Nora病影像学与临床病理分析
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摘要
目的探讨Nora病(NL)的临床影像学和病理组织学特征、鉴别诊断、治疗及预后。方法对7例NL进行HE染色,光镜观察,结合文献复习分析其临床影像及病理组织学特点并随访。结果 7例NL发病年龄5～49岁,平均32岁,男性3例,女性4例。病变位于手部者6例,足部1例。X线示骨旁边界清晰的高密度肿块,CT、MRI图像显示病变与附着骨的骨髓腔不相通。镜下见由分化成熟的骨、软骨和纤维3种成分构成。轻度异型的软骨细胞可伴钙化,在HE染色切片上呈蓝色而称为"蓝骨";骨小梁周围被覆无异型的骨母细胞。7例均行手术治疗,1例术后复发。结论 NL是一种好发于手足管状骨的罕见的、有复发倾向的良性增生性病变,有特征性的X线和组织病理学表现,应与骨软骨瘤、骨旁骨肉瘤及甲下外生性骨疣等鉴别。
Objective To explore the clinical-radiological and pathological features of the Nora's lesion(NL). Methods The clinical and pathological data of 7 patients with NL were collected. All cases were investigated by light microscopy,and the related literatures were reviewed. Results 7 cases(7 patients,three males,four females) were identified. The average age was32( from 5 to 49) years. Six cases involved the hand and one the foot. NL was a well-defined parosteal lesion. CT and MRI images showed no cortical/medullary infiltration. Under light microscope,the lesion was mainly composed of three different mature tissues: bone,cartilage and fibrous. The cartilage component may show mild pleomorphic and calcification,and stainsed blue on HE slides,which was characteristically called "blue bone". The osteoblastic cells lined the trabecular bone surface and show no atypia. All of the 7 cases were treated with surgery initially,and recurrence occurred only in one patients(14. 3%). Conclusion NL is a rare benign surface osteocartilaginous lesion mainly affecting the tubular bones of the hands and feet with higher rate of recurrence,showing unique imaging and histopathological characteristics. The diagnosis is suspected by imaging characteristic features and is conrmed by histopathology. The differential diagnosis of the NL includes osteochondroma,parosteal osteosarcoma,subungual exostosis,etc.
Objective To explore the clinical-radiological and pathological features of the Nora's lesion(NL). Methods The clinical and pathological data of 7 patients with NL were collected. All cases were investigated by light microscopy,and the related literatures were reviewed. Results 7 cases(7 patients,three males,four females) were identified. The average age was32( from 5 to 49) years. Six cases involved the hand and one the foot. NL was a well-defined parosteal lesion. CT and MRI images showed no cortical/medullary infiltration. Under light microscope,the lesion was mainly composed of three different mature tissues: bone,cartilage and fibrous. The cartilage component may show mild pleomorphic and calcification,and stainsed blue on HE slides,which was characteristically called "blue bone". The osteoblastic cells lined the trabecular bone surface and show no atypia. All of the 7 cases were treated with surgery initially,and recurrence occurred only in one patients(14. 3%). Conclusion NL is a rare benign surface osteocartilaginous lesion mainly affecting the tubular bones of the hands and feet with higher rate of recurrence,showing unique imaging and histopathological characteristics. The diagnosis is suspected by imaging characteristic features and is conrmed by histopathology. The differential diagnosis of the NL includes osteochondroma,parosteal osteosarcoma,subungual exostosis,etc.
引文
[1]Fltcher DM,Bridge JA,Hogendoorn PCW,et al.WHO classification of tumoues of soft tissue and bone[M].Lyon:IARC Press,2013.259-260.
[2]Yu H,Sheng H,Yang X,et al.Bizarre parosteal osteochondromatous proliferation in the ffth rib:report of a case with novel presentations[J].Int J Clin Exp Pathol,2016,9(5):5797-5800.
[3]王强修,李加美,林晓燕.Nora's病的诊治进展[J].中华临床医生杂志(电子版),2012,6(16):4802-4803.
[4]Doganavsargil B,Argin M,Sezak M,et al.A bizarre parosteal osteochondromatous proliferation(Nora's lesion)of metatarsus,a histopathologicaland etiological puzzlement[J].Joint Bone Spine,2014,81(6):537-540.
[5]Joseph J,Ritchie D,Mac Duff E,et al.Bizarre parosteal osteochondromatous proliferation:a locally aggressive benign tumor[J].Clin Orthop Relat Res,2011,469(7):2019-2027.
