What is fibrosis? Splitmassage in the fight against fibrosis on the face and neck Fibrous tissue functions.

A fibroma (fibrous growth) is a benign lump of fibrous connective tissue. It is formed from fibrocytes, fibroblasts, collagen fibers and blood vessels.

Although this neoplasm is not life-threatening, it often reaches a significant size and causes psychological discomfort in the patient. Fortunately, this defect can be successfully combated with the help of modern medical advances.

Localization and prevalence of fibroma

This disease is quite common (occurs in 5% of the population), and equally affects both men and women. The pathological process can be localized on almost any part of the body where there is skin or mucous membranes, as well as inside the body (lungs, gastrointestinal tract, liver, kidneys, etc.).

Overgrowth of fibrous tissue on the chest

Often in women there is an overgrowth of fibrous breast tissue. This should not be a cause for concern, but, of course, every tumor detected in this area should be examined by a doctor and be properly diagnosed (ultrasound, mammography, aspiration biopsy, tumorectomy with a section sample taken for histological analysis). Diffuse growth of fibrous breast tissue should not be confused with the most common benign form of breast tumor, fibroadenoma.

Breast fibrosis symptoms treatment

Fibrous gum growth

Fibromas are also very often localized in the oral cavity - usually on the inside of the cheek and across the hard palate. The disease is the result of chronic irritation from mechanical, chemical or physical factors (for example, poorly fitting dentures, alcohol, smoking may be the culprits).

oral fibroma

Causes of fibroids

The etiology of the disease is not fully understood. Possible reasons include:

• injuries;
• bites;
• prolonged exposure to alcohol and drugs;
• congenital neurofibromatosis in children;
• genetic factors;
• local inflammatory process.

Symptoms and clinical forms of fibroma

Fibrous growth is characterized by the following properties:

• it is usually enclosed in a sac of connective tissue;
• grows slowly;
• does not cause local recurrence after surgical resection;
• does not inhibit local blood vessels and neighboring tissues;
• does not metastasize;
• has a poorly developed vascular network.

There are several clinical forms of the disease.

1. Solid fibroma () - consists of collagen fibers and a small number of connective tissue cells (fibroblasts). Their formation, as a rule, is reactive in nature (the trigger is previous injuries, wounds, bites and a local inflammatory reaction). Thus, it is an acquired (not congenital) change. The incidence of this pathology increases with age. Dermatofibromas usually form on the upper and lower extremities. This is a single small nodule with a smooth or rough surface. It may be round or oval in shape and red or brown in color. The growth is hard to the touch.
2. Soft fibroma - consists of connective and adipose tissue cells with a small amount of collagen fibers. It is most often localized on the neck, armpit or groin area, but can form anywhere on our body, including the eyelids. The neoplasm is soft to the touch, has a flesh-colored or brown color, grows directly on the skin, or is connected to the epidermis using the so-called “leg”. Unlike relatively hard fibroids, the soft variety often occurs in the form of several nodules and is congenital in nature.
3. Fibroma of the oral mucosa is the most common type of benign tumor in dentistry. It forms on the inside of the cheeks, at the borders of the hard and soft palate, or on the gums. This change is round or oval in shape, pink in color, and looks like a lump. New growths in the mouth can be single or multiple.

Diagnosis of fibroma

To make a correct diagnosis, you should contact a dermatologist (not a cosmetologist) or a dentist (if the growth appears in the mouth). Fibrous proliferation requires differentiation from:

• papillomas;
• lipomas;
• genital warts (if located on the genitals).

To find out the nature of the tumor, it is sometimes necessary to undergo a histological examination.

Fibroma treatment

Treatment of this defect is not necessary for medical reasons. It is used only when the growths disfigure the patient or cause physical discomfort (for example, rubbing against clothing, causing pain).

When making decisions about dealing with fibroids, you must remember that after removal they can grow back in the same place or in a different area of ​​the body.

Electrocoagulation

Electrocoagulation is the surgical removal of fibrous growth using high frequency alternating current. Under the influence of current, protein bonds are destroyed, due to which the pathological tissue is easily removed. The procedure does not violate the integrity of the skin, and therefore rarely leads to complications. The only thing that may remain after the manipulation is a small scar or pigment spots.

The duration of electrocoagulation ranges from one to several tens of minutes (depending on the size of the lesion). Often the doctor uses a local anesthetic (especially in the case of large growths). The first few hours after the procedure, the patient may notice swelling of the skin, as well as pain and bruising in the area where the excision took place, but these symptoms disappear the same day. During the first week, you will need to regularly wash the wounds with hydrogen peroxide and observe increased personal hygiene measures to avoid infection.

Electrocoagulation is a very convenient, modern and safe method of combating skin defects, but it has contraindications: pacemaker, blood clotting and circulatory disorders, diabetes, pregnancy, tendency to scar formation.

CO2 laser

This technique is widely used in aesthetic dermatology, as it leaves virtually no traces behind. Using a special apparatus, the doctor acts on the selected object with a beam invisible to the eye, having a wavelength of 10,600 nm. This beam is absorbed by intracellular water, causing it to evaporate and fold the protein that makes up the tissue being operated on. There is no bleeding, and the surrounding healthy cells remain unharmed. The epidermis almost always heals without scarring.

Contraindications to laser surgery are pregnancy, active bacterial infection or virus, a tendency to form keloid scars, and oncological problems.

Typically, laser treatment is performed without anesthesia (the person only feels a slight burning sensation), but if a large lump is to be removed, the doctor uses a local anesthetic. After the manipulation, there will be a shallow wound that needs to be disinfected with hydrogen peroxide, but in case of large wounds it is recommended to wear a breathable bandage. The healing process takes from several days to 3-4 weeks. Due to the formation of new skin at the laser site, the affected area will need to be protected from direct sunlight to prevent pigmentation.

Freezing with liquid nitrogen (cryotherapy)

This manipulation is based on short-term contact of a stream of liquid nitrogen vapor (which has a temperature of about -140 ° C) with the surface of the body. It is safe even for pregnant women and small children.

Surgical excision

In the case of large fibromas on the body, as well as any growths in the oral cavity, only surgical excision is prescribed. It is performed under local anesthesia. Complete healing of the wounds is noted after a week; until this time, the patient must treat the surgical site with disinfectant solutions and, if necessary, change the dressings. Surgical resection very rarely causes complications (there is a risk of bacterial infections, hematomas, keloid scars).

Traditional medicine

Naturopaths have accumulated a lot of home recipes to combat unaesthetic growths on the body. They can be tied with thread, treated with birch tar, burned with a torch, evaporated in concentrated salt solutions, and lubricated with the juice of celandine and other poisonous plants. But we draw your attention to the fact that all these methods can do more harm than good. Any violation of the integrity of the dermis threatens infection and even the transition of the disease to a malignant form.

Prognosis and prevention of fibroids

In 20% of cases, after removal, the fibroma reappears on the body. However, this disease does not affect a person’s physical well-being in any way, does not become complicated and does not turn into a cancerous state. It doesn’t even need to be eliminated if the patient is not bothered by the appearance of the growths.

There are no effective recipes or tips to help prevent this problem. However, avoiding skin injuries, proper care of wounds and scratches, and a healthy lifestyle will eliminate several risk factors for such formations. And remember that a timely visit to a dermatologist is a guarantee of the beauty and health of your skin!

Multiple fibromas in the armpits

The appearance of temporary slight discomfort and some passing adverse reactions of the dermis is absolutely normal.

However, after filler injections, they often form atypical compaction of connective tissue, in other words – fibrosis.
In some cases, you need to immediately consult a cosmetologist.

What tissue fibrosis is, the causes of its occurrence, treatment methods, and many other issues will be discussed further.

General concept of fibrous formation

Despite the fact that they are fully compatible with the human body in terms of biological characteristics, nevertheless, after administration of the drug, inflammation may develop, which usually goes away after 2-3 days.

If the formations persist for two weeks or more, you should consult a doctor - probably the inflammatory process has become chronic and the growth of connective tissue begins to be excessive. Such local compaction (the medical term is fibrosis) in the area where the special gel was introduced indicates the beginning of the process of producing new collagen fibers.
Capsules of the fibrous type become noticeable not only upon palpation, but also visually (the relief of the skin changes).

Fibrous deformation of tissues is considered to be a late and difficult-to-treat consequence of correction and modeling of facial contours with fillers.

Possible causes

Multiple growing fibrous capsules, lumps and other compactions are the most common complications after filler injection.
Of course, only a doctor can determine the cause of their appearance, while in some cases the cause of fibrosis is never established and is considered an individual reaction of the body, but some factors can be listed:

• direct transfer of funds or its low quality;
• incorrectly chosen injection technique;
• development of a focus of inflammation;
• mechanical damage to the walls of blood vessels;
• individual reaction of rejection of a foreign substance by the body;
• in the injection area there is a noticeable growth of connective tissue - scars, nodules or cysts (for example, hyaluronic acid enhances the production of fibroblasts);
• failure to comply with hygiene and care rules, and as a result, infection;
• unprofessionalism of the cosmetologist.

In addition, the formation of fibrous capsules can be provoked by an incorrectly calculated dose of the drug, as well as its too superficial administration.

Characteristic signs and symptoms of fibrosis

The introduction of fillers is accompanied by a variety of complications, many of them are very similar to each other: swelling, nodules, bumps, keloids, scars, granulomas.
Therefore, it is necessary to be able to distinguish fibrous type capsules from other neoplasms.

Symptoms indicating the development of fibrosis:

1. Neoplasms on the face are hard when palpated and can be located in the deep layers of the skin.
2. The tumor has clearly defined boundaries, does not move during palpation, its shape is often round, but mushroom-shaped compactions are also found.
3. Fibrous capsules contain a large number of blood vessels, which cannot be said about scars.
4. Unlike small granulomas, fibrous compactions are larger in size and occupy a very large surface of the skin (from 1 to 7 cm).
5. The diagnosis is made based on a visual examination of the affected area, palpation, and ultrasound examination.

Areas of the face most prone to fibrosis

A complication such as tissue fibrosis can occur in any area being corrected: nasolabial folds, lips, area around the mouth, area under the eyes, neck, chest, décolleté.
But most often, fibrous type capsules appear when the gel is injected into wrinkles located around the mouth, lower eyelid, upper part of the nasolabial folds, and upper lip.

The formation of fibrosis on the lips is especially often diagnosed.. The fact is that the skin in this area is hypersensitive, so swelling can appear even with an injury caused by a needle in the absence of any gel, not to mention the formation of fibrous nodes.

Treatment of fibrosis

In the vast majority of cases, various methods of conservative therapy help to cope with fibrous elements that appear as a result of filler injections.
When tissue fibrosis cannot be treated with highly effective drugs, they turn to a surgeon.

Methods of combating neoplasms can be classified as follows:

1. Injection into the center of the tumor of medications aimed at destroying the filler - called hyaluronidase (for example, the drug Diprospan). This manipulation will allow you to remove excess amounts of gel, destroy the filler, or replace it with another drug (if it was introduced too superficially). Also, using hyaluronidase injections, you can remove the agent that compresses the blood vessels. But the introduction of hyaluronidase can provoke a serious problem - tissue necrosis.

2. Injection directly into the area of ​​compaction of a steroid hormonal drug (used when rejection of the gel occurs against the background of the action of the human immune system).

3. Cryodestruction (exposure to cold), cauterization with chemicals or electrocoagulation (exposure to electric current) are effective only against small superficial formations.

4. Surgical excision of nodes. This method is used if fibrous capsules are located in the deep layers of the epidermis or are of impressive size.

