Solitary multinodular giant cell tumor of tendon sheath.

We present a 74 year old man with a solitary multinodular tumor of the right thumb and an adenocarcinoma of the prostate. Histologic examination of the hand tumor revealed a giant cell tumor of tendon sheath.     

骨巨细胞瘤的诊断与治疗

骨巨细胞瘤是一高侵袭性良性肿瘤,主要发生于年轻人中,骨端发病.典型的影像学表现是骨端完全溶骨的膨胀性改变,多不伴有骨膜反应及软组织包块.CT及MRI可以很好地显示肿瘤的侵及范围,X线平片最具诊断意义.圆形及卵圆形基质细胞及多核巨细胞是骨巨细胞瘤的基本组织构成成分.刮除术是治疗骨巨细胞瘤的基本外科手段,但其复发率较高,应加用物理及化学的方法扩大至边缘或广泛的外科治疗边界.放疗可用于治疗难以手术的病例,但可致肉瘤变.化疗对于骨巨细胞瘤基本无效.骨巨细胞瘤的转移及恶变可能与以往治疗有关.     

Osteoclast-like giant cell tumor of the pancreas

 A rare case of osteoclast-like giant cell tumor of the pancreas is reported. A 45-year-old woman presented with upper abdominal pain and weight loss. Examination revealed a tumor in the tail of pancreas, and distal pancreatectomy with splenectomy was performed. Pathological findings showed the tumor was composed of two cell types: atypical mononuclear round cells and abundant osteoclast-like multinucleated giant cells with central nucleoli. Immunohistochemical study showed that the atypical cells were strongly reactive for vimentin and negative for CD68, while the giant cells were immunoreactive for CD68, but negative for vimentin. The tumor was diagnosed as osteoclast-like giant cell tumor of the pancreas. We report this case and review 31 cases previously described in the literature. Received: March 29, 2002 / Accepted: October 10, 2002 Correspondence to:M. Shiozawa     

Osteoclastoma-like giant cell tumor of the lung

The main components of an unusual form of lung tumor were osteoclast-like multinucleated giant cells and mononuclear stromal cells. Besides, scattered islands of moderately differentiated squamous cells also appeared. Both the mononuclear and the osteoclast-like giant cells reacted with antibodies against CD68 and vimentin, but did not react with antibodies against cytokeratin, EMA and CEA, or lysozyme and α-1-antitrypsin. The p53 and PCNA antigens were positive only in mononuclear cells and not the osteoclast-like giant cells, suggesting that mononuclear cells represent proliferating elements with histiocytic differentiation while osteoclast-like giant cells are stromal, presumably reactive components of the tumor.     

骨巨细胞瘤的综合分期法的临床价值

目的评价骨巨细胞瘤的临床、Ｘ线、病理学表现及三者结合综合分期的意义。方法收集经手术病理证实的骨巨细胞瘤７８例,以其临床、Ｘ线、病理特征为依据,进行临床分症,Ｘ线分型、病理分级三结合回顾性观察分析,将骨巨细胞瘤综合分为三期。结果三项均符合者６４例,占８２．０％。对Ⅰ、部分Ⅱ期的治疗选择瘤体刮除烧灼加植骨,部分Ⅱ期采用瘤体整块切除加植骨治疗共５６例,随访５年４例复发。对Ⅲ期患者采取截肢或瘤体整块切除加骨水泥充填,５年生存率５０．０％（６／６）。结论骨巨细胞瘤的三结合综合分期法对选择适当的治疗方案有重要的临床指导意义。     

评估骨巨细胞瘤生物学行为的相关指标研究

  由于传统的对于骨巨细胞瘤生物学行为的评估标准越来越多地在临床上受到质疑，寻找新的评估指标和标准就成为骨巨细胞瘤研究领域的重点。综述近几年有关骨巨细胞瘤生物学行为的研究进展，归纳和总结相关的评估指标，阐述其对于解决临床上骨巨细胞瘤预后的重要意义。     

自体骨复合旋转铰链膝关节治疗骨巨细胞瘤

Objective  

The aim of the research was to study the clinical feasibility of autograft-prosthesis composite for aggressive giant cell tumor of bone around knee.     

