鼻腔血管球血管肌瘤：一例病例报告及面部浅表血管球瘤文献复习

文献信息

中文摘要

背景： 血管球瘤是少见的血管周细胞肿瘤，最常发生于四肢甲下区域，而面部浅表部位定位罕见，可能带来诊断挑战。方法：我们报告一例63岁女性的鼻腔血管球血管肌瘤，表现为右上鼻侧壁无痛、缓慢增大的皮下肿块，临床上疑为脂肪瘤。结果：病变被完全切除，最近切除边缘在显微镜下0.5 mm clearance处无肿瘤。组织病理学检查显示血管腔隙周围环绕均匀的上皮样血管球细胞，并伴有显示平滑肌分化的细长梭形细胞束，两种成分之间可见逐渐的形态学过渡。免疫组化方面，血管球细胞表达平滑肌肌动蛋白，而平滑肌成分显示强desmin阳性；增殖活性低。这些发现支持血管球血管肌瘤的诊断。6个月随访时未观察到复发的临床证据。对文献的重点复习发现已报道的面部浅表血管球瘤数量有限，其中许多并无指（趾）部病变相关的特征性疼痛。结论：本病例提示，在持续性面部浅表结节（包括临床外观良性的病变）的鉴别诊断中应考虑血管球瘤，并强调组织病理学评估对于明确诊断和适当分类的重要性。

英文摘要

Glomus tumors are uncommon pericytic neoplasms that most frequently occur in the subungual regions of the extremities, while superficial facial localization is rare and may present a diagnostic challenge. We report a nasal glomangiomyoma in a 63-year-old woman presenting as a painless, slowly enlarging subcutaneous mass of the upper right nasal sidewall that was clinically suspected to represent a lipoma. The lesion was completely excised, with the closest resection margin free of tumor at a microscopic clearance of 0.5 mm. Histopathological examination demonstrated vascular spaces surrounded by uniform epithelioid glomus cells together with fascicles of elongated spindle cells showing smooth-muscle differentiation and a gradual morphological transition between the two components. Immunohistochemically, the glomus cells expressed smooth muscle actin, while the smooth-muscle component showed strong desmin positivity; proliferative activity was low. These findings supported the diagnosis of glomangiomyoma. No clinical evidence of recurrence was observed at 6-month follow-up. A focused review of the literature identified a limited number of reported superficial facial glomus tumors, many of which presented without the characteristic pain associated with digital lesions. This case highlights that glomus tumors should be considered in the differential diagnosis of persistent superficial facial nodules, including clinically benign-appearing lesions, and emphasizes the importance of histopathological evaluation for definitive diagnosis and appropriate classification.