Purpose To study the climcopathologic characteristics and differential diagnosis of nodular fasciitis ( NF ). Methods 50cases primarily diagnosed as NF were investigated with clinical data analyses, light microscopy and immunochemistry, and the litera tures were also reviewed. Results Among 50 cases. 43 cases were correct. but 7 cases should he classified as other soft tissu tumors. Among 43 cases, 26 cases were males and 17 were females. with age ranging from 18 to 56 years ( mean 32. 5 years ). The le sions occurred in any part of the body, most commonly in the upper extremity ( 20 cases,46. 5％ ). followed by trunk ( 9 cases20. 9％ ). head and neck ( 8 cases. 18. 6％ ), and lower extremity was uncommon ( 6 cases, 13. 9％ ). Clinically, NF grew rapidl and often was solitary and small in size. and no recurrence or metastasis after operation. Histopathologically, NF was composed of plump fibrohlasts or myofihroblasts. which often arranged in c-shaped, fascicles or atypical storiform pattern , no pleomorphic cell could seen with more mitoses. The lesions contained loose and myxoid stroma. abundant vessels . extravagated red cells and irregular cranny 7 cases of NF should be diagnosised as myxofihrosarcoma, myxoid liposarcoma. low-grade fibromyxoid sarcoma, palisading fibrous his tiocytoma, cellular fibrous histiocytoma, dermatofibroma and abdominal fibromatos respectively. Immunophenotyping of 11 cases dem onstrated that tumor cells were positive for vimentin, SMA and MSA, but negative for CK, desmin, CD34 and[3-catenin. Conclusion NF is a benign, pseudosarcomaous tumour, which is composed of plump fibroblasts or myofibroblasts. It is important to make a diag nosis in comhination with the clinical and histological features. Overdiagnosis and underdiagnosis should be avoided.%目的 探讨结节性筋膜炎(nodular fasciitis,NF)的临床病理特征及鉴别诊断.方法 重新复查原诊断NF的病例50例,应用光镜和免疫组化技术进行研究,同时复习临床资料并文献复习.结果 50例原诊断NF的病例中,43例仍维持原诊断,7例为其他软组织肿瘤.43例NF中,男26例,女17例,年龄18～56岁,平均32.5岁.病变主要侵犯全身皮下组织,上肢最多见(20例46.5%),其次为躯干(9例20.9%)、头颈部(8例18.6%),下肢少见(6例13.9%).临床表现为病程短、生长迅速的孤立性结节,体积小,术后切除无复发、无转移.病理组织学主要表现为增生肥胖的梭形纤维母细胞/肌纤维母细胞呈束状、C形或不典型车辐状排列,细胞无多形性,核分裂象易见;间质疏松,黏液样,含有丰富的血管及红细胞外渗,以及不规则裂隙、微囊等.另7例分别为黏液纤维肉瘤、黏液型脂肪肉瘤、低度恶性纤维黏液样肉瘤、富于细胞纤维组织细胞瘤、栅栏状肌纤维母细胞瘤、真皮纤维瘤、韧带样纤维瘤,误诊率为14%.免疫表型:11例vimentin、SMA、MSA阳性,而CK、desmin、CD34、β-catenin阴性.结论 NF是一种以纤维母细胞/肌纤维母细胞增生性、良性反应性软组织假肉瘤性病变,病理诊断应紧密结合临床和组织学形态的特征,注意防止过度诊断或诊断不足.
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