原发性骨外骨肉瘤的影像诊断(附7例报道及文献复习)
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摘要
目的探讨原发性骨外骨肉瘤的影像表现及临床特征,提高对该病的认识。方法回顾性分析7例经病理证实的原发性骨外骨肉瘤的临床及影像资料,并结合相关文献复习。结果 7例原发性骨外骨肉瘤均行CT检查,4例行MRI检查,其中4例行CT增强检查,2例行MRI增强。发病部位分别位于左侧股内侧肌、左侧膝部髌下软组织、前纵隔、乳腺、右肾、腹膜后间隙及膀胱各1例。患者均无骨的原发骨肉瘤病史,临床表现各不相同;CT上均表现为骨外的一不规则软组织肿块影,5例肿瘤内伴有结片状钙化或瘤骨成分,4例CT增强呈明显不均匀强化,2例可见斑片状坏死,2例可见肿瘤供血动脉;4例MRI平扫均表现为一不规则软组织信号肿块影伴信号不均,2例MRI增强呈明显不均匀强化。7例患者均经病理证实为原发性骨外骨肉瘤。结论原发性骨外骨肉瘤临床特征缺乏特异性,其影像特点表现为骨外的不规则软组织肿块伴有钙化或瘤骨成分,但诊断特异性低,确诊主要依靠病理活检。
Objective To investigate the imaging manifestations and clinical features of primary extra-skeletal osteosarcoma.Methods The clinical data, CT(7) and MRI(4) findings of primary extra-skeletal osteosarcoma in 7 patients were retrospectively analyzed. Results 4 cases in CT were contrast enhanced and 3 cases in MRI were contrast enhanced. The osteosarcoma involved the left vastus medialis, left infra-patellar soft tissue, anterior mediastinum, breast, right kidney, retroperitoneum, and bladder without primary osteosarcoma of bone. The irregular soft tissue mass was entirely shown on CT in all patients with nodal calcification or tumor ossification (5), heterogeneous enhancement (4), or patchy necrosis (2). The supply arteries were found in 2 tumors. MRI showed irregular soft tissue mass with heterogeneous signal intensities (4) and enhancement (3). Conclusion The clinical features of primary extra-skeletal osteosarcoma are nonspecific. The main imaging manifestations are an irregular soft tissue mass with calcification or ossification. Diagnosis requires histological confirmation.
Objective To investigate the imaging manifestations and clinical features of primary extra-skeletal osteosarcoma.Methods The clinical data, CT(7) and MRI(4) findings of primary extra-skeletal osteosarcoma in 7 patients were retrospectively analyzed. Results 4 cases in CT were contrast enhanced and 3 cases in MRI were contrast enhanced. The osteosarcoma involved the left vastus medialis, left infra-patellar soft tissue, anterior mediastinum, breast, right kidney, retroperitoneum, and bladder without primary osteosarcoma of bone. The irregular soft tissue mass was entirely shown on CT in all patients with nodal calcification or tumor ossification (5), heterogeneous enhancement (4), or patchy necrosis (2). The supply arteries were found in 2 tumors. MRI showed irregular soft tissue mass with heterogeneous signal intensities (4) and enhancement (3). Conclusion The clinical features of primary extra-skeletal osteosarcoma are nonspecific. The main imaging manifestations are an irregular soft tissue mass with calcification or ossification. Diagnosis requires histological confirmation.
引文
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[17]陈天水.骨外骨性和软骨性肿瘤的病理诊断.临床与实验病理学杂志,1999,15:341-344.
[18]刘维帅,郭晓宁,董炜疆,等.腹膜后骨外骨肉瘤临床病理特征和鉴别诊断.中国肿瘤临床与康复,2017,24:197-199.
[19]徐红卫,王金淳,徐晶鸿.骨外骨肉瘤影像学表现分析.医疗卫生装备,2014,35:88-90.
[20]Lee JS,Fetsch JF,Wasdhal DA,et al.A review of 40 patients with extraskeletal osteosarcoma.Cancer,1995,76:2253-2259.
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[23]张斌青,杨静,郭会利,等.局限性骨化性肌炎45例影像学分析.实用放射学杂志,2014,30:1348-1350.
[24]方三高,李艳青,马强,等.骨旁骨肉瘤5例临床病理分析.诊断病理学杂志,2016,23:247-251.
[25]Chen Y,Wang X,Guo L,et al.Radiological features and pathology of extraskeletal mesenchymal chondrosarcoma.Clin Imaging,2012,36:365-370.
[26]贺召焕,刘雷雷,卢晓倩,等.后纵隔间叶性软骨肉瘤一例.临床放射学杂志,2017,36:503-504.
[27]Mc Auley G,Jagannathan J,O’Regan K,et al.Extraskeletal osteosarcoma:spectrum of imaging findings.Am J Roentgenol,2012,198:W31-W37.
[28]侯高峰,陈秀,王道喜,等.胸腔内巨大转移性骨肉瘤二例.中国胸心血管外科临床杂志,2011,18:386.
[29]樊俊威,阿克拜尔·苏来曼,边毅,等.骨肉瘤皮肤转移一例.中华皮肤科杂志,2016,49:482-484.
