微波灭活治疗胫骨巨细胞瘤一年后瘤段病理分析(附一例报告并文献复习)

Pathological analysis of the segment of tibial giant cell tumor 1 year after the treatment by microwave hyperthermia:a case report and literature review

目的评价植入式微波瘤段灭活方法在胫骨巨细胞瘤手术后的肿瘤灭活效果,并观察骨、软骨、周围软组织改变及再生情况以及再骨折发生处的病理特点。方法对1例胫骨巨细胞瘤瘤段微波灭活后病例,1年后进行了瘤段的病理检查,检查部位包括胫骨平台,髌腱附着点,肌肉附着点,骨折断端、截骨处,检查组织包括关节软骨,皮质骨,松质骨,再生血管,髌腱等,并复习相关文献进行分析和讨论。结果瘤段骨质内及周围组织未见明确肿瘤细胞;胫骨平台关节面处可见存活软骨细胞和软骨下方的松质骨内血管增生,提示存在软骨化成骨进程。胫骨平台皮质骨板层结构存在,松质骨骨小梁结构完整,骨细胞陷窝空虚,骨细胞消失,髓腔内容物大片坏死,部分区域可见淋巴细胞、浆细胞浸润和纤维、血管组织增生。胫骨后侧肌肉附着处局部靠近骨膜处可见存活的软骨细胞和毛细血管及明显的血管再生。髌腱附着点情况:纤维细胞存活,其下方皮质骨内可见软骨细胞,伴有钙化。再骨折发生在骨水泥与骨粉填充的远端,钢板转折并有钉孔处。结论植入式微波灭活胫骨巨细胞瘤对肿瘤杀灭确实,对正常组织保护可靠;但瘤段的骨再生及再血管化在术后1年的时间内并未完成,因此建议患者限制负重和支具保护的时间最少应大于1年,以避免再骨折的发生。

Objective To evaluate the effect of implanted microwave hyperthermia of the segment for tibial giant cell tumor after sugery and to explore the changes and regenerations of bone, cartilage and surrounding soft tissue as well as the characteristic of the site of re-fracture. Methods 1 case with tibial giant cell tumor was treated by microwave hyperthermia on tumor segment. After 1 year, pathological examination was carried out for tumor segment including detection sites of tibial plateau, patellar tendon attachment, soleus muscle attachment, broken ends of fracture bone and nub of osteotomy. Detection tissues included cartilage of joint, cortical bone, cancellous bone, regeneration vessels, patellar tendon and so on. The relative literature was reviewed, analyzed and discussed. Results No obvious tumor cell was found in the segment of the focus and surrounding tissue, while viable chondrocytes were found on genicular articular surface and blood capillaries proliferation in cancellous bone under the cartilage showing endochondral ossification was going on was observed. In tibia plateau, cortical bone lamella structure still existed and bone trabecula in the cancellous bone had complete structure. There were massive empty bone lacunas and cavity without bone cells. Necrosis of substances in medullary cavity happened, and the infiltration of lymphocytes and plasmocytes and hyperplasia of fibroblasts and blood capillaries were found in some areas. Moreover, there were survival chondrocytes, blood capillaries and obvious revascularization closed to periosteum in soleus muscle attachment of posterior tibial plateau. Patellar tendon attachment： survival fibroblasts in patellar tendon attachment and calcified chondrocytes in the cortical bone below tendon were found. The site of re-fracture was the turning point of the plate with a nail hole which was located at the distal end of bone cement and bone powder filling. Conclusions For tibial gian cell tumors, planted microwave hyperthermia is an confirmed choice because it can focus on the ablated tissues and protect normal tissues. As the bone healing and revascularization of tumor segment have not been finished in 1 year after operation, we suggest that the patient should be restricted weight-bearing and protected by orthosis more than 1 year to avoid the occurrence of bone re-fracture.