5. The latest methods used in the fight against the described problem are laser or radio wave therapy. After 5-7 such procedures, subtle cosmetic defects remain, but the downside is their high cost and absolute ineffectiveness in some cases, while no doctor can confidently guarantee the desired result.

Consequences and measures to prevent the situation from getting worse

The appearance of fibrous nodes after the filler injection procedure is not a fatal condition. Fibrosis is usually perceived as a kind of cosmetic defect of the skin.
However, mechanical damage to such a seal may result in complications:

• minor bleeding;
• wound infection;
• pain syndrome;
• necrosis of injured tissues.

The last of the listed complications - tissue necrosis - is worth considering in more detail, due to the fact that it is the most undesirable, unpleasant of all possible consequences of the injection of fillers.
In addition, the result of such a complication can even be fatal.

Necrotic changes in the skin

Tissue necrosis is an irreversible pathological process accompanied by the death of some cells and tissues in a living organism.
The vital activity of cells in the necrotic area completely stops after a certain period of time.

Main causes:

• Impaired blood supply to the epidermis and surrounding layers.
• Tears, compression.
• Exposure to pathogenic microorganisms (bacteria or viruses).

Symptoms of necrosis:

1. Numbness of the damaged area, loss of sensitivity.

2. Very pale color of the epidermis in this place. Afterwards it gives way to a blue, dark green, black skin tone.

3. General deterioration of the condition: pulse quickens, temperature rises, fever, swelling appears.

Detection of these signs is a reason to immediately seek medical help.!

Getting rid of such a defect on the face is not easy.
Therapy for tissue necrosis is long-term, in most cases ineffective and, as a result, visible changes in the skin almost always remain.

Returning to fibrous compactions, it should also be noted that they extremely rarely degenerate into malignant tumors. But in the absence of treatment, and with changes in hormonal levels, the number and size of fibrous lumps may increase.

In order not to aggravate the situation, damage or friction of the fibrous capsules should be avoided, and if possible, they should be surgically removed in a timely manner.

In conclusion, it is worth saying that tissue fibrosis after filler injection is a consequence of contour plastic surgery that does not threaten human life. However, the risk of lumps degenerating into malignant formations still remains, so at the first signs of fibrosis you should consult an experienced dermatologist or surgeon.

Watch the short video “Treatment of complications of contouring with hyaluronic acid fillers”

Mastopathy is characterized by various forms, which, according to the characteristics of the neoplasm and the properties of their composition, are divided into groups. One option is diffuse fibrous mastopathy. It is appropriate for it to have a huge number of seals that vary in size and shape. Fibrous tissue is the cause of these lumps as a result of the predominance of the connective component in the breast cells.

Diffuse fibrous mastopathy of the mammary glands occurs due to hormonal imbalance: estrogen exceeds the norm, and progesterone, on the contrary, decreases. As a result, breast tissue changes its composition and tumors appear, negatively affecting nerve endings and blood vessels. At first, only minor inconveniences are felt during the cycle (pain and swelling of the glands). In the case of a more serious stage, pain of a pulling and burning nature is felt; a lot of cloudy liquid is released from the nipples, drowsiness and apathy appear; the temperature may rise.

Experts divide mastopathy into:

The following classification is also possible: focal and bilateral.

Usually the conclusion sounds like diffuse fcm with a predominance of fibrosis or diffuse fibrocystic mastopathy with a predominance of fibrosis (dfc), diffuse mastopathy with a predominance of the fibrous component indicates that there are benign lumps in the breast.

Causes

There are different opinions on the reasons that influence the appearance of mastopathy. For the appearance of diffuse fibromastopathy, the following factors are included that lead to an imbalance of female hormones:

At risk are females who have experienced miscarriages, abortions, and those who have problems breastfeeding. Diffuse fibrosis of the breast occurs in women before menopause, when hormone levels increase.

Diagnosis and treatment of the disease

Mastopathy can be diagnosed by a large number of complexes. They are combined to get the most accurate conclusion. Women under forty should undergo an ultrasound examination at least once a year. It will show whether there are formations and what shape they have. For those who are older, this method is not used; mammography is prescribed.

If a fibroma is detected, a puncture is taken. A piece of tissue is used to determine the presence of cancer cells. Confirmation of the diagnosis is possible by donating blood for analysis and visiting a gynecologist. To monitor the condition of the breast, self-palpation should be performed regularly. Palpation will help you understand whether the shape and mobility of the formation have changed.

Diffuse fibrous mastopathy:

Treatment is carried out both with medications and folk remedies. Initially, the disease is attributed to homeopathic remedies, as well as preparations based on various herbs (burdock, belladonna, yarrow, celandine). Fibrous changes of a more severe form lead to the prescription of tablets, injections, and ointments based on hormones; It is recommended to use a new type of contraceptive. For mastopathy of complex form Treatment with steroids and testosterone is prescribed. The colposcopy method is also used, as well as an analysis of vaginal cell cytology.

Recommended traditional medicine methods- moderate use of herbal and vegetable compresses. You can take cabbage, burdock, celandine, beets, hemlock. It is good to include strengthening tea, balm based on plant oil and honey in your diet. Don't forget about diet. Avoid eating fatty foods, canned foods, smoked foods and coffee. You should eat fish, poultry, dairy and fruits and vegetables. Taking vitamins should not be an afterthought. But alcohol and smoking are the first enemy. Nicotine tars lead to hormonal suppression, inflammation and the formation of fibroids.

Tumors and tumor-like processes of fibrous tissue are extremely diverse in both clinical and morphological manifestations. This tissue arises as a derivative of mesenchyme and is part of the stroma of all organs, without forming independent organ structures (fascia, tendons and other formations of this kind are an integral part of organ complexes - muscles, joints, etc.) According to modern data, the composition of connective tissue includes, in addition to fibroblasts, smooth muscle cells, as well as derivatives of ectomesenchyme. The issue of the origin of fibroblasts is debated; many regard them as heterogeneous cells in origin; one part of them arises locally from precursor cells located in tissues, while the other part (for example, fibroblasts in areas of inflammation) is of bone marrow origin and is the descendants of pluripotent stem cells of the bone marrow

The main function of fibroblasts is to produce fibrous structures, namely collagen; the latter is also heterogeneous in its origin, structure and antigenic properties. It has been established that, in addition to fibroblasts, fibrous structures can also produce other cells of mesenchymal origin. Myofibroblasts also play a significant role in the composition of the stroma of many organs; the question of the existence of a genetic connection between these cells and fibroblasts and smooth muscle cells has not yet been finally resolved

The position about the presence of two functionally different forms of connective tissue cells - fibroblasts and fibrocytes is controversial; many believe that there is a single cell - a fibroblast, which can be in different functional states. Fibroblasts, in addition to collageogenesis, are important in intermedial metabolism, in particular in regulation of electrolyte metabolism, water balance, etc.

These complex morphofunctional features of connective tissue in general and its main cellular elements - fibroblasts in particular - create, both during compensatory and adaptive processes and in pathological conditions, an extraordinary diversity of structures

Although the question of the presence of immature mesenchymal cells in adulthood is debated, the existence of reserve connective tissue cells is beyond doubt

Connective tissue is in close morphofunctional relationships with immunocompetent cells and especially with the system of mononuclear phagocytes, which, like various types of lymphoid cells, are a constant, although quantitatively different, component of connective tissue structures, the significance of which, in particular in oncomorphology, it's hard to overestimate

Modern data on immunocompetent cells, the system of mononuclear phagocytes, the bone marrow origin of histiocytes, macrophages and partly fibroblasts, existing in oncology, histogenetic and histological concepts are being revised. This applies primarily to the group of so-called fibrohistiocentric lesions

Histiocytes, which most authors considered derivatives of the reticuloendothelial system, according to the latest research, are formed in the bone marrow from special progenitor cells, which, entering the blood, turn into monocytes. The latter penetrate from the blood into tissues, where they become histiocytes (“wandering cells in rest”, according to A A Maksimov) Under special functional conditions, these cells turn into macrophages. The experiment showed that the reproduction of histiocytes and poppy

rophages do not occur in tissues, and their number increases only due to the influx from the bone marrow. To what extent these patterns relate to tumors is still unknown, as a result of which the question of the sources of tumors and tumor-like formations of the fibrohistiocin series and similar processes is unclear. The fact that a histiocyte is not a specific type of cell, but a term that is applied to cells of various origins that are in a certain functional state (reticular fibroblasts), does not seem to correspond to reality, and the term “histiocyte” should only be applied to cells included in the system of mononuclear phagocytes. It also raises doubts about the possibility of transforming a histiocyte into a fibroblast, which was associated with the formation of part of the so-called soft fibromas, fibrohistiocytes, etc.

The variety of physiological characteristics of connective tissue cells and histiocytic elements, according to D. and Mackenzie, also explains the extreme polymorphism of the pathological structures that form them; their analysis allowed the author to propose the concept of the fnbroblastic spectrum, highlighting 4 parts in it: inflammatory and reactive processes, fibromatoses, benign fibroblastic and hxtiocytic tumors, malignant fibroblastic and histiocytic tumors

Considering the pronounced pluripotency of the mesenchyme in general and especially the elements developing in the direction of the connective tissue, it is advisable to consider tumors and tumor-like processes of fibrous tissue in the form of two subsections of fibroblastic and fibrognstiocytic lesions. In each of them, in accordance with the “fibroblastic spectrum”, a group of reactive and inflammatory processes should be distinguished , a group of benign and a group of malignant tumors, and among fibroblastic lesions it is necessary to distinguish a group of fibromatoses

It should be noted at the same time the exceptional importance that the theoretical developments of MF have in relation to the group of processes under consideration as a whole.

Glazunov (1947), as well as fundamental research by A R Stout (1948, 1951, 1954, 1961), F M Enzinger (1965), J L Bonnenfant

(1966), D N Mackenzie (1970), R W Allen (1977), etc.

FIBROBLASTIC TUMORS

FIBROBLASTIC REACTIVE AND INFLAMMATORY TUMOR-LIKE LESIONS

These include nodular fasciitis with all its variants, ossifying and proliferating myositis, keloid, hypertrophic scar, idiopathic retroperitoneal and mediastinal fibrosis, radiation fibromatosis

Nodular fasciitis (subcutaneous pseudosarcomatous fibromatosis or fasciitis, pseudosarcomatous fibromatosis or fasciitis, nodular fasciitis, infiltrating or proliferating fasciitis, nodular fibrositis, fasciitis, pseudosarcomatous dermatophnbroma) was first described and identified as an independent variety by B. Konwaler, L Keasbey and L Kaplan in 19 55 g., was later studied by S. S. Avednsov and A. F. Ushkalov

(1967), A. M Wichert et al (1972), V M Blinov (1979), A R Stout (I960, 1961), E Soule (1962), R Tutter et al (1962), R W Allen (1972) etc.

