原发性骨干骨肉瘤的影像学表现

中华骨科杂志

CHINESE JOURNAL OF

ORTHOPAEDICS

2000 Vol.20 No.1 P.40-43

原发性骨干骨肉瘤的影像学表现

姚健孙鼎元王林森

【摘要】目的总结原发性骨干骨肉瘤的影像学表现，探讨有关的临床特点和鉴别诊断。方法1980～1998年14例原发性骨干骨肉瘤患者，均经手术与病理证实。男6例，女8例，平均年龄23.5岁。其中股骨干9例，腓骨干2例，肱骨干2例，胫骨干1例。回顾性分析14例原发性骨干骨肉瘤的X线、CT和MRI的表现及相对应的病理学表现。结果原发性骨干骨肉瘤影像学表现包括广泛骨质破坏、骨膜反应、软组织肿块，部分病例可见肿瘤骨和瘤样钙化。病理证实影像学确定病变范围不准确。同时原发性骨干骨肉瘤具有发病年龄大、病变范围广泛的临床特点。X

线的诊断最佳，CT检查和MRI有助于鉴别诊断。结论原发性骨干骨肉瘤是一种特殊部位的骨肉瘤，发病率低，骨破坏范围大，无病理性骨折。成骨型骨干骨肉瘤较易诊断，溶骨型应与Ewing瘤、恶性巨细胞瘤等鉴别。

【关键词】骨肉瘤；骨干；诊断显像；病理学

The imaging features of primary diaphysial osteosarcoma

YAO Jian SUN Dingyuan WANG Linsen （Department of Radiology, Tianjin Hospital, Tianjin 300211, China）

【Abstract】Objective To summarize the imaging manifestations of the primary diaphysial osteosarcoma, and discuss its clinical features and differential diagnosis. Methods From 1980 to 1998, fourteen cases of osteosarcoma proved by surgery and pathology were reviewed; there are six males and eight females, with an average age of 23.5 years. The pathological types of these lesions were classic in 6, telangiectatic in 2, small cell in 1, parosteal in 1, and osteoblastic in 2. Nine tumors were located in the femur, two fibula, two humerus and one tibia. All of the patients had roentgenography, five were evaluated by computer tomography, and one had MRI examination. The imaging manifestations including X ray,CT scan and MRI were analyzed, and the relationship of the imaging features with the pathological types of primary diaphysial osteosarcoma was also observed. Results The imaging features of primary diaphysial osteosarcoma were

composed of large bone destruction, periosteal reaction and soft tissue mass. The typical clinical characters consisted of large lesions, with the patients usually over the second decade of life. By roentgenographic examination, the parosteal and classic osteosarcoma manifested with osteogenic destruction, the telangiectatic osteosarcoma osteolytic lesion, while the small cell and osteoblastic type manifested with mixed destruction of osteolytic and osteogenic focus. Periosteal reaction was found in 11 of 14 patients. Tumor calcification was demonstrated more clearly on CT scan than that in the roentgenogram, particularly for osteogenic lesion. MRI is helpful to diagnose the involvement of soft tissue and nervovascular bundle by the tumor. Conclusion Primary diaphysial osteosarcoma is a special clinical type of osteosarcoma. It has lower incidence, large bone destruction and no pathological fracture. The osteogenic type is diagnosed easily, but the osteolytic lesion should be differentiated from Ewing's sarcoma, malignant giant cell tumor of bone and so on.

【Key words】Osteosarcoma；Diaphyses；Diagnostic imaging; Pathology

骨肉瘤是骨原发性恶性肿瘤中最常见的一种，好发于青少年长管状骨的干骺端，而发生于骨干者极少见。我们收集了天津医院1980～1998年经手术和病理证实的354例骨肉瘤，其中14例为典型长骨骨干骨肉瘤。本文回顾性分析了原发性骨干骨肉瘤影像学资料及相关病理学表现，以提高对原发性骨干骨肉瘤诊治的认识[1，2]。

临床资料

一、一般资料

14例原发性骨干骨肉瘤患者年龄为12～42岁，平均23.5岁，其中男6例，女8例。股骨干9例，腓骨干2例，肱骨干2例，胫骨干1例。

二、临床表现

骨干骨肉瘤的临床症状无特异性，仍以疼痛、肢体功能障碍等恶性肿瘤临床症状为主，另外短时间内可出现软组织肿块。病程2个月～1年。常因认识不足误诊为其他病变，如3例误诊为急性骨髓炎、2例误诊为Ewing瘤，其他各例被误诊为巨细胞瘤、转移性疾患等。原发性骨干骨肉瘤首选治疗是截肢。14例中截肢8例，灭活再植2例，切取活检4例。其中随访6例，均1～2年内死亡，其他各例失访。本组6例随访中，3例截肢患者存活时间均超过1年，未手术1例3个月后死亡，灭活再植2例分别于10个月、14个月后死亡。国内文献对原发性骨干骨肉瘤的治疗和预后报道极少，国外文献报道截肢结合化疗最长存活时间可达5年以上。

结果

一、X线表现与相关病理对比