骨巨细胞瘤的临床,X线,病理观察与分期探讨

目的 评价骨巨细胞瘤的临床,Ｘ线,病理观察及三结合综合分期的意义。方法 收集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类三期。结果 三项均符合者６４例,占８２％。     

29例骨巨细胞瘤临床病理分析

骨巨细胞瘤（ＧｉａｎｔＣｅｌｌＴｕｍｏｒｏｆＢｏｎｅ,ＧＣＴ）是我国常见的骨肿瘤之一。自采用Ｊａｆｆｅ病理诊断和分级标准以来,文献报道日益增多。尽管应用电镜、组织培养、组织化学、免疫组化、细胞定量和组织图像分析研究ＧＣＴ已取得很大进展［１,３］,但目前许多作者对骨巨细胞瘤的起源,其形态学特征、分级标准与生物学特性之间的关系等问题,仍存在不同的看法。本文通过对２９例ＧＣＴ的病理诊断和临床资料分析,结合文献复习,对其临床病理特征和生物学特性进行分析。１资料和方法１．１临床资料本文２９例ＧＣＴ的资料,来自本院…     

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。     

影响骨巨细胞瘤预后的临床和病理因素研究

目的：研究影响骨巨细胞瘤预后的临床和病理因素，探讨可供临床预测患者预后和选择治疗方式的病理形态学指标。方法：从存档病例中选取有完整病历记录和追踪观察的骨巨细胞瘤病例41例，分复发和无复发两组，分析预后与组织学分级、组织形态学测量、免疫组化CD68和Ki67双重表达以及手术方式（病灶内刮除、肿瘤完整切除或广泛切除）的关系。结果：骨巨细胞瘤的预后与组织学分级、单核基质细胞的细胞面积、核面积、核分裂数和Ki67的阳性细胞数以及手术方式有关，而与多核巨细胞的数目和形态、单核基质细胞的核周长、核长／短径比值无关。结论：组织学分级对预测肿瘤的预后仍有一定意义，值得保留供临床参考；组织形态学测量将细胞形态指标量化，能客观地反映肿瘤细胞的异型性，对预测本瘤的预后意义更大，值得进一步探讨；单核基质细胞的异型性和Ki67阳性表达的细胞数与肿瘤复发有关，同时支持单核基质细胞是肿瘤细胞成分的学说；病灶内刮除的术后复发率较高，应尽量避免采用这种手术方式，尤其是对于Jaffe分级为Ⅱ或Ⅲ级的肿瘤、组织细胞形态学测量显示单核基质细胞的细胞面积、核面积及核分裂数高的病例、Ki67免疫组化显示阳性细胞多的病例，应更多选择肿瘤完整切除或广泛切除术。     

骨巨细胞瘤26例临床病理分析

目的 :探讨骨巨细胞瘤分级治疗的临床意义与鉴别诊断。方法 :按Jaffe分级 ,2 6例中 ,Ⅰ级12例 ,Ⅱ级 11例 ,Ⅲ级 3例 ,术后随访 16例 ,Ⅰ级 7例 ,Ⅱ级 6例 ,Ⅲ级 3例。结果 :7例复发 ,Ⅰ级 3例 ,Ⅱ级 3例 ,Ⅲ级 1例 ,复发率Ⅰ级 4 2 .86% ,Ⅱ级 50 % ,Ⅲ级 33.33% ,Ⅱ、Ⅲ级肺转移各 1例。结论 :分级与复发无明显关系 ,与远处转移有关     

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,部位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切     

骨巨细胞瘤26例临床病理分析

目的：探讨骨巨细胞瘤分级治疗的临床意义与鉴别诊断。方法：按Jaffe分级，26例中，I级12例，II级11例，III例3例，术后随访16例，I级7例，II级6例，III级3例，结果：7例复发，I级3例，II级3例，III级1例，复发率I级42．86％，II级50％，III级33．33％，II，III级肺转移各1例，结论：分级与复发无明显关系，与远处转移有关。     

骨盆骨巨细胞瘤X线、CT及MRI表现

目的 结合病理总结骨盆骨巨细胞瘤影像学特点及鉴别诊断要点.方法 32例骨盆骨巨细胞瘤患者均经手术与病理证实,其中骶骨18例,髂骨6例,耻骨4例,坐骨4例.所有病例均行X线、CT和MRI检查,将影像学表现与手术病理结果进行对照,并由双盲法分析确认.结果 骨盆骨巨细胞瘤影像学表现包括膨胀性骨质破坏、溶骨性骨质破坏和软组织肿块.32例中,膨胀性病变26例,溶骨性骨质破坏6例,软组织肿块18例.CT显示骨质破坏优于x线平片,MRI可清晰显示肿瘤周围的软组织肿块和神经血管侵犯情况.结论 综合临床表现与X线平片、CT、MRI检查资料可提高骨巨细胞瘤诊断及鉴别诊断的准确性.     

