临床儿科杂志 ›› 2022, Vol. 40 ›› Issue (12): 939-943.doi: 10.12372/jcp.2022.22e0863

• 综合报道 • 上一篇    下一篇

儿童法瓦病临床影像学及病理学分析

王雪莉1, 陈莲2(), 王庆煜1, 张彬1   

  1. 1.上海市儿童医院 上海交通大学医学院附属儿童医院病理科(上海 200062)
    2.复旦大学附属儿科医院病理科(上海 201102)
  • 收稿日期:2022-06-22 出版日期:2022-12-15 发布日期:2022-12-06
  • 通讯作者: 陈莲 E-mail:doctchenlian@163.com
  • 基金资助:
    上海市儿童医院教学课程建设专项基金(2020KC02)

Clinical imaging and pathological analysis of fibro-adipose vascular anomaly in children

WANG Xueli1, CHEN Lian2(), WANG Qingyu1, ZHANG Bin1   

  1. 1. Department of Pathology, Shanghai Children’s Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200062, China
    2. Department of Pathology, Children's Hospital of Fudan University, Shanghai 201102, China
  • Received:2022-06-22 Online:2022-12-15 Published:2022-12-06
  • Contact: CHEN Lian E-mail:doctchenlian@163.com

摘要:

目的 总结法瓦病(FAVA)在儿童的临床病理特征,探讨其诊断及治疗方法,以提高临床医师和病理医师对该病的认识,降低误诊率。方法 回顾性分析2016年7月至2022年2月收治的22例诊断为FAVA及诊断存疑病例的临床特点,总结其影像学及病理学诊断要点。结果 22例患儿(男11例、女11例,平均年龄7.22岁)均符合FAVA临床、放射学和组织病理学的纳入标准。临床表现为缓慢生长的肿块伴有疼痛和/或挛缩。磁共振成像发现非均匀肌内、肌间或皮下高低信号混杂弥漫性病变伴静脉扩张;病理学表现为骨骼肌中密集的纤维组织,过多的脂肪、血管、淋巴管和淋巴细胞、浆细胞灶性聚集,脉管增生,骨骼肌萎缩。22例中除去2例姑息切除和1例局部旷置手术外,其余19例均为肉眼下完整切除。随访2个月~5年10个月,复发2例,复发率10.5%;其余患儿疼痛均消失。结论 对于一些反复硬化剂治疗无效的脉管肿瘤/畸形以及临床和影像学不能明确诊断的病例,可以尽早手术,既能通过术后病理明确诊断又能达到治疗的目的。

关键词: 法瓦病, 纤维脂肪血管异常, 儿童

Abstract:

Objective To summarize the clinicopathological features of fibro-adipose vascular anomaly (FAVA) in children, explore its diagnosis and treatment, improve the understanding of the disease by clinicians and pathologists, and reduce the rate of misdiagnosis. Methods The clinical data of 22 children with suspected FAVA admitted from July 2016 to February 2022 were retrospectively analyzed. According to the clinical data, the clinical characteristics were analyzed, and the key points of imaging and pathological diagnosis were summarized. Results Twenty-two patients (11 boys and 11 girls, with mean age of 7.22 years) met the clinical, radiological, and histopathological inclusion criteria for FAVA. The clinical presentation is a slow-growing mass with pain and/or contracture. Magnetic resonance imaging showed heterogeneous intramuscular, intermuscular or subcutaneous high and low signal mixed diffuse lesions with venous dilatation. Pathological findings included dense fibrous tissue in skeletal muscle, excessive fat, focal aggregation of blood vessels, lymphatics and lymphocytes and plasma cells, vascular hyperplasia, and skeletal muscle atrophy. In 22 cases, except for 2 cases of palliative resection and 1 case of local disengagement surgery, the remaining 19 cases underwent macroscopic complete resection. The follow-up period ranged from 2 months to 5 years and 10 months. Two children recurred, with a recurrence rate of 10.5%. The pain disappeared in all children except the recurrence cases.Conclusions Early surgery is recommended for vascular tumors/malformations that do not respond to repeated sclerotherapy and for those that cannot be clearly diagnosed clinically or radiographically. Postoperative pathology can confirm the diagnosis, and surgery can achieve the purpose of treatment.

Key words: fibro-adipose vascular anomaly, vascular malformation, child