继发性骨肉瘤的临床特点及影像学表现

发布时间：2018-03-22 12:09

本文选题：骨肉瘤　切入点：继发性　出处：《放射学实践》2017年12期 　论文类型：期刊论文

【摘要】：目的:分析继发性骨肉瘤的临床特点及影像学表现。方法:回顾性分析经手术病理证实的25例继发性骨肉瘤患者的病例资料。25例均行X线及CT检查(5例行增强CT),16例行MRI增强检查。结果:本组患者的中位年龄45岁(14~76岁),中位恶变时间为8年(0.5~18.0年)。25例中骨纤维结构不良、骨母细胞瘤等良性肿瘤或肿瘤样病变恶变12例,表现为溶骨性破坏、软组织肿块形成及病灶迅速增大等与原发骨肉瘤相仿的影像学改变;骨巨细胞瘤植骨后恶变继发性骨肉瘤8例、金属植入相关的继发性骨肉瘤2例,均表现为移植骨吸收、周围出现明显软组织肿块及肿瘤骨形成;放疗后继发性骨肉瘤2例,以成骨性骨质破坏为主;Paget病继发性骨肉瘤1例,表现为在患骨增粗、不规则变形基础上,出现溶骨性破坏及软组织肿块。病理结果:镜下有不同程度的细胞异形性、肿瘤骨形成。所有病例术后随访时间为1.5~12.0年(平均3.4年),8例出现肺部转移。结论:病理组织学上继发性骨肉瘤与原发性骨肉瘤无明显差异,但结合其临床资料及影像学表现可明确诊断。
[Abstract]:Objective: to analyze the clinical features and imaging manifestations of secondary osteosarcoma. Methods: the data of 25 cases of secondary osteosarcoma proved by operation and pathology were retrospectively analyzed. Results: the median age of the patients was 45 years old and 1476 years old. The median time of malignant transformation was 8 years (0.5 ~ 18.0 years). 25 cases had fibrous dysplasia. 12 cases of benign tumors or tumor-like lesions such as osteoblastoma showed osteolytic destruction, soft tissue mass formation and rapid enlargement of lesions, which were similar to those of primary osteosarcoma. There were 8 cases of malignant secondary osteosarcoma and 2 cases of secondary osteosarcoma associated with metal implantation in giant cell tumor of bone, all of which showed bone graft resorption, obvious soft tissue mass and tumor bone formation, and secondary osteosarcoma after radiotherapy in 2 cases. A case of osteosarcoma secondary to osteogenic bone destruction was found in Paget's disease, which was characterized by osteolytic destruction and soft tissue mass on the basis of bone thickening and irregular deformation. All cases were followed up for 1.5 ~ 12.0 years (mean 3.4 years) with pulmonary metastasis. Conclusion: there is no significant difference between secondary osteosarcoma and primary osteosarcoma in histopathology. But combined with its clinical data and imaging findings can be clearly diagnosed.
【作者单位】：上海交通大学医学院附属瑞金医院放射科;
【分类号】：R445.2;R730.44;R738

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