摘要
目的探讨表面骨肉瘤的组织类型、临床、病理及影像学特征。方法回顾性分析经病理证实的表面骨肉瘤19例,其中骨膜骨肉瘤4例,部位分别为胫骨干中上段(3例)和腓骨下段(1例);X线片及CT显示肿物位于骨旁,外缘不规则,可见放射状骨针影;镜下为低度或中度恶性软骨肉瘤样改变。高度恶性表面骨肉瘤2例,肿物均位于股骨内侧;X线片显示肿物以广泛基底附于患骨,混杂骨膜反应;镜下显示高度恶性,似髓内型。去分化骨旁骨肉瘤1例,肿物位于股骨下端;患者曾先后4次手术,术后病理显示高分化组织内出现低分化区。经典骨旁骨肉瘤12例,肿物75%位于股骨下端干骺端后部。结果骨膜骨肉瘤4例均行保肢手术,已无瘤生存1.1～6.5年。高度恶性表面骨肉瘤2例,其中1例拒绝手术,3个月后死于肺及肝转移;另1例应用大剂量化疗及保肢治疗,现已无瘤生存19个月。去分化骨旁骨肉瘤1例,行假体旁复发性肿瘤切除,现已无瘤生存6个月。经典骨旁骨肉瘤的初始治疗均为保肢手术,其中9例随访1.2～9.6年,除1例局部复发、1例死于肺转移外,另外7例均无瘤生存。结论表面骨肉瘤四种组织类型各具有特殊性,应区别对待。骨膜骨肉瘤及经典骨旁骨肉瘤应以局部广泛切除或瘤段切除为主,预后较好;去分化型和高度恶性表面骨肉瘤恶性程度较高,预后较差。
Objective To investigate the histological,clinical,pathologic and radiographi c char-acters of surface osteosarcoma.Methods Ninteen cases of surface osteosarcoma confirmed by pathology were reviewed retrospectively.There we re 4patients with periosteal osteosarcoma aged from 16-22years.The lesions in 3cases were situated in th e middle-upper part of tibia and 1case in the lower part of fibula.X -ray and CT scan showed that the tumors located at periosteum with irregular rim and visible radiated shadow of bone substance.Microscopically,t he tumors showed low or middle-grade malignant changes of chondrosarco-ma.Two cases were high-grade surface osteosarcoma and the tumors locate d in the medial aspect of the femur.X -ray showed that the lesions attach ed to affected bone with a broad base a nd confused periosteal reaction.Microscopically,the tumors showed high-malignant similar to marrow ca vity type.One female patient with th e dedifferentiated tumor located in t he lower part of the femur had been operated upon for 4times.Postoperativ e pathological examination showed th at among the high differentiated tis sue there was low differentiated high-grade malignant area.The classic parosteal osteosarcoma was seen in 12patients in this series.The av-erage age of the patients at the surge ry was 28.2years and 75%of the tumors located at the posterior medial or lateral part of metaphysis of the l ower part of femur.Results Four cases of periosteal osteosarcoma were treated with limb salvage operation s,and all the patients still alive at1.1-6.5years follow-up study.Of th e2cases with high-grade surface oste osarcoma,one refused operation and died of lung and liver metastasis.The other one was treated with high-dose chemotherapy combined with limb salvage operation and still alive at 19months follow-up.One case with dedi fferentiated lesion survived for 6months after removal of the recurrent tumor near the artificial knee joint .Of the 12cases with classic paroste al osteosarcoma treated with limb sa l-vage operation,9cases were followe d up for 1.2-9.6years,one case recur red locally,another one died from lung metastasis and the other 7cases were still alive.Conclusion Surface osteosarcoma can be distinguished with four histologic types and each w ith its own characteristics.For periosteal osteosarcoma and classic parosteal osteosarcoma,surgery wi th wide incision usually ends with a g ood prognosis.For the poorly differ-entiated parosteal osteosarcoma an d high-grade surface osteosarcoma,the prognosis are poor and the limb salvage or amputation combined with high dose chemotherapy should be the treatment of choice.[
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第7期414-418,共5页
Chinese Journal of Orthopaedics
关键词
病理学
诊断
预后
外科手术
手术方法
表面骨肉瘤
Osteosarcoma
Pathology
Diagnostic imaging
Orthopedic procedures
Prognosis
