多发性骨肉瘤三例

Multi-focal osteogenic sarcoma

目的 探讨多发性骨肉瘤的临床特点及诊断治疗的方法。方法 对3例多发性成骨肉瘤病人,进行了临床特点及治疗方法的分析,3例年龄分别为17、19、63岁;例1:病人以病变部位在右股骨远端,有肱骨近端及右胫骨近端、左锁骨、左5、6、8前肋,胸7、12椎体、左耻骨、左股骨头,以右膝关节肿痛、功能障碍就诊,例2:病人病变发生在右股骨远端,右胫骨近端,以右膝关节肿胀疼痛为主因就诊,例3:女病人病变发生在左股骨远端、左侧骨盆、右第3、5前侧肋骨,以左膝关节肿痛,左髋酸胀不适就诊。所有病人X光检查见成骨改变为主合并溶骨性改变,边界不清,骨皮质破坏,可见骨膜反应呈日光状,还有Codman三角的出现,周围见软组织阴影,其基质可见钙化,CT扫描见骨皮质破坏,侵袭到髓腔及周围的软组织,ECT检查可见多个部位的放射性浓聚,MRI检查见病变区的信号改变,T1呈低信号影、T2加权肿瘤呈高信号影;病理穿刺活检均可见典型的恶性梭形成骨细胞瘤的组织特征。明确诊断后均给予化疗2例男性病人并行外科手术治疗。结果 3例病人均获得随访,1例死于诊断后5个月,1例死于诊断后的11个月,1例死于诊断后13个月。结论 多发性的骨肉瘤是骨肉瘤中一种十分少见的类型,治疗总的效果不理想,化疗早期有明显的局部反应。

Objective To analyze the clinical manifestation, diagnosis and treatment for multi - focal osteogenic sarcoma. Methods There were three cases in the study including 2 males, 1 female. The ages of patients were 17,19 and 63 years old, respectively. Case 1:The X-ray films showed that bone deteriorations were seen in the distal part of the right femur, proximal part of the right humerus and the right tibia, left clavicle, left rib of 5,6,8, the vertebra of T7 and T12,left pubis and left femoral head, respectively; The patient was hospitalized for the right painful and swollen knee;Case 2:The radiological findings revealed that the bone deteriorations were located at the distal part of right femur and the proximal part of right tibia. The patient was hospitalized for the right painful and swollen knee; Case 3: The radio- logical findings showed the bone lesions occurred around the distal part of left femur, the left pelvic and the right rib of 3 and 5, respectively. The patient was hospitalized for the left painful knee and hip. Radiographic findings of all three patients showed that the main change of radiographs was sclerotic, attended by lytic with blur margin, the sunburst neo- plastic bone pattern and Codman triangle. The shadow of soft tissue around focuses and calcified matrix appeared on the X - ray films. CT scan showed bone and soft tissue invasion. ECT showed multiple radioactivity high accumulation. MRI showed high - signal in T1 weighted image and low-signal in T2 weight image. Needle aspiration biopsy showed typical features of osteosarcoma. All the patients received chemotherapy, two males underwent surgery. Results Three patients were followed up and died 5 months, 11 months and 13 months after diagnose, respectively. Conclusion Multi - focal osteosarcoma is rare in osteosarcoma, the outcomes of treatment were not satisfactory. Obvious local reactions were seen at the early stage uf chemotherapy. As the chemotherapy went on, thc patients died of lung metastases. It is possibly because of multi-drug resistance in intermediate and advanced stages of chemotherapy. However,we can see the potential pros- pect from the effects of early stage of chemotherapy.