手足部内生软骨瘤及原发性软骨肉瘤的临床病理分析

Enchondroma and primary chondrosarcoma of the hands and feet:a clinicopathologic analysis

目的探讨手足短管状骨内生软骨瘤及原发性软骨肉瘤的影像学及临床病理学特征,为二者的诊断及鉴别诊断提供依据。方法回顾性研究手足短管状骨的内生软骨瘤204例,年龄6～72岁(平均34岁),高峰年龄20～40岁,女:男约为2:1。其中指骨166例,掌骨34例,足趾骨4例。原发性软骨肉瘤2例,均发生于指骨,年龄分别为52岁、76岁,男女各1例。对上述病例的临床影像学资料进行分析,病理学特征通过石蜡切片HE染色进行观察。结果手足短管状骨的内生软骨瘤临床多无症状,影像学呈现膨胀性的骨破坏,组织学表现为分化较好的软骨组织伴不同程度黏液变、钙化及细胞轻度非典型性,未见浸润骨及软组织。软骨肉瘤临床多伴有疼痛,影像学可见皮质破坏、软组织包块形成。2例病理组织学分级均为II级,其肿瘤细胞较内生软骨瘤更为丰富,非典型性及黏液变显著,可见肿瘤性软骨浸润宿主骨、侵破皮质进入软组织。结论手足短管状骨以内生软骨瘤多见,尽管组织学具有非典型特征,但其呈现"软骨岛"结构及为宿主骨小梁包绕的生长方式与软骨肉瘤的浸润性生长不同,手足短管状骨软骨肉瘤罕见,其组织学显示显著的恶性特征,二者诊断时应结合临床、影像学特征及病理学特点进行综合分析。

Objective To investigate the radiological and clinicopathologic features of enchondroma and primary chondrosarcoma in the short tubule-like bone of the hands and feet, and to provide evidence for their diagnosis and differential diagnosis. Methods 204 patients with enchondroma in the short tubule-like bone of the hands and feet were studied retrospectively, whose mean age was 34 years old （range; 6-72 years）. The peak age range was 20- 40 years old, and the proportion of female and male was about 2：1. Among them, there were 166 cases located in the phalanges of the hand, 34 cases in the metacarpus and 4 cases in the phalanges of the foot. There were 2 cases of primary chondrosarcoma, which were both located in the phalanges of the hand. There was 1 male and 1 female, whose age was 52 and 76 years old respectively. The clinical and radiological data of the above cases were analyzed and the pathological features were observed by paraffin section and hematoxylin and eosin （HE） staining. Results Clinically, the enchondroma in the short tubule-like bone of the hands and feet was asymptomatic, with imaging manifestations of expanded lesions. The histological appearance was well-differentiated cartilage tissues with myxoid matrix degenerated and calcified to different degrees and slightly atypical cells without infiltrated bones or soft tissues. Clinically, in chondrosarcoma, pain was the important symptom and the cortical disruption with extension into soft tissues was observed in radiographic images. 2 cases of chondrosarcoma were grade Ⅱ in histopathological grading. Comparing with the enchondroma, they showed more abundant chondrocytes with atypia and obvious myxoid matrix. Cartilage tumors infiltrated into the host bone, disrupted the cortex and entered the soft tissues. Conclusions The enchondroma in the short tubule-like bone of the hands and feet is more common, with atypical characteristics histologically. However, the growth pattern of the enchondroma with the structure of cartilage island surrounded by the trabecula of the host bone is different from the invasive growth pattern of the chondrosarcoma. The chondrosarcoma in the short tubule-like bone of the hands and feet is rarely seen, which shows significant malignant characteristics histologically. The clinical symptoms, radiological features and pathologic characteristics should be analyzed comprehensively when doing the differential diagnosis between them.