Описан первый в мире случай диагностики генерализованной формы кальцифицирующей апоневротической фибромы у 52-летнего мужчины, длительно получавшего терапию по поводу серонегативного ревматоидного артрита с ревматоидными узелками. Учитывая распространенность поражения (наличие множественных подкожных узелков в области апоневрозов и фасций головы, шеи, туловища, верхних и нижних конечностей с массивным отложением солей кальция), сочетание с моноклональной секрецией (IgGκ в сыворотке, BJκ в моче), выраженной воспалительной активностью, случай заболевания является уникальным, так как в отечественной и зарубежной литературе отсутствуют описания такого необычного течения данной мезенхимальной опухоли. Показано, что проведение биопсии подкожных узлов с последующим морфологическим и иммуногистохимическим исследованием является обязательным в диагностике заболевания. Приведены данные литературы, касающиеся клинических проявлений, методов диагностики и дифференциальной диагностики этого заболевания со спектром патологий, сопровождающихся развитием множественного кальциноза.
We describe the first case of diagnosis of generalized calcifying aponeurotic fibroma in 52 year-old man receiving long-term therapy for seronegative rheumatoid arthritis with rheumatoid nodules. The prevalence of lesions (presence of multiple subcutaneous nodules in the aponeuroses and fascia of the head, neck, trunk, upper and lower extremities with massive deposition of calcium salts), and a combination with monoclonal secretion (IgGκ serum, BJκ in the urine), raised inflammation markers, suggest that this case of the disease is unique, so both in domestic and foreign literature contains no description of this unusual course of this type of mesenchymal tumor. We have shown that subcutaneous nodules biopsy followed by morphological and immunohistochemical study is required in the diagnosis of the disease. We have given the literature data on the clinical manifestations, methods of diagnosis and differential diagnosis of this disease with a variety of pathologies, accompanied by the development of multiple calcification.
1. Goldblum JR, Folpe AL, Weiss SW, editors. Enzinger and Weiss's Soft Tissue Tumors. 6th ed. In: Calcifying aponeurotic fibroma. Philadelphia: Elsevier Saunders; 2014 P. 257-87. doi: 10.1097/PAP. 0000000000000020
2. Keasbey LE. Juvenile aponeurotic fibroma (calcifying fibroma): A distinctive tumor arising in the palms and soles of young children. Cancer. 1953;6(2):338-46. doi: 10.1002/1097-0142(195303)6:2<338::AID-CNCR2820060218>3.0.CO;2-M
3. Keasbey LE, Fanselau HA. The aponeurotic fibroma. Clin Orthopaedi Relat Res. 1961;19:115-31.
4. Kilpatrick SE. Calcifying aponeurotic fibroma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. World Health Organization Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon: International Agency for Research on Cancer Press; 2013. P. 63.
5. Sharma R, Punia RS, Sharma A. Juvenile (calcifying) aponeurotic fibroma of the neck. Ped Surg Intern. 1998;13:295-9. doi: 10.1007/s 003830050322
6. Tai LH, Johnston JO, Klein HZ, Rowland J, Sudilovsky D. Calcifying aponeurotic fibroma features seen on fine needle aspiration biopsy: case report and brief review of the literature. Diagn Cytopathol. 2001;24:336-9. doi: 10.1002/dc.1072
7. Fetsch JF, Miettinen M. Calcifying aponeurotic fibroma: A clinicopathologicstudy of 22 cases arising in uncommon sites. Hum Pathol. 1998;29:1504. doi: http://dx.doi.org/10.1016/S0046-8177(98)90022-3
8. Murphy BA, Kilpatrick SE, Panella MJ, et al. Extra-acral calcifying aponeurotic fibroma: A distinctive case with 23-year follow-up. J Cut Pathol. 1996;23:369-72. doi: 10.1111/j.1600-0560.1996.tb0
1312.x
9. Oruç M, Uysal A, Kankaya Y, Yildiz K, Aslan G, Sengül D. A case of calcifying aponeurotic fibroma of the scalp: case report and review of the literature. Dermatol Surg. 2007;33(11):1380-3. doi: 10.1111/j.1524-4725.2007.33296.x
10. Yura S, Terahata S, Ohga N, Ooi K. A Case of Calcifying Aponeurotic Fibroma Arising in the Medial Pterygoid Muscle. J Oral Maxillofacial Surg. 2008;66(2):359-61. doi: 10.1016/j.joms.2006.10.032
11. Chisolm SS, Schulman JM, Fox LP. Adult Xanthogranuloma, Reticulohistiocytosis, and Rosai-Dorfman Disease. Dermatol Clin. 2015;33(3):465-73. doi: 10.1016/j.det.2015.03.011
12. Baek IW, Yoo SH, Yang H, Park J, Kim KJ, Cho CS. A case of multicentric reticulohistiocytosis. Modern Rheumatol. 2014;11:1-4.
doi: 10.3109/14397595.2014.952702
13. Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, Quellard N, Lacombe C, Goujon JM, Lavergne D, Abraham J, Touchard G, Fermand JP, Jaccard A. Al amyloidosis. Orph J Rare Dis. 2012 Aug 21;7:54. doi: 10.1186/1750-1172-7-54
14. Васильев В.И., Городецкий В.Р., Раденска-Лоповок С.Г. и др. Новые подходы к определению органных поражений при AL-амилоидозе. Научно-практическая ревматология. 2012;50(1):83-90 [Vasilyev VI, Gorodetskiy VR, Radenska-Lopovok SG, Probato-
va NA, et al. New approaches to the definition of organ damage in
AL-amyloidosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2012;50(1):83-90 (In Russ.)].
doi: 10.14412/1995-4484-2012-510
15. Fabreguet I, Saurat JH, Rizzoli R, Ferrari S. Calcinosis cutis associated with connective tissue diseases. Rev Méd Suisse. 2015 Mar 18;11 (466):668-72.
