经手术或穿刺活检后骨盆恶性骨肿瘤患者病理分析及病灶特点分析

Pathological analysis and lesion features of patients with malignant pelvic bone tumors after surgery or biopsy

目的分析经手术或穿刺活检后病理确诊为骨盆恶性骨肿瘤患者的病理类型以及病灶特点。方法收集136例经病理确诊为骨盆恶性骨肿瘤患者的临床资料。根据WHO 2013版骨肿瘤分型标准以及骨盆分区对136例患者的病灶特点以及病理类型进行分类分析总结。结果本组患者浆细胞瘤发病率最高(30.1%),其次为非霍奇金淋巴瘤(21.3%)、软骨肉瘤(16.2%)、骨肉瘤(9.6%);骨肉瘤好发于青少年以及儿童,平均年龄为(24.6±14.9)岁,好发年龄段位为2~28岁,男性发病率高于女性(男女发病比例为2.25∶1);尤文肉瘤也是青少年好发的骨盆恶性骨肿瘤之一,年龄为2~39岁,相比骨肉瘤年龄跨度更大。136例患者中41例患者单区发病,Ⅲ区发病例数最多为20例,发病率最高(48.8%),其次为Ⅰ区、Ⅳ区、Ⅱ区,单区发病中软骨肉瘤病例数为16例,发病率最高(39.0%);53例患者为多区发病,Ⅰ+Ⅱ+Ⅳ区发病例数17例,发病率最高(32.1%),其次为Ⅰ+Ⅳ、Ⅰ+Ⅱ、Ⅱ+Ⅲ、Ⅰ+Ⅱ+Ⅲ+Ⅳ区,非霍奇金淋巴瘤发病例数为15例,发病率最高(28.3%)。结论根据经手术或穿刺病理活检分析得出骨盆恶性骨肿瘤中浆细胞瘤发病率最高,其次为非霍奇金淋巴瘤、软骨肉瘤、骨肉瘤;各个年龄段都有发病,总体男性发病率高于女性,其中骨肉瘤以及尤文肉瘤好发于青少年;骨盆恶性骨肿瘤患者单发病灶中以Ⅲ区相对好发,且软骨肉瘤在单区病灶中发病率最高;多区病灶中Ⅰ+Ⅱ+Ⅳ区相对好发,非霍奇金淋巴瘤发病率最高。

Objective To analyze the pathological types and characteristics of the malignant pelvic bone tumors con-firmed by surgery or biopsy. Method The clinical data of 136 cases of pathologically confirmed malignant pelvic bone tumors were collected. According to the WHO Classification of Bone Tumors （2013）, the pathological features and patho-logical types of the patient cohort were analyzed and summarized. Result Plasmacytoma had the highest incidence rate （30.1%）, followed by non-Hodgkin lymphoma （21.3%）, chondrosarcoma （16.2%）, and osteosarcoma （9.6%）;osteosarco-ma usually occurred in adolescents and children, the average age at onset was （24.6±14.9） years old, and a marked increase of incidence was observed in those at 2-28 years old, and also in men compared with women （male vs female：2.25：1）;be-sides, Ewing sarcoma was also common in adolescents （in those at 2-39 years old）, with a larger age span compared with osteosarcoma. In the 136 patients, 41 had solitary lesions, and nearly half were in zone Ⅲ （20 cases, 48.8%）, followed by zone Ⅰ, Ⅳ, and Ⅱ;chondrosarcoma was the most common solitary lesion （16 cases, 39.0%）;another 53 cases had multiple lesions, and there were 17 cases in zone Ⅰ＋Ⅱ＋Ⅳ, which was of the highest incidence rate （32.1%）, followed by those with zone Ⅰ＋Ⅳ,Ⅰ＋Ⅱ, Ⅱ＋Ⅲ and Ⅰ＋Ⅱ＋Ⅲ＋Ⅳ, non-Hodgkin＇s lymphoma was the most common type in this subgroup （15 cases, 28.3%）. Conclusion According to the surgery or biopsy, it is known that in malignant pelvic bone tumors, plasmacyto-ma is the major pathological type, followed by non-Hodgkin lymphoma, chondrosarcoma, and osteosarcoma;patients of all ages may develop the disease, and the overall incidence is relatively higher in men than women, including osteosarco-ma and Ewing＇s sarcoma that usually occurs in adolescent and children; solitary lesions are prone to be presenting in zone Ⅲ, with chondrosarcoma being the most common type;while multiple lesions usually present in zone Ⅰ＋Ⅱ＋Ⅳ, and non-Hodgkin＇s lymphoma is of the highest incidence.