Nodular fasciitis occurs at any age, mainly between 20 and 40 years, more often in men. Localized mainly on the upper bone, especially on the forearm. Distal limbs 206

are affected extremely rarely. In the vast majority of cases, the lesion is localized in the subcutaneous tissue near the superficial fascia, much less often - in the thickness of the striated muscles, very rarely - paraosseously. Isolated cases of damage to the mammary gland, as well as places where there is no fascia, such as the vulva, trachea, salivary glands, have been described , mucous membranes of the cheek, esophagus Usually occurs spontaneously, less often - after injury (up to 36% of cases), grows quickly, has the appearance of a poorly contoured, often painful node, usually solitary, but can also be multiple In the work of W. Kowac et al (1970) provide information about generalized lesions. The prognosis is favorable. The number of relapses after removal does not exceed 1%; spontaneous reverse development can be observed even after partial excision. Nodular fasciitis on the section usually presents a poorly contoured node of a grayish-white color, in places a variegated appearance with foci of weakness in the center. The size of the node rarely exceeds 5 cm

The microscopic picture is variable and is characterized by a diverse cellular composition and structural features, giving it a resemblance to many malignant tumors. The most characteristic are the proliferation of fibroblastic elements and capillary-type vessels, as well as mnxomatosis of the intermediate substance. Proliferation of fibroblasts with elongated and oval hyperchromic nuclei, forming randomly intertwined bundles, the most expressed in the peripheral parts of the node (Fig. 52, a, b)

The node is rich in capillary-type vessels, often in the form of capillary buds, characteristic of granulation tissue (Fig. 52, c). It is often possible to observe the radial orientation of the vessels in relation to the center of the formation (“saw teeth”, no R Hutter et al., 1962)

Myxomatosis of the intermediate substance is pronounced, especially in the central areas, which are poor in cells, which usually have an irregular or stellate shape (Fig. 52, d). In most observations, a zonal arrangement of the described three components of myxomatous areas is noted - in the center, rich in cells - in the periphery, and angiomatous - in the middle part of the node

A characteristic diagnostic sign is lymphoid infiltration of a node of a diffuse focal type and accumulations of histiocytes, which are found in groups in the stroma or in small cavities devoid of lining (Fig. 53, a, b). In some cases, giant multinucleated cells such as osteoclasts, focal calcifications, foci may be found cartilage and bone tissue, hyalnosis of the stroma, especially in the central parts of the node (Fig. 53, c, d).

Nodular fascint must be differentiated from fibrosarcoma, malignant and benign fibrous gnstiocytoma, malignant hemangioendothelioma, myxoid liposarcoma, leiomyosarcoma, schwannoma, neurofibroma, nodular teiosynovitis

It is important to note some features of the so-called proliferating fascinitis, described by E B Chung and F M Enzinger in 1975, which is indistinguishable from nodular fasciitis according to clinical and macroscopic signs

Microscopically, the tissue of the nodes of proliferating fasciitis has a variegated structure and is represented by fibroblast-like oval and elongated cells, among which are located either in groups or alone giant round-shaped cells, very reminiscent of ganglion nerve cells or mnoblasts. In their cytoplasm, clumps of collagen, scraps of elastic fibers, and grains can sometimes be found hemosderin, drops of lipids Occasionally, cells have 2 nuclei A few typical mitoses are found Cells are folded into randomly intertwined bundles enclosed in a loose stroma of collagen fibers Giant cells are located mostly in areas of the node located in the subcutaneous tissue; in its intramuscular sections they are rare Stroma This formation is in some places hyaline, in some places it has a myxoid character, the inflammatory phenomena are slightly expressed. Unlike nodular fascinitis, there is no zonation of the structure in the lesion

The described structure is close to proliferative myosis and differs from it only in the location of the focus in the subcutaneous fatty tissue. This process should also be differentiated from rhabdomyosarcoma, liposarcoma, malignant fibrous gnstiocytoma, haigliojeuroblastoma

Myositis ossificans (local myositis ossificans, ossifying hematoma, calcified hematoma, traumatic larososseous bone formation, traumatic myositis, heterotopic ossification) as a local process was studied by A A Korzh (1963), G Geschickter and J Maseritz (1938), L Ackerman (1958), A Leca (1967) Occurs frequently More than half of the cases are associated with trauma, observed mainly in young men Typical localization of the lesion is the deep parts of the skeletal muscle Sometimes it is located near the periosteum, which is sharply thickened Most common localization - upper and lower extremities (in 70-80%), especially the area of ​​the hip, shoulder and buttock. In clinical manifestations, the presence of injury and its nature play an important role. In case of serious injury with vascular damage, rapid development of symptoms is noted and after 1-4 weeks painful pain appears swelling The pain sharply increases when the periosteum is involved in the process; in such cases, patients are usually operated on in the first 3 months after the injury. Myositis ossificans, which occurs after repeated microtraumas, is characterized by a mainly asymptomatic course, a slightly painful swelling is noted, which is the only complaint. In these cases, patients operate within 4-15 months and later. Initially, a soft, doughy swelling is noted, then the tissues become denser due to ossification. Patients are operated on more often after 6-24 months, although the true time of existence of the lesion cannot be identified. Non-traumatic ossifying myositis may be characterized by rapid growth, the presence of a distinct periosteal component, which sometimes simulates sarcoma, which is erroneously “confirmed” by rapid biopsy. Such errors can lead to mutilation (Ackerman L, 1958; Jeffreys F, Stiles P, 1966; Gongeon J et al M J97U) The method of treatment is surgical excision of the ossification. According to most researchers, the operation should be performed only after its maturation, that is, 2-3 months after detection. Relapses are rare and are caused primarily by the surgical trauma itself, if cavities remain after the operation , hemorrhages, areas of crush injury

The size of the lesion varies, but most often exceeds 5 cm in diameter. The node can be surrounded by a jelly-like mass as a result of degeneration of the surrounding muscles. Long-term lesions are clearly contoured due to the proliferation of fibrous tissue, the strands of which extend radially into the adjacent muscles. Such a node is almost completely replaced well formed bone or contains significant osteochondral inclusions, permeated with fibrous tissue with cysts. In early removed formations, areas of organized hematomas are found, and sometimes the entire lesion is saturated with blood

The microscopic picture of myositis ossificans varies depending on the duration of its existence. In the early period, it consists of hemorrhages organized by hematomas, cartilaginous formations, eichondral and periossal ossification, inclusions of myxomatous and aigiomatous areas with hyalization of capillary walls, calcification and degeneration of muscle fibers, hyperplasia connective tissue (Fig. 54, a) With a traumatic origin of myositis ossificans, hemorrhagic manifestations dominate, and with a traumatic origin - proliferation of fibroblasts. Against this background, focal bone formation is observed in various stages of development from osteoid formations to randomly arranged formed bone beams, surrounded by osteoblasts and cellular fibrous tissue , sometimes of the granulation type, cartilaginous, without clear boundaries, as if transforming into each other (Fig. 54, b c) By the end of this early stage, the bone tissue has the appearance of spongy bone, the dense interlacing of bone beams of which is especially pronounced in the peripheral parts of the formation, in the central connective tissue growths predominate. On the outside of the bone beams there is a layer of scar connective tissue, among which there are sections of cartilage and individual bone beams oriented in the same direction, which gives these areas a resemblance to the periosteum. The adjacent bundles of muscle fibers are replaced by fibrous tissue. During this period, near the bone giant cells such as osteoclasts appear in the beams, collagen formation is expressed in the inter-beam spaces. Among the disconnected dystrophically altered muscle fibers “immured” in the connective tissue, there are randomly scattered large, irregularly shaped cells with fine-grained eosinophilic cytoplasm, which, along with the often occurring “muscle regenerates”, can simulate rhabdomnosarcoma

At later stages (2 months or more), osteogenesis continues mainly in the interbeam spaces and in the surrounding fibrous tissue, where a shell like periosteum is formed. Adjacent to this fibrous capsule is a bone plate, with which bone beams are connected, forming a cellular network inside the ossificate (Fig. 54, d). During this period, bone restructuring occurs, which acquires a lamellar structure. You can often see osteoclastic resorption of bone beams. Central areas of formation and inter-beam spaces made of fibrous connective and sometimes adipose tissue; In some places myeloid bone marrow can also be detected

In conclusion, it should be recalled that the morphological study of myositis ossificans must be compared with clinical and radiological data, bearing in mind that the so-called “zone phenomenon” begins to be detected no earlier than after 1.5 months, and is clearly expressed no less than after 2-3 months from the onset of the disease

Myositis ossificans must be differentiated from osteogenic sarcoma, paraossal sarcoma, rhabdomyosarcoma and fibrosarcoma. It should be taken into account that a morphological picture similar to that described is also observed in local manifestations of progressive myositis, which occurs in young children and is characterized by multicentric lesions. This form is caused by metabolic disorders IGreval K , Das N, 1953] or is a consequence of a congenital anomaly (fibrodisplasia ossificans progressiva)

Most researchers believe that complete replacement of muscle tissue, as occurs, for example, with myositis ossificans and nodular fasciitis, does not occur even in long-existing foci of proliferating myositis. Occasionally, especially in the collagenization zone, foci of choidrogenesis and osteogenesis may be noted

Proliferating myositis must be distinguished from embryonal rhabdomyosarcoma, haiglioneuroblastoma, fibrosarcoma, extra-abdominal Desmond and proliferating fasciitis

Idiomatic retroleritotic and mediastial fibrosis (fibrosis of the mediastinum and retroperitoneal tissue, sclerosing inflammation of the retroperitoneal space, pernurethral fibrosis, Ormond’s disease) is a poorly limited diffuse proliferation of dense connective tissue rich in collagen fibers with varying degrees of inflammatory, predominantly lnmphoplasmacytic diffuse infiltration focal nature. In places, areas of calcification and osteogenesis may occur

This process usually takes a long time, clinical symptoms depend on the degree of dysfunction of certain organs involved in it. In the retroperitoneal space these are primarily the ureters, in the mediastinum - the pericardium, superior vena cava, trachea, bronchi, aorta with its branches, nerves

Retroperitoietal and mediastial fibrosis should be kept in mind when making a differential diagnosis of various tumors of these localizations. The causes of the process are unknown

A keloid is an excess formation of scar tissue in the dermis and deep tissues in the area of ​​injury. It occurs more often in people of color after injuries, burns, tattoos, in women on the earlobe after piercing for wearing earrings. A keloid scar extends beyond the boundaries of its own damage, which is one of the differential diagnostic differences from a hypertrophic scar. Genetic factors contribute to its occurrence. , especially in peoples of color, and age (newborns and young children).

It occurs weeks or months after the traumatic injury has healed. It begins in the form of finely nodular compactions on the surface to a smooth rubia, covered with atrophic epithelium with underlying areas of angiectasia. The nodes deepen into the dermis and protrude above the surface of the skin

Microscopically, it is characterized by the proliferation of fibrous tissue with the presence of thick glassy, ​​randomly intertwined collagen fibers (Fig. 56). Along the periphery of the keloid, infiltrates of lymphoid and plasma cells occur, non-formation of blood vessels and proliferation of young fibroblasts occur, which leads to an increase in the size of the lesion. The central part of the keloid contains fewer cells than the peripheral part. Keloid often recurs.

The same microscopic picture is observed in the so-called disease of spontaneous kedoidosis, when the process is expressed in the appearance of multiple nodes merging with each other without previous trauma

A hypertrophic scar (cicatricial fibromatosis, cicatricial fibroma) is characterized by excessive growth of fibrous tissue in the scar. After months or 2-3 years, it takes on the appearance of a regular scar, which is how it differs from a keloid. Another difference is that the scar is limited to only the area of ​​primary damage.