CD147在骨巨细胞瘤中的表达及临床意义

目的：研究CD147在骨巨细胞瘤组织中的表达，探讨其与临床病理及预后的关系。方法：运用免疫组织化学S—P法，检测CD147在36例骨巨细胞瘤中的表达，分析其与肿瘤临床病理资料及Jaffe分级、En-neking分期和复发的关系。结果：CD147的阳性表达率为47．2％，阳性表达与患者性别、年龄、肿瘤发生部位等因素无关。在Jaffe分级中随着级别的增高，阳性表达率也升高，差异有显著性（P〈0．05）；按Enneking分期Ⅱ、Ⅲ期阳性表达率明显高于Ⅰ期，差异有显著性（P〈0．05）；复发组的CD147阳性表达率明显高于未复发组，差异明显（P〈0．05）。结论：CD147与骨巨细胞瘤的侵袭、转移密切相关，CD147可作为评价骨巨细胞瘤恶性程度和判断预后的重要指标。     

MMP-9在骨巨细胞瘤的表达及其与肿瘤复发转移的关系

目的　探讨基质金属蛋白酶家族 (MMPs)成员之一MMP 9在骨巨细胞瘤中的表达及其与肿瘤复发转移的关系。方法　应用免疫组织化学技术 ,对 5 1例骨巨细胞瘤进行MMP 9抗体染色 ,显示MMP 9在骨巨细胞瘤中的表达 ,并应用计算机图像分析系统对其阳性表达进行处理分析。结果　骨巨细胞瘤MMP 9阳性表达结果与Jaffe分级无关 (P >0 .0 5 ) ,与Enneking分级有一定的关系 ,1级或 2级瘤阳性细胞数均值低于 3级瘤 ,其差异有显著性 (P <0 .0 5 ) ;骨巨细胞瘤复发转移组MMP 9阳性细胞数均值均明显高于无复发组 ,其差异也有显著性 (P <0 .0 1) ;骨巨细胞瘤MMP 9的阳性细胞数均值与其微血管密度呈显著正相关 (r =0 .75 )。结论　MMP 9在骨巨细胞瘤中的表达与其肿瘤的分级、复发和转移有一定关系 ,还与其微血管密度相一致 ,MMP 9可作为判断骨巨细胞瘤预后的一项重要参考指标。     

原发恶性骨巨细胞瘤11例临床病理分析

复习解放军济南军区总医院和山东医科大学附院20年间治疗的11例原发恶性骨巨细胞瘤。男4例,女7例。年龄平均22.6岁。发生于股骨下端5例,胫骨上端6例。疼痛和肿胀为主要临床症状。所有患者均行手术治疗,平均随访6年1个月(2年～13年7个月)。无复发、转移和死亡。另对8例标本进行了流式细胞计分析。证明了原发恶性骨巨细胞瘤的恶性程度。作者认为瘤段切除术是一种可取的手术方法。化疗对提高保肢手术成功率和生存率有一定作用。     

Diagnosis and treatment of giant cell tumor in the thoracic spine

A 23-year-old woman with incomplete paralysis was operated upon for a giant cell tumor in the thoracic spine. X-ray films revealed a destruction lesion in the vertebral body of the 12th thoracic vertebra. On the plain thoracic computed tomography scan, the finding was a soap-bubble appearance with a linear high density area in the mass lesion which destroyed the vertebral body. Preoperative angiography showed no apparent feeding artery to the tumor tissue; preoperative myelography showed incomplete block at the level of the 12th thoracic vertebra. A radical operation was carried out in one stage via a combined antero-posterior approach. In order to give radiotherapy immediately after operation, a vascular pedicled rib graft was made. This paper discusses the role of thoracic computed tomography scan in the diagnosis of giant cell tumor and the surgical techniques used in treatment.     

