骨膜骨肉瘤的临床病理分析

A clinicopathological analysis of Periosteal osteosarcoma and review

目的分析研究骨膜骨肉瘤(periosteal osteosarcoma,POOS)的临床病理特征、影像学特点、诊断及鉴别诊断要点。方法对1例骨膜骨肉瘤(POOS)进行常规病理观察及影像学分析。结果该例POOS临床表现为局部肿块伴有疼痛;影像学显示骨皮质表面软组织阴影,不侵犯骨髓腔。镜下由中等分化的软骨母细胞构成,呈分叶状排列,小叶被有一定异型性的梭形细胞分割,细胞间可见少量肿瘤性骨样基质形成。结论骨膜骨肉瘤是发生于骨表面的罕见骨肉瘤,伴发髓腔浸润者极少见,诊断时需结合临床病理特征及影像学特点做综合判断,需要与骨膜软骨肉瘤、普通骨肉瘤、高级别骨表面骨肉瘤、骨旁骨肉瘤等进行鉴别。

Objective The aim of this work is to discuss the clinicopathologic feature,imaging performance,diagnosis and differential diagnosis of the periosteal osteosarcoma. Method one case of periosteal osteosarcoma was analyzed by light microscopy and radiography. Results This patient presented a growing painful mass. Radiographically,the case is located superficially at the cortex of the bone and the medullary cavity was not invaded by tumor. The histological appearance of the tumor was moderately differentiated chondroblastic osteosarcoma,with small islands of anaplasic spindle cells that produced malignant osteoid. Conclusion Periosteal osteosarcoma is a rare intermediated- grade surface osteosarcoma,and secondary bone marrow involvement is unusual. Pathological Diagnosis should be combined with clinicopathologic feature and imaging performance. And diagnosis of Periosteal osteosarcoma should be differentiated from periosteal chondrosarcoma,conventional osteosarcoma,high grade surface osteosarcoma,parosteal osteosarcoma.