四肢良性骨肿瘤恶变九例报告

Report of 9 cases of malignant transformation in extremity benign bone tumors

目的报道传统上认为不会恶变或恶变很罕见的良性骨肿瘤发生恶变的病例,证明传统上认为不会或极少恶变的病种也有恶变可能,从而丰富对骨肿瘤的认识,并为骨肿瘤的诊治提供参考。方法查找本中心成立以来所有住院患者的病案,从中筛选出证据明确的罕见恶变的肢体良性骨肿瘤的恶变病例,并作报道。结果 7446例非恶性骨肿瘤骨病中,排除骨软骨瘤、内生软骨瘤、神经纤维瘤病、骨巨细胞瘤四种常见易恶变疾病后,四肢骨良性病变4662例,其罕见的恶变者9例,恶变比例为0.193%(9/4662)。发生恶变的良性病种包括骨纤维结构不良、良性纤维性肿瘤、骨炎性病变、滑膜软骨瘤病、软骨黏液瘤、动脉瘤样骨囊肿、软骨黏液样纤维瘤等。各病例在临床、影像、病理等角度表现出恶变特征;既往文献中提出的恶变机制不能完全解释本组病例的恶变原因。结论骨纤维结构不良、良性纤维性肿瘤、骨炎性病变、滑膜软骨瘤病、软骨黏液瘤、动脉瘤样骨囊肿、软骨黏液样纤维瘤等骨肿瘤有发生恶变的可能,值得临床医师重视。

Objective To report cases of malignant transformation of bone tumors which were conventionally thought to be rare so as to prove the existence of malignant transformation in benign bone tumors, providing reference for clinical management of bone tumors.Methods Records of all in-patient since the establishment of our center were searched and rare cases of malignant transformation in benign bone tumors were selected.Results There were 7446 cases of non-malignant bone tumors including osteochondroma, enchondroma, neurofibromatosis, and giant cell tumors which were 4 common malignant tumor types. Nine cases of rare malignant transformation in extremity bone tumors were found out from a total of 4662 cases to date. Malignant transformation rate was 0.193% （ 9 / 4662 ）. Pre-existing benign tumors of 9 cases included fibrous dysplasia, benign fibrous tumor, inflammatory lesion of the bone, synovial chondromatosis, chondromyxoma, aneurysmal bone cyst and chondromyxoid ifbroma, etc. Clinical, radiographic and pathological characteristics were analyzed. Previously proposed hypotheses were also reviewed in an effort to speculate the possible reasons of malignant transformation of these cases.Conclusions The possibility of malignant transformation exists in ifbrous dysplasia, benign ifbrous tumor, inlfammatory lesion of the bone, synovial chondromatosis, chondromyxoma, aneurysmal bone cyst and chondromyxoid ifbroma, which should be noted in the management of bone tumors.