骨巨细胞瘤的生物学行为研究

本文对骨巨细胞瘤（ＧＣＴ）的传统组织学分级与其生物学行为不甚相符的原因进行了研究。采用５１例ＧＣＴ为研究对象，以１３例骨囊肿（良性）和１５例骨肉瘤（恶性）为对照组，采用图像分析仪（ＩＡＴ）对细胞核（ＧＣＴ取基质细胞核），进行了形态计量研究（８项参量），ＤＮＡ含量，ＤＮＡ倍体类型研究，及术后复发病例的ＤＮＡ倍性与其传统分级的比较研究。结果经统计学处理发现ＧＣＴⅠ级和Ⅱ级之间无显著差别，且它们的生物学属性在潜在恶性和低度恶性范畴。研究还揭示ＧＣＴ的ＤＮＡ≥５ｃ细胞数超过７％者系术后复发、转移的高危病例。     

膝关节置换治疗膝关节周围骨巨细胞瘤

目的：探讨膝关节置换治疗膝关节周围骨巨细胞瘤的疗效。方法：自2000年5月-2010年2月应用膝关节置换治疗骨巨细胞瘤共14例,男9例,女5例,年龄25岁-56岁,平均37岁。股骨远端6例,胫骨近端8例。Campanacci分级：Ⅱ级1例,Ⅲ级13例。结果：随访时间1年-10年,平均5年,无患者复发,术后患者MSTS功能评定：优8例,良4例,可2例,总体满意率为85.7%。结论：应用瘤段切除＋膝关节置换方法治疗严重骨巨细胞瘤（CampanacciⅢ级）,效果满意。     

胆汁中CEA浓度测定在大肠癌肝转移诊断中的意义

We investigated the clinical features of soft-tissue recurrence in giant cell tumor of bone (GCTB). Among 106 cases with GCTB in our hospital, there were 2 cases occurring soft-tissue recurrence which histories were reported. These two soft-tissue recurrences occurred with the interval of 6.9 years and 2.5 years respectively from primary diagnosis. The clinical presentation was nonspecific masses in soft tissue. Radiographic ossification was not found at periphery or within the masses. Through pathological examination peripheral ossification was found in 1 case and malignant transformation occurred in the other case. Through retrieving and reviewing literatures in PubMed, 19 cases of soft-tissue recurrence with detailed materials were collected and analyzed. Soft-tissue recurrence of GCTB is a rare episode which reflects its locally aggressive nature, the reasons of which are tumor cells implantation and tumor residual. Ossification at periphery or in the masses can be considered as a pathognomonic character of this episode in radiographic and pathohistological examination. The prevention lies in determining tumor extension preoperatively, proper non-tumor manipulations, removing the tumor and irrigating operative wound as completely as possible.     

骨巨细胞瘤AgNOR和DNA的定量研究

 采用AgNOR染色和流式细胞术分别对50例和30例骨巨细胞瘤（GCT）进行研究。AgNOR计数Ⅰ级7．49±1．57，Ⅱ级9．47±1．08，Ⅲ级10．67±0．37。Ⅰ级与Ⅱ级，Ⅱ级与Ⅲ级之间皆有显著性差异，Ⅱ级与Ⅲ级之间无显著性差异。FCM分析结果表明，DNA异倍体率在各级GCT之间有显著差异，各级GCT的S期百分比无显著性差异。整倍体和异倍体AgNOR计数有显著性差异。GCT复发浸润与倍体水平及AgNOR计数有关。     

Giant cell fibroblastoma in a 3-year-old boy

Giant cell fibroblastoma (GCF) is a rare soft tissue tumor most often discovered during the first two decades of life. We present a case of a 3- year- old boy with a history of a recurrent lesion in the knee, the tumor growth progressively and enlarged to 2.1 cm in the previous two years before diagnosis. It involved the subcutaneous tissue, had infiltrative borders and extended into the superficial dermis. The tumor was surgically excised with free margins. There was no evidence of local recurrence, and a metastatic workup was negative after 10 years of follow up. We review herein the clinicopathologic features, histogenesis, differential diagnosis and relationship to dermatofibrosarcoma protuberans (DFSP).     

