摘要
目的探讨骨关节弥漫型巨细胞肿瘤的临床病理学特征。方法回顾性分析42例弥漫型巨细胞肿瘤的临床病理资料，并结合随访资料进行总结。结果42例中男性19例，女性23例，男女比为1：1．2，发病年龄8-69岁，平均37．6岁。临床首发症状为局部疼痛8例，肿胀34例（其中合并功能障碍18例）。发生部位：膝关节30例（71．4％），髋、踝关节和足部各3例（21．4％），腕、肘关节3例（7．1％）。27例行MRI检查，诊断为弥漫型巨细胞肿瘤者9例（33．3％），关节腔积液5例、滑膜病变3例以及其他非肿瘤性病变。镜检：滑膜细胞弥漫性增生、绒毛结节状生长，肿瘤细胞增生明显活跃，细胞排列密集，但无肿瘤性坏死和核分裂；常见吞噬含铁血黄素的组织细胞、多核巨细胞及淋巴细胞反应；17例（40．5％）肿瘤呈浸润性生长并累及关节及周围软组织。6例复发（20％），其中2例复发2次。结论弥漫型巨细胞肿瘤好发于膝关节，其次是髋和踝关节；术前MRI检查有助于诊断；病理组织学呈现富于滑膜肿瘤细胞的弥漫性增生和细长绒毛结构者更易复发；侵袭性生长为其主要生物学特征，易侵袭关节周围软组织。
Purpose To investigate the clinicopathological changes of the diffuse-type giant cell tumor of the bone and joint. Methods 42 cases of the diffuse-type giant cell tumor of the bone and joint were studied and the follow-up data were reviewed. Results The male patients were 19 and the female were 23, with the male to female ratio of 1 ： 1.2. The age of the patients was 8 - 69 years （ the average age was 37.6）. It was displayed that the patients presented local pain and swelling （34 cases）, including dysfunction （ 18 ca- ses） of the bone and joint. Clinically, the lesions located on the knee joint （71.4%） in 30 cases, the hip and ankle in 9 cases （21.4%）, and the wrist elbow in 3 cases （7.1%）. 27 cases were examined by MRI. Among them, the diffuse-type giant cell tumor was diagnosed in 9 cases （33.3%）. The effusive lesions of the joint presented in 5 cases, the non-specific synovial lesions and others in 3 cases. The obviously diffuse hyperplasia of synovial cells with nodular growth pattern was found. However, a high proliferative in- dex of the tumor ceils and the rich-cell tumor were found. But there was no tumor necrosis. Histopathologically, the tumor cells of dif- fuse-type giant cell tumor contained marked brown pigments, muhinucleated giant cells formation and a lot of lymphocytes proliferation or follicular reaction in 17 cases （40. 5% ） with invasive growth and involvement of the joint and surrounding tissue. 6 cases recurred （20%）, including 2 cases with 2 times. Conclusions The diffuse type-giant cell tumors most commonly involve the knee, followed by the hip and ankle. Preoperative examination of MRI can be help for the diagnosis of the tumor. Histopathologically, diffuse-type gi- ant cell tumor with synovial cells rich-hyperplasia and the villous structures formation more likely recur. The main biological character- istics of diffuse-type giant cell tumor are invasive growth pattern, usually into the soft tissue around the joints.
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2015年第4期422-425,共4页
Chinese Journal of Clinical and Experimental Pathology
关键词
骨关节肿瘤
弥漫型巨细胞肿瘤
临床病理
预后
bone and joint neoplasms
diffuse-type giant cell tumor
clinical pathology
prognosis