[6]Hussain MM,Arif KS.Bizarre parosteal osteochondromatous proliferation causing angular deformities:a case report[J].J Orthop Case Rep,2015,5(1):45-47.
[7]段智维,王晓红,张彦龙.奇异性骨旁骨软骨瘤样增生一例[J].中华病理学杂志,2015,44(7):525-526.
[8]孙琦,周强,王冬梅,等.Nora病的临床病理分析[J].临床与实验病理学杂志,2012,28(1):84-86.
[9]Kershen LM,Schucany WG,Gilbert NF.Nora's lesion:bizarre parosteal osteochondromatous proliferation of the tibia[J].Proc(Bayl Univ Med Cent),2012,25(4):369-3671.
[10]Matsui Y,Funakoshi T,Kobayashi H,et al.Bizarre parosteal osteochondromatous proliferation(Nora’s lesion)affecting the distal end of the ulna:a case report[J].BMC Musculoskelet Disord,2016,17(1):130.
[11]Pal JN,Kar M,Hazra S,et al.Differential diagnosis of BPOP arising in relation to patella[J].J Orthop Case Rep,2015,5(4):3-6.
[12]Kim SM,Myoung H,Lee SS,et al.Bizarre parosteal osteochondromatous proliferation in the lingual area of the mandibular body versusosteochondroma at the mandibular condyle[J].World J Surg Oncol,2016,14(1):35-43.
[13]夏燕,吴玲玲,封扬.奇异性骨旁骨软骨瘤样增生5例临床病理学分析[J].临床与实验病理学杂志,2015,32(9):1033-1036.
[14]Broehm CJ,M'Lady G,Bocklage T,et al.Bizarre parosteal osteochondromatous proliferation:a new cytogenetic subgroup characterized by inversion of chromosome[J].Cancer Genet,2013,206(11):402-405.
[2]Yu H,Sheng H,Yang X,et al.Bizarre parosteal osteochondromatous proliferation in the ffth rib:report of a case with novel presentations[J].Int J Clin Exp Pathol,2016,9(5):5797-5800.
[3]王强修,李加美,林晓燕.Nora's病的诊治进展[J].中华临床医生杂志(电子版),2012,6(16):4802-4803.
[4]Doganavsargil B,Argin M,Sezak M,et al.A bizarre parosteal osteochondromatous proliferation(Nora's lesion)of metatarsus,a histopathologicaland etiological puzzlement[J].Joint Bone Spine,2014,81(6):537-540.
[5]Joseph J,Ritchie D,Mac Duff E,et al.Bizarre parosteal osteochondromatous proliferation:a locally aggressive benign tumor[J].Clin Orthop Relat Res,2011,469(7):2019-2027.
[6]Hussain MM,Arif KS.Bizarre parosteal osteochondromatous proliferation causing angular deformities:a case report[J].J Orthop Case Rep,2015,5(1):45-47.
[7]段智维,王晓红,张彦龙.奇异性骨旁骨软骨瘤样增生一例[J].中华病理学杂志,2015,44(7):525-526.
[8]孙琦,周强,王冬梅,等.Nora病的临床病理分析[J].临床与实验病理学杂志,2012,28(1):84-86.
[9]Kershen LM,Schucany WG,Gilbert NF.Nora's lesion:bizarre parosteal osteochondromatous proliferation of the tibia[J].Proc(Bayl Univ Med Cent),2012,25(4):369-3671.
[10]Matsui Y,Funakoshi T,Kobayashi H,et al.Bizarre parosteal osteochondromatous proliferation(Nora’s lesion)affecting the distal end of the ulna:a case report[J].BMC Musculoskelet Disord,2016,17(1):130.
[11]Pal JN,Kar M,Hazra S,et al.Differential diagnosis of BPOP arising in relation to patella[J].J Orthop Case Rep,2015,5(4):3-6.
[12]Kim SM,Myoung H,Lee SS,et al.Bizarre parosteal osteochondromatous proliferation in the lingual area of the mandibular body versusosteochondroma at the mandibular condyle[J].World J Surg Oncol,2016,14(1):35-43.
[13]夏燕,吴玲玲,封扬.奇异性骨旁骨软骨瘤样增生5例临床病理学分析[J].临床与实验病理学杂志,2015,32(9):1033-1036.
[14]Broehm CJ,M'Lady G,Bocklage T,et al.Bizarre parosteal osteochondromatous proliferation:a new cytogenetic subgroup characterized by inversion of chromosome[J].Cancer Genet,2013,206(11):402-405.