Radiation fibromatosis. This lesion was isolated during the analysis of observation

denies of radiation fibrosarcoma [Perelegin IA et al, 1974; Stout A. R, 1951; Pettit V. et al., 1954; Rachmaninoff N. et al 1961; Mackenzie D. H, 1970] Considering the connection of this process with radiation exposure, one should agree with D. N. Mackenzie (1970) and consider it as a reactive process. The process is rare, its true frequency is difficult to determine, since it is often misdiagnosed as fibrosarcoma. Among the patients, elderly people predominate. Localized in the area that was subjected to training. A specific property is the tendency to be located in the dermis with secondary involvement of subcutaneous fatty tissue and only

in advanced cases - deeper tissues. The latent period after irradiation can vary within very wide limits - 1.5 - 40 years, usually averaging 10-12 years. The total radiation dose varies between 300-600 Gy. In the thickness of the skin, a poorly contoured dense formation is determined, often ulcerated and painful on palpation, which sometimes consists of several nodes fused together. Radiation fibromatosis often recurs repeatedly. Usually, relapses occur in patients with large lesions localized in places inconvenient for radical removal (face, neck) May be a direct cause of death due to growth into large blood vessels

Microscopically, radiation fibromatosis has the appearance of a flattened node without clear boundaries, dense consistency, gray in section, layered, without foci of necrosis. The size of the node is very variable.

The microscopic picture is characterized by pronounced proliferation and polymorphism of fibroblastic elements. Most of the cells are spindle-shaped with oval or fusiform nuclei and scanty cytoplasm (Fig. 57, a, b), the nuclei are hyperchromic, less often vesicular with single mitoses. Characteristic is the presence of large cells of irregular shape with ugly hyperchromic nuclei and distinct eosinophilic cytoplasm, sometimes containing fat (Fig. 57, c) In these cells, figures of atypical mitosis can be determined. Transitional cell forms are found between spindle-shaped and large cells. The stroma, especially in the peripheral areas, is rich in collagen fibers. Cells and fibers are arranged randomly, sometimes with beam grouping (Fig. 57, d)

When diagnosing radiation fibromatosis, differentiation must first be made from radiation fibrosarcoma, atypical fibroxanthoma of the skin and malignant fibrous histnocytoma.

BENIGN FIBROBLOGICAL TUMORS

Term 5), F M Hnzinger (1965), D. N Mackenzie (1970), R W Allen (1977), M l.arregue et al (1980), in which issues of classification were also considered. Most

Rice. 60. Congenital fibrosarcoma-like fibromatosis.

a, b proliferation of fnbroblastic elements with polymorphism of nuclei and the formation of a “herringbone” pattern simulating gliacomuscular growths (b) (a X250, b X160) in the focus of necrosis, surrounded by palisade-shaped cells 1X160) d infiltration of tumor tissue with lymphoid moments zh> nshmiyn subwindows u X IMi ft\25oi

survive the “critical” first 5 days of life. New nodes can appear at 18-20 months and even at 5 years. birth trauma Relapses after excision are common Cases of spontaneous regression have been reported

Juvenile aponeurotic fibroma (cartilaginous analogue of fibromatosis, juvenile calcifying fibroma) was first described by L. E Keasbey in 1953. It occurs at the age of 3-15 years, but can also be observed in adults. Localized mainly on the hand and foot, more often in males The lesion is a poorly demarcated, often associated with an aponeurosis, dense node of grayish color, crispy when cut Can infiltrate the underlying tissues down to the bone Its diameter does not exceed 3 cm, although nodes with a diameter of 6-10 cm (Keasbey L E, Fauselan H, 1961, Goidmann R L, 1970] Microscopically, the node is formed by spindle-shaped and oval cells with “plump” oval nuclei and light homogeneous cytoplasm. The cells are located either compactly, especially on the periphery, or loosely. A characteristic feature of the structure are

foci of calcification and cartilaginous transformation (Fig. 66, a, b, c) The process often recurs, especially when localized on the hand and foot (Allen R W, Enzinger F M., 1970], which is probably due to the difficulty of excision, given the tendency to relapses, most researchers attribute it to fibromatosis

Fibrous hamartoma of infants (synonymous with subepidermal fibrous tumor of infants) was first described by R D K Reye in 1956, and given its present name by F M Enzinger in 1965. Most researchers tend to consider this process as a variant of fibromatosis, and not as a “hamartoma”. It has been detected since birth and up to 4 years of age, mainly in the first 2 years of life; boys predominate among patients (up to 70% of observations) The formation is located mainly in the subcutaneous tissue and is localized mainly on the forearm, shoulder, axillary and buttock areas Multiple lesions can be observed The lesion is a vaguely contoured node of a grayish-yellow color on the section, usually with a diameter no more than 4 cm, although nodes measuring 7-10 cm have been described (Enzinger F M, 1965; Mackenzie D N, 1970]

Microscopically, the node is characterized by the presence of 3 main structural components: fibrous tissue of varying degrees of cellularity in the form of cords and rays, foci similar to primitive mesenchyme, mature adipose tissue, occupying about half the volume of the node (Fig. 67, a, b, c). Some authors (Wichert A M et al, 1973, Reye R. D K., 1956; Allen R W D., 1977] also note a significant number of capillary-type vessels. The prognosis is favorable, relapses after excision are rare. According to A M Wnchert (1969 ), the formation evolves towards the maturation of all tissue components and by the age of 4 years can turn into a keloid with layers of mature adipose tissue

Juvenile aigiofibroma of the nasopharynx was described by S Sternberg in 1954. It occurs predominantly in males, mainly between 10 and 20 years. Clinical symptoms are associated with the size of the lesion and the degree of its spread to neighboring areas. It occurs from cartilago basalis, consists of connective tissue with a moderate number of cells, the latter often with ugly nuclei The formation contains fairly evenly spaced vessels of the sinusoidal type (Fig. 68, a, b, c) Invasion into adjacent tissues, including bones, is characteristic. Cases of spontaneous regression were not observed, only partial regression is possible (Dane W. N, 1954]

Hereditary gingival fibromatosis (hereditary gingival hyperplasia, primary generalized gingival hypertrophy, congenital idiopathic gingival fibromatosis, congenital macrogingivia, gingival gigantism, multiple epulids) is described in detail by D Winstock (1964), E R Hehefer, L A Kay (1967 K G Farrer-Brown et al (1972) Occurs equally often in people of both sexes and is expressed by tumor-like thickening of the gums with loosening and loss of teeth The process can occur from the moment of eruption of baby teeth, and sometimes from birth, is often hereditary Sometimes combined with hypertrichosis, keirofibromatosis, dementia, cherubism Histologically noted proliferation of dense avascular connective tissue with a small number of cells and a large amount of collagen, which makes the process similar to a keloid Inflammatory changes are minimal Opxan is also a cellular and vascular variant with large fibroblasts, small foci of bone formation and a few osteoclast-type cells Relapses are possible Spontaneous regression has not been described but a fibromatolic variant b sarcomagolic variant in the chixomato and zone of the infcdytraimn axillary tissue d aggressive fibroma and use of the infml^rain of the transversely striated mouse

Mixed fcbromatoses of desmoid type. Abdominal fibromatosis

(abdominal desmoid, muscular aponeurotic fibromatosis, desmoid tumor, desmoid fibroma, fibrosarcoma) - a dense tumor-like formation localized in the thickness of the anterior abdominal wall, mainly in connection with the posterior layer of the rectus sheath, less often - other muscles. Characterized by pronounced infiltrative growth. Often a family predisposition is noted, may be a component of Gardner's syndrome Occurs mainly in women after childbirth In rare cases, it is observed in men, children and even newborns Microscopically characterized by the ordered structure of collagen bundles and the presence of fibroblasts located between them, reminiscent of the structure of the aponeurosis Depending on the number of cells, some authors distinguish fibromatous and sarcomatous variants of desmoid (Fig. 69, a, b) The latter, rich in cells, is close to fibrosarcoma, differs from it mainly in the moiomorphic structure, abundance of collagen fibers, rarity of mitoses. In desmond, foci of mucus with an abundance and polymorphism of cells are possible. Such neoplasms have more pronounced invasive properties and in rare cases can give metastases. Based on this, in the literature there are ideas about desmoid myxoma and desmoid myxosarcoma (Figure 69, c), which are essentially varieties of abdominal fnbromatosis and at the same time demonstrate the difficulties of clearly distinguishing between different forms tumor-like growths and connective tissue tumors

Aggressive fibromatosis (desmoid fibroma, muscular apoieurotic fibromatosis, extra-abdominal desmoid) is observed in most cases in young people, localized in the area of ​​aponeuroses and fascia, mainly on the limbs, shoulder girdle, buttocks. Some authors point to the occurrence of the process in scars in the area of ​​the former injuries Has pronounced infiltrative growth (rns 69, g), a tendency to repeated relapses Macro- and microscopically identical to the abdominal desmoid, differing from the latter in the presence of giant cells, an almost complete absence of mitoses, more abundant lymphohistiocytic infiltration along the periphery. Electron microscopy notes an abundance of myofibroblasts The process is often relapses

Intra-abdominal desmoid is characterized by a similar proliferation of fibrous tissue in the mesentery and omentum with the formation of a poorly contoured node reaching a diameter of up to 20 cm. It occurs as an independent process or as a component of Gardner’s syndrome. It is observed at any age, more often in male patients.

Mixed fibromatoses of the Dupuytrea type. Palmarian fibromatosis. Dupuctren first demonstrated a patient with palmar fibromatosis in 1832. Currently, the occurrence of the disease is assumed to be an immunological response to its own altered collagen. It has been suggested that there is a connection with heavy physical work, especially during manual labor, which, however, is not shared by everyone. It has been noted that in foci of proliferation fibroblasts, the presence of myofibroblast-type cells is possible; in 2/3 cases there is a bilateral lesion; a long time interval is possible between lesions of one arm and the other

Palmarian fibromatosis has the appearance of an infiltrating and nodular formation emanating from the palmar aponeurosis and leading to contracture of the IV, V and, less commonly, other fingers of the hand. It can be combined with plantar fibromatosis and Peyronier’s disease. There are 3 stages of the disease: proliferative, characterized by random proliferation of fibroblasts with the formation of soft, rich cells multiple nodules with small

and proliferation of fiRRLL. yu" polymorphic nuclei 6 "meiamni" the number of cells and the increase in collagen formation, "shaping". aunts in parallel rows in longitudinal and

the number of collagen fibers and the accumulation of amorphous interstitial substance (Figure 70, a), involutive, characterized by the ordered arrangement of fibroblasts, a decrease in the number of cells, an increase in collagen mass, the beginning of wrinkling (Figure 70, b, c), residual, in which dense cords are formed, resembling tendons (Fig. 70, d) There are relapses after operations, metastases are not described

Plantar fibromatosis (Ledderhose syndrome, described by him in 1897), unlike palmar fibromatosis, is rarely accompanied by flexion contracture. It usually affects the medial part of the sole of the foot (plantar aponeurosis) and has the form of nodules, over time reaching 4-5 cm in diameter. The nodes are usually dense, multiple, associated with fascial formations Microscopically, the newly formed tissue is rich in fibroblast-like cells

Fibromatosis of the penis (Peyronier's disease) The disease is named after the court physician of Louis XIV who first described this process. Occurs mainly at the age of 40-60 years. Sometimes combined with palmar and plantar fibromatosis

According to D N Mackenzie, the disease has an inflammatory basis, its cause remains unknown. D N Mackenzie, not including it in the group of fibromatoses and considering it as idiopathic fibrosis, notes that Peyronier’s disease can spontaneously regress, which is unusual for true fibromatoses, which are also not have features of inflammation. The localization of the process in the penis is unclear. Some authors believe that the cavernous bodies (intercavernous septa) are initially affected, others suggest that the process begins in the tunica albuginea or in the loose, vascular-rich tissue separating the cavernous bodies from the tunica albuginea. Initially, 1-2 appear fibrous plaques, over which the skin remains mobile Plaques increase in size and number Based on this, there is proliferation of fibroblasts with its progressive increase and subsequent hyalinosis of collagen. Along with this, inflammatory infiltration by lymphoid and plasma cells occurs; the infiltrate is located perivascularly. Other authors suggest that the process begins with vasculitis in the areolar zone deeper than the tunica albuginea, and then fibrosis occurs, also initially perivascular. Osteogenesis is also possible, which is unusual for fibromatosis and occurs with retroperitoneal fibrosis. With long-term existence, fibrosis spreads to the cavernous bodies, destroying intercavernous septa Inflammatory infiltration is observed during all periods of the disease The disease leads to curvature of the penis and is accompanied by painful erections

