腰椎原发尤文肉瘤的诊断学特征

Diagnostic features of Ewing''s sarcoma of lumbar spine

目的探讨腰椎原发尤文肉瘤的临床、病理学特征和影像学表现。方法对1例原发于腰椎尤文肉瘤患者的实验室检查、CT、磁共振、病理检查等进行分析并复习文献。结果患者实验室检查结果,除神经元特异性烯醇化酶111.30μg/L外,余皆正常;X线显示T_5椎体楔形变,相邻间隙变窄,CT结果示T_5椎体楔形变,局部骨质后突。磁共振结果显示多椎体破坏,并局部软组织肿块形成。免疫组化结果:S-100散在+,突触核蛋白(Syn)局灶+,增值指数67(Ki-67):10%~30%,FLI-1弱+,波形蛋白(Vim)+,CD99+,CD56+,肌酸激酶(CK)-,CD3-,CD20-,甲状腺转录因子-1(TTF-1)-,髓过氧化物酶(MPO)-,CD34-,末端脱氧核苷酸转移酶(TdT)-,嗜铬蛋白A(CgA)-,CD7-,CD38-,B细胞特异性激活蛋白(PAX-5)-,CD138-,CD79a-,CK8/18-,病理诊断为尤文肉瘤。结论尤文肉瘤病程短,早期即可发生广泛转移,预后差,结合临床及影像学检查,可以对该病做出诊断。

Objective To explore the clinical, pathological and imaging features of Ewing＇s sarcoma in lumbar and to improve the understanding and diagnosis rate of the disease. Methods Laboratory tests, computed tomography （CT）, magnetic resonance imaging （MRI）, pathological examination of one patient with Ewing＇s sarcoma in lumbar were analyzed and the related literatures were reviewed.Results Expect the level of Neuron Specific Enolization Enzyme was 111.30 μg/L, the rest of the laboratory test results were normal.The X-ray demonstrated T5 vertebral wedge deformation and adjacent gap narrowed.CT resuhs showed T5 vertebral wedge deformation and local bone kyphosis.MRI results revealed multiple vertebral destruction, and local soft tissue mass formation.Imnaunohistochemical results ：S-100, synuelein （Syn） , proliferation index （Ki-67） , FLI- 1 were partial positive, vimentin （ Vim ） , CD99, CD56 were positive, creatine kinase （ CK ） , CD3, CD20, thyroid transcription factor- 1 （ TTF- 1 ） , myeloperoxidase （ MPO）, CD34, terminal deoxynucleotidyl transferase （TdT） , chromogranin A （CgA） , CD7, CD38, B-cell specific activator protein （ PAX-5 ） , CD138, CD79a,CK8/18 were negative. Finally, pathological diagnosis of Ewing＇s sarcoma were made. Conclusions Ewing＇s sarcoma is characterized by short duration, early widespread metastases and poor prognosis. The disease can be diagnosed by clinical and imageological examination.