肩胛骨恶性骨肿瘤的影像分析?
|
摘要
目的:总结肩胛骨恶性骨肿瘤的类型和影像表现。材料与方法:收集2006年4月到2018年12月18例(男女比14:4,平均年龄47岁)手术病理证实的肩胛骨恶性骨肿瘤的术前X线、CT及MRI资料进行回顾性分析。结果:肩胛骨恶性骨肿瘤以转移瘤多见(9/18,50%),大多是肺腺癌转移,肝胆系统的肿瘤也可转移至此部位。尤文肉瘤在此部位也比较好发(3/18),小的骨破坏灶伴骨膜反应和钙化、巨大软组织肿块是常见表现。其次是孤立性浆细胞瘤(2/18),部分病灶进展缓慢,膨胀生长,呈低度恶性过程。磁共振T2WI及增强扫描有助于区分软骨肉瘤和骨肉瘤。存在放射状骨膜反应时,除了骨肉瘤、尤文肉瘤、软骨肉瘤,上皮样血管内皮瘤也应考虑。结论:X线、CT、MRI综合运用可以提高肩胛骨恶性骨肿瘤的术前诊断率。
Objective: To summarize the types and imaging features of malignant bone tumors of scapula.Materials and methods: From April 2006 to December 2018, the preoperative X-ray and CT, MRI data of 18 cases of malignant scapular tumors confirmed by surgical pathology(male to female ratio: 14:4, average age: 47 years old) were collected for retrospective analysis. Results: Metastatic tumors were more common in scapular malignant bone tumors(9/18, 50%), most of which were metastatic from lung adenocarcinoma. Ewing's sarcoma was also more common in this area(3/18), with small bone lesions with periosteal reaction and calcification, and large soft tissue masses are common manifestation. The second was solitary plasma cell tumor(2/18). Some of the lesions developed slowly and expanded, showing a low-grade malignant process. Magnetic resonance imaging(T2 WI) and contrast-enhanced MRI are helpful to distinguish chondrosarcoma from osteosarcoma. In addition to osteosarcoma, Ewing's sarcoma, chondrosarcoma, epithelioid angioendothelioma should also be considered in the presence of radial periosteal reaction. Conclusion: Combined use of X-ray and CT, MRI can improve the preoperative diagnosis rate of scapular malignant tumor.
Objective: To summarize the types and imaging features of malignant bone tumors of scapula.Materials and methods: From April 2006 to December 2018, the preoperative X-ray and CT, MRI data of 18 cases of malignant scapular tumors confirmed by surgical pathology(male to female ratio: 14:4, average age: 47 years old) were collected for retrospective analysis. Results: Metastatic tumors were more common in scapular malignant bone tumors(9/18, 50%), most of which were metastatic from lung adenocarcinoma. Ewing's sarcoma was also more common in this area(3/18), with small bone lesions with periosteal reaction and calcification, and large soft tissue masses are common manifestation. The second was solitary plasma cell tumor(2/18). Some of the lesions developed slowly and expanded, showing a low-grade malignant process. Magnetic resonance imaging(T2 WI) and contrast-enhanced MRI are helpful to distinguish chondrosarcoma from osteosarcoma. In addition to osteosarcoma, Ewing's sarcoma, chondrosarcoma, epithelioid angioendothelioma should also be considered in the presence of radial periosteal reaction. Conclusion: Combined use of X-ray and CT, MRI can improve the preoperative diagnosis rate of scapular malignant tumor.
引文
[1]UNNI K K,INWARDS C Y.Dahlin’s bone tumors:General aspects and data on 10165 cases[M].6th ed.Philadelphia,PA:Lippincott Williams.Wilkins,2010:7.
[2]刘杰,陈勇,于宝海,等.51例肩胛骨肿瘤及肿瘤样病变的影像学分析[J].中国临床医学影像杂志,2013,24(6):414-418.LIU J,CHEN Y,YU B H,et al.Imaging analysis of 51 cases of scapular tumors and tumor-like lesions[J].Chinese Journal of Clinical Imaging,2013,24(6):414-418.(in Chinese).
[3]高明,张清,徐立辉,等.单中心肩胛骨肿瘤166例流行病学分析[J].中国骨与关节杂志,2015,4(7):539-545.GAO M,ZHANG Q,XU L H,et al.Epidemiological analysis of single center scapula tumor in166 cases[J].Chinese Journal of Bone and Joint,2015,4(7):539-545.(in Chinese).
