骨巨细胞瘤临床误诊分析

Misdiagnosed Analysis of Giant Cell Tumor of Bone

目的探讨骨巨细胞瘤(GCT)临床及影像学特点,分析误诊原因。方法回顾分析2017年3月—2019年12月收治的6例GCT误诊患者病例资料。结果本组误诊率为8.70%。1例触及胸前明显肿物,2例右侧髋部疼痛、行走困难,3例局部肿痛不适、有明显压痛;有外伤史1例,肺结核病史1例;夜间盗汗1例,关节活动受限4例。误诊为胸锁关节结核1例,骨囊肿2例,非骨化性纤维瘤2例,软骨母细胞瘤1例。6例均经术后病理学检查确诊为GCT,误诊时间2~7 d。6例均予手术切除治疗,出院后随访半年,均未复发及转移。结论GCT发病率较低,早期症状及影像学表现常不典型,极易误诊。加强对GCT临床及影像学特点的认识,仔细鉴别诊断,及时行CT、MRI及病理学检查,有利于提高诊断率。

Objective To investigate the clinical and imaging features of giant cell tumor of bone(GCT)and to analyze misdiagnosed causes.Methods The case data of 6 patients with GCT misdiagnosed as having other diseases between March 2017 and December 2019 was retrospectively analyzed.Results The misdiagnosed rate was 8.70%.There were 1 patient with obvious chest mass,2 patients with right hip pain and difficulty in walking,3 patients with local swelling,pain and discomfort with obvious tenderness.There were 1 patient with trauma history,1 patient with history of pulmonary tuberculosis,1 patient with night sweats and 4 patients with limitation of joint movement.There were 1 patient misdiagnosed as having sternoclavicular joint tuberculosis,2 patients as having bone cyst,2 patients as having non ossifying fibroma and 1 as having chondroblastoma.All 6 patients were confirmed as having GCT by postoperative pathological examinations,and the misdiagnosed duration was 2-7 d.All the 6 patients were treated by surgical resection.They were followed up for half a year after discharge,and there was no recurrence or metastasis.Conclusion The incidence rate of GCT is low,and the early symptoms and imaging findings are often atypical,and therefore it is more likely to be misdiagnosed.Strengthening the understanding of clinical and imaging characteristics of GCT,carefully differential diagnosis,and timely performing CT,MRI and pathological examinations are helpful to improve the diagnostic rate.