Electron microscopy in the study of myofibroblastic lesions

Electron microscopy in the diagnosis and academic study of myofibroblastic lesions is discussed. Myofibroblasts from granulation tissue and tumor stroma are regarded as the nearest equivalent to a "normal" myofibroblast population with which to define myofibroblastic differentiation in tumoral and pseudotumoral lesions. Histological features include a plump-spindle-cell morphology, with an ill-defined cytoplasm paler and less fibrillar than in smooth-muscle cells, and matrix collagen. Myofibroblasts stain for alpha-smooth-muscle actin, fibronectin, and vimentin. Desmin is found in some lesional myofibroblasts. The main ultrastructural features are prominent rough endoplasmic reticulum, modestly developed myofilaments with focal densities ("stress fibers"), and fibronexus junctions. The latter are foci on the cell surface where intracellular myofilaments and extracellular fibronectin filaments converge. Myofibroblastic lesions vary in the extent to which they mirror this overall phenotype. Hypertrophic scar, Dupuytren's disease, nodular fasciitis, the fibromatoses, and inflammatory myofibroblastic tumors have the most developed myofibroblastic features. Keloid, postoperative spindle-cell nodule, and fibroma of tendon sheath are less well differentiated. Myofibroblastoma is among many lesions described as myofibroblastic which, however, appear to show a kind of smooth-muscle differentiation. Some spindle-cell malignancies express myofibroblastic features.