老年性原发骨肉瘤五例报告

Osteosarcoma of old-age: a report of 5 cases

目的探讨老年人原发性骨肉瘤的临床特点及诊治方法。方法回顾分析5例老年原发性骨肉瘤患者的临床特点及诊断和治疗方法。5例患者年龄53～61岁。男3例,女2例。病变部位:肱骨近端2例,骨盆及胫骨近端各1例;多发性病灶1例。X线检查见:病灶为成骨、溶骨混合性骨破坏,可见骨膜反应,周围见巨大的软组织肿块,基质内可见钙化;CT、MRI、ECT均有不同程度的骨质破坏及核素浓聚信号改变。病理镜下见典型的恶性梭形成骨细胞及肿瘤性骨样基质的组织特征。发病首诊时均被误诊或漏诊。确诊后2例接受了新辅助化疗及保肢手术;1例给予化疗及放疗(DT6000cGy);1例单纯化疗;另1例单纯放疗(DT6000cGy)。结果5例患者均获随访,2例分别于确诊后8个月及10个月死于肺转移,3例仍在治疗随访中,2例接受保肢(全膝,半肩)手术者,患肢功能恢复满意。结论老年人原发性骨肉瘤较为少见,临床上容易误诊或漏诊,确诊后给予积极的个体化综合治疗,可以缓解症状,获得相对满意的治疗效果。

Objective To analyze the clinical manifestation, diagnosis and treatment for primary osteogenic sarcoma of old-age. Methods There were five cases in the study and they were 3 males and 2 females. The age of patients ranges from 53 to 61years old. The tumor occurred at proximal humerus in 2 cases and one case at pelvic and one case at proximal tibia and one case with multi-focal lesions. Radiographic findings of all patients showed that the main change was sclerotic attended by lytic with blur margin. The soft tissue mass was around focuses and calcified matrix appeared on the X-ray films. CT MRI scan showed the bone and soft tissue invasion. Needle biopsy showed typical features of osteosarcoma. 2 Cases accepted chemotherapy or/and radiotherapy respectively and 2 cases accepted limb salvage after neo-adjuvant chemotherapy. 1 case accepted radiotherapy and the total fdose was 60 Gy. Results All patients were followed up and two patients died within ten months. Conclusions Primary osteosarcoma of old-age is rare. Chemotherapy and surgical treatment is an effective method and the quality of patients could be effectively improved.