骨肉瘤亚型影像诊断(附5种亚型23例报告)

Imaging diagnosis of subtypes of osteosarcoma(A report of 23 cases)

目的探讨骨肉瘤亚型的临床、影像学特征,以提高对骨肉瘤亚型的认识。方法回顾性分析23例临床、影像学表现,结合文献进行讨论。结果经临床、病理证实的5种亚型23例骨肉瘤中毛细血管扩张型11例,骨旁型7例,多形性未分化型2例,骨膜型2例,髓内高分化型1例。11例毛细血管扩张型分别位于股骨上段3例,股骨下段、胫骨下段各2例,肱骨下段、桡骨下段、第2腰椎和髋臼各1例。X线显示骨质呈囊状、膨胀性、溶骨性破坏,软组织肿块,其中1例骨质改变类似动脉瘤样骨囊肿;7例骨旁型分别位于股骨下段2例,股骨中段、股骨上段、胫骨中段、肩胛骨、下颌骨各1例。X线显示骨致密性骨块为主要表现,骨髓腔内未见异常,突起骨块与骨皮质之间见有透光带;2例多形性未分化骨肉瘤分别位于骶骨、股骨中下段。位于骶骨CT示骨质呈溶骨性破坏,有轻度膨胀,内有囊性变,有巨大的软组织肿块。位于股骨CT示骨皮质呈不规则致密性瘤骨,有长短不一的骨针伸入软组织,周围软组织肿块明显。2例骨膜型位于股骨下段和胫骨下段。CT显示骨皮质轻度破坏,骨髓腔内未见病灶,有巨大的软组织肿块,肿块密度不均;1例髓内高分化型位于肱骨中上段。X线显示骨质囊状破坏,局限清楚,髓腔扩张,骨皮质变薄。结论该5种亚型各自具有一定的影像学特征,有助于诊断。

Objective To analyze the distinct imaging features of various subtypes of osteosarcoma. Methods Twenty- three cases of osteosarcoma aged from 13-85 years with an average of 35 were enrolled. Five subtypes of osteosarcoma were confirmed clinically and pathologically, including 11 cases of telangiectatic ostecosarcoma, 7 of conventional paroteal osteosarcoma, 2 of malignant fibrohistiocytic osteosarcoma, 2 of periosteal osteosarcoma and 1 of intrasseous well differentiated osteosarcoma. Results The imaging findings of 11 cases of telangiectatic osteosarcoma presented expansive, cystoids ,osseous solution destraction,fracture and soft tissue mass ,including 1 case of aneurymal-like bone cyst. In 7 cases of conventional parosteal osteosarcoma the X-ray findings were condensed mass projection in soft tissue and the involved area immediate with acortical of bone. In 2 malignant fibrohistiocytic osteosarcoma the CT findings were expansive and dissolved osseous destraction with soft tissue mass and cystic. In 2 periosteal osteosarcoma CT findings were osseous solution destraction with soft tissue mass. One intrasseous well-differentiated osteosarcoma showed cystoid destraction,expansive in medullary cavity of hone. Conclusions The distinct roentgenographic features are present in five subtypes of osteosarcoma, which is of value in diagnosis.