Intradermal Nodular Fasciitis: A Case Report

真皮型結節性肌膜炎：病例報告

呂柏萱(Po-Hsuan Lu) ； 林揚志(Yang-Chih Lin) ； 吳育弘(Yu-Hung Wu)

《中華皮膚科醫學雜誌》 23卷4期 (2005/12) Pp. 212-216

https://doi.org/10.29784/DS.200512.0005

摘要

結節性肌膜炎是肌纖維母細胞的反應性增生，常被誤認為肉瘤。大多位於上肢的皮下組織。有些發生於肌肉內，其他罕見類型有血管型和頭顱型。眞皮型結節性肌膜炎，在1990年首先由Goodlad及Fletcher提出，因其少發於眞皮，可能造成診斷的困難。
一位三十二歲男性病人最近一個月出現頭枕部的疼痛結節。病理切片顯示一界限模糊結節形病灶，由成束的梭形細胞交錯排列在鬆散的黏液基質所組成，並伴隨有局部出血。本例診斷為眞皮型結節性肌膜炎。為了排除顱筋膜炎的可能性，我們安排頭部X光但是無侵犯跡象。核磁共振顯示可能是手術後疤痕的局部低訊號。雖然影像學檢查並無深部侵犯，但皮膚切片邊緣仍有腫瘤細胞浸潤。我們報告一例眞皮型結節性肌膜炎，並對這個病灶的臨床表徵，影像學檢查及病理做一些討論和回顧相關的文獻。

並列摘要

Nodular fasciitis is a reactive myofibroblastic proliferative lesion frequently misdiagnosed as a sarcoma. Most lesions are located in the subcutaneous tissue of the upper extremities. Rarely, intravascular, intradermal, and cranial variants have been described. Intradermal nodular fasciitis, first reported by Goodlad and Fletcher in 1990, may be confused with fibrohistiocytic tumors because of the unexpected location.
A 32-year-old male had a rapidly growing tender nodule in the occipital region of the scalp for one month. Histopathology revealed an ill-defined dermal nodule composed of interwining fascicles of spindle cells in a loose myxoid stroma with focal hemorrhage. The diagnosis was intradermal nodular fasciitis. Because of the possibility of cranial fasciitis, skull films were obtained to evaluate for possible bony involvment, but no lesion was identified. Although the deep surgical margin contained tumor spindle cells, MRI showed only a linear low intensity signal suggestive of scar. We report a case of intradermal nodular fasciitis and discuss the clinical, pathologic and radiographic findings.

並列關鍵字

Intradermal nodular fasciitis ； Cranial fasciitis