16. Yalin AS, Altiparmak MR, Trabulus S, Yalin SF, Yalin GY, Melikoglu M. Calciphylaxis: a report of six cases and review of literature. Renal Failure. 2013;35(1):163-9. doi: 10.3109/0886022X.2012.741426
17. Shah A, Miller CJ, Nast CC, Adams MD, Truitt B, Tayek JA, Tong L, Mehtani P, Monteon F, Sedor JR, Clinkenbeard EL, White K, Mehrotra R, LaPage J, Dickson P, Adler SG, Iyengar SK. Severe vascular calcification and tumoral calcinosis in a family with hyperphosphatemia: a fibroblast growth factor 23 mutation identified by exome sequencing. Nephrol Dial Transplant. 2014 Dec;29(12):2235-43. doi: 10.1093/ ndt/gfu324
18. Yamada S, Taniguchi M, Tokumoto M, Tsuruya K, Iida M. Osteoclast-like multi-nucleated giant cells in uraemic tumoral calcinosis. NDT Plus. 2009 Apr;2(2):155-7. doi: 10.1093/ndtplus/sfp010
19. Kaplan FS, Le Merrer M, Glaser DL, Pignolo RJ, Goldsby R, Kitterman JA, Groppe J, Shore EM. Fibrodysplasia ossificans progressiva. Best Pract Res: Clin Rheumatol. 2008;22:191-205. doi: 10.1016/j. berh.2007.11.007
20. Антелава О.А., Никишина И.П., Гусева И.А., Мякоткин В.А., Хелковская-Сергеева А.Н., Насонов Е.Л., Раденска-Лоповок С.Г. Прогрессирующая оссифицирующая фибродисплазия. Русский медицинский журнал. 2015;(7):415-20 [Antelava OA, Nikishina IP, Guseva IA, Myakotkin VA, Khelkovskaya-Sergeeva AN, Nasonov EL, Radenska-Lopovok SG. Progressive ossifying fibrodysplasia. Russkii Meditsinskii Zhurnal. 2015;(7):415-20 (In Russ.)].
21. Васильев В.И., Седышев С.Х., Городецкий В.Р., Раденска-Лоповок С.Г., Родионова Е.Б., Логвиненко О.А., Пробатова Н.А., Варламова Е.Ю., Дмитриев А.А. Сухой синдром как проявления AL-амилоидоза. Научно-практическая ревматология. 2011;49(5):92-7 [Vasilyev VI, Sedyshev SK, Gorodetskii VR, Radenska-Lopovok SG, Rodionova EB, Logvinenko OA, Probatova NA, Varlamova EYu, Dmitriev AA. Dry syndrome as manifestations of AL-amyloidosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2011;49(5):92-7 (In Russ.)]. doi: 10.14412/1995-4484-2011-1467
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1. Goldblum JR, Folpe AL, Weiss SW, editors. Enzinger and Weiss's Soft Tissue Tumors. 6th ed. In: Calcifying aponeurotic fibroma. Philadelphia: Elsevier Saunders; 2014 P. 257-87. doi: 10.1097/PAP. 0000000000000020
2. Keasbey LE. Juvenile aponeurotic fibroma (calcifying fibroma): A distinctive tumor arising in the palms and soles of young children. Cancer. 1953;6(2):338-46. doi: 10.1002/1097-0142(195303)6:2<338::AID-CNCR2820060218>3.0.CO;2-M
3. Keasbey LE, Fanselau HA. The aponeurotic fibroma. Clin Orthopaedi Relat Res. 1961;19:115-31.
4. Kilpatrick SE. Calcifying aponeurotic fibroma. In: Fletcher CDM, Bridge JA, Hogendoorn PCW, Mertens F, editors. World Health Organization Classification of Tumours of Soft Tissue and Bone. 4th ed. Lyon: International Agency for Research on Cancer Press; 2013. P. 63.
