长骨内生软骨瘤及原发性软骨肉瘤的临床病理分析

Enchondroma and chondrosarcoma of long bones:a clinicopathologic analysis and review of literature

目的探讨长骨内生软骨瘤及原发性软骨肉瘤的临床病理特征、诊断及鉴别诊断。方法收集长骨内生软骨瘤26例,原发性软骨肉瘤35例,对其临床影像学及病理学特征进行分析并文献复习。结果 26例内生软骨瘤患者(股骨18例,肱骨5例,胫骨、腓骨和桡骨各1例)年龄9～51岁,平均31岁,男女之比为2∶1。35例软骨肉瘤患者(股骨22例,胫骨3例,肱骨7例,尺骨1例,腓骨2例),年龄26～77岁,平均47岁,男女之比为2∶3;病理学分级Ⅰ级20例,Ⅱ级14例,Ⅲ级1例。组织学上,长骨的Ⅱ级和Ⅲ级软骨肉瘤通过组织形态不难诊断,而Ⅰ级软骨肉瘤与内生软骨瘤组织形态相似,鉴别较困难。软骨肉瘤多伴有疼痛,影像学可见髓腔侵犯、皮质破坏或软组织包块;组织学可见软骨浸润、包绕宿主骨,浸润皮质或进入软组织。结论长骨的Ⅰ级软骨肉瘤与内生软骨瘤的鉴别应结合临床、影像学特征及病理学特点进行综合分析。

Objective To study the clinicopathologic features of enchondroma and chondrosarcoma of long bones.Methods The clinical,radiological and pathologic features were analyzed in 26 cases of enchondroma and 35 cases of chondrosarcoma.The literature was reviewed.Results 26 cases of enchondroma were located in the long bones,including femur（N=18）,humerus（N=5）,tibia（N=1）,fibula（N=1）,and radicus（N=1）.Age ranged from 9-51 years,with a mean of 31 years.There was female predilection（ratio of female to male = 2 ∶1）.In 35 cases of chondrosarcoma,it occured in the femur（N=22）,tibia（N=3）,humerus（N=7）,ulna（N=1）,and fibula（N=2）.20 cases were grade I,14 cases were grade Ⅱ and only one case was grade Ⅲ.Age ranged from 26-77 years,with a mean of 47 years.There was male predilection（ratio of female to male =2∶3） Histologically,enchondroma was similar to normal hyaline cartilage.Grade Ⅱ and grade Ⅲ chondrosarcoma could be diagnosed by histologic features,but the histological appearances of grade I chondrosarcoma was similar to the enchondroma,the malignant histological features included the marrow involvement,invading the plates of lamebullar bone and soft tissue masses.The spontaneous pain was often present in grade I chondrosarcoma and radiological feature showed the cortex destruction.Conclusion Grade I chondrosarcoma is difficult to be differentiated from the enchondroma,and the diagnosis should be combined with the clinical symptoms,radiological features and histological characteristics.