中华病理学杂志
中華病理學雜誌
중화병이학잡지
Chinese Journal of Pathology
2014年
6期
379-382
,共4页
骨肉瘤%巨细胞瘤,骨%诊断,鉴别
骨肉瘤%巨細胞瘤,骨%診斷,鑒彆
골육류%거세포류,골%진단,감별
Osteosarcoma%Giant cell tumor of bone%Diagnosis,differential
目的 探讨富于巨细胞的骨肉瘤(GCRO)和骨巨细胞瘤(GCT)的临床病理特征及鉴别诊断.方法 从临床、影像学、病理形态及免疫表型等方面对18例GCRO和118例GCT进行对比分析和研究.结果 GCRO 18例,平均年龄24.6岁,大多发生于长骨干骺端(15/18),影像学表现为渗透性骨质破坏,肿瘤边界不清,伴或不伴骨膜反应和软组织肿块.镜下大量反应性破骨细胞样巨细胞之间的肿瘤性单核细胞有不同程度异型,可见病理性核分裂象,并产生幼稚的肿瘤性骨样基质.GCT118例,平均年龄34.5岁,大多发生于长骨骨端(108/118),影像学表现为膨胀性地图样骨质破坏,病灶边缘清楚,早期骨皮质连续,侵袭期骨皮质破坏,偶有软组织肿块.镜下由卵圆形或短梭形的单核间质细胞、多核巨细胞和单核巨噬细胞组成,单核间质细胞边界不清,无明显异型和病理性核分裂象,单核间质细胞多表达p63(83.9％,99/118).肿瘤边缘区域常有反应性骨.结论 GCRO是普通型骨肉瘤中的罕见组织学亚型,与侵袭期GCT在临床、影像学及病理学改变上都有交叉.虽然单核肿瘤细胞的异型性、病理性核分裂象及其直接形成的肿瘤性骨样组织这三项GCRO的主要诊断依据是GCT所缺乏的,但这三项特征在活检组织中并不一定都出现,综合分析资料对确定诊断尤为重要.
目的 探討富于巨細胞的骨肉瘤(GCRO)和骨巨細胞瘤(GCT)的臨床病理特徵及鑒彆診斷.方法 從臨床、影像學、病理形態及免疫錶型等方麵對18例GCRO和118例GCT進行對比分析和研究.結果 GCRO 18例,平均年齡24.6歲,大多髮生于長骨榦骺耑(15/18),影像學錶現為滲透性骨質破壞,腫瘤邊界不清,伴或不伴骨膜反應和軟組織腫塊.鏡下大量反應性破骨細胞樣巨細胞之間的腫瘤性單覈細胞有不同程度異型,可見病理性覈分裂象,併產生幼稚的腫瘤性骨樣基質.GCT118例,平均年齡34.5歲,大多髮生于長骨骨耑(108/118),影像學錶現為膨脹性地圖樣骨質破壞,病竈邊緣清楚,早期骨皮質連續,侵襲期骨皮質破壞,偶有軟組織腫塊.鏡下由卵圓形或短梭形的單覈間質細胞、多覈巨細胞和單覈巨噬細胞組成,單覈間質細胞邊界不清,無明顯異型和病理性覈分裂象,單覈間質細胞多錶達p63(83.9％,99/118).腫瘤邊緣區域常有反應性骨.結論 GCRO是普通型骨肉瘤中的罕見組織學亞型,與侵襲期GCT在臨床、影像學及病理學改變上都有交扠.雖然單覈腫瘤細胞的異型性、病理性覈分裂象及其直接形成的腫瘤性骨樣組織這三項GCRO的主要診斷依據是GCT所缺乏的,但這三項特徵在活檢組織中併不一定都齣現,綜閤分析資料對確定診斷尤為重要.
목적 탐토부우거세포적골육류(GCRO)화골거세포류(GCT)적림상병리특정급감별진단.방법 종림상、영상학、병리형태급면역표형등방면대18례GCRO화118례GCT진행대비분석화연구.결과 GCRO 18례,평균년령24.6세,대다발생우장골간후단(15/18),영상학표현위삼투성골질파배,종류변계불청,반혹불반골막반응화연조직종괴.경하대량반응성파골세포양거세포지간적종류성단핵세포유불동정도이형,가견병이성핵분렬상,병산생유치적종류성골양기질.GCT118례,평균년령34.5세,대다발생우장골골단(108/118),영상학표현위팽창성지도양골질파배,병조변연청초,조기골피질련속,침습기골피질파배,우유연조직종괴.경하유란원형혹단사형적단핵간질세포、다핵거세포화단핵거서세포조성,단핵간질세포변계불청,무명현이형화병이성핵분렬상,단핵간질세포다표체p63(83.9％,99/118).종류변연구역상유반응성골.결론 GCRO시보통형골육류중적한견조직학아형,여침습기GCT재림상、영상학급병이학개변상도유교차.수연단핵종류세포적이형성、병이성핵분렬상급기직접형성적종류성골양조직저삼항GCRO적주요진단의거시GCT소결핍적,단저삼항특정재활검조직중병불일정도출현,종합분석자료대학정진단우위중요.
Objective To study the clinicopathologic features and differential diagnosis of giant cell-rich osteosarcoma (GCRO) and giant cell tumor of bone (GCT).Methods The clinical,radiologic,pathologic and immunohistochemical features of 18 cases of GCRO and 118 cases of GCT were evaluated.Results The mean age of patients with GCRO was 24.6 years.Fifteen of the 18 cases arose in the metaphysis of long bones.GCRO presented as a large poorly-defined mixed lytic and blastic mass,associated with cortical destruction and formation of large soft tissue component.Histologically,GCRO was characterized by a predominance of numerous osteoclast-like giant cells admixed with scanty osteoid which was formed by neoplastic cells in different levels of anaplasia and pleomorphism.In the 118 cases of GCT studied,the mean age of patients was 34.5 years.Most of them (108 cases) arose in the epiphyseal region of long bones.They usually presented as expansile eccentric and osteolytic lesions.Invasive GCT displayed local cortical destruction.Histologic examination of GCT revealed the presence of large number of osteoclastlike giant cells and mononuclear stromal cells.The mononuclear stromal cells possessed poorly defined cytoplasm,showed little cytological atypia and did not carry atypical mitotic figures.They were positive for p63 (83.9％,99/118).Reactive bone could be observed at the periphery.Conclusions GCRO represents a special form of osteosarcoma which shows overlapping clinicopathologic features with invasive GCT.The presence of nuclear atypia,atypical mitoses and osteoid matrix produced directly by neoplastic cells are more in favor of GCRO.These features however may not be demonstrated in full in limited small biopsy samples.It is thus important to analyze all clinical,radiologic and pathologic features before a definitive diagnosis is made.