[30]Nystrom LM,Reimer NB,Reith JD,et al.The treatment and outcomes of extraskeletal osteosarcoma:institutional experience and review of the literature.Iowa Orthop J,2015,36:98-103.
[2]Roller LA,Chebib I,Bredella MA,et al.Clinical,radiological,and pathological features of extraskeletal osteosarcoma.Skeletal Radiol,2018,Mar 3.[Epub ahead of print].
[3]Wilson H.Extraskeletal ossifying tumors.Ann Surg,1941,113:95-112.
[4]Hu B,Liu Y,Cheng L,et al.SPECT/CT imaging of retroperitoneal extraskeletal osteosarcoma.Clin Nucl Med,2014,39:200-202.
[5]王巍,全昌斌,李宁,等.胸膜腔内骨外骨肉瘤一例并文献复习.中华结核和呼吸杂志,2010,33:202-205.
[6]Trimble CR,Burke A,Kligerman S.Primary cardiac osteosarcoma:AIRP best cases in radiologic-pathologic correlation.Radiographics,2015,35:1352-1357.
[7]张成虎,杨文增,安丰,等.肾原发性骨肉瘤一例.中华腔镜泌尿外科杂志(电子版),2016,10:62-63.
[8]Tao SX,Tian GQ,Ge MH,et al.Primary extraskeletal osteosarcoma of omentum majus.World J Surg Oncol,2011,9:25.
[9]Choi LE,Healey JH,Kuk D,et al.Analysis of outcomes in extraskeletal osteosarcoma:a review of fifty-three cases.J Bone Joint Surg Am,2014,96:e2.
[10]Iannaci G,Luise R,Sapere P,et al.Extraskeletal osteosarcoma:a very rare case report of primarytumor of the colon-rectum and review of the literature.Pathol Res Pract,2013,209:393-396.
[11]李华明,吕淑华,罗彦英,等.多形性未分化肉瘤复发为骨外骨肉瘤临床病理观察.诊断病理学杂志,2016,23:365-368.
[12]Bane BL,Evans HL,Ro JY,et al.Extraskeletal osteosarcoma.A clinicopathologic review of 26 cases.Cancer,1990,65:2762-2770.
[13]Berner K,Bjerkehagen B,Bruland覫S,et al.Extraskeletal osteosarcoma in Norway,between 1975 and 2009,and a brief review of the literature.Anticancer Res,2015,35:2129-2140.
[14]Murphey MD,Robbin MR,Mc Rae GA,et al.The many faces of osteosarcoma.Radiographics,1997,17:1205-1231.
[15]Fine G,Stout AP.Osteogenic sarcoma of the extraskeletal soft tissues.Cancer,1956,9:1027-1043.
[16]郭亮,李小林,王颖,等.骨外骨肉瘤的影像学诊断.实用医技杂志,2006,13:2194-2196.
[17]陈天水.骨外骨性和软骨性肿瘤的病理诊断.临床与实验病理学杂志,1999,15:341-344.
[18]刘维帅,郭晓宁,董炜疆,等.腹膜后骨外骨肉瘤临床病理特征和鉴别诊断.中国肿瘤临床与康复,2017,24:197-199.
[19]徐红卫,王金淳,徐晶鸿.骨外骨肉瘤影像学表现分析.医疗卫生装备,2014,35:88-90.
[20]Lee JS,Fetsch JF,Wasdhal DA,et al.A review of 40 patients with extraskeletal osteosarcoma.Cancer,1995,76:2253-2259.
[21]Hoch M,Ali S,Agrawal S,et al.Extraskeletal osteosarcoma:a case report and review of the literature.J Radiol Case Rep,2013,7:15-23.
[22]Baydar DE,Himmetoglu C,Yazici S,et al.Primary osteosarcoma of the urinary bladder following cyclophosphamide therapy for systemic lupus erythematosus:a case report.J Med Case Rep,2009,3:39.
[23]张斌青,杨静,郭会利,等.局限性骨化性肌炎45例影像学分析.实用放射学杂志,2014,30:1348-1350.
[24]方三高,李艳青,马强,等.骨旁骨肉瘤5例临床病理分析.诊断病理学杂志,2016,23:247-251.
[25]Chen Y,Wang X,Guo L,et al.Radiological features and pathology of extraskeletal mesenchymal chondrosarcoma.Clin Imaging,2012,36:365-370.
[26]贺召焕,刘雷雷,卢晓倩,等.后纵隔间叶性软骨肉瘤一例.临床放射学杂志,2017,36:503-504.
[27]Mc Auley G,Jagannathan J,O’Regan K,et al.Extraskeletal osteosarcoma:spectrum of imaging findings.Am J Roentgenol,2012,198:W31-W37.
[28]侯高峰,陈秀,王道喜,等.胸腔内巨大转移性骨肉瘤二例.中国胸心血管外科临床杂志,2011,18:386.
[29]樊俊威,阿克拜尔·苏来曼,边毅,等.骨肉瘤皮肤转移一例.中华皮肤科杂志,2016,49:482-484.
[30]Nystrom LM,Reimer NB,Reith JD,et al.The treatment and outcomes of extraskeletal osteosarcoma:institutional experience and review of the literature.Iowa Orthop J,2015,36:98-103.