5. Sharma R, Punia RS, Sharma A. Juvenile (calcifying) aponeurotic fibroma of the neck. Ped Surg Intern. 1998;13:295-9. doi: 10.1007/s 003830050322
6. Tai LH, Johnston JO, Klein HZ, Rowland J, Sudilovsky D. Calcifying aponeurotic fibroma features seen on fine needle aspiration biopsy: case report and brief review of the literature. Diagn Cytopathol. 2001;24:336-9. doi: 10.1002/dc.1072
7. Fetsch JF, Miettinen M. Calcifying aponeurotic fibroma: A clinicopathologicstudy of 22 cases arising in uncommon sites. Hum Pathol. 1998;29:1504. doi: http://dx.doi.org/10.1016/S0046-8177(98)90022-3
8. Murphy BA, Kilpatrick SE, Panella MJ, et al. Extra-acral calcifying aponeurotic fibroma: A distinctive case with 23-year follow-up. J Cut Pathol. 1996;23:369-72. doi: 10.1111/j.1600-0560.1996.tb0
1312.x
9. Oruç M, Uysal A, Kankaya Y, Yildiz K, Aslan G, Sengül D. A case of calcifying aponeurotic fibroma of the scalp: case report and review of the literature. Dermatol Surg. 2007;33(11):1380-3. doi: 10.1111/j.1524-4725.2007.33296.x
10. Yura S, Terahata S, Ohga N, Ooi K. A Case of Calcifying Aponeurotic Fibroma Arising in the Medial Pterygoid Muscle. J Oral Maxillofacial Surg. 2008;66(2):359-61. doi: 10.1016/j.joms.2006.10.032
11. Chisolm SS, Schulman JM, Fox LP. Adult Xanthogranuloma, Reticulohistiocytosis, and Rosai-Dorfman Disease. Dermatol Clin. 2015;33(3):465-73. doi: 10.1016/j.det.2015.03.011
12. Baek IW, Yoo SH, Yang H, Park J, Kim KJ, Cho CS. A case of multicentric reticulohistiocytosis. Modern Rheumatol. 2014;11:1-4.
doi: 10.3109/14397595.2014.952702
13. Desport E, Bridoux F, Sirac C, Delbes S, Bender S, Fernandez B, Quellard N, Lacombe C, Goujon JM, Lavergne D, Abraham J, Touchard G, Fermand JP, Jaccard A. Al amyloidosis. Orph J Rare Dis. 2012 Aug 21;7:54. doi: 10.1186/1750-1172-7-54
14. [Vasilyev VI, Gorodetskiy VR, Radenska-Lopovok SG, Probato-
va NA, et al. New approaches to the definition of organ damage in
AL-amyloidosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2012;50(1):83-90 (In Russ.)].
doi: 10.14412/1995-4484-2012-510
15. Fabreguet I, Saurat JH, Rizzoli R, Ferrari S. Calcinosis cutis associated with connective tissue diseases. Rev Méd Suisse. 2015 Mar 18;11 (466):668-72.
16. Yalin AS, Altiparmak MR, Trabulus S, Yalin SF, Yalin GY, Melikoglu M. Calciphylaxis: a report of six cases and review of literature. Renal Failure. 2013;35(1):163-9. doi: 10.3109/0886022X.2012.741426
17. Shah A, Miller CJ, Nast CC, Adams MD, Truitt B, Tayek JA, Tong L, Mehtani P, Monteon F, Sedor JR, Clinkenbeard EL, White K, Mehrotra R, LaPage J, Dickson P, Adler SG, Iyengar SK. Severe vascular calcification and tumoral calcinosis in a family with hyperphosphatemia: a fibroblast growth factor 23 mutation identified by exome sequencing. Nephrol Dial Transplant. 2014 Dec;29(12):2235-43. doi: 10.1093/ ndt/gfu324
18. Yamada S, Taniguchi M, Tokumoto M, Tsuruya K, Iida M. Osteoclast-like multi-nucleated giant cells in uraemic tumoral calcinosis. NDT Plus. 2009 Apr;2(2):155-7. doi: 10.1093/ndtplus/sfp010
19. Kaplan FS, Le Merrer M, Glaser DL, Pignolo RJ, Goldsby R, Kitterman JA, Groppe J, Shore EM. Fibrodysplasia ossificans progressiva. Best Pract Res: Clin Rheumatol. 2008;22:191-205. doi: 10.1016/j. berh.2007.11.007
20. [Antelava OA, Nikishina IP, Guseva IA, Myakotkin VA, Khelkovskaya-Sergeeva AN, Nasonov EL, Radenska-Lopovok SG. Progressive ossifying fibrodysplasia. Russkii Meditsinskii Zhurnal. 2015;(7):415-20 (In Russ.)].
21. [Vasilyev VI, Sedyshev SK, Gorodetskii VR, Radenska-Lopovok SG, Rodionova EB, Logvinenko OA, Probatova NA, Varlamova EYu, Dmitriev AA. Dry syndrome as manifestations of AL-amyloidosis. Nauchno-Prakticheskaya Revmatologiya = Rheumatology Science and Practice. 2011;49(5):92-7 (In Russ.)]. doi: 10.14412/1995-4484-2011-1467
1 ФГБНУ «Научно-исследовательский институт ревматологии им. В.А. Насоновой», Москва, Россия;
2 ФГБНУ «Российский онкологический научный центр им. Н.Н. Блохина» Минздрава России, Москва, Россия
1 V.A. Nasonova Research Institute of Rheumatology, Moscow, Russia;
2 N.N. Blokhin Russian Cancer Research Center, Ministry of Health of Russia, Moscow, Russia