少见部位骨巨细胞瘤的X线影像分析

目的统计分析一组少见部位骨巨细胞瘤的Ｘ线影像表现,对易与之混淆的４种骨病提出鉴别诊断,以加深认识。方法搜集经手术、病理证实的少见部位骨巨细胞瘤４８例Ｘ线平片、ＣＴ和动脉造影片资料进行回顾性分析。结果表现为囊状膨胀性骨质破坏３０例,且内多有肥皂泡沫状表现;溶骨性骨质破坏１０例;骨外有软组织肿块,骨塌陷变扁伴局部膨出４例;侵犯邻骨４例;骨质增生硬化３例;异常血管及“肿瘤染色”３例。结论Ｘ线平片对少见部位骨巨细胞瘤诊断具有重要价值,ＣＴ优于平片,动脉造影有助于诊断与制定治疗方案。     

骨巨细胞瘤影像学诊断价值的比较

目的通过骨巨细胞瘤常见和典型的X线、CT及MRI表现的比较,提高对该病诊断和鉴别诊断的能力。方法回顾性分析19例经手术病理证实为骨巨细胞瘤患者的X线、CT及MRI表现。结果 X线平片表现:溶骨性骨质破坏14例,均呈膨胀性生长,边界尚清晰;硬化性骨质破坏1例,病理性骨折。CT表现:13例呈偏心膨胀性骨质破坏,均见局限性硬化边,12例见棘状、尖角状、条索状骨嵴及硬化边征象,10例软组织肿块影。MRI表现:7例MRI T1WI上均主体呈等信号夹杂少量低信号,T2WI及T2压脂相呈低信号等信号、高混杂信号,DWI呈高信号。结论骨巨细胞瘤的影像学表现为偏心性、膨胀性溶骨破坏,X线平片、CT及MRI影像检查相互补充,能够增加骨巨细胞瘤诊断及鉴别诊断的准确性。     

Secondary Malignancy in Giant Cell Tumor: A Single-Center Study

Giant cell tumor of bone (GCTB) undergoes a sarcomatous transformation. Secondary malignancy in giant cell tumor (MGCT) is associated with radiotherapy and has a dismal prognosis. We reviewed medical records to investigate the clinicopathological characteristics and prognosis of MGCT patients. The enrollment criterion was high-grade spindle-cell sarcoma, which developed at the site of prior GCTB treatment. Twelve patients were analyzed: six females and six males. The median age was 42.5 years. Benign recurrence occurred in five GCTB patients not treated with radiotherapy. No pulmonary implants were observed. The median latency to the malignant transformation was 63 months. Nine patients were AJCC stage IIB, and three were stage IVA. The median follow-up period after malignant transformation was 62.5 months. Five patients developed local recurrence, and six had distant metastasis. Five-year overall recurrence and metastasis-free survival rates were 61.9%, 66.7%, and 58.3%, respectively. Initial metastasis was a predictive factor for overall survival. Benign local recurrence of GCTB was also a negative factor for metastasis-free survival of MGCT patients. Differences in overall survival according to benign recurrence also showed a tendency toward significance. In our series, secondary MGCT did not occur after radiotherapy. The prognosis was better than previous findings. Benign recurrence of GCTB could reflect the prognosis of MGCT.     

Association of Metastasis with Clinicopathological Data in Mexican Patients with Osteosarcoma,Giant Cell Tumor of Bone and Chondrosarcoma

Background: Bone tumors are neoplasias with a high overall mortality; one of the main factors that reduce survival is their high capacity to develop metastases. It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. In this study, we inquire the relationship of metastases caused by these tumors with different clinical and pathological aspects, in order to guide medical personnel in the diagnosis and opportune treatment of metastases or micro metastases. Materials and Methods: We collected data of 384 patients with clinical, radiological and histopathological diagnosis of OS, GCTb and CS that attended the National Rehabilitation Institute (INR) during 2006 to 2014. Chi-square and Fisher’s exact tests were performed for data analysis. Results: In the three tumor types, the presence of metastases at diagnosis was variable (p=0.0001). Frequency of metastases was 36.7%, 31.7% and 13.2% for OS, CS and GCTb respectively. The average age had no significant difference (p>0.05) in relation to metastases, even so, patients with OS and GCTb and metastases, were older while patients with CS and metastases were younger, in comparison to patients without metastases. Males had a higher frequency of metastases (68.2%, p = 0.09) in contrast to CS and GCTb, in which the metastases was more frequent in women with 51.9% (p = 0.44) and 57.9% (p = 0.56) respectively. Broadly, metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS. Conclusions: The frequency of metastases in OS, GCTb and CS is high in our population and is determined by different clinicopathological variables related to the kind of tumor. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors , as well as to determine the sensitivity and specificity of current methods of detection.     

