摘要
目的探讨低度恶性中心型骨肉瘤的影像表现和病理组织学特征。方法回顾性分析经手术病理证实的12例低度恶性中心型骨肉瘤患者资料。12例均行X线检查，11例行CT检查，10例行MR检查。总结该病的临床、影像特征及组织学表现，并随访其预后情况。结果12例低度恶性中心型骨肉瘤患者，病变位于股骨远端6例，胫骨近端3例，股骨近端2例，距骨1例。X线表现7例以髓腔为中心溶骨性破坏为主，3例有成骨和溶骨混合性破坏伴有致密、粗糙骨脊或小梁骨，2例以成骨硬化为主。cT表现9例示局部骨皮质破坏，5例软组织受侵，6例病灶周边不完整硬化带，2例有骨膜反应。MR表现10例均有髓腔异常信号，8例显示软组织肿块，增强有明显肿瘤实质强化。病理组织学主要由纤维组织和不规则的肿瘤性骨小梁混合组成，可有少量的异型细胞或无明显病理核分裂象。4例患者初诊时误诊为纤维结构不良或纤维组织细胞瘤等良性病变，术后复发。所有患者随访1～7年，其中8例首次明确诊断者经广泛切除无复发、转移。结论低度恶性中心型骨肉瘤影像表现具有一定特征，确诊依赖于结合多种影像资料和详细的组织学检查。
Objective To explore the imaging manifestations of low-grade central osteosarcoma （LGCOS） and discuss their pathological features. Methods Twelve patients of LGCOS proved by surgery and pathology were analyzed retrospectively and a review of related literature was performed. All twelve patients had plain X-ray, 11 patients CT examination, and 10 patients contrast-enhanced MR scan. Imaging features of the LGCOS were summarized, their clinical and pathological manifestations were discussed for differential diagnosis. Their prognosis was evaluated with followed up examination. Results Of the 12 patients with LGCOS, six tumors were located in the distal femur, 3 in the proximal tibia, 2 in the proximal femur and 1 in the talus. The radiographic features of LGCOS were variable. There were 7 patients with predominantly osteolytic destruction, 3 patients with mixed sclerotic and lytic changes, with well-defined margins,2 patients with Osteogenic changes on X-ray. On CT, 9 patients showed a clear cortical breach, 5 patients with soft tissue involvement,6 patients with peripheral incompletely sclerotic zone,2 patients with periosteal reaction. On MRI,there were 10 patients with abnormal signal in medullary cavity,8 patients with soft tissue masses, and all 10 patients exhibited contrast enhancement. The microscopic features of LGCOS were characteristically bland, comprising spindle cells arranged in interlacing fascicles in a heavily collagenous background with variable bone or osteoid production. There were mild nuclear atypia and rare mitoses. In four patients, misdiagnoses were made by biopsy or surgical pathology as fibrous dysplasia or fibrous histiocytoma and other benign lesions, all four patients had postoperative recurrence. Conclusions LGCOS should be differentiated form fibrous dysplasia, non-ossifying fibroma, and other benign lesions. An accurate diagnosis can be made in most cases by careful pathological and radiological correlation.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2013年第4期352-356,共5页
Chinese Journal of Radiology
基金
国家自然科学基金资助项目（81072188）
关键词
骨肉瘤
磁共振成像
体层摄影术
X线计算机
Osteosarcoma
Magnetic resonance imaging
Tomography,X-ray computed
