Orbital fibrous histiocytoma
Introduction
Introduction to fibrous histiocytoma in the sac Fibroushistiocytoma is a tumor composed of fibroblasts and hypertrophic tissue cells. In the past, there were many names, which are now collectively called fibroblastomas. It occurs in the muscles, fascia, and adipose tissue of the limbs. It has recently been recognized that it is also common in the sputum. Jakobiec et al. called fibroblastoma, which is the most common mesenchymal tumor in the adult sputum. It can also occur in the eye, the conjunctiva, the lacrimal sac and the limbus, but it is most common in the sputum. The tumor is classified as a mesenchymal tumor but has many fibrous cell components, and it is also discussed by the author as a fibrous connective tissue tumor. basic knowledge The proportion of the disease: the incidence of this disease is generally seen in trauma, the incidence rate of 2-4%. Susceptible people: no specific population Mode of infection: non-infectious Complications: valgus valgus
Cause
Causes of fibrous histiocytoma in the sac
Cause:
The cause of this tumor is unknown, but high-dose radiation exposure can cause malignant fibrous histiocytoma.
This tumor consists of tissue cells and fibroblasts that undergo changes. There is no calcification, the tissue cells are round or nearly round, the nucleus is round or kidney-shaped, with obvious abnormality, rich in cytoplasm and phagocytosis. The foam cells contain cell debris and hemosiderin. Fibroblasts are densely packed, and the cells are arranged in a spiral or car-like manner. The cells are large in volume, oval in shape, and the nucleus is obviously shaped. Multinucleated giant cells have benign and malignant. The former is very similar to osteoclasts or Dudton giant cells, and the malignant is giant tumor cells.
The mass is often leafy, grayish white, sometimes yellow or yellowish brown (lipid, hemosiderin) in the mass, especially in mucosal variants with a gelatinous area. In the aneurysm-like type, the hemorrhagic lesion is superior and is accompanied by a large cavity filled with blood. In the inflammatory lesions, yellow is particularly noticeable. Sometimes bleeding and necrosis are extensive, so that the entire tumor mass becomes a fluid-containing sac similar to a cystic hematoma. Sometimes the tumor appears to be completely covered, but in fact, the lesion has infiltrated into the surrounding tissue.
Prevention
Intraorbital fibrous histiocytoma prevention
Vasculitis is very common in the clinic and occurs mostly in young people. It may be accompanied by multiple systemic damage, or ischemic or blood stasis symptoms and signs. The lesions are uplifted purpura and other nodular necrotizing rashes. Some symptoms may also be accompanied by fever. If you want to stay away from the disease as soon as possible, you should start from prevention, early diagnosis, early treatment, as far as possible to find the pathogen, and the key to treatment and prevention.
Complication
Intraorbital fibrous histiocytoma complications Complications
After the lesion of the lesion is absorbed, the underlying tissue can be atrophied into a white atrophic scar.
Atrophic scars are scars named after the dysfunction that they cause. More common after deep burn healing, due to scar contraction, often lead to shape changes and dysfunction, long-term scar contracture can affect the development of bones, muscles, blood vessels, nerves and other tissues, should be treated early. Clinically common deformities caused by scar contracture include valgus valgus, lip valgus, chest-thoracic adhesion, hand scar contracture deformity, and flexion or atrophic scar extension and contracture deformity of each joint.
Symptom
Intraorbital fibrous histiocytoma symptoms Common symptoms Eyeball edema double vision
One-sided eyeball protrusion is the most common clinical sign. The malignant eyeballs develop rapidly and are more serious. Due to the multiple invasion of the tumor and the muscle cone, the eyeball is often displaced to one side. The tumor is located in the front of the ankle. It can be swollen and swollen. The benign person has a hard texture, the malignancy is larger, softer, and can not be promoted. The early vision of the malignant is decreased, the eyelid and conjunctival edema, eye movement limitation and double vision, and spontaneous pain and tenderness. Fundus examination showed normal or optic disc edema, clinical manifestations of fibroblastic cell tumors, image display and laboratory tests were lack of specificity, and the diagnosis often relied on biopsy.
Examine
Examination of fibrous histiocytoma in the sac
Histopathological examination: The basic components of fibrous histiocytoma are hypertrophic tissue cells and fibroblasts. The former cytoplasm may contain lipid bodies, so-called adipose cells or foam cells. The tumor cells are in the shape of a wheel or a roll. The cloud arrangement can be divided into three types according to clinical behavior and pathological features: benign, intermediate and malignant fibrous histiocytoma.
Benign fibrous histiocytoma
The most common, accounting for more than half, the tumor volume is small, relatively limited, grayish white, hard texture, with incomplete or thin capsule, tumor cells have shuttle forming fibroblasts and hypertrophic tissue cells, and contain appropriate amount of collagen and net Fibrous fibers, tumor cells are arranged in two forms, one is bundled fibroblasts and their fibers in a common focus, or small blood vessels as the center, arranged in a spoke or cirrus, the other form is The bundles of fibroblasts are arranged in a braided shape. In addition to different amounts of tissue cells, Touton's cells, hemosiderin-containing macrophages and inflammatory cells, nucleus pleomorphism is not obvious, and mitosis is observed. Rarely, there are more blood vessels in the tumor.
2. Intermediate type
The tumor is grayish white without capsule, and the edge is infiltrated. The microscopic findings are basically the same as those of benign, but the tumor cell components are increased, the interstitial is reduced, and the mitotic division is common. The tumor cells have pleomorphic tendency and the blood vessels are rich. There may be a mucus area inside.
3. Malignant fibrous histiocytoma
Rarely, accounting for about 10% of such tumors, large tumor volume, gray-red, no envelope, invasive growth, necrotic areas within the tumor, tumor cells have obvious morphological, active mitosis, and abnormal nuclear division and Tumor giant cells, tumor cells can be arranged in a cloud or multi-form, with hemorrhagic and mucinous changes in the interstitial, with inflammatory cell infiltration, sometimes misdiagnosed as fibroproliferative inflammatory pseudotumor, clinical manifestations of fibrous histiocytoma The image shows a lack of specificity. Indeed, the diagnosis often relies on histological examination. The benign or malignant fibrous histiocytoma is clinically lacking in characteristic performance.
4. X-ray inspection
The early stage is normal, and the longer the course of the disease is enlarged.
5. Ultrasound exploration
The shape of the tumor is irregular, the boundary is clear, the internal echo is rare, the sound attenuation is significant, the compression is not deformed, the malignant fibrous histiocytoma has necrosis, hemorrhage, blocky echo in the tumor, and D-mode ultrasound detects color flow.
6. CT scan can be seen in the lesions, the contours are clear, homogeneous, or the density is inconsistent due to necrosis, malignant can have bone destruction, MRI T1WI lesions are medium signals, due to hemorrhage, necrosis, signal inhomogeneity, T2WI tumor For high signals.
Diagnosis
Diagnosis and diagnosis of fibrous histiocytoma in the orbit
Under the microscope, it needs to be differentiated from vascular epithelioma, neurofibromatosis, schwannomas, fibroangioma and rhabdomyosarcoma. The distinguishing point is benign. The intermediate or malignant fibrous histiocytoma contains adipose tissue cells, ie foam cells. .
