血管扩张型骨肉瘤术前穿刺活检误诊原因分析

发布时间：2018-08-18 19:30

【摘要】：目的探讨血管扩张型骨肉瘤(telangiectatic osteosarcoma,TOS)的临床、影像学和病理学特征,对术前穿刺活检的误诊原因进行分析。方法复查15例TOS的术前穿刺活检、切开活检及手术病理切片,并结合文献及临床、影像学、病理形态学表现和预后随访,分析术前穿刺活检误诊原因。结果 15例TOS中,10例患者行术前穿刺活检:3例确诊为TOS;2例诊断为肉瘤;1例高度怀疑为肉瘤;3例考虑动脉瘤样骨囊肿(aneurysmal bone cyst,ABC)或TOS;1例诊断为符合良性纤维骨性病变。10例行切开活检,其中5例为穿刺活检未能确诊为骨肉瘤的患者:6例确诊为TOS;3例诊断为骨肉瘤;1例以TOS可能性大,动脉瘤样骨囊肿不能完全除外。结论 TOS术前穿刺活检确诊率较低(30%),切开活检确诊率相对较高(60%)。术前穿刺活检误诊的原因主要因为TOS呈囊性,穿刺活检中标准的囊壁组织较难取材;病变早期影像学特征不明显或囊壁内肉瘤细胞的异型性不明显。因此,对于影像学疑为TOS的囊性病变,建议慎重采用穿刺活检,而应直接行切开活检。术前活检诊断需密切结合患者的临床、影像学及病理形态学表现,以提高TOS活检的诊断准确率。
[Abstract]:Objective to investigate the clinical, imaging and pathological features of telangiectatic osteosarcoma, and to analyze the causes of misdiagnosis of preoperative biopsy. Methods Fifteen cases of TOS were reviewed with preoperative biopsy, open biopsy and surgical and pathological sections. The misdiagnosis reasons of preoperative biopsy were analyzed in combination with literature, clinical, imaging, pathomorphological and prognostic follow-up. Results among the 15 cases of TOS, 10 cases were diagnosed by preoperative biopsy, 3 cases were diagnosed as TOSN, 2 cases were diagnosed as sarcoma, 1 case was highly suspected as sarcoma, 3 cases were considered as (aneurysmal bone cystoma (n = 3) or 1 case was diagnosed as benign fibrous osteopathy. 10 cases were diagnosed as benign fibrous osteopathy. Among them, 5 cases were diagnosed as osteosarcoma by puncture biopsy, 6 cases were diagnosed as Tosarcoma, 3 cases were diagnosed as osteosarcoma, 1 case was diagnosed as osteosarcoma and 1 case was diagnosed as osteosarcoma, with the exception of aneurysm like bone cyst. Conclusion the diagnostic rate of TOS biopsy before operation is lower (30%), and that of open biopsy is relatively high (60%). The causes of misdiagnosis of preoperative biopsy were mainly due to the cystic nature of TOS and the difficulty of obtaining the standard tissue of the cyst wall in the puncture biopsy, and the early imaging features of the lesion were not obvious or the heterogeneity of the sarcoma cells in the cyst wall was not obvious. Therefore, for cystic lesions suspected to be TOS, it is recommended that biopsy should be performed directly instead of puncture biopsy. In order to improve the diagnostic accuracy of TOS biopsy, clinical, imaging and pathomorphological features should be closely combined with preoperative biopsy diagnosis.
【作者单位】：上海交通大学附属第六人民医院病理科;
【基金】：上海交通大学医学院科技基金(13XJ10066)
【分类号】：R738.1

【相似文献】