头面部弥漫性腱鞘巨细胞瘤二例误诊原因及病理分析  

Diffuse-type Giant Cell Tumor of Tendon Sheath on Craniofacial Region: Causes of Misdiagnosis and Clinicopathological Features of Two Cases

作　　者：晏红[1] 朱薇[1] 向琳[1] 刘建莉[2] YAN Hong;ZHU Wei;XIANG Lin;LIU Jian-li(Department of Pathology,the Second Hospital of Lanzhou University,Lanzhou 730030,China;Department of Radiology,the Second Hospital of Lanzhou University,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院病理科,兰州730030 [2]兰州大学第二医院放射科,兰州730030

出　　处：《临床误诊误治》2018年第4期18-21,共4页Clinical Misdiagnosis & Mistherapy

基　　金：甘肃省卫生行业科研计划项目(GSWSKY2016-06)

摘　　要：目的探讨头面部弥漫性腱鞘巨细胞瘤的临床表现及病理学特点,以减少临床误诊误治。方法回顾性分析2例头面部弥漫性腱鞘巨细胞瘤误诊病例资料。结果 1例以左侧颞部肿物伴左耳听力下降2年余就诊,1例以耳鸣、听力下降1年余就诊,查体及影像学检查见颞下颌关节区的关节外肿物,侵犯乳突、颞骨等。1例在外院和我院术前分别误诊为脑膜瘤和软骨母细胞瘤。另1例外院未明确诊断,我院术前考虑软骨来源肿瘤。两例术后病理组织学特点为弥漫排列的滑膜样细胞背景中散在多核巨细胞;免疫组织化学染色示:CD68、Vim(+),S-100(-),Ki-67阳性率2%。均确诊为头面部弥漫性腱鞘巨细胞瘤。术后行放射治疗,随访1~2年均无复发。结论头面部弥漫性腱鞘巨细胞瘤是临床少见的良性肿瘤,可以颞部肿物、听力障碍为主要表现,由于临床表现无特异性,易误诊;加强对本病的认识,及早行组织病理学检查并结合临床表现,可避免误诊误治。Objective To investigate the clinical manifestations,imaging and pathological features of diffuse-type giant cell tumor of tendon sheath on craniofacial region,so as to reduce misdiagnosis.Methods Clinical data of 2 cases of diffuse-type giant cell tumor of tendon sheath on craniofacial region were analyzed retrospectively and related literature was reviewed.Results One patient presented with left temporal tumor with hearing loss in the left ear for more than two years,whereas the other patient had tinnitus and hearing loss for more than one year.Physical and imaging examination revealed extra-articular mass in temporomandibular joint area,affecting mastoid and temporal bone in both cases.The first patient was misdiagnosed as meningioma and cartilaginous tumor prior to operation in the other hospital and our hospital respectively.There was no definite diagnosis in the second patient,who was diagnosed with tumor originated from cartilage in our hospital.Histopathology showed diffuse-type multinucleated giant cells in synovial cells that were diffusely distributed.Immunohistochemistry indicated CD68(+),Vim(+),S-100(-),and Ki-67(2%).Both were pathologically confirmed as diffuse-type giant cell tumor of the tendon sheath in the head and face postoperatively.Conclusion Diffuse-type giant cell tumor of the tendon sheath in the head and face is a rare benign tumor in clinic setting,which can be seen in patients with hearing impairment or temporal tumor.Given its atypical characteristics that contributes to difficult diagnosis,clinical features coupled with timely histopathology and immunohistochemistry examination can help avoid misdiagnosis.

关 键 词：巨细胞瘤 腱鞘 误诊 脑膜瘤 软骨母细胞瘤 

分 类 号：R730.262[医药卫生—肿瘤]