肠系膜异位骨化2例临床病理分析.pdfVIP

临床与实验病理学杂志 JClinExpPathol 2011Dec；27(12) ·1333 · 肠系膜异位骨化 2例临床病理分析 陆亚平 ，杨小兵 ，黄文斌 摘要：目的 探讨肠系膜异位骨化(heterotopicmesentericossification，HMO)的临床病理学特征、诊断及鉴别诊断。方法 对2 例HMO的临床、病理组织学形态和免疫组化染色观察 ，并结合文献进行探讨。结果 2例均为男性，有近期腹部手术史 ，临床 表现为急性肠梗阻。大体形态为肠管纤维性粘连，肠系膜僵硬斑块。镜下见 HMO与骨化性肌炎区带生长模式非常相似，骨 样组织、软骨组织、(肌)纤维母细胞无恶性细胞学特征，常伴脂肪坏死及炎症反应发生。免疫标记梭形细胞 Ki一67增殖指数 低 ，脂肪坏死中散在 CD68阳性的组织细胞。结论 HMO属于少见的假肉瘤样反应性病变，应重点与骨外骨 肉瘤鉴别。HMO 的临床和病理改变具有特征性 ，两者密切结合并辅以免疫组化是正确诊断的关键。 关键词：异位骨化；假肉瘤样病变 ；骨化性肌炎 ；肠系膜 中图分类号：R572．3 文献标识码：A 文章编号 ：1001—7399(2011)12—1333—04 Heterotopicmesentericossification：twocasesofreportandreview ofliteratures LU Ya—ping‘YANG Xiao—bing2 HUANG W en—bin ， ， (DepartmentofPathology，RugaoHospitalofTranditionalChineseMedicine，Rugao 226500，China；DepartmentofPathology， NanjingMedicalCollegeFirstHospital，Nanfing 210006，China) Abstract：Purpose Toexplorethe clinicopathologicalfeaturesofheterotopiemesentericossificationanditsdifferentialdiagnosis． Methods Theclinicalfeatures，histopathologyandimmun0phenotypeoftwocasesofheterotopicmesenterieossificationwereanalyzed retrospectively．Results Bothofpatientsweremaleandtheyhadpreviousabdominalsurgery．Theypresentedwithacutebowelob— struction．Grossly，thelesionswerefibrousadhesionsofthesmallbowels，andmesentery ofbowelhadafirm andstiffplaque．Micro— scopically，thelesionsdemonstratedexuberant，reactive(myo)fibroblasticproliferationandosteoidandcartilagefomrationresembling myositisossificans，withfatnecrosisandinflammatorycellinfiltration，and(myo)fibroblasticcellslackedmalignantcytologicfeatures． Immunohist0chemically，theproliferatingindexlabeledbyKi-67inspindlecellswasverylow．ThereweresomeCD68一positivehistio— cyteswithintheaftnecrosis．Conclusions Heterotopicmesentericossificationisararepseudosarcomousreactiveprocesswhichmust bedistinguishedfrom extraskeletalosteosarcoma．Combinedclinicalpathologywithimmunohistoehemistrymaybehelpfulformakinga correctdiagnosisofheterotopicmesent