MALIGNANT FIBROBLASTIC TUMORS

Fibrosarcoma is a malignant tumor of fibrous connective tissue, characterized by the proliferation of fibroblast-like cells with the production of reticulin and collagen without signs of any other cell differentiation. According to A P Stout, R Lattes (1967), F M Enzinger (1969), only those malignant tumors can be considered fibrosarcomas in which mature type 1 or type III collagen is formed and no other structures are formed. If this criterion is strictly taken into account, the number of fibrosarcomas decreases sharply, and many tumors previously regarded as fibrosarcomas should be classified as other sarcomas - synovial, malignant fibrous histnocytoma, leionosarcoma and etc. It turns out that fibrosarcoma is not the most common malignant tumor of mesenchymal origin.

walking, and one of the rare It should be mentioned that fnbrosarcoma was the first tumor to which the criterion A C. Broders (1939) was applied by analogy with epithelial tumors

Fnbrosarcoma is more often found in the proximal parts of the thigh, shoulder, in the thickness of soft tissues, mainly in adults of both butts. Macroscopically, the tumor in some cases is a clearly defined node, in their tier it has a pronounced infiltrative growth. The tumor is usually associated with the fascia, aponeurosis or located in the thickness of the muscles Microscopically represented by fibroblast-like cells and collagen fibers Depending on their relationship, as well as the degree of cell cataplasia, differentiated and poorly differentiated fibrosarcomas are distinguished

Differentiated fnbrosarcoma (Fig. 71, b) is characterized by an abundance of collagen fibers, an ordered arrangement of cellular* fibrous strands. Giant cells can be found in small numbers. The abundance of the latter is not typical for fibrosarcoma and requires differential diagnosis with rhabdomyosarcoma, liposarcoma

Undifferentiated fnbrosarcoma (Fig. 71, c, d) is characterized by a predominance of cells over fibers. Nuclear perchromatosis, nx polymorphism, and an abundance of irregular mitoses are noted. The number of collagen fibers varies widely, argyrophilic ones often predominate. In fibrosarcomas, there are foci of mnksomatosis, in which the cells acquire a stellate shape, nuclei they are rich in DNA, mitoses occur. With a significant number of areas of myxomatosis, we can talk about fibromyxosarcoma. According to some authors, such tumors are more malignant. The structure of fibrosarcoma is usually polymorphic, in some areas it is typical for a differentiated form, in others - for a poorly differentiated form. When verifying a tumor, one should be guided to the least differentiated areas, since they determine the course and prognosis of the disease

Differential diagnosis of fnbrosarcoma often presents great difficulties, especially nodular fasciitis, monophasic spindle cell synovial sarcoma, as well as rhabdomyosarcoma and some forms of liposarcoma. The basis for the differential diagnosis of fibrosarcoma from fibromatosis is the orderliness of the tumor structure, monomorphism of cells, irregular mitoses, the absence of inflammatory infiltration, the presence areas of myxomatosis However, D N Mackenzie (1970), for example, indicates that in the “fibroblastic spectrum”, that is, in the dynamics of the transformation of fibroblasts during inflammatory-regenerative, dysplastic and blastomatous processes, “there is a point where cell-rich nodular fibromatosis , mainly of the fascintal type, extra-abdominal desmoid, is indistinguishable from fibrosarcoma, and in these cases, morphological analysis cannot help verify and predict the detected process."

From monophasic synovial sarcoma of the spindle-shaped type, fnbrosarcoma differs in its large size and rounded shape of the cells. They are located more closely, forming orderly interwoven strands, which is less typical for synovial sarcoma. For the differential diagnosis, it is also important to detect the epithelioid “phase” of synovial sarcoma, without which the diagnosis of this tumor is always doubtful It is relatively easy to distinguish fibrosarcoma from rhabdomnosarcoma by the presence in the latter of differentiation typical for muscle tumors

It should be especially emphasized that the number and degree of maturity of the fibrous part of the tumor in differential diagnosis with other tumors are not important, since the fibrous basis of many other tumors of mesenchymal and neuroectodermal origin can be quite well expressed. At the same time, a tumor of connective tissue origin can reach such a degree of catplasia that its cells lose the ability to form fibers or the latter is limited to argonrophilic fibers, sometimes only with a perivascular location. The term “fibroblastic sarcoma,” which is sometimes still used, is identical to the concept of poorly differentiated fibrosarcoma. Among tumors previously classified as sarcomas with a predominance of certain types cell shape (round-, oval-, spindle-, giant cell sarcomas), there may be low-grade cancer, hemoblastosis, tumors of neurogenic origin. The diagnosis of sarcoma indicating only the shape of the cells does not provide a complete histological, and therefore clinical and anatomical characteristics of the tumor. impossibility of determining the histological identity of such tumors, they should be included in the category of unclassified. They account for up to 15% of all malignant soft tissue blastomas. The term “cyntoblastoma” [Glazunov M. F., 1971], “meristoma” [Fischer-Wasels E., cited by Glazunov M F., 1971] should not be used

It is known from the literature that in a retrospective analysis, the established diagnosis of fibrosarcoma in the 19th - early 20th centuries was confirmed in no more than 50%. This is explained not only by the difficulties of verifying this tumor, but also by the fact that in recent decades such forms, previously unknown pathological processes of cellular-fibrous structure, such as “pseudosarcoma”, nodular fasciitis, some other fibromatoses To date, the percentage of false conclusions, of course, has sharply decreased, and many factors that cause them continue to operate, and, in particular, many difficulties remain in the morphological differential diagnosis of fibrosarcomas

Fibrosarcoma can occur anywhere in soft tissues, but more often on the thigh, in the dermis and subcutaneous tissue of other parts of the body. Many indicate the more frequent localization of fibrosarcoma in the area of ​​scars after burns, osteomyelitis, radiation exposure (including for therapeutic purposes)

In recent years, 3-4 degrees of differentiation of fibrosarcomas have been distinguished, which better correlates with the prognosis (frequency of metastases, relapses) compared to the previous two degrees. The prognosis is also influenced by the location of the tumor in the superficial or deep tissues, the size of the tumor, and the age of the patients. It is also noted that the frequency relapse depends on radicality

1st operation and the number of subsequent operations Depending on the listed factors, according to various statistics, it ranges from 9-80% After conventional excision, tumors occur in 80%, after extended (radical) - in no more than 9% With the same procedure same surgical technique, with more mature fibrosarcomas, relapses occur less frequently than with poorly differentiated ones. Metastases in regional lymph nodes are observed in 4-6%, distant ones, starting from the lungs, in 55%

According to some data, with highly differentiated fnbrosarcoma, 38% die in the first 5 years after surgery, with poorly differentiated - 50% of patients

Fibrosarcoma in children is a rarer tumor than in adults. Based on the observations of E N Soule et al. (1968) fibrosarcomas accounted for only 4% of all malignant soft tissue tumors in children, while in adults they accounted for 12%

Fibrosarcoma in children occurs mainly in the first 5 years of life, and more than in 3 cases - in newborns. Boys are more often affected (approximately 60%) In most cases in children, fibrosarcoma is localized on the extremities (up to 75%), most often the lower ones. Typically, it is characterized by grows rapidly and can reach large sizes within a few weeks or months. Congenital fibrosarcomas may cause skin ulceration and bone destruction

The treatment method for fibrosarcoma in children is wide excision of the tumor; amputation seems inappropriate for primary surgery

The relapse rate ranges from 16.6-43% (Chung E W, Enzinger F M, 1976; Soule E N, Pritchard S J, 1977] and even 60% The metastasis rate is 8-10% Relapses and metastases can occur within a period of several months up to 17 years after primary surgery The five-year survival rate in children can reach 84%, although at the age of 10 to 15 years it is practically the same as in adults and is approximately 50%.

There is no prognostic dependence on the degree of cellularity, the number of mitoses, the prevalence of hemorrhages and necrosis. In the differential diagnosis of fibrosarcoma in children, it is necessary first of all to distinguish it from embryonal rhabdomnosarcoma, malignant schwannoma and some forms of congenital fibromatoses

FIBROHISTIOCYTIC TUMORS AND TUMOR-LIKE LESIONS

Some neoplasms from this group, in particular dermatofibroma, are already known to Davio (Unna P, 1894), and to date the literature regarding these tumors is very extensive. However, there are still conflicting views on their origin and essence (blastomatous or reactive process) Difficulties in diagnosis are also significant, especially clinical

The variety of structural features and views on the nature of fibrognstiocytic processes is reflected in a broad terminology; the following are more often used: fibrous histiocytoma, fibroxanthoma, dermatofibroma, angiofibromatosis, histiocytoma, nodular subepidermal fibrosis, sclerosing angioma, neurofibroma with a bizarre pattern, protuberant dermatitis ophibrosarcoma, malignant fibrous gnstiocytoma, malignant fibroxanthoma, fibroxanthosarcoma. The most important role in proving their single histogenesis and in their clinical and morphological characteristics was played by the works of M. F. Glazunov (1956), Yu. V. Postnov

(1961), A K Apatenko (1973, 1976), R E Gross, S B Wollach (1943), D F Dauson (1948), J O'Brien, A P Stout (1964), etc.

Currently, in this group of lesions, a group of fnbrohistiocytic tumor-like lesions (xanthomas, xanthelasmas, juvenile xanthogranuloma, atypical fibroxanthoma) should be distinguished. a group of benign tumors, denoting all their various clinical and morphological manifestations with the term “fibrous histiocytoma”, proposed by A. P. Stout and R. Lattes in 1967, and a group of malignant tumors (dermatofibrosarcoma protuberans and malignant fibrous 1Hstiocytoma)

PHYROHISTIOCYTIC LESIONS

Xaitoia is a rare formation, most often localized in the skin. It occurs in people with impaired lipid metabolism, usually multiple. Also localized in the tendons, including the Achilles, in the fingers, in the area of ​​the patellas, in the area of ​​​​the joints. Represented by small nodules, part of the xanthelaem type

Microscopically, it is represented by large histiocytes with foamy cytoplasm. containing lipids Groups of cells are located between bundles of collagen fibers. With long-term existence, cholesterol new granulomas appear

Xanthelasma occurs in middle age, often without symptoms of xanthomatosis or lipidemia. localized in the skin of the eyelids, in the corners of the eyes

Microscopically, the process is represented by groups of large monomorphic foam cells concentrated around the vessels

Juvenile xanthogranuloma is a tumor that is a formation from the xanthoch group, which occurs mainly in children, and can be congenital; usually multiple. Macroscopically it has the form of a small \ nozzle in the thickness of the dermis or in the subcutaneous tissue. Disappears spontaneously Localized mainly on the head, neck, torso The histological structure of the nodules does not differ from that of other types of xanthoma. An admixture of acylophiloids (eosinophytes) is noted (Fig. 721

Atypical fibroxaitoma (paradoxical fibrosarcoma of the skin, leevdosarcomatous dermatofibroma, pseudosarcomatous reticulohistiocytoma, pseudosarcoma of the skin) The term was first proposed by H Lund and J Krause

(1962), emphasizing the benign nature of the lesion. Previously, most researchers considered this process as malignant. Some authors and at present are predominantly localized on the skin of the head and neck; rarely occurs on the trunk and limbs Often occurs in areas of pathologically altered skin - in scars after burns and wounds, in irradiated areas (for example, due to cancer or basal cell carcinoma)

The formation has the appearance of a soft nodule with unclear boundaries, localized in the dermis, grayish-yellowish in color in section. The size of the nodule rarely exceeds 2-3 cm in diameter, although sometimes, especially in the trunk and limbs, it can reach 5-10 cm. Foci of necrosis are absent even in large nodes, although sometimes the formation can ulcerate

The microscopic structure is very variegated: fibroblast-like cells, xanthoma cells, small and large polymorphic histiocyte-like cells, inflammatory, predominantly lymphoplasmacytic infiltration. The quantitative ratio of cellular forms is also very variable. In the central areas of the formation there is a tendency for large histiocyte-like cells to predominate, and in the peripheral areas - fibroblastic; the absence of a clear “moiré” pattern in fibroblastic growths is emphasized. In large cells, mitoses are often visible, including atypical ones

Atypical fibroxaitoma should be differentiated primarily from malignant fibrous histiocytoma, desmoplastic melanoma, and anaplastic cell carcinoma.

