原发性骨恶性纤维组织细胞瘤24例临床特征及预后分析

摘要 目的：总结原发性骨恶性纤维组织细胞瘤（PBMFH）的临床特征和预后。方法：回顾性分析我院2000年10月至2011年1月收治的24例PBMFH患者的术前影像学资料、诊断依据、治疗方案和随访资料。结果：24例患者全部通过术后病理确诊，穿刺准确率为75.00%.胸部X线检查结果显示：2例发现肺部转移灶，22例未发现肺部转移灶。肿瘤局部X线检查结果显示：3例出现骨质溶解性破坏，1例出现肿块影，20例表现为骨膜反应。MRI检查结果显示：4例MRI检查肿瘤局部情况时发现3例T1WI等信号、T2WI稍高信号，1例T1WI低信号、T2WI低信号。本研究中行放化疗18例，有6例（33.33%）发生转移，转移时间为6~45个月，中位转移时间为（25.30±6.24）个月，单纯手术治疗6例中有5例发生转移（83.33%），转移发生时间为3~6月，中位转移时间为（5.00±0.24）个月。结论：PBMFH患者单纯手术出现转移多发生于术后5月，根治性手术辅以放化疗出现转移多发生于术后25月。由此可见，术前穿刺活检病理有助于疾病诊断，术后辅助化疗有助于降低PBMFH的复发率和转移率。

Clinical Features and Prognosis Analysis of 24 Cases of Primary Malignant Fibrous Histiocytoma of Bone

ABSTRACT Objective: To summarize the clinical features and prognosis of primary malignant fibrous histiocytoma of bone (PBMFH). Methods: The preoperative imaging data, diagnostic basis, treatment plan, and follow-up data of 24 PBMFH patients who were admitted to our hospital from October 2000 to January 2011 were retrospectively analyzed. Results: All the 24 patients were confirmed by postoperative pathology, the puncture accuracy rate was 75.00%. The results of chest X-ray showed that pulmonary metastasis was found in 2 cases, and none pulmonary metastasis was found in 22 cases. The results of local X-ray examination of tumor showed that: 3 cases presented osteolysis destruction, 1 case presented mass shadow, and 20 cases presented periodate reaction. The results of MRI examination showed that in 4 cases, MRI showed isointensity on T1WI and slightly hyperintensity on T2WI in 3 cases, and 1 case had low signal on T1WI and low signal on T2WI. In this study, metastasis occurred in 6 cases (33.33%) of the 18 patients undergoing chemoradiotherapy, transfer time was 6 ~ 45 months, median transfer time was (25.30±6.24) months, 5 cases of the 6 patients in the surgical treatment group had metastasis (83.33%), transfer time was 3 ~ 6 months, median transfer time was (5.00±0.24) months. Conclusion: In PBMFH patients, metastasis occurred mostly at 35 months after surgery alone, and metastasis occurred mostly at 25 months after surgery combined with radical surgery and chemoradiotherapy. Thus it can be seen, preoperative biopsy pathology contributes to the diagnosis of the disease, and postoperative adjuvant chemotherapy helps to reduce the recurrence and metastasis rate of PBMFH.