浅表性骨肉瘤临床病理分析及其微血管密度研究

A clinicopathological and the microvascular density study on the surface osteosarcoma

目的分析浅表性骨肉瘤（OS）的临床、影像学及病理学特征,以CD105标记微血管密度（MVD）探讨与临床病理因素的关系,提高对浅表性OS诊断、鉴别诊断水平和生物学行为评估。方法回顾性分析2006年1月至2012年12月经手术病理证实的11例浅表性OS临床、影像学及病理资料,并进行随访;应用免疫组化SP法检测11例浅表性OS中CD105的表达及MVD,并与18例正常骨组织、29例普通OS对照,分析CD105在浅表性OS中的表达及CD105-MVD与临床病理因素的关系。结果 （1）11例浅表性OS中,骨旁OS 7例（1例双肺胸膜下转移）,骨膜OS 3例,高级别表面OS 1例;年龄16∽68岁,平均26岁;7例股骨远端后面,胫骨近端3例,肱骨远端1例。（2）影像学显示7例呈均一致密的骨性肿块,4例围绕骨表面生长,肿瘤与骨皮质间形成1∽2 mm透亮间隙;CT扫描7例示肿瘤呈高密度肿块,3例骨皮质不完整,肿块内可见低密度间隔,邻近骨皮质增厚,无骨质破坏,1例见骨膜反应,11例均无Codman三角,未侵犯骨髓腔;诊断准确率DR为81.8%（9/11）,CT为54.5%（6/11）,MRI为63.6%（7/11）,3种影像学检查方法结合准确率为90.9%（10/11）。（3）CD105、CD105标记的MVD在浅表性OS中的阳性表达（81.8%、32.51±11.02）明显高于正常对照组（38.9%、22.51±9.53）（P〈0.05）,与普通OS阳性表达率（82.76%）差异无统计学意义（P〉0.05）,但CD105标记的MVD差异有统计学意义（P〈0.05）,而CD105、CD105标记的MVD在浅表性OS及普通OS中的阳性表达与肿瘤大小、性别、年龄无关（P〉0.05）,在普通OS中与转移有关（P〈0.05）。（4）浅表性OS随访2∽7年,10例患者无瘤健在,1例存活74个月（高级别表面OS,49个月后复发为去分化OS）。结论浅表性OS诊断依靠临床、影像学及病理多学科结合,采用传统X线、DR和CT联合检查可提高诊断准确率;浅表性OS中CD105-MVD明显增高,肿瘤性血管生成,参与浅表性OS的发生、发展及影响预后,CD105及CD105-MVD可作为判断生物学行为的参考指标。

Objective To study the clinical, radiographic and pathologic characteristics of surface osteosarcoma （OS） and to investigate the expressions of CD105 and microvascular density（CD105-MVD） in surface OS and their relationship with biological characteristics and clinical significance. Methods A retrospective review of clinical, radiographic, and pathologic features was performed on 11 patients of surface OS by surgery and pathology between 2006 and 2010. The expressions of CD105 and CD105-MVD were examined by SP immunohistochemical staining in 11cases of surface OS tissues, and their relationship to the clinicopathologic parameters was analyzed. Results Seven patients had parosteal, three had periosteal, and one had high-grade surface OS. The median age at diagnosis was 26 years （range, 16-68 years）. Six patients were male, five were female. One had pulmonary metastasis at diagnosis. Primary tumor sites included distal femur （n=7）, proximal tibia （n=3）, and distal humerus （n=1）. The expressions of CD105 and CD105-MVD were closely associated with differentiation degree of the tumors（P〈0.05）,and had no obvious relationship to the patient’age,sex,and size of tumor（P〉0.05）. All 11 patients were treated with surgery. Ten patients remained alive and disease-free range 2-7 years after diagnosis, and one patient died of high-grade undifferentiated OS recurrenced 6 years after diagnosis of with periosteal OS. Conclusions The histologic grade predicts the clinical behavior of surface OS.The overexpressions of CD105 and CD105-MVD may＆amp;nbsp;play important role during the malignant progression of surface osteosarcoma and they were closely associated with tumor angiogenesis. CD105 detection of surface OS is valuable in judging prognosis in surface osteosarcoma.