BENIGN FIBROHISTIOCYTIC TUMORS

It seems appropriate to assign the term “fibrous histiocytoma” to this clinically and morphologically very diverse group of tumors, given that it is more general in nature than others, and that the term “malignant fibrous histiocytoma” has firmly entered the literature and practice

It is more common in middle and old age, localized mainly on the lower extremities. Usually the tumor is solitary, has the form of a small dense node (rarely exceeding 1.5 cm in diameter, and sometimes reaching 10 cm), pinkish-yellow, ocher-yellow, brownish in section or almost black Grows slowly, sometimes growth stops for a long time Relapses are rare

The microscopic diversity of the structure of this tumor is reflected primarily in the terminological diversity that we noted above. Paying tribute to tradition, we will also present the morphology of this formation in accordance with the ideas of M. F. Glazunov (1956), who identified 4 main variants of the structure: simple, lnpidiyn, siderotnic and combined However, it should be noted that the identification of these options does not have any clinical or prognostic significance and is important only for morphological differential diagnosis

The simple form, also known as dermatofibroma, is characterized by an abundance of capillaries, often with dilated lumens, between which there is connective tissue that has a peculiar pathognomocc rhythmic structure (“moiré” structures) (Fig. 73, a) Fibers, usually thin and slightly crimped, form regular patterned weaves, consisting of thin bundles emanating from one center, or ribbon-like figures. Cells such as fibroblasts or fibrocytes are located parallel to the fibers. Birefringent lipids are sometimes found in them

The lipid variant (fibroxaitoma) is represented by the same capillaries and moiré structures, but the cells are large, with fine cytoplasm and light, large polymorphic nuclei. A large number of birefringent lipids are detected in the cytoplasm, continuous fields of xanthoma cells with foamy, fat-containing cytoplasm, giant multinucleated cells, individual Touton cells (Figure 73, b)

The sclerotic form (sclerosing angioma) is distinguished by a large number of large hemosiderinophages, sometimes forming continuous fields (rns 73, c)

It is also worth highlighting the so-called angiomatous variant of this formation, in which the vascular component predominates. It resembles a vascular tumor, for example, hemangioeidothelioma or hemangiopericytoma (Fig. 73, d). The boundaries of the tumor are usually unclear, which creates the impression of infiltrating growth. Mitoses are rare. Characteristic property the tumor is prone to fibrosis, often with pronounced hyalinosis. At the same time, the number of vessels and fat-containing cells decreases over time, hemosderophagus disappears. A similar process can occur in the central or peripheral parts of the tumor, and in some cases it covers the entire neoplasm and creates a picture of dermatofibroma

The literature describes reticulohistocytoma, characterized by the presence of many giant, often multinucleated cells containing lipids and iron, as well as an abundance of capillary-type vessels. The tumor also shows fibrous evolution and, apparently, is a peculiar variant of reticulohistnocytoma

This group also includes the so-called non-voxantoendothelioma. Its signs and macroscopic picture are close to angnofibroxanthoma. The favorite localization is the head, especially the face. It often appears in children and young people, sometimes it is multiple. Microscopically, under the atrophic epidermis, it is not clearly demarcated from the surrounding tissue. a tumor consisting of cells of various shapes and sizes

There are small cells with dark nuclei and very scanty basophilic cytoplasm, epcthelioid type cells with foamy cytoplasm containing fat (usually birefringent), and many Touton giant cells. These are very large multinucleated cells with numerous nuclei located in the form of a ring or semi-ring around the basophilic area of ​​the cytoplasm in the center of the cell. Clusters of typical xaitomytic cells, a significant number of capillary-type vessels and delicate loose fibrous tissue, here and there with rhythmic “moiré” structures, are also observed

Differential diagnosis should be carried out with fibrosarcoma, from which angiofibroxanthoma differs in the absence of mitoses (especially atypical) and destructive growth. Siderotic angiofibroxanthoma may resemble melanoma, but the pigment in the latter does not contain iron.

Rice. 74. Selected dermyatofibrsh’arkomya clear moire pattern (X Shm

Angiofibroxanthoma can be distinguished from vascular tumors by the presence of “moiré* structures, which are a reliable identifying sign of tumor formation.”

(.lOKAMF ("TBKHHWf FIBRO! IM"POCITAR! TUMORS

Dermatofibrosarcoma protuberans is the most common malignant non-native tissue tumor of the skin |Hundeiker Part 19Y1) Name of the skin.) 1) ag rier, M Ferrand (1924) According to modern data, the tumor originates from the neural connective tissue. gender, rarely in children. Mostly on the body (more than 50%). less often on the limbs, head, neck. Similar to dormatofibroma, at first it looks like a plaque on the skin with clear edges, grows slowly. Later it looks like bulging nodes, the growth of which is rapid. It grows within the dermis, later penetrates into the subcutaneous tissue. may also invade the underlying fascia

Microscopically, it is characterized by the presence of large fibroblast-like cells, distinguished by segmented nuclei and an abundance of mitoses; a few giant cells are found. Orocha is represented mainly by argyrophilic fibers with small thin layers of collagen fibers; lymphoid infiltrates are often formed. Bundles of cells and fibers form “vortex”, “moiré” ribbon-like structures (Fig. 74). Foci of myceocatosis and ulceration of the skin over the tumor may occur. Relapses occur in 30% of cases, metastases are extremely rare and appear with “inadequate” therapy, usually with relapses. In the latter, compared with the primary tumor, cellular polymorphism increases, and the number of cells increases.

Malignant fibrous histiocytoma 7 was first identified as its own nosological form in 1964. It ranges from 44 to 68%, and in half of the cases they are repeated and can occur a long time (up to 8 years) after excision of the primary tumor. Metastases occur in 40-45 %, mainly to the lungs (up to 87%), to the lymph nodes (30%) The five-year survival rate is about 60% (Fedenko A. N. et al, 1985]

The method of choice for the treatment of malignant fibrous histiocytoma is wide excision of the tumor or amputation of the limb (especially after repeated relapses), supplemented by radiation and chemotherapy. There is a clear dependence of the rates of recurrence, metastasis and five-year survival on the depth of the tumor in the thickness of the soft tissues; superficially located tumors recur more often ( up to 94.7%), less likely to metastasize (up to 21%), five-year survival rate reaches 94.6% Deeply located - recur less often (up to 67%), more often metastasize (up to 54.5%), five-year survival rate does not exceed 54.6% Tumors of retroperitoneal localization behave extremely unfavorably; the five-year survival rate is only 14-16.7%. The size of the tumor also affects the prognosis. For tumors smaller than 5 cm, the recurrence rate ranges from 37.25% (Weiss S W., Enzinger Q M,

1978] up to 75% (Fedenko A N et al, 1985), the metastasis rate is from 33.3 to 44.4%, and the five-year survival rate is 70%. For tumors larger than 10 cm in diameter, the recurrence rate ranges from 39 to 68%, the metastasis rate is from 57 to 85%, and the five-year survival rate is only 26%. None of the researchers have yet been able to identify a statistically significant correlation between the morphological variant of malignant fibrous histiocytoma and its course. We can only point out a more favorable course of the myxoid variant of the tumor

It should be noted that there are two more very peculiar variants of a malignant tumor from histiocyte-like cells, the moyomorphic malignant histiocnthoma and its angiomatoid variant.

Without denying the possibility of the existence of a monomorphic or “pure” variant of malignant gnstiocytoma, which is a rather rare tumor with a tendency to rapid generalization, it nevertheless seems necessary to carefully study such tumors and compare them with histocytic reticulosarcoma and local manifestations of malignant histiocytosis

The annomatoid variant of malignant fibrous histiocytoma, isolated by F M Enzinger in 1979, is distinguished by a certain clinical and morphological originality. This variant occurs mainly in children and young people (88% of patients, according to F M Enzinger, are younger than 30 years old), often localized in the extremities (thigh, elbow area) and is located mainly in the superficial tissues. Macroscopically, this tumor is clearly demarcated, multinodular or multilocular, with hemorrhages or cavities filled with hemorrhagic contents, can reach 10 cm in diameter (on average, about 3 cm) Microscopically, it is characterized by central foci hemorrhages or hemorrhagic cyst-like spaces to hemorrhagic contents, surrounded by solid accumulations of fnbroblasto- and histiocytoma-like cells, often containing varying amounts of hemosiderin and lipids Can be well grown

a general aid nodular growth pattern (UbZ), b stimulation of forchir) Biii vascular structures (X16L|. c pronounced proliferation of gnetiocyte-like mementes (u250) d presence in the proln ferats of elongated fibroblastic memects Diffuse focal itfiltration. "ymphoid elements (X 160)

female lymph node infiltration, which is mainly perifocal in nature, which makes the process similar to metastasis to the lymph node (Fig. 77, a, b, c, d)

The lngiomatoid variant has a relatively favorable course. Relapses are observed in 63% of cases [Ilshmtsr R M. 1979]. usually in the 1st year, and metastases in 20%

This variant should be differentiated from various benign and malignant vascular tumors.

ADIAT TISSUE

Adipose tissue in embryogenesis arises from mesenchymal lipoblast cells, initially associated with the walls of capillaries.

The accumulation of fat in the lipoblasts occurs in the 12-13th week of the intrauterine period; According to some data, in the form of small vacuoles, which later merge into one large one, according to others, immediately in the form of one vacuole, gradually enlarging. Fetal fat cells contain a lot of glycogen, which accumulates in them before the deposition of fatty substances begins. Fat accumulates unevenly, and in the same lobule, along with formed lipocytes, there may be cells that do not yet contain fat, which gives the fat tissue significant polymorphism in the early embryonic period. In addition to the fibrous stroma, it contains an amorphous mucous intermediate substance containing mucoid substances, as well as foci of hematopoiesis and accumulations of histocytic elements. Some authors [Abelier A, 1955] consider adipose tissue to be close to reticular, and perhaps one of its varieties, others point to a close genetic connection between adipose and fibrous connective tissue. Ordinary adipose tissue is characterized by a significant predominance of neutral fat

In the body of adults, islands of brown fat can sometimes be found, morphologically and in the composition of fatty substances reminiscent of the brown fat of hibernating animals.

