尺骨软骨样副脊索瘤的诊断与误诊分析

Analysis of Misdiagnosis and Diagnosis of Primary Chondroid Parachordoma of Ulna

目的 探讨尺骨原发软骨样副脊索瘤的诊断、误诊原因及预防对策。方法 对 1例尺骨软骨样副脊索瘤的标本 ,采用 10 %福尔马林固定 ,石蜡切片 ,HE染色 ,光镜观察及免疫组化 ,会诊和病理读片会讨论。结果 临床、X线均诊为骨囊肿 ,病理则因组织形态学上既象软骨样细胞又象脂肪样细胞而发不出明确诊断。会诊结果为副脊索瘤。免疫组化及病理读片会讨论的结果为软骨样副脊索瘤。结论 原发于尺骨的软骨样副脊索瘤非常罕见。组织学上为 :在粘液基质中可见软骨和脊索两种成分恶性双相分化的肿瘤细胞。误诊的主要原因是 :临床、X线均不具特征性和与其它骨病不易区别。肿瘤发病部位及类型罕见。临床、X线未想到 ,病理对此类型不认识。

Objective To investigate the diagnosis of the primary chondroid parachordoma of ulna and the misdiagnosis causes and the countermeasure. Methods Specimen from one case of primary chondroid parachordoma of ulna were fixated with 10% Formalin. The sections were stained with HE and the immunohistochemical method, observed under light microscope, and analyzed by consultation.Results Bone cyst was diagnosed by X ray, and in pathology, because of its likeness between chondroid cells and liporoid cells, diagnosis of primary chondroid parachordoma of ulna couldn't be made until consulatation. Conclusion Primary chondroid parachordoma of ulna was rare . It was characterized by biphasic malignant neoplasm possessing elements of both cartilaginous and chordoma tissue in a myxoid stroma in histology. The main causes of misdiagnosis laid in little characteristics in both clinic and X ray manifestation, rare lesion location and type, and hard differentiation from other osteopathia.