罕见骨母细胞瘤合并动脉瘤样骨囊肿3例报告及文献复习

Rare Osteoblastoma Associated Aneurysmal Bone Cysts: Image Analysis in 3 Cases and Review of Literatures

目的分析骨母细胞瘤合并动脉瘤样骨囊肿(ABCs)的影像学表现,以提高对该病的认识。方法对3例术前行影像学检查,病理证实为骨母细胞瘤合并ABCs病例进行回顾性分析,并结合文献复习。结果病灶均为单发。病例1初次检查表现为C5左侧椎板椭圆形磨玻璃样骨质破坏区,边界清楚。7个月后病灶范围增大,位于C5左侧椎板及棘突,呈不规则膨胀性骨质破坏,边界清楚,边缘骨质硬化,内见小点状、斑片状高密度影及线样分隔。MRI表现为T1WI等信号,T2WI及短时间反转恢复(STIR)呈病灶前份等信号、后份高信号,增强扫描显示不均匀明显强化。病例2位于右侧耻骨上支、髂骨,表现为膨胀性骨质破坏。病灶体积大,边界清楚,骨质不连续,见软组织肿块,边缘未见骨质硬化或骨膜反应。病例3位于左股骨远端,首次就诊时X线平片表现为边界清楚的类圆形骨质破坏,其内见结节状钙化或骨化灶,边缘骨质硬化。18个月后,X线平片显示骨质破坏区边界不清,呈斑片状。结论骨母细胞瘤合并ABCs罕见,其影像表现随病程进展而变化,术前影像正确诊断难度大。CT及MRI表现,对该病的术前诊断有一定的价值。

Objective To analyse the imaging features of osteoblastoma associated aneurysmal bone cysts in order to raise awareness of the disease.Methods 3 cases of osteoblastoma associated aneurysmal bone cysts with pre-operation radiographic examination and pathologic diagnosis were retrospectively analysed,and related literatures were reviewed.Results Case 1 located at the fifth vertebral appendix(left vertebral plate)at his initial visit,which showed oval ground glass opacity with sharp margin.About 7 months later,an irregular expansible destruction with sclerotic edge could be seen in the C5 left vertebral plate and spinous process,in which high density small dot and macular were found.MRI showed the lesion equal signal on T1WI.The anterior part of it was equal signal and the posterior part was slightly high signal intensity on T2WI and STIR.The lesion was obviously and uneven enhancement after enhancing scan.Case 2 showed an clear and large expansive osteolytic destruction with incomplete cortex in the right superior ramus of pubis and iliac bone.Soft tissue mass could be found,and no osteosclerosis or periosteal reaction.Case 3 located at the left distal femur.In DR,the lesion displayed as a well-demarcated bone destruction with sclerotic edge,within nodular calcification or ossification,at his first visit.18 months later,some changes could be seen,such as vague margin,irregular shape and unclear boundary.Conclusion Osteoblastoma associated aneurysmal bone cysts is rare and its imaging features changes with the course of disease.Accordingly,its preoperative image diagnosis is difficult.CT and MRI are beneficial for making the diagnosis before surgery.