长骨毛细血管扩张型骨肉瘤与动脉瘤样骨囊肿的影像及病理学特征比较  

Imaging and pathological features of telangiectatic osteosarcoma and aneurysm bone cyst of long tubular bone

作　　者：史云恒[1] 刘向东[1] 吴慧钊[1] 吴聪哲[2] 刘名[2] 刘俊茹[2] 赵静品[1] 吴文娟[1] 

机构地区：[1]河北医科大学第三医院放射科,河北石家庄05005l [2]唐山市协和医院影像科

出　　处：《实用放射学杂志》2013年第4期619-622,共4页Journal of Practical Radiology

摘　　要：目的比较长骨毛细血管扩张型骨肉瘤与动脉瘤样骨囊肿的IIi{i床、影像与病理学特征。方法分析本院发生在长管状骨的16例毛细血管扩张型骨肉瘤和14例动脉瘤样骨囊肿的l临床、影像、病理学资料。结果毛细血管扩张型骨肉瘤的x线平片和CT除l例可见放射状骨针，类似普通型骨肉瘤，其余均以溶骨性破坏为主，边界不清，具有普通溶骨性骨肉瘤的一般特征；CT或MR最示肿瘤区内多发囊变和液一液平面，常伴明显的软组织肿块。动脉瘤样骨囊肿边界清晰，可见薄的骨壳，MRI显示病变边缘低信号。毛细血管扩张型骨肉瘤的组织学特征是高倍镜下出血或坏死囊变的间隔中有高度异型的恶性肿瘤细胞及多少不等的肿瘤性骨样组织，而动脉瘤样骨囊肿的囊壁由增生的成纤维细胞组成，其中散在破骨细胞型多核巨细胞及被覆骨母细胞的反应性编织骨，细胞无异型性。结论毛细血管扩张型骨肉瘤以溶骨性破坏为主，具有普通骨肉瘤的一般特性，与动脉瘤样骨囊肿影像及病理学表现有一些重叠相似之处，需要注意鉴别。Objective To explore the clinical, imaging and pathological characteristics of the telangiectatic osteosarcomas （TOS） and aneurysmal bone cyst（ABC） of long tubular bone. Methods Clinical, imaging and pathological features of TOS in 16 cases and ABC in 14 cases were analyzed. Results On X-ray and CT images, TOS showed osteolytic destruction with ill-defined margins, sun- burst periosteal reaction was seen in one case. CT and MRI showed that there were multiple small cystic formation and fluid-fluid level within the tumors and often associated with soft tissue masses. The boundarys of the ABC groups were well-defined, with a thin bone shell around the lesions. MRI showed low signal rims in all the ABC cases. Histologic evaluation of T（）S showed blood- filled cystic structures with a thick-walled Iining and septa. The septa contained markedly atypical malignant tumor cells with imma- ture osteoid production, which were showed in higher-power view. The cystic walls of ABC were composed of a proliferation of fi- broblasts, with scattered multinucleated osteoclast-type giant ceils and reactive woven bone rimmed by osteohlasts, but atypical cells were absent. Conclusion TOS has common imaging appearances seen in osteosarcoma, but imaging and pathological characteristics are of some overlapping with ABC, the differentiating diagnosis of T（）S from ABC should be considered comprehensively.

关 键 词：骨 骨肉瘤 X线摄影 磁共振成像 病理学 计算机体层成像 

分 类 号：R738.1[医药卫生—肿瘤] R814[医药卫生—临床医学]