成年人骨肉瘤的临床及影像学特点(附33例分析)  

Clinical and Imaging Features of Osteosarcoma in Adults (an Analysis of 33 Cases)

作　　者：付立平[1] 包迎伟[1] 巫智强 叶月霞 龚向阳[2] 

机构地区：[1]遂昌县人民医院放射科,浙江323300 [2]浙江大学医学院附属第二医院放射科,浙江310009

出　　处：《放射学实践》2007年第3期282-285,共4页Radiologic Practice

摘　　要：目的:分析成年人骨肉瘤的临床和影像学特点。方法:回顾性分析33例30岁以上的骨肉瘤患者的临床和影像学资料,并与对照组和文献比较。探讨成年人骨肉瘤的发病率、病程、血清碱性磷酸酶水平、病灶分布特点、影像学特点及诊断正确率等。结果:成年人骨肉瘤占所有病例的15.6%,发病率随年龄升高而下降;病程较长,平均8.7个月;约33%的病例血清碱性磷酸酶水平正常,明显少于对照组;皮质旁骨肉瘤和骨干骨肉瘤的发病率较高,骨干骨肉瘤常见于邻近干骺端部位;与青少年相比,典型部位发病低而髋关节周围发病率高;骨质破坏类型(成骨型、溶骨型或混合型)无特殊性;特殊影像学表现多见,其中4例呈囊样骨破坏,病灶内囊变明显,肿瘤实质成分少。结论:成年人骨肉瘤诊断正确率低,容易误诊为骨巨细胞瘤、软骨肉瘤、转移瘤、其他恶性骨肿瘤、良性骨肿瘤甚至骨髓炎等。其临床和影像学特点与青少年不同,应引起重视。Objective：To investigate the clinical and imaging features of osteosarcoma in adults. Methods：The clinical and imaging materials of 33 cases of osteosarcoma in adult patients （with an age of over 30y） were reviewed and compared with those of a control series of 33 cases of osteosarcoma in adolescent patients. Relative literatures were also reviewed. The following issues of osteosarcoma in adult patients including the incidence rate, clinical history, serum alkaline phosphatase level, site distribution of lesions, imaging characteristics and accuracy rate of diagnosis were discussed. Results： The incidence rate of osteosarcoma in adults accounted for about 15.6%0 in all the osteosarcoma patients and this rate was descending as the age of the patients increased. Adult patients with osteosarcoma always presented a longer clinical history than that of the juvenile and younger adult patients （mean 8.7months）. In about one third of the adult patients with osteosarcoma,a normal serum alkaline phosphatase level was noted, this showed a significant difference between the two groups, high serum alkaline phosphatase level was more frequently found in the adolescent group. Osteosarcoma involved in adults showed a predilection for the sites of periosteum or diaphyses, particularly at the sites adjacent to metaphyses. In our series of adult patients with osteosarcoma,few of the cases revealed involvement of the bones of the knee joint and proximal humerus, contrarily, tumor involving the bones of the hip joint seemed to show a high occurrence rate. No specific signs on the modes of bone erosion （e. g. osteoblastic,osteolytic or mixed ） in our series were demonstrated. However, an imaging feature of ＂ pseudocyst＂ （bone destruction with marked cystic change and little tumor parenchyma left） was shown. Conclusion：The accuracy rate of imaging diagnosis of osteosarcoma in older adults was low. It was easily misdiagnosed as other bone tumors such as osteoclastoma （giant-cell tumor）, chondrosarcoma, bo

关 键 词：体层摄影术 X线计算机 磁共振成像 骨肉瘤 成年人 

分 类 号：R738.1[医药卫生—肿瘤]