原位微波消融治疗骨肉瘤术后43个月病理随访报告

Pathological analysis of the microwave ablation treatment of osteosarcoma in situ:a 43-month follow-up report after the operation

目的评价微波消融术治疗骨肉瘤的中期疗效,探讨瘤段骨的病理学转归。方法对1例股骨远端骨肉瘤,患者进行了原位微波消融+内固定保肢治疗,术后随访43个月。末次随访时,拆除内固定,术中取股骨(原瘤段骨)中部、远端骨质及其周围软组织进行病理检查。结果该患者手术后53个月无瘤生存,肢体功能MTST评分30分。组织病理提示:瘤段骨中部见少量板层骨小梁、脂肪组织及再生的血管组织;瘤段骨远端骨质可见部分退变坏死及新生骨组织;股骨远端周围软组织镜下可见退变的横纹肌组织、胶原化的纤维结缔组织和神经组织。所有镜下均未见肿瘤细胞。结论该例接受微波消融治疗骨肉瘤患者的中期无瘤生存;术后43个月,原瘤段骨中仍有死骨存在,再血管化没有全部完成,仍有再骨折风险。

Objective To evaluate the mid-term clinical effects of the microwave ablation treatment of osteosarcoma and to investigate the pathological changes of the bone with tumors. Methods One patient with distal femoral osteosarcoma underwent microwave ablation in situ and limb salvage of internal ifxation, who was followed up for 43 months after the operation. In the latest follow-up, the internal ifxator was removed, and the pathological examination was carried out in the middle （ with primary tumors ） and distal femur and the surrounding the soft tissues. Results The patient was disease-free for 53 months after the operation. The Musculoskeletal Tumor Society （ MSTS ） scoring system was used to evaluate the joint function, and the score for the patient was 30 points. The pathological examination results were stated as following. There were some lamella trabeculas, adipose tissues and regenerative vascular tissues in the middle tumor-bearing femur. In the distal tumor-bearing femur, both partial degeneration and necrosis of the bone and formation of fresh bone tissues could be observed. Meanwhile, degenerated striated muscles, collagenous ifbrillar connective tissues and nervous tissues could be noticed in the surrounding soft tissues of the distal femur microscopically. No residual tumor cells were found microscopically. Conclusions Excellent mid-term clinical effects are obtained in this patient undergoing the microwave ablation treatment of osteosarcoma, who is free of cancer now. Necrosis of the bone still exists and complete revascularization can not been observed in the treated segment at 43 months after the operation, which predicts the possibility of postoperative fractures.