51例肩胛骨肿瘤及肿瘤样病变的影像学分析

Imaging features of scapular tumor and tumor-like lesions

目的:探讨肩胛骨肿瘤和肿瘤样病变的分布特征及其影像学征象。方法:回顾性分析2007—2011年间经病理证实的肩胛骨病变51例,分析其发病情况及影像学特点。结果:肩胛骨病变共51例,占同期全身骨肿瘤的2.15%,涉及15种病变。其中良性肿瘤22例(43.1%),肿瘤样病变6例(11.8%),恶性肿瘤23例(45.1%)。良性肿瘤以骨软骨瘤最为多见(17例,占肩胛骨良性肿瘤的77.3%),其次是软骨瘤2例;肿瘤样病变主要为嗜酸性肉芽肿和邻关节骨囊肿,各2例;恶性肿瘤主要为转移瘤(14例,占肩胛骨恶性肿瘤的60.9%),其次是软骨肉瘤4例(占肩胛骨原发恶性肿瘤的44.4%)。除1例软骨母细胞瘤涉及盂部外,余软骨类肿瘤均位于体部和骨突部。肩胛骨骨突部的病变种类分布与体部相似。体部中心区多为恶性肿瘤,边缘区多为软骨类良性肿瘤;盂部主要为转移瘤,良性病变中邻关节骨囊肿是该处较具特征性病变。肩胛骨恶性肿瘤具有边界不清、骨皮质破坏、软组织内蔓延征象,除软骨肉瘤可见肿瘤软骨钙化征象,余恶性肿瘤缺乏影像特征性。肩胛骨良性病变多边界清楚,常伴有硬化边。结论:肩胛骨肿瘤和肿瘤样病变相对少见,以软骨类肿瘤及转移瘤为主。病变分布有一定规律,与相应病变在长骨的分布有一定相似性。

Objective： To analyze the characteristic imaging features and distribution of tumor and tumor-like lesions of the scapula. Methods： From 2007 to 2011, 51 cases of scapular lesions confirmed by pathology were enrolled into this study. The imaging characteristics and location of the lesions were ananlyzed retrospectively. Results： The fifty-one cases of scapular lesions accounted for 2.15% of the whole body bone tumors over the same period, which including 15 types of pathological lesions, 22 cases（43.1%） were benign tumors, 6 cases were tumor-like disorders, 23 cases（45.1%） were malignant tumors. Os- teochondroma was the most common benign tumor （n=17, accounting for 77.3% of scapular benign tumors）, and followed by chondroma（n=2） which was the second common benign tumor. Eosinophilic granuloma（n=2） and intra-osseous ganglion cyst（n=2） were the two common tumor-like disorders. The most common malignant tumors were metastatic tumor （n=14, 60.9% of the 51 cases）. Chondrosarcoma was the second common malignant tumor of the scapula（n=4, 44.4% of the primary malignant scapular tumors）. Except one case of chondroblastoma in which the lesion involved the glenoid cavity, all of the other cartilaginous tu- mors located in the scapular body and bony processes. The type of lesion in the bony process is the same as in the scapular body. The common lesions in the central area of body were malignant tumors. The most common lesions in the glenoid area were metastasis, and the intra-osseous ganglion cyst was the characteristic benign lesion in this area. The common imaging features of malignant scapular tumors were ill defined margin, cortical destruction and soft tissue involvement. But the imaging features except calcification within chondrosarcoma are lack of specificity. The benign lesions of scapula usually showed clear boundary and marginal sclerosis. Conclusion： Scapular tumors or tumor-like lesions are relatively rare. The most common types of tumor are cartilage tumor and metastasis. The location and distribution of different types of lesions in the scapula are similar to those of long bones in some degree.