[4]PUCHNER S E,PANOTOPOULOS J,PUCHNER R,et al.Primary malignant tumours of the scapula-a review of 29 cases[J].International Orthopaedics,2014,38(10):2155-2162.
[5]MAVROGENIS A F,VALENCIA J D,ROMAGNOLI C,et al.Tumors of the coracoid process:Clinical evaluation of twenty-one patients[J].Journal of Shoulder and Elbow Surgery,2012,21(11):1508-1515.
[6]CLEEMAN E,AUERBACH J D,SPRINGFIELD D S.Tumors of the shoulder girdle:A review of 194cases[J].Journal of Shoulder and Elbow Surgery,2005,14(5):460-465.
[7]BICKELS J,WITTIG JC,KOLLENDER Y,et al.Limb-sparing resections of the shoulder girdle[J].Journal of the American College of Surgeons,2002,194(4):422-435.
[8]OGOSE A,SIM F H,O’CONNOR M I,et al.Bone tumors of the coracoid process of the scapula[J].Clinical Orthopaedics and Related Research,1999,(358):205-214.
[9]MALAWER M M,MELLER I,DUNHAM W K.A new surgical classification system for shoulder-girdle resections:Analysis of 38 patients[J].Clinical Orthopaedics and Related Research,1991,(267):33-44.
[10]SAMILSON R L,MORRIS J M,THOMPSON R W.11 Tumors of the scapula:A review of the literature and an analysis of 31 cases[J].Clinical Orthopaedics and Related Research,1968,58:105-115.
[11]PRIN CHINDAPRASIRT,JULALUCK PROMSORN,Piti Ungareewittaya,et al.Bone metastasis from cholangiocarcinoma mimicking osteosarcoma:A case report and review literature[J].Molecular and Clinical Oncology,2018,9:532-534.
[12]萧炜亮,陈晓明.肝癌并孤立肩胛骨转移的诊治分析[J].循证医学,2017,17(4):253-256.XIAO W L,CHEN X M.diagnosis and treatment of liver cancer with isolated scapula metastasis[J].Evidence-Based Medicine,2017,17(4):253-256.(in Chinese).
[13]娄路馨,白荣杰,于爱红,等.髂骨原发骨肉瘤和尤文肉瘤的影像学分析[J].中国医学影像技术,2016,32(8):1255-1259.LOU L X,BAI R J,YU A H,et al.Imaging analysis of primary osteosarcoma of the ilium and ewing's sarcoma[J].Chinese Medical Imaging Technology,2016,32(8):1255-1259.(in Chinese).
[14]罗振东,陈卫国,沈新平,等.骨盆孤立性浆细胞瘤的临床及影像表现分析[J].中国CT和MRI杂志,2017,15(8):131-133.Luo Z D,CHEN W G,SHEN X P,et al.Analysis of clinical and imaging findings of pelvic solitary plasma cell tumor[J].Chinese Journal of CT and MRI,2017,15(8):131-133.(in Chinese).
[15]FLETCHER C D M,BRIDGE J A,HOGENDOORN P,et al.WHO classification of tumours of soft tissue and bone[M].Lyon:IARC Press,2013:335-336.
[16]YIM KL,SUMATHI VP,SPOONER D.Radiotherapy as an effective primary treatment for epithelioid haemangioendothelioma of the cervical spine[J].Anticancer Research,2012,32(10):4597-600.
[17]王鹏,张丹,陈怡楠,等.脊柱上皮样血管内皮瘤的CT及MRI表现(附6例报道并文献复习)[J].放射学实践,2018,33(2):192-196.WANG P,ZHANG D,CHEN Y N,et al.CT and MRI findings of spinal epithelioid hemangioendothelioma(6 cases report and literature review)[J].Radiological Practice,2018,33(2):192-196.(in Chinese).
[2]刘杰,陈勇,于宝海,等.51例肩胛骨肿瘤及肿瘤样病变的影像学分析[J].中国临床医学影像杂志,2013,24(6):414-418.LIU J,CHEN Y,YU B H,et al.Imaging analysis of 51 cases of scapular tumors and tumor-like lesions[J].Chinese Journal of Clinical Imaging,2013,24(6):414-418.(in Chinese).
