中华临床医师杂志(电子版)
中華臨床醫師雜誌(電子版)
중화림상의사잡지(전자판)
CHINESE JOURNAL OF CLINICIANS(ELECTRONIC VERSION)
2013年
15期
6875-6879
,共5页
张军喜%梁粉花%王刚平%田胜花
張軍喜%樑粉花%王剛平%田勝花
장군희%량분화%왕강평%전성화
骨肉瘤%骨肉瘤,近皮质%诊断%预后%微血管密度
骨肉瘤%骨肉瘤,近皮質%診斷%預後%微血管密度
골육류%골육류,근피질%진단%예후%미혈관밀도
Osteosarcoma%Osteosarcoma,juxtacortical%Diagnosis%Prognosis%Microvascular density
目的:分析浅表性骨肉瘤(OS)的临床、影像学及病理学特征,以CD105标记微血管密度(MVD)探讨与临床病理因素的关系,提高对浅表性OS诊断、鉴别诊断水平和生物学行为评估。方法回顾性分析2006年1月至2012年12月经手术病理证实的11例浅表性OS临床、影像学及病理资料,并进行随访;应用免疫组化SP法检测11例浅表性OS中CD105的表达及MVD,并与18例正常骨组织、29例普通OS对照,分析CD105在浅表性OS中的表达及CD105-MVD与临床病理因素的关系。结果(1)11例浅表性OS中,骨旁OS 7例(1例双肺胸膜下转移),骨膜OS 3例,高级别表面OS 1例;年龄16~68岁,平均26岁;7例股骨远端后面,胫骨近端3例,肱骨远端1例。(2)影像学显示7例呈均一致密的骨性肿块,4例围绕骨表面生长,肿瘤与骨皮质间形成1~2 mm透亮间隙;CT扫描7例示肿瘤呈高密度肿块,3例骨皮质不完整,肿块内可见低密度间隔,邻近骨皮质增厚,无骨质破坏,1例见骨膜反应,11例均无Codman三角,未侵犯骨髓腔;诊断准确率DR为81.8%(9/11),CT为54.5%(6/11),MRI为63.6%(7/11),3种影像学检查方法结合准确率为90.9%(10/11)。(3)CD105、CD105标记的MVD在浅表性OS中的阳性表达(81.8%、32.51±11.02)明显高于正常对照组(38.9%、22.51±9.53)(P<0.05),与普通OS阳性表达率(82.76%)差异无统计学意义(P>0.05),但CD105标记的MVD差异有统计学意义(P<0.05),而CD105、CD105标记的MVD在浅表性OS及普通OS中的阳性表达与肿瘤大小、性别、年龄无关(P>0.05),在普通OS中与转移有关(P<0.05)。(4)浅表性OS随访2~7年,10例患者无瘤健在,1例存活74个月(高级别表面OS,49个月后复发为去分化OS)。结论浅表性OS诊断依靠临床、影像学及病理多学科结合,采用传统X线、DR和CT联合检查可提高诊断准确率;浅表性OS中CD105-MVD明显增高,肿瘤性血管生成,参与浅表性OS的发生、发展及影响预后,CD105及CD105-MVD可作为判断生物学行为的参考指标。
目的:分析淺錶性骨肉瘤(OS)的臨床、影像學及病理學特徵,以CD105標記微血管密度(MVD)探討與臨床病理因素的關繫,提高對淺錶性OS診斷、鑒彆診斷水平和生物學行為評估。方法迴顧性分析2006年1月至2012年12月經手術病理證實的11例淺錶性OS臨床、影像學及病理資料,併進行隨訪;應用免疫組化SP法檢測11例淺錶性OS中CD105的錶達及MVD,併與18例正常骨組織、29例普通OS對照,分析CD105在淺錶性OS中的錶達及CD105-MVD與臨床病理因素的關繫。結果(1)11例淺錶性OS中,骨徬OS 7例(1例雙肺胸膜下轉移),骨膜OS 3例,高級彆錶麵OS 1例;年齡16~68歲,平均26歲;7例股骨遠耑後麵,脛骨近耑3例,肱骨遠耑1例。(2)影像學顯示7例呈均一緻密的骨性腫塊,4例圍繞骨錶麵生長,腫瘤與骨皮質間形成1~2 mm透亮間隙;CT掃描7例示腫瘤呈高密度腫塊,3例骨皮質不完整,腫塊內可見低密度間隔,鄰近骨皮質增厚,無骨質破壞,1例見骨膜反應,11例均無Codman三角,未侵犯骨髓腔;診斷準確率DR為81.8%(9/11),CT為54.5%(6/11),MRI為63.6%(7/11),3種影像學檢查方法結閤準確率為90.9%(10/11)。(3)CD105、CD105標記的MVD在淺錶性OS中的暘性錶達(81.8%、32.51±11.02)明顯高于正常對照組(38.9%、22.51±9.53)(P<0.05),與普通OS暘性錶達率(82.76%)差異無統計學意義(P>0.05),但CD105標記的MVD差異有統計學意義(P<0.05),而CD105、CD105標記的MVD在淺錶性OS及普通OS中的暘性錶達與腫瘤大小、性彆、年齡無關(P>0.05),在普通OS中與轉移有關(P<0.05)。(4)淺錶性OS隨訪2~7年,10例患者無瘤健在,1例存活74箇月(高級彆錶麵OS,49箇月後複髮為去分化OS)。結論淺錶性OS診斷依靠臨床、影像學及病理多學科結閤,採用傳統X線、DR和CT聯閤檢查可提高診斷準確率;淺錶性OS中CD105-MVD明顯增高,腫瘤性血管生成,參與淺錶性OS的髮生、髮展及影響預後,CD105及CD105-MVD可作為判斷生物學行為的參攷指標。
