摘要
目的探讨肠系膜异位骨化(HMO)的临床病理学特征、诊断与鉴别诊断要点。方法对1例HMO的临床特征、病理组织学形态和免疫组化染色结果进行观察,并复习相关文献。结果患者有腹部手术史和外伤史,临床表现为肠梗阻。大体形态为肠管纤维性粘连,肠系膜有僵硬斑块。组织学形态与骨化性肌炎相似,肿瘤由呈束状排列的梭形纤维母细胞/肌纤维母细胞、骨和骨样基质、脂肪组织组成,还可见少量的软骨组织,偶见核分裂,但无病理性核分裂,常伴有炎症反应与脂肪坏死。免疫组化:梭形细胞SMA、calponin和desmin(+),脂肪坏死组织中的组织细胞CD68(+),Ki-67增殖指数较低。结论 HMO是一种非常少见的假肉瘤样反应性病变,易误诊为骨外骨肉瘤,需要结合病史、病理组织学形态及免疫表型综合分析确诊。
Objective To investigate the clinincopathologic features,diagnosis and differential diagnosis of heterotopic mesenteric ossification（ HMO）. Methods The clinical features,histopathology and immunophenotype of 1 case of heterotopic mesenteric ossification were analyzed,retrospectively and relevant literatures were reviewed. Results Patients had previous abdominal surgery and trauma history,with bowel obstruction being the most common clinical features. Grossly,the lesions were fibrous adhesions of the small bowels,and mesentery of bowel had a firm and stiff plaque. Microscopical characteristics were similar to that of myositis ossificans,with the tumor containing mainly spindle fibroblasts/myofibroblasts,bone,bone-like matrix,adipose tissue and a small amount of cartilage tissue. Mitosis was occasionally observed with no pathological fission, and inflammation and fat necrosis were often present.Immunohistochemically,SMA, Calponin, desmin were positive in spindle cells and there were some CD68-positive histiocytes within the fat necrosis but the proliferating index labeled by Ki-67 in spindle cells was very low. Conclusion Heterotopic mesenteric ossification is a rare pseudosarcomatous reactive process that may be mistook for extraskeletal osteosarcoma,and confirmed diagnosis should be made after a comprehensive analysis of clinical history,pathological histology and the immune phenotype.
出处
《诊断病理学杂志》
2017年第9期670-673,683,共5页
Chinese Journal of Diagnostic Pathology
基金
江苏省连云港市科技局社会发展计划学科建设课题资助(SH1325)
关键词
异位骨化
肠系膜
病理学特征
鉴别诊断
Heterotopic ossification
Mesentery
Clinincopathologic features
Differential diagnosis
