骨小细胞恶性肿瘤套针穿刺活检与术后病理诊断比较

Small cell malignant tumors of bone： comparison between diagnosis using core needle biopsies and surgical specimens

目的比较骨小细胞恶性肿瘤穿刺活检及术后标本的常规组织学及免疫组织化学方面的差异和鉴别诊断。方法回顾分析1995至2010年间诊断的77例小细胞恶性肿瘤的穿刺活检与术后病理情况，分别对他们的临床资料、常规组织学和免疫组织化学染色结果进行总结。结果77例患者中男48例，女29例，年龄6—73岁，其中尤文肉瘤／PNET38例，淋巴瘤10例，浆细胞骨髓瘤23例，小细胞骨肉瘤2例，小细胞转移癌2例，间叶性软骨肉瘤2例。骨小细胞恶性肿瘤发生部位可以累及全身，依次好发于四肢长骨及中轴骨、扁骨。镜下常见密集分布的核蓝染小圆或短梭形细胞，形态及结构类似，穿刺标本与手术标本病理诊断结果完全符合率达到84．4％（65／77），支持率100％（77／77）。结论骨小细胞恶性肿瘤较罕见，分类复杂，光镜下形态学类似，组织结构不典型，需结合临床资料、影像学改变、病理形态及免疫组织化学结果综合分析，有条件者加作分子生物学检测才能做出正确判断。穿刺活检对诊断骨小细胞恶性肿瘤效果肯定。．

Objective To compare the pathologic diagnosis and immunohistochemistry of small cell malignant tumors （SCMT） of bone using both core needle biopsy and surgical specimen. Methods Seventyseven cases of SCMT with core needle biopsies and surgical specimens available were respectively analyzed by histologic examination and immunohistochemical study, with literature review. Results The male-to- female ratio was 48： 29. The age of the patients ranged from 6 to 73 years. The tumors studied included Ewing sarcoma/PNET （ n = 38）, myeloma （ n = 23 ）, lymphoma （ n = 10）, small cell osteosarcoma （ n = 2）, small cell carcinoma （n = 2） and mesenchymal chondrosarcoma （n = 2）. The tumors involved limbs, axial skeleton and fiat bones. Microscopically, the tumors shared similar histology, with small round cells and spindly cells arranged in diffuse sheets. The pathologic diagnosis by core needle biopsies correlated with that by surgical specimens in 84. 4% （65/77） of the cases. Conclusions SCMT represents a heterogeneous group of malignancy. Correlations with clinicoradiologic findings and application of ancillary investigations including immunohistochemistry and molecular study are important for definitive diagnosis. Pathologic diagnosis using core needle biopsies shows good results and provides useful information for surgical planning.