膝关节置换治疗膝关节周围骨巨细胞瘤

目的:探讨膝关节置换治疗膝关节周围骨巨细胞瘤的疗效。方法:自2000年5月-2010年2月应用膝关节置换治疗骨巨细胞瘤共14例,男9例,女5例,年龄25岁-56岁,平均37岁。股骨远端6例,胫骨近端8例。Campanacci分级:Ⅱ级1例,Ⅲ级13例。结果:随访时间1年-10年,平均5年,无患者复发,术后患者MSTS功能评定:优8例,良4例,可2例,总体满意率为85.7%。结论:应用瘤段切除+膝关节置换方法治疗严重骨巨细胞瘤(CampanacciⅢ级),效果满意。     

股骨远端骨巨细胞瘤的外科分型与术式探讨

目的:探讨股骨远端骨巨细胞瘤的外科分型和术式。方法:回顾性分析1999年1月-2010年1月间我院收治的股骨远端骨巨细胞瘤患者62例的临床资料,其中男33例,女29例。平均年龄29.4岁。根据解剖部位及肿瘤病理学特点概括分为Ⅰ-Ⅴ型。Ⅰ型主要采用囊内刮除、50%氯化锌及磨钻处理、植骨复合内固定术;Ⅱ型主要采用边缘切除、结构性植骨复合内固定术;Ⅲ型主要采用瘤段切除、大段异体骨复合人工半关节置换术;Ⅳ型主要采用定制人工全膝关节置换术;Ⅴ型主要采用股骨中上段离断术,必要时结合放疗进行综合治疗。对相应分型给予的不同术式治疗和预后进行总结。结果:随访9-110个月(平均53.6个月)。术后复发8例,恶变2例,肺转移1例。参照Mankin等评定标准进行手术效果综合评价优良率(不包括Ⅴ型):Ⅰ型81.5%;Ⅱ型50%;Ⅲ型75%;Ⅳ型79.2%;总优良率为78.7%。综合文献报道,术式对于相应分型的股骨远端骨巨细胞瘤效果良好。结论:股骨远端是骨巨细胞瘤的好发部位,根据解剖部位及肿瘤性质予以外科分型是科学合理的。这种分类方法和相应术式在控制肿瘤复发和指导后续治疗方面具备一定的优势。     

双膦酸盐对骨巨细胞瘤细胞超微结构的影响及细胞组织学变化

目的:探讨双膦酸盐对骨巨细胞瘤细胞超微结构的影响及细胞组织学变化。方法:取我院收治的7例双膦酸盐(唑来膦酸)治疗前后的患者肿瘤组织切片进行了透视电镜观察和TUNEL凋亡染色及图像分析。结果:双膦酸盐(唑来膦酸)治疗后的肿瘤组织切片中透视电镜下多核巨细胞和基质细胞出现了明显的凋亡表现,细胞质变化的特点是大量扩张紊乱的粗面内质网及分散于细胞质中包含于囊泡中央的高电子密度核。线粒体水肿或空泡化。巨细胞核变化的特点是形成致密的染色质材料分散于细胞核中,核膜增厚或分离,部分核碎裂和形成凋亡小体;双膦酸盐(唑来膦酸)治疗后的肿瘤组织切片中TUNEL染色强烈阳性,基质细胞凋亡率从治疗前的1.31%至治疗后的33.42%,差异有显著性意义(P=0.018),多核巨细胞凋亡率从治疗前的8.41%至治疗后的56.83%,差异有显著性意义(P=0.018)。结论:双膦酸盐可以诱导骨巨细胞瘤基质细胞和多核巨细胞的凋亡。从细胞和分子生物学水平证实双膦酸盐作为骨巨细胞瘤辅助治疗方法的可行性。