地舒单抗(Denosumab)治疗后骨巨细胞瘤假肉瘤样变伴有高核分裂活性的罕见组织形态特征分析  

Rare histological features of giant cell tumor of bone with pseudosarcomatous changes and high mitotic activity after Denosumab treatment

作　　者：沈艳[1] 杨通[1] 陈贵东[1] 古婉仪[1] SHEN Yan;YANG Tong;CHEN Guidong;GU Wanyi(Department of Pathology,The Second Affiliated Hospital of Guangzhou Medical University,Guang zhou 510260,China)

机构地区：[1]广州医科大学附属第二医院病理科,广州510260

出　　处：《中国癌症防治杂志》2023年第4期406-410,共5页CHINESE JOURNAL OF ONCOLOGY PREVENTION AND TREATMENT

摘　　要：目的 探讨地舒单抗(Denosumab)治疗后伴有假肉瘤样改变和高核分裂活性的骨巨细胞瘤的组织形态特征、诊断及鉴别诊断。方法 回顾性分析广州医科大学附属第二医院收治的1例术前经Denosumab治疗3周的骨巨细胞瘤患者的临床、影像学和病理学资料,并复习相关文献。结果 患者,男性,39岁,以右膝关节肿痛伴行走受限为主要临床表现。X射线显示右侧股骨远端关节下髓腔内见一膨胀性、溶骨性病变。Denosumab治疗前穿刺活检显示为骨巨细胞瘤的典型形态特征。Denosumab治疗3周后,行病灶刮除术。组织学表现为巨细胞几乎完全消失,肿瘤以中等至高密度的梭形单核细胞构成为主,伴有高核分裂活性、片灶状坏死及幼稚新骨生成,形成骨肉瘤样形态。术后随访9个月未见复发。结论 假肉瘤样改变伴有高核分裂活性是Denosumab治疗后骨巨细胞瘤组织学特征谱中一种罕见组织表型,易误诊为真性肉瘤或骨巨细胞瘤恶性转化。关注临床治疗史并熟悉这些组织形态特征,对于准确诊断至关重要。Objective To investigate the histological features,diagnosis and differential diagnosis of giant cell tumor of bone(GCTB)with pseudosarcomatous changes and high mitotic activity after Denosumab treatment.Methods The clinical data,radiologic and pathological features of a patient with GCTB treated with Denosumab for 3 weeks prior to surgery in the Second Affiliated Hospital of Guangzhou Medical University was retrospectively analyzed,and the relevant literature was reviewed.Results A 39⁃year⁃old male patient presented with swelling and pain right knee joint and walking limitation as the main clinical symptom.The X⁃ray result showed an expansive,osteolytic lesion in the subarticular medullary cavity of the right distal femur.Th initial biopsy before Denosumab treatment showed typical features of GCTB.After 3 weeks of Denosumab treatment,curettage was performed.Histological findings showed that giant cells almost completely disappeared,and the tumor was mainly composed of spindle mononuclear cells with moderate to high density,accompanied by high mitotic activity,focal necrosis and immature new bone formation,forming a osteosarcoma⁃like morphology.No recurrence was found in 9 months follow⁃up.Conclusions The pseudosarcomatous change with high mitotic activity is a rare histological phenotype of GCTB after Denosumab treatment,which is easily misdiagnosed as the true sarcoma or malignant transformation of GCTB.Paying attention to clinical treatment history and being familiar with the histological features are essential for accurate diagnosis and avoiding misdiagnosis.

关 键 词：骨巨细胞瘤 地舒单抗(Denosumab) 组织学特征 鉴别诊断 

分 类 号：R738.1[医药卫生—肿瘤]