Extradural Nodular Fasciitis Arising in the Spinal Canal
Extradural Nodular Fasciitis Arising in the Spinal Canal
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DOI：
10.1097/brs.0b013e318224568a
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发表时间：
2012-01-15
期刊：
影响因子：
3
通讯作者：
Iwamoto, Yukihide
中科院分区：
文献类型：
--
作者：
Kubota, Kensuke;Okada, Seiji;Iwamoto, Yukihide
研究设计。report.Objective。描述一位腰硬膜外间隙结节性筋膜炎患者。背景资料摘要。结节性筋膜炎是成纤维细胞和肌成纤维细胞的良性增生。它通常发生在上肢、躯干、头部和颈部的皮下组织，但很少发生在椎管。一个7岁的男孩在他的下背部挫伤后，经历了从双侧臀部到下肢逐渐增加的强烈放射性疼痛。计算机断层扫描和磁共振成像显示从第一腰椎（L1）到第二腰椎的背侧硬膜外间隙有一个相对局限的肿块。基于放射学表现的推定诊断包括侵袭性肿瘤，如骨骼外尤文氏肉瘤/原始神经外胚层肿瘤或恶性淋巴瘤。患者行L1-L2椎板切除术并切除肿瘤。组织学上，肿瘤主要由梭形细胞增生组成，无异型性，波形蛋白和平滑肌肌动蛋白阳性，粘液样区具有松散的羽状纹理。这些表现是结节性筋膜炎的典型特征。手术减轻了患者的疼痛，在最近4年的随访中没有复发的迹象。本文报告一例发生于腰椎管的罕见硬膜外结节性筋膜炎，由于其生长迅速且无明显的影像学特征，可能被误诊为恶性肿瘤，如骨骼外尤文氏肉瘤/原始神经外胚层肿瘤。详细的组织病理学检查包括免疫组织化学对正确诊断很重要。
Study Design. Case report.Objective. To describe a patient with nodular fasciitis arising in the lumbar extradural space.Summary of Background Data. Nodular fasciitis is a benign proliferation of fibroblasts and myofibroblasts. It commonly occurs in the subcutaneous tissue of an upper extremity, trunk, head, and neck, but rarely arises in the spinal canal.Methods. A 7-year-old boy experienced gradually increasing intense radiating pain from the bilateral buttocks to the lower extremities after a bruise on his lower back. Computed tomography and magnetic resonance imaging demonstrated a relatively circumscribed mass in the dorsal epidural space from the first lumbar vertebra (L1) to L2. The presumptive diagnosis based on the radiologic findings included aggressive neoplasm such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor or malignant lymphoma.Results. The patient underwent L1-L2 laminectomy and resection of the tumor. Histologically, the tumor was mainly composed of a proliferation of spindle cells without atypia, positive for vimentin and smooth muscle actin, and myxoid areas with a loosely textured feathery pattern. These findings are the typical features of nodular fasciitis. Surgery relieved the patient's pain, with no evidence of recurrence at a recent 4-year follow-up.Conclusion. This report presents a very rare case of extradural nodular fasciitis arising in the lumbar spinal canal, which could have been misinterpreted as a malignant tumor such as extraskeletal Ewing sarcoma/primitive neuroectodermal tumor because of its rapid growth and absence of distinguishing radiologic features. A detailed histopathologic examination including immunohistochemistry is important for the correct diagnosis.