Rice. 79. Lipoma with cellular nolimorphy 1 of the adrenal glands. In human embryos, islets of fat are blown and blown by the wind (Fig. 78)

Microscopically, brown fat differs from ordinary fat in the predominance in it of so-filled mutilocular fat cells, the lining of which is made of small fat vacuoles, as a result of which it has a foamy appearance, the nucleus is located centrally. Brown fat cells are smaller than ordinary liponites. They are grouped into lobules, abundantly supplied with blood capillaries, to which the cells are closely adjacent.

Brown fat is dominated by phosphatides, bi-refractory lipids (especially cholesterol), a lot of saturated fatty acids, as well as proteins. The different composition of fat can be judged by the coloring of sections with Nile blue, which gives different shades of blue-violet and orange. The question of whether brown fat is a special type of adipose tissue, or, as some authors believe, the embryonic stage of ordinary adipose tissue, can now be considered decided in favor of the first

Lipoma is one of the most common benign tumors (30–40%) Can occur anywhere there is adipose tissue When localized in the dermis, it is usually encapsulated; in other parts of the body it is often poorly demarcated. Rarely found on the extremities and internal organs, in particular, it can occur in the extradural space, in the bones. Recurs often due to difficulty in removal or due to possible (for example, with peritoneal localization) malignancy

Lipomas are often multiple and sometimes develop symmetrically. Their growth is not related to the general condition of the body; So. when exhausted, lipomas not only do not lose fat, but continue to accumulate it.

Macroscopically, lipoma is characterized by a nodular shape, less commonly

unclearly demarcated A node with a lobular structure can reach a very large size due to connective tissue layers

Microscopically, the tumor is built like ordinary adipose tissue and differs from it in the different sizes of lobules and fat cells. The latter are either very small or reach gigantic sizes. Between ordinary unlocular cells (i.e. containing one large fat vacuole), small groups of multilocular cells are sometimes found (Fig. 79) Some authors consider multilocular cells to be cambial

A lipoma has an abundant capillary network that entwines the cells. The connective tissue layers contain basophils. The amount of fibrous connective tissue is different, as a result of which the tumors have different consistencies and are divided into soft and dense, also called fibrolipomas (Fig. 80). The abundance of vessels (Fig. 81) in some tumors allows talk about angiolipomas

With prolonged existence, degenerative changes, calcification, and sometimes ossification can develop in the lipoma. Occasionally, mucus formation in individual areas is observed, which is combined with atrophy of fat cells and pronounced edema. It is not always possible to distinguish such a lipoma from the so-called embryonic lipoma

Intramural (infiltrating) lipoma is distinguished by the fact that, located deep in the muscles, it does not have clear boundaries, simulating infiltrating growth

There are numerous variants of mature fatty tumors that differ from the described “classical” fatty tumors both in clinical manifestations and in some morphological features

Naevus lipomatodes superficialis - subcutaneous flat plaques, sometimes with proliferation of the epidermis. They are congenital or occur in early childhood, mainly in the pelvic area. Microscopically, between the bundles of dermal fibers, mainly perivascularly, the proliferation of adipose tissue is determined against the background of a pronounced reduction of elasticity

Myelolipoma is a rare tumor in which mature adipose tissue is mixed with hematopoietic tissue. It is found in retroperitoneal tissue, pelvic tissue, and adrenal glands. The neoplasm remains benign in nature and is not accompanied by hematopoietic disorders

In addition to nodular lipomas, there are some forms that not all authors classify as blastomas. Such forms include retrorectal lipoma, branched joint lipoma, ring lipoma of the neck (Madeluig's fatty neck). The latter is more often observed with long-term alcoholism simultaneously with alcoholic liver damage. There are also symmetrical lipomas, for example, on the thighs - lipomatosis of the “pants naez” type. Subcutaneous angiolipoma (hemolipoma, “angiophnbroma”, telangioecgatic lipoma, “lipoma dolorosa”, multiple familial lipoma) consists of lilococytes, similar in nature and structure to the lipocytes of the classic lipoma described above, differs abundance of capillaries and fibrous layers The frequency of occurrence is inferior to classical lipoma It is often represented by numerous, painful nodes, occurs at a young age (usually in the 2nd decade of life, i.e. in the puberty), more often in males The most typical localization is in the anterior wall abdomen, on the forearm Thrombosis of dilated vessels is observed in the tumor (Haydu S J, 1979)

A very peculiar spindle cell lipoma (subcutaneous spindle cell lipoma), described in detail by F M Enzinger and D A Harvey in 1975, L Angervall - in 1976. Initially, it was often assessed as liposarcoma

Spindle cell lipoma occurs predominantly in adults, mainly after 45 years. Men are affected in 90%

In most cases, the swelling is located in the dermis or subcutaneous tissue in the form of an oolitic, slowly growing nodule, most often localized in the shoulder girdle, back and back of the neck. These can occur on the extremities, especially the upper ones, torso, head

Spindle cell lipoma looks like a round or oval, usually well-demarcated node, dense consistency, gelatinous, size I 13 cm. Gray-yellow-pink color on the section

Microscopically, the tumor is formed by well-demarcated, but sharply encapsulated mature adipose tissue, which is diffusely or locally replaced by “roliferates of small thin spindle-shaped cells (Fig. 82). These cells are monomorphic, have one elongated nucleus and narrow bipolar cytoplasmic processes, but individual lipid vacuoles are determined in their cytoplasm . Mitoses are rare, the intermediate substance is variable depending on the predominance of mucoid substance or collagen. Basophils, small accumulations of lymphocytes, are found. The vessels are mostly thick-walled and small in size. The cells are often located perivascularly, which resembles the structure of an angioperipitoma. The prognosis is favorable. No relapses or metastases have been described, although there are areas where the tumor infiltrates surrounding tissues.

The histogenesis of spindle cell lipoma is unclear G. M Kiuinger and D A Harvey suggest the influence of endocrine and hereditary factors that play a role in stimulating the growth of these tumors, relative confirmation of which can be the almost exclusive lesion of men 45-70 years old. Spindle cell lipoma must be distinguished from highly differentiated and myxoid liposarcomas , mixo-. fibro- and ayagiolipoma.

Chondro- and osteolipoma are distinguished by the formation of subcutaneous

placed lipoma nodes of metaplaetic bone and cartilaginous parts, foci of myxomatosis and fibrosis. Such tumors are sometimes referred to as mesen-hnmomas or soft tissue hamartomas.

Pleomorphic lipoma (atypical fibrolipoma, pleomorphic spindle cell linoma, “ancient lipom”) was described by V. M. Srnookler and F. M. Knzinger in 1980 and was also isolated from the group of liposarcomas. It affects mainly men (83%). 50 70 years

Pleomorphic linoma is localized mainly on the back of the neck, shoulder and back

The tumor is a clearly demarcated node of a round or oval shape, lobulated in appearance, similar to a lipoma

Microscopically (Fig. 83), pleomorphic lipoma and hoi almost entirely consist of non-leomorphic and more characteristic giant multinucleated cells located in the mycoid stroma, with areas of mature adipose tissue, sometimes a predominance of the latter is observed. Most cases occupy an intermediate position. A characteristic feature is the presence of multinucleated cells with moderate amount of eosinophilic cytoplasm and many nuclei located along the edge, often overlapping each other, which gives them a resemblance to the arrangement of petals of small flowers Nuclei with delicate chromatin and one eosinophilic nucleolus, less often hyperchromic Nuclear atypia is expressed The number of multinucleated cells varies Stroma myxomatosan, rich in chucopolysaccharides Vessels thick-walled, often with hyalinized walls. In 2 D cases, inflammatory infiltration is noted, in 1/4 cases - areas such as spindle cell lipoma, areas of brown fat may be found.

The histogenesis of the tumor is unclear. M. Slmtookler and G. M. Knzinger (1981) draw an analogy with the so-called old schwannoma and believe that

morphic lipoma develops as a result of the progression of cellular changes, possibly degenerative, that occur in spindle cell lipoma

Differential diagnosis of pleomorphic lipoma is quite difficult; often the primary morphological diagnosis is liposarcoma

The tumor is localized mainly on the lower limbs, in the area of ​​the buttocks and thighs, upper limbs (shoulder and hand). The development of the tumor in the neck, mediastinum, trunk, retroperitoneal space is described. Macroscopically, the tumor is lobulated, encapsulated, oval or spherical in shape, often soft, less often elastic or medullary Size ranges from 2 to 14 cm, most often 3-5 cm On section, the tumor has various shades of yellow, with homogeneous gelatinous or myxoid fields, sometimes with small cysts

Microscopically, the lobed arrangement of the fat cells of the lobe is separated by fibrous partitions of various thicknesses in the partitions, many vessels of the capillary type are often found, forming fatty cells, fat cells vary in the degree of diphracias of mature fat cells among lipoblasts, spindle-shaped and stellar meshimal species of cells LNPoblasts and stelled vacuolysized lungs are usually found along the periphery of the lobules and near the capillaries Undifferentiated cells (prelipoblasts) are usually scattered in the myxomatous stroma Mitoses are usually typical Myxomatosis is more pronounced along the periphery of the lobules and small cysts are sometimes found here Occasionally, foci of chondroid metaplasia, lymphoplasmacytic infiltration and foci of extramedullary erythropoiesis are observed Relapses are possible, sometimes repeated, mainly with a diffuse type of lesion

The histogenesis of the tumor is unclear. Some authors believe that the development of benign lnpoblastomatosis occurs on the basis of an anomaly characterized by continued proliferation of lipoblasts in the postnatal period. R A Willis (1962) and M Shear (1967) consider this process as a fatty hamartoma G Geschickter (1934) and D R Van Meurs (1947) believe that benign lipoblastomatosis arises from persistent embryonic tissue during the period of life when there is active transformation of connective tissue into adipose tissue. A Greco (1980) regard the lesion as a proliferation of mesenchymal cells exhibiting all levels of maturation of white adipose tissue and lack of differentiation towards brown fat

In the differential diagnosis of benign lipoblastoma or lnpoblastomatosis, they should be distinguished from the myxoid and well-differentiated variant of liposarcoma

Liposarcoma (lipoblastic lipoma, lipomyxoma, lipomyxosar-

a gchiimorphnchm lippints obn.ne nmkn hlggoktika yanpoblasts single multnlohu gyarn cells polyiprphysi and gnperchronogo" nuclei IX 100), b expression * polyiorphyii ile gok predominance of non-quiet dipoaitiv non-myopgchio eii shpoblasts) d c chronic liuhlrkoka single l)w*you in the fibrous line of yuderzhashey |kin norfiye fibroblastoiolobnye xlgtki (X |(*>)

coma, embryonal cell lipoma, lipoblastoma. malignant lipoma). a malignant tumor of adipose tissue, which is represented by; numerous variants and varieties, differing in I and otological structure and clinical course. The structure of most ZTI-op>choles resembles the structure of adipose tissue at one or another stage of embryonic genesis, which is associated with their unusual polymorphism. In addition to this, in groups of liposarcomas, but - apparently, they often include some other tumors of mesenchymal origin, in which adipose tissue is a significant component (for example, some mesenchymomas). Liposarcoma can be multiple, developing simultaneously or sequentially in one part of the body (for example, a limb) or in different places. , which makes it difficult to resolve the issue of metastasis and its frequency. Some authors classify primary multiple liposarcomas as systemic diseases, calling the process lipoblastomatosis

