长骨釉质瘤10例临床病理形态及免疫表型分析  

Adamantinomas involving long bones:clinicopathological and immunophenotypic analyses of 10 cases

作　　者：丁宜[1] 孙晓淇[1] 孟淑琴[1] 鱼锋[2] 黄啸原[1] 

机构地区：[1]北京积水潭医院病理科,北京100035 [2]北京积水潭医院骨肿瘤科,北京100035

出　　处：《诊断病理学杂志》2011年第3期169-172,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的研究釉质瘤临床病理特点,分析免疫组化在釉质瘤、骨性纤维结构不良(OFD)样釉质瘤及骨性纤维结构不良的诊断与鉴别诊断中的作用,探讨三者之间的关系。方法回顾性分析发生于胫、腓骨的釉质瘤10例,其中OFD样釉质瘤2例;并与胫、腓骨发生的15例OFD进行比较。结合文献讨论这些病例的临床表现、病理形态、免疫组化及随访结果。结果 10例釉质瘤均位于胫、腓骨皮质,其中8例镜下有明确的上皮样分化,2例镜下见骨性纤维结构不良背景下散在少数活跃的上皮样梭形细胞,经免疫组化检测后支持OFD样釉质瘤。釉质瘤患者均行肿瘤广泛切除,随访4个月～5年(平均4.3年)无复发。OFD患者接受刮除植骨治疗,随访3个月～3年(平均2.2年)无复发。结论釉质瘤为少数低度恶性骨原发肿瘤之一,诊断依据为镜下见到明确的上皮样成分并经免疫组化支持。需与临床、影像学密切结合并充分取材行上皮抗原免疫组化检测方能避免漏诊。Objective To explore the clinicopathological features of adamantinoma,and to confirm the role of immunohistochemical stains in the diagnosis and differential diagnosis of osteofibrous dysplasia（OFD）-like adamantinoma from OFD,with special focus on OFD-like adamantinioma and the correlation among these three diseases.Methods Ten cases of adamantinoma on tibia and fibula and 15 OFD on tibia and fibula were collected from 2005-2010 in this hospital,their clinical manifestations,pathological features,immunohistochemical findings were analyzed with the follow-up and review of the literature.Results The male/female ratio in patients with adamantinoma was 3∶2,and it always involved tibia and/or fibula.Microscoplly,8 cases of adamantinoma had epithelial-like cells,2 cases had OFD-like background with only several nests or a cluster of epithelial-like cells which were positive for epithelial antigens.The follow-up from 4 months to 5 years（average 4.3 years） showed that no recurrence was noted after wide resection in adamantinoma,and 15 cases of OFD with curage and transplantation were found no recurrence after follow-up from 3 months to 3 years（average 2.2 years）.Conclusions Adamantinoma is a rare low-grade primary bone tumor,and its diagnosis bases on the epithelial cell component with immunohistochemical evidence.The comprehensive analyses of clinical data and image with enough tumor tissues and immunohistochemical detection of epithilial antigens are needed to prevent the mis-diagnosis.

关 键 词：釉质瘤 骨性纤维结构不良样釉质瘤 骨性纤维结构不良 免疫组化 

分 类 号：R739.96[医药卫生—肿瘤]