背景:直肠皮瘘很常见。感染起源于肛门腺内,随后扩展到相邻区域,最终导致瘘管的发展。细胞性血管纤维瘤(CAF),也被称为血管肌纤维母细胞瘤样肿瘤,是一种罕见的良性软组织肿瘤,主要在阴囊中观察到,会阴,男性腹股沟区和女性外阴区。我们描述了第一个记录的病例CAF,该病例在直肠皮肤瘘中发展并表现为会阴肿块。
方法:在门诊,一名52岁的男性患者,有2年的会阴肿块病史,伴有阵痛和轻微的阴囊擦伤。体检显示,定义明确,左臀部向会阴延伸的非触痛肿块,没有可见的开口。最初的评估确定了一个软组织肿瘤,实验室数据在正常范围内。腹部和盆腔计算机断层扫描(CT)显示脓肿腔肿胀,与直肠皮肤瘘有关,左侧会阴区域有一条6cm×0.7cm的径迹样病变,并附着在左侧直肠上。直肠镜检查未发现明显的内孔。左臀侧切口显示厚壁肿块,随着延伸的管道被切除,进行了刮宫。组织病理学检查证实CAF诊断。患者在随访评估期间达到了总分辨率,不需要额外住院。
结论:CT成像支持会阴病变的诊断和治疗。会阴血管纤维瘤,即使有皮肤瘘,可以经会阴切除。
BACKGROUND: Rectocutaneous fistulae are common. The infection originates within the anal glands and subsequently extends into adjacent regions, ultimately resulting in fistula development. Cellular
angiofibroma (CAF), also known as an angiomyofibroblastoma-like tumor, is a rare benign soft tissue neoplasm predominantly observed in the scrotum, perineum, and inguinal area in males and in the vulva in females. We describe the first documented case CAF that developed within a rectocutaneous fistula and manifested as a perineal mass.
METHODS: In the outpatient setting, a 52-year-old male patient presented with a 2-year history of a growing perineal mass, accompanied by throbbing pain and minor scrotal abrasion. Physical examination revealed a soft, well-defined, non-tender mass at the left buttock that extended towards the perineum, without a visible opening. The initial assessment identified a soft tissue tumor, and the laboratory data were within normal ranges. Abdominal and pelvic computed tomography (CT) revealed swelling of the abscess cavity that was linked to a rectal cutaneous fistula, with a track-like lesion measuring 6 cm × 0.7 cm in the left perineal region and attached to the left rectum. Rectoscope examination found no significant inner orifices. A left medial gluteal incision revealed a thick-walled mass, which was excised along with the extending tract, and curettage was performed. Histopathological examination confirmed CAF diagnosis. The patient achieved total resolution during follow-up assessments and did not require additional hospitalization.
CONCLUSIONS: CT imaging supports perineal lesion diagnosis and management. Perineal angiofibromas, even with a cutaneous fistula, can be excised transperineally.