- 期刊
Chronic Expanding Hematoma-Report of 2 Cases
慢性擴展性血腫－案例報告
摘要
背景：慢性擴展性血腫是指持續變大及存在超過一個月的血腫。在軟組織中的慢性擴展性血腫有時難以和惡性肉瘤區分，對臨床醫師來說是一個挑戰。目的及目標：藉由介紹兩例少見的慢性擴展性血腫之案例，進行案例分析及文獻回顧。材料及方法：案例一為42歲男性，19年前因下肢脛腓骨開放性骨折接受過闊背肌自由皮瓣手術。病患於就醫前兩周於之前皮瓣捐贈處出現逐漸擴大的背部腫塊，就醫時達到12 × 18公分。案例二為30歲女性，有急性淋巴性白血病的病史經治療達到完全緩解。病患於三個月前於左側臉頰出現逐漸擴大的腫塊，粗針切片顯示紡錘狀細胞瘤。兩位病患都接受外科手術，病理報告均為器質性血腫。結果：慢性擴展性血腫發生在闊背肌自由皮瓣捐贈處及臉部，甚少於文獻中被報告。粗針切片顯示的紡錘狀細胞，可能來自於血腫疤痕化的過程中所出現的肌肉纖維母細胞。單一的粗針切片可能得到完全不同的病理診斷。結論：針對慢性擴展性血腫的病患，手術前要得到確切的診斷有時是很困難的。在面對一些逐漸增大的腫塊時，慢性擴展性血腫是為一個可能的鑑別診斷。
關鍵字
無資料並列摘要
Background:Chronic expanding hematoma is referred to as hematoma that has persisted and increased in size for more than a month after the initiating hemorrhage. Chronic expanding hematoma over soft tissue can manifest as a space-occupying lesion which mimics a sarcoma and is a challenge for clinical doctors.Aim and Objectives:Here we report two such cases, one in a long-ago free latissimus dorsi flap donor site and a second one on the cheek, clinically indistinguishable from soft tissue sarcoma.Materials and Methods:Case 1 is a 42-year-old man who had a left tibia-fibula open fracture status post free latissimus dorsi flap reconstruction 19 years ago. He presented himself to our ER with an enlarged back mass over the flap donor site about 12 × 18 cm for 1 month. Case 2 is a 30-year-old woman with a history of acute lymphoblastic leukemia in complete remission. She had a gradually enlarging swelling over left cheek for 3 months, and core needle biopsy revealed a spindle cell tumor. Both of the cases underwent surgical exploration and the pathology revealed organized hematoma.Results:Chronic expanding hematomas in the latissimus dorsi flap donor site and cheek have rarely been reported in the literature. Spindle cells, such as myofibroblasts, may be present in the chronic expanding hematoma during the process of scarring. A single biopsy may lead to a totally different diagnosis.Conclusion:It was difficult to obtain a definitive diagnosis of the patients with chronic expanding hematoma before surgery. As surgeons, we should consider this disease in cases of a gradually expanding mass.