骨巨细胞瘤肺转移的临床和影像特征

The clinical and imaging features of pulmonary metastasis of giant cell tumor of bone

目的 分析骨巨细胞瘤肺转移的临床和影像特征,为临床更好诊治骨巨细胞瘤提供帮助.方法 回顾性分析5例经病理证实为骨巨细胞瘤肺转移患者的资料,重点关注肺转移瘤影像表现和发展特点.结果 5例患者原发灶术式都为瘤段刮除并经历肿瘤复发,肺转移瘤被发现在原发灶诊断后5 ～26个月.X线平片诊断肺转移4例,CT初诊时即诊断全部5例.骨巨细胞瘤肺转移灶的CT表现为单发实性结节1例、多发实性结节4例、肿块1例、多发磨玻璃样结节1例,其中混合型2例;CT动态随诊可见自发退变结节1例,单发结节切除术后19个月肺内再发转移1例,3例多发实性结节中少数结节可长期维持不变.结论 骨巨细胞瘤肺转移的CT动态随访观察有一定特征性,原发灶诊断后2年内规律随访,有助于及时发现肺转移灶并帮助临床判断预后.

Objective To analyze the clinical and imaging features of pulmonary metastasis of giant cell tumor of bone for clinical diagnosis and treatment.Methods Five patients with histologically proven pulmonary metastasis from giant cell tumor of bone were reviewed,the imaging features and the progression of the pulmonary metastasis were evaluated.Results The first operation of primary tumor was curettages and then local recurrence was seen in all 5 cases.The interval to metastasis ranged from 5 to 26 months.Pulmonary metastasis was diagnosed by chest radiographs in 4 cases and CT in all 5 cases.The imaging findings included solitary solid nodule （n =1）,multiple solid nodules and mass （n =5）,multiple groundglass nodules （n =1） and complex form （n =2）.The dynamic follow-up CT findings showed spontaneous regress nodules （n =1）,metastasis occurring again 19 months after surgery of solitary nodule （n =1）,some solid nodules unchangable for a long time in 3 patients with multiple nodules.Conclusions The dynamic follow-up CT findings of pulmonary metastasis of giant cell tumor of bone are specific.The regular follow-up could play an essential role in early detection and prognosis of pulmonary metastasis within 2 years after primary tumor diagnosed.