[3]高明,张清,徐立辉,等.单中心肩胛骨肿瘤166例流行病学分析[J].中国骨与关节杂志,2015,4(7):539-545.GAO M,ZHANG Q,XU L H,et al.Epidemiological analysis of single center scapula tumor in166 cases[J].Chinese Journal of Bone and Joint,2015,4(7):539-545.(in Chinese).
[4]PUCHNER S E,PANOTOPOULOS J,PUCHNER R,et al.Primary malignant tumours of the scapula-a review of 29 cases[J].International Orthopaedics,2014,38(10):2155-2162.
[5]MAVROGENIS A F,VALENCIA J D,ROMAGNOLI C,et al.Tumors of the coracoid process:Clinical evaluation of twenty-one patients[J].Journal of Shoulder and Elbow Surgery,2012,21(11):1508-1515.
[6]CLEEMAN E,AUERBACH J D,SPRINGFIELD D S.Tumors of the shoulder girdle:A review of 194cases[J].Journal of Shoulder and Elbow Surgery,2005,14(5):460-465.
[7]BICKELS J,WITTIG JC,KOLLENDER Y,et al.Limb-sparing resections of the shoulder girdle[J].Journal of the American College of Surgeons,2002,194(4):422-435.
[8]OGOSE A,SIM F H,O’CONNOR M I,et al.Bone tumors of the coracoid process of the scapula[J].Clinical Orthopaedics and Related Research,1999,(358):205-214.
[9]MALAWER M M,MELLER I,DUNHAM W K.A new surgical classification system for shoulder-girdle resections:Analysis of 38 patients[J].Clinical Orthopaedics and Related Research,1991,(267):33-44.
[10]SAMILSON R L,MORRIS J M,THOMPSON R W.11 Tumors of the scapula:A review of the literature and an analysis of 31 cases[J].Clinical Orthopaedics and Related Research,1968,58:105-115.
[11]PRIN CHINDAPRASIRT,JULALUCK PROMSORN,Piti Ungareewittaya,et al.Bone metastasis from cholangiocarcinoma mimicking osteosarcoma:A case report and review literature[J].Molecular and Clinical Oncology,2018,9:532-534.
[12]萧炜亮,陈晓明.肝癌并孤立肩胛骨转移的诊治分析[J].循证医学,2017,17(4):253-256.XIAO W L,CHEN X M.diagnosis and treatment of liver cancer with isolated scapula metastasis[J].Evidence-Based Medicine,2017,17(4):253-256.(in Chinese).
[13]娄路馨,白荣杰,于爱红,等.髂骨原发骨肉瘤和尤文肉瘤的影像学分析[J].中国医学影像技术,2016,32(8):1255-1259.LOU L X,BAI R J,YU A H,et al.Imaging analysis of primary osteosarcoma of the ilium and ewing's sarcoma[J].Chinese Medical Imaging Technology,2016,32(8):1255-1259.(in Chinese).
[14]罗振东,陈卫国,沈新平,等.骨盆孤立性浆细胞瘤的临床及影像表现分析[J].中国CT和MRI杂志,2017,15(8):131-133.Luo Z D,CHEN W G,SHEN X P,et al.Analysis of clinical and imaging findings of pelvic solitary plasma cell tumor[J].Chinese Journal of CT and MRI,2017,15(8):131-133.(in Chinese).
[15]FLETCHER C D M,BRIDGE J A,HOGENDOORN P,et al.WHO classification of tumours of soft tissue and bone[M].Lyon:IARC Press,2013:335-336.
[16]YIM KL,SUMATHI VP,SPOONER D.Radiotherapy as an effective primary treatment for epithelioid haemangioendothelioma of the cervical spine[J].Anticancer Research,2012,32(10):4597-600.
[17]王鹏,张丹,陈怡楠,等.脊柱上皮样血管内皮瘤的CT及MRI表现(附6例报道并文献复习)[J].放射学实践,2018,33(2):192-196.WANG P,ZHANG D,CHEN Y N,et al.CT and MRI findings of spinal epithelioid hemangioendothelioma(6 cases report and literature review)[J].Radiological Practice,2018,33(2):192-196.(in Chinese).