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1、萬方數(shù)據(jù)·776·中國腫瘤臨床炎性肌纖維母細(xì)胞瘤2007年第34卷第13期摘要炎性肌纖維母細(xì)胞瘤(IMT)是近年被認(rèn)識(shí)和正式命名的獨(dú)立的中間型(低度惡性)腫瘤,涵蓋了以往從炎性反應(yīng)性病變到腫瘤的一系列診斷。發(fā)生于肺和全身各處,表現(xiàn)局部腫塊,可伴有發(fā)熱、體重減輕、盜汗及淋巴結(jié)腫大等全身癥狀。病變以單發(fā)或多灶發(fā)生,局部浸潤性生長,侵犯血管,局部復(fù)發(fā),少數(shù)病程進(jìn)展快而致死。較大腫塊局部浸潤性生長臨床和影像學(xué)頗似惡性腫瘤。組織學(xué)顯示炎癥背景下不同數(shù)量纖維母細(xì)胞、肌纖維母細(xì)胞、淋巴細(xì)胞、漿細(xì)胞、嗜酸性粒細(xì)胞和組織細(xì)胞,間質(zhì)為粘液性、纖維血管
2、性或膠原性。病變可類似炎癥性反應(yīng)性增生,也可出現(xiàn)壞死、細(xì)胞異型增生易與梭形細(xì)胞肉瘤/癌混淆。真正病因尚不清楚,已證實(shí)腫瘤內(nèi)肌纖維母細(xì)胞有間變性淋巴瘤激酶(ALK)基因重排和表達(dá),并有ALK基因與Rb-2蛋白基因的融合,證實(shí)腫瘤性增生本質(zhì)。本文對(duì)該病的認(rèn)識(shí)過程、遺傳學(xué)研究、病理學(xué)、影像學(xué)及臨床行為做一綜述。關(guān)鍵詞炎性肌纖維母細(xì)胞瘤中間型腫瘤診斷InflammatoryMyofibroblasticTumorCaoHaiguangReviewedbyLiuSuxiangENTDepartmentoftheTianjinFirstCen
3、tralHospital.TianjinInflammatorymyofibroblastictumor(IMT)hasbeenrecognizedandformallydescribedasaninter—mediatetypeoftumorwithlowpotentialmalignancy,comprisingarangeofdiagnosesfrompathologicalchangesinvolvedininflammatoryreactionstotumors.Itisfoundinallpartsofthehuman
4、body。usual-lypresentingwithaclinicalmanifestationofalocallumpandgeneralsymptomssuchasfever,weightloss,nightsweatsandlymphadenectasis,etc.Ithasunifocalormuhifoealsymptomswithacapacityforregionalinfiltrativegrowth,vascularinvasion,localrecurrenceandevenrapiddevelopment,
5、causingac—celerateddeathinafewcases.Thetumorscanbeofconsiderablesizeandarecapableofinfiltrativegrowth,mimickingamalignanttumorclinicallyandradiologically.Myofibroblast,lymphocyte,plasmo—cyte,eosinophilgranulocyte,histiocyte,mucousinterstitium,andvascularorcollagenousf
6、iberinvary—ingamountscanbefoundmicroscopically.Thesefeaturesmimicinflammatoryreactivehyperplasiaandalso,butlessSO,necrosis,cellulardysplasiaandfascicularsarcoma.Theexactetiologyofthislesionisunknown.Thereisexpressionofanaplasticlymphomakinase(ALK)inIMTresultingfromafu
7、sionoftheALKgenetotheRan—bindingprotein2(RANBP2)gene.Thediagnosticprocess,genetics,patholo—gy,radiology,andclinicalbehaviorofIMTisdescribedherein.KeywordsInflammatorymyofibroblastomaIntermediatetypetumorDiagnosis1概述炎性肌纖維母細(xì)胞瘤(Inflammatorymyofibroblastictumor.IMT)是一種少見而
8、獨(dú)特的間葉性腫瘤.表現(xiàn)低度惡性或交界性腫瘤特點(diǎn),近年通訊作者:曹海光hg—c@163.netWHO提出此命名。已逐漸得到廣泛認(rèn)同[1,2】。IMT多發(fā)生于肺,也見于頭頸、軀干、內(nèi)臟及四肢軟組織。由于臨床及影像學(xué)表現(xiàn)侵襲性占位性病變,組織形態(tài)變化多樣