목적:분석천표성골육류(OS)적림상、영상학급병이학특정,이CD105표기미혈관밀도(MVD)탐토여림상병리인소적관계,제고대천표성OS진단、감별진단수평화생물학행위평고。방법회고성분석2006년1월지2012년12월경수술병리증실적11례천표성OS림상、영상학급병리자료,병진행수방;응용면역조화SP법검측11례천표성OS중CD105적표체급MVD,병여18례정상골조직、29례보통OS대조,분석CD105재천표성OS중적표체급CD105-MVD여림상병리인소적관계。결과(1)11례천표성OS중,골방OS 7례(1례쌍폐흉막하전이),골막OS 3례,고급별표면OS 1례;년령16~68세,평균26세;7례고골원단후면,경골근단3례,굉골원단1례。(2)영상학현시7례정균일치밀적골성종괴,4례위요골표면생장,종류여골피질간형성1~2 mm투량간극;CT소묘7례시종류정고밀도종괴,3례골피질불완정,종괴내가견저밀도간격,린근골피질증후,무골질파배,1례견골막반응,11례균무Codman삼각,미침범골수강;진단준학솔DR위81.8%(9/11),CT위54.5%(6/11),MRI위63.6%(7/11),3충영상학검사방법결합준학솔위90.9%(10/11)。(3)CD105、CD105표기적MVD재천표성OS중적양성표체(81.8%、32.51±11.02)명현고우정상대조조(38.9%、22.51±9.53)(P<0.05),여보통OS양성표체솔(82.76%)차이무통계학의의(P>0.05),단CD105표기적MVD차이유통계학의의(P<0.05),이CD105、CD105표기적MVD재천표성OS급보통OS중적양성표체여종류대소、성별、년령무관(P>0.05),재보통OS중여전이유관(P<0.05)。(4)천표성OS수방2~7년,10례환자무류건재,1례존활74개월(고급별표면OS,49개월후복발위거분화OS)。결론천표성OS진단의고림상、영상학급병리다학과결합,채용전통X선、DR화CT연합검사가제고진단준학솔;천표성OS중CD105-MVD명현증고,종류성혈관생성,삼여천표성OS적발생、발전급영향예후,CD105급CD105-MVD가작위판단생물학행위적삼고지표。
Objective To study the clinical, radiographic and pathologic characteristics of surface osteosarcoma (OS) and to investigate the expressions of CD105 and microvascular density(CD105-MVD) in surface OS and their relationship with biological characteristics and clinical significance. Methods A retrospective review of clinical, radiographic, and pathologic features was performed on 11 patients of surface OS by surgery and pathology between 2006 and 2010. The expressions of CD105 and CD105-MVD were examined by SP immunohistochemical staining in 11cases of surface OS tissues, and their relationship to the clinicopathologic parameters was analyzed. Results Seven patients had parosteal, three had periosteal, and one had high-grade surface OS. The median age at diagnosis was 26 years (range, 16-68 years). Six patients were male, five were female. One had pulmonary metastasis at diagnosis. Primary tumor sites included distal femur (n=7), proximal tibia (n=3), and distal humerus (n=1). The expressions of CD105 and CD105-MVD were closely associated with differentiation degree of the tumors(P<0.05),and had no obvious relationship to the patient’age,sex,and size of tumor(P>0.05). All 11 patients were treated with surgery. Ten patients remained alive and disease-free range 2-7 years after diagnosis, and one patient died of high-grade undifferentiated OS recurrenced 6 years after diagnosis of with periosteal OS. Conclusions The histologic grade predicts the clinical behavior of surface OS.The overexpressions of CD105 and CD105-MVD may play important role during the malignant progression of surface osteosarcoma and they were closely associated with tumor angiogenesis. CD105 detection of surface OS is valuable in judging prognosis in surface osteosarcoma.