinically, 66. 67% of patients presented no particular clinical symptoms other than a painless mass. Tenderness or mild pain was present in 33.33% of cases. A history of trauma related to the development of the tumor was known in 10.26% of cases. 14. 29% of cases have a recurrence with 1 to 95 months of follow-up after resection. MRI as a representative of imagings with FTS ap- peared as focal lobular masses adjacent to tendon, tendon sheaths or articular capsule. The lesions were gray-white in general. Most were firm or hard in consistency. Sometimes, they were soft, ＂mucoid＂ and focally cystic. Histologically, it is typically characterized for the lobuled lession by a dense fibrocllagenous stroma with scattered spindle-shaped fibroblasts and narrow slit-like vascular spaces. Histological appearances in some cases may change muhiterminally, similar to desmoplastic fibroblastoma, fibrous histiocytoma, fibro- matosis, nodular faseiitis or microvenular hemangioma. Immunophenotype showed all elements strongly positive for vimentin, partly pos- itive for ot-SMA, ealponin and CD163, and focally, spindle cells stained weakly for 13-catenin（cytoplasm-type）, CD68, MSA and h- ealdesmon, pinacocytes lining in the slit-like spaces stained for CD34, CD31 and FVI^RAg. Conclusions FFS consists of a relatively rare, benign proliferation of fibrobla

关 键 词：软组织肿瘤 肢体肿瘤 腱鞘纤维瘤 临床病理学特征 

分 类 号：R738.6[医药卫生—肿瘤]