Tumors are more common in men at any age. Localization is similar to lipomas. More often than others, the low-lying soft tissues of the extremities are affected, especially the thigh, popliteal fossa, lower leg, buttocks, as well as the retroperitoneal region. Tumors also occur in other places, but in the form of casuistic observations, for example, in the meninges, spermatic cord, vulva, mammary gland, uterus, stomach, bones. In general, the entire group of liposarcomas, unlike other mesenchymal malignant tumors, is characterized by relatively slow growth. Tumors can reach large sizes, often weighing 3 kg or more. AR 8 (oi (1UN) mentions a tumor weighing 32 kg. Tumors do not survive for a long time metastasize: although some morphological varieties differ little in clinical course from other sarcomas (for example, round cell liposaggoma)

Macroscopically, liposarcoma has the form of a node or a conglomerate of fused nodes, sometimes well delimited, sometimes with infiltration of surrounding tissues, especially during relapses. Consistency comparison

with lipomas the tissue is more dense, the cut surface is variegated, sometimes it resembles a lipoma, sometimes it is mucous or fibrous; often juicy, white, reminiscent of “fish meat” Areas of necrosis and hemorrhage are common

The microscopic structure of liposarcomas is variegated, which, along with the peculiarities of the course, led to the creation of numerous classifications that served as the starting point for the classification of the WHO commission (1969). This classification is important, although most of these tumors are extremely polymorphic, and their verification is carried out on the basis of the predominance of certain cells and maturity of tumor tissue. Thus, among the cells that make up the tissue of liposarcomas, there are mature lipocytes, lipoblasts of varying degrees of maturity, cells with an abundance of vacuoles in the cytoplasm, reminiscent of raspberries, giant cells with bizarre nuclei, polymorphic large cells, etc. The cells are enclosed in a heterogeneous stroma containing varying amounts collagen, argyrophilic fibers, and mnxoid substance in varying quantities The degree of malignancy of tumors is different. The least malignant is highly differentiated liposarcoma, the most malignant are polymorphic and mixed. It should be borne in mind that almost every tumor combines all possible structural variants of liposarcoma, therefore their verification is based on predominance of areas characteristic of one or another variant. Such a high polymorphism of tumors requires the study of many areas, preferably using stains for lipids, mucopolysaccharides, glycogens

Predominantly highly differentiated lnosarcoma is characterized by a predominance of mature lnzonts of various sizes with some polymorphism and nuclear hyperchromatosis, a small number of mitoses (Fig. 84, a, b, c, d). Often in such tumors the connective tissue component is very pronounced, which gives the tumor the features of fibroliposarcoma. If connective tissue predominates, then the fatty differentiation of the tumor can be established only by the presence of large, often giant tumors scattered in small groups or individually, often having the structure of multilocular cells. Such tumors are called sclerosing liposarcomas (Fig. 84, e) [Puchkov Yu, G, 1972] In well-differentiated liposarcomas, there are also focal complications with the presence of loose bundles of collagen fibers, swollen round connective tissue cells and polymorphic lnocytes, as well as stellate cells with numerous thin anastomosing processes containing PAS-positive substance. The connective tissue component of the described group of liposarcomas is structurally reminiscent of a fibroma or well-differentiated fibrosarcoma. If the examination is insufficiently careful, this is the reason for the erroneous diagnosis of a tumor of connective tissue origin

Predominantly myxoid (embryonic) lnosarcoma has been studied in detail in recent years [Laviikova G A, Daiel-Bek K M, 1965] and in our country is known as embryonic lipoma. Its structure resembles the adipose tissue of the embryo. It is most often localized in the thickness of the soft tissues of the thigh and other parts of the limbs in persons of both sexes of different ages

Macroscopically resembles a myxoma, sometimes consisting of several fused nodes. The microstructure is extremely polymorphic. Characterized by an abundance of capillaries, between which are located amorphous myxomatous masses containing stellate and spindle-shaped cells, the cytoplasm of which contains droplets of fat. Islands are interspersed with the tumor.

from round lipoblasts and areas of lipocytes with one large fat vacuole (Fig. 85, a), multilocular fat cells, small islands of hematopoiesis The stroma is represented by thin argyrophilic fibers with a small admixture of collagen The predominance of cells, an amorphous intermediate substance and fibers determines that in some in some areas the tumor has a reticular alveolar structure, in others - a spongiform alveolar structure, in others - a multicellular structure with a predominance of mature fat cells [Lavnnkova G A, 1969] Reticular alveolar areas are characterized by the presence of a network of capillaries, between which stellate and spindle-shaped cells are located in the mucoid amorphous substance Spongitoalveolar structures differ in that the cells are pushed to the walls of the capillaries by a mucoid substance, sometimes even with the formation of microcysts (Fig. 85, b, c, d, e, f, g). Tumor cells are classified as lipoblastic, located at different phases of maturation from stellate, spindle-shaped to a mature lipocyte During histochemical examination, glycogen is found in them even in greater quantities than fat cells. They have high enzymatic activity. Embryonic lipoma grows expansively, often recurs many times, and metastases are relatively rare. This allows us to regard it for the most part as a tumor with mestiodestructive growth. Isolated There is also a more malignant variant of this tumor called “lipomyxosarcoma”, which indicates a greater cataplasia of cells, an abundance of mitoses in them and a high frequency of metastasis

Predominantly round cell liposarcoma v is characterized by a predominance of round-shaped lipocytes, mostly with a centrally located nucleus and small fat vacuoles in the cytoplasm, which gives them a foamy appearance (Fig. 86, a, b, c). Typical uinlocular lipocytes are represented in the minority. Giant cells with hcperchromic nuclei containing vacuoles

Predominantly polymorphic (differentiated) linosarcoma is characterized by a polymorphic cellular composition (Fig. 87, a, b, c) Small and large round cells predominate with a large nucleus, a coarse chromatin structure. Atypical mitoses are frequent in the nuclei. Small cells have a delicate granular cytoplasm containing glycogen granules. Nuclei of large ones. the cells are ugly, and the cytoplasm contains several fat drops or one large one. These vacuoles do not always contain fat; They are often filled with a protein mass that gives a reaction and glycogen. Large and small cells belong to the lipocytes. Small cells, which multiply quickly, do not have time to accumulate fat, but contain glycogen, which in the embryogenesis of adipose tissue is a precursor of fat. Tumor cells are surrounded by thin argyrophytic fibers, which can be hyalized around large cells Small lipocytes form focal accumulations in the tumor, surrounded by large ones, or both cells are randomly mixed In other areas of the tumor, small lipocytes consist of cellular cords, surrounded by collagen fibers and adjacent to capillaries, which are located in dense networks in the tumor The malignancy of polymorphic liposarcoma is higher, the more small lipocytes it contains. It is especially significant when entire lobules are formed from these cells

A mixed form of liposarcoma is identified, which may contain structures typical of all types of liposarcoma (Kindblom L G et al, 1975; Allen P W, 1981). In the presence of areas such as round cell or pleomorphic liposarcoma, such tumors are described as focally differentiated

According to the literature, the myxoid variant is most common

liposarcoma, in 2nd place is highly differentiated, less often than others are polymorphic, round cell and mixed variants. In the presence of liposarcoma, general symptoms such as fever, leukocytosis, anemia may occur

Differential diagnosis of liposarcoma is not always easy, which is partly explained by defects in microscopic examination. Thus, verification of a well-differentiated liposarcoma encounters difficulties when fibrous tissue predominates in it, when it can be mistaken for a tumor of connective tissue origin. Well-differentiated lipooarcoma should be distinguished from lipoblastomatosis. The myxoid variant of liposarcoma is not easy to distinguish from embryonal rhabdomyosarcoma, the so-called mykgoma, neurilemmoma of the Anthony type. The basis of differential diagnosis in these cases should be the search for lipocytic differentiation of tumor cells, in this case the detection in them not only of fat, but and glycogen, as well as the maturation of stellate cells into lipocytes. The round cell variant of liposarcoma may resemble poorly differentiated fibrosarcoma, fibrous hyaetiocytoma, or rhabdomyosarcoma. malignant paraganglioma Identification in these cases of lipocytic differentiation is the main diagnostic sign

Liposarcoma in children is extremely rare. It occurs in both newborns and adolescents, mainly in boys, in half of the cases in children under 5 years. Its clinical and morphological characteristics are indistinguishable from liposarcomas in adults. Unlike adults, the prognosis for liposarcoma in children is good. Only in some cases. the tumor recurs and metastasizes

Hibernoma (fetal lipoma) (brown fat tumor. Pros glandulare, lipoblast lipoma, pseudolipoma, atypical lipoma) is an extremely rare tumor, most often localized in the neck. in a co il

polar region, on the back, thigh, abdominal wall, “in the mediastinum, i.e. in areas that normally contain brown fat in embryogenesis Does not recur and does not metastasize

Macroscopically, it has the shape of a node with a lobular structure, brownish color, no more than 6 -6 cm in diameter (usually less). Microscopically (Fig. 88) it is characterized by round or polygonal cells folding into cells or lobules, limited by thin connective tissue layers. The cell nuclei are located centrally, clear, with one nucleolus, the cytoplasm is fine-grained or foamy due to the presence of a large number of small fat vacuoles (multilocular fat cells).

Ordinary fat cells are also found in small quantities. When stained with Nile blue, the fat in multi-ocular cells takes on various shades of orange-red and purple. This indicates a different chemical composition of fatty substances. Among them there are also bi-crystalline lipids such as cholesterol, which is clearly visible when examined under a polarizing microscope. The tumor is abundantly supplied with capillaries, to the walls of which tumor cells are closely adjacent

Malignant hibernoma. The localization of the tumor, gender and age of the patients coincide with similar indicators for hiberioma. although statistical data are very scarce due to the small number of published observations. The most detailed malignant hibernoma was described by A.K. Apatenko and K. K. Poroshin (1962, 1963). This tumor is not mentioned in the WHO classification. Meanwhile, in Fig. 39 of the Histological Classification of Soft Tissue Tumors (Geneva, 1974), in our opinion, it is malignant hibernoma, designated as a variant of pathomorphic liposarcoma. Our experience suggests that malignant hibernoma is a special variant of liposarcoma. The tumor is prone to repeated relapses and in this respect is close to other liposarcomas. metastases are observed extremely rarely

Macroscopically, malignant hibernoma resembles Rush liposarcoma, developing under the skin, it can ulcerate and partially necrotize. Microscopically (Fig. 89) it is characterized by extreme polymorphism of multilocular type cells. These cells have different sizes, sometimes round, sometimes polygonal in shape. Among them there are many giant mono- and multinuclear elements with basophilic homogeneous or fine-grained cytoplasm. Along with areas in which such cells predominate, there are fields typical of lipo- or polymorphic cell sarcoma. Mitoses are rare. Swell richly in vasculature; hemorrhages are frequent

Fibrous (fibrous) tissue- a type of connective tissue that has relatively high tensile strength. It consists of collagen and elastic fibers. Most often, such tissue consists of ligaments and tendons. This type of tissue contains practically no living cells and mainly consists of polysaccharides, proteins and water.

Disorder of fibrous tissues

During connective tissue aging, the pathology of fibrous tissues outstrips the aging of other systems.

Disruption of fibrous tissues gives a picture of the appearance of an old man, typical of old age. Clinical manifestations include joint stiffness and pain. These are not inflammatory pains and therefore do not benefit from well-developed scientific anti-inflammatory therapies. The cause of these pains is age-related degenerative changes in connective tissue, leading to disruption of the main property of fibrous tissue - elasticity.

In this regard, the leading clinical symptom of this pathology becomes clear - pain in the musculoskeletal system at the beginning of movement and improvement with moderate physical activity, walking or massage. It becomes difficult to hold a pose and especially change it.

Violation of the ligamentous apparatus of the organ of vision makes accommodation difficult, as a result of which age-related farsightedness develops. The voice becomes hoarse (impaired elasticity of the vocal cords).