手术治疗骨巨细胞瘤44例分析

目的 分析比较不同手术方法治疗四肢长骨骨巨细胞瘤的临床效果。方法 回顾分析1991年11月-2005年9月手术治疗的44例骨巨细胞瘤。结果 44例患者均获得随访,随访时间10个月至14年1个月,平均10年2个月。病灶刮除植骨11例,肿瘤复发3例;病灶刮除骨水泥填充16例,肿瘤复发2例;瘤段切除灭活再植7例,肿瘤复发1例;瘤段切除关节融合3例,肿瘤复发0例;瘤段切除人工假体置换7例,肿瘤复发0例。病灶刮除组总复发率19％,瘤段切除总复发率为6％。结论 病灶刮除骨水泥填充术和肿瘤瘤段切除术均是治疗骨巨细胞瘤的可靠方法。     

Epidemiological Aspects of Osteosarcoma,Giant Cell Tumor and Chondrosarcoma Musculoskeletal Tumors - Experience of the National Rehabilitation Institute,Mexico City

Background: Primary bone neoplasms are rare, contributing only 0.2% of the global burden of all humanmalignancies. Osteosarcoma (OS) and chondrosarcoma (CS) are the most common malignancies of bone. Thegiant cell tumor of bone (GCTb) is a benign tumor with behavior characterized by osteolytic bone destruction.The OS, CS and GCTb affect both sexes, all races and generally have incidence peaks regarding the age of thepatient which vary according to the tumor type. We analyzed the incidences of OS, CS and GCTb and theirrelations with gender and age in patients treated in the National Rehabilitation Institute (INR, for its acronymin Spanish) over a period of nine years. Materials and Methods: In the study period, clinic pathological datafor 384 patients were obtained with clinical, radiological and histopathological diagnosis for OS, GCTb and CS.Data analysis was performed using the chi-square and Fisher’s exact tests. Results: From 2006 to 2014 wererecorded 384 cases of bone malignancies in the database of INR. The GCTb had the highest incidence (53.1%),followed by OS (31.3%) and finally the CS (15.6%). The overall average age was 33.6±15.8 years and the overallfrequency of gender had a ratio of 1/1.03 male/female. The states with the highest incidence were Distrito Federaland Estado de Mexico with 29.2% and 25.3% respectively. Malignant neoplasms of bone assessed in the courseof nine years show three significant increases in 2008, 2011 and 2014 (p=0.14). We found association betweensex and tumor type (p=0.03), GCTb and CS predominated in females (54.9% and 56.6% respectively), while forthe OS males were most affected (59.1%). Age was different in relation with tumor type (p=0.0001), average agewas 24.3±11.2 years for OS, 34.5±13 years for GCTb and 49.2±18.5 years for CS. Furthermore, associations oftumor type with topographic location of the primary tumor (P=0.0001) were found. Conclusions: In this studywe can see that incidence of musculoskeletal tumor in our population is continuously increasing and in nineyears an approximately 200% increase of musculoskeletal tumor cases was observed.     

Giant Cell Tumor of Bone: Effect of Longer Dosing Intervals of Denosumab on Tumor Control and Bone-related Complications

BackgroundDenosumab is an effective treatment for giant cell tumor of the bone (GCTB) but can cause clinically significant adverse effects. Current approved dosing is every 4 weeks after 3 weekly loading doses. We assessed whether alternative, longer dosing intervals are associated with differences in efficacy or bone toxicity.MethodsSingle institution retrospective chart review was conducted on patients with GCTB over 18 years old who received at least 1 year of standard denosumab dosing. Patients identified using a free-text search engine with keywords “giant cell tumor” and “denosumab” from January 1998 to August 2020.ResultsApproximately 37 patients with GCTB (19F, 18M) were identified with median age of 37 years (range 22-73). Dosing interval was increased in 38% (n = 14), with the most common final dosing interval 12 weeks (n = 8). Six patients (16%) had bone complications: osteonecrosis of the jaw (n =5), atypical fracture (n = 1), and nonhealing dental wounds (n = 2). All patients with bone complications were on the monthly dosing schedule, but there was no statistically significant difference compared to longer dosing intervals (P = .22). No statistically significant difference in median PFS was noted (P = .97). However, 5-year PFS was superior in patients treated with less frequent versus standard dosing of denosumab (P = .036).ConclusionsIncreasing the interval of denosumab dosing for GCTB provided similar tumor control compared to standard dosing and lower absolute number of bone toxicity events. Larger studies are needed to better define the optimal interval of denosumab administration and the effect on efficacy, toxicity, and associated healthcare expense.     

Biological Behavior and Tumorigenesis of Subependymal Giant Cell Astrocytomas

In spite of the benign nature of subependymal giant cell astrocytomas (SEGAs), some show massive hemorrhage, rapid growth, and tumor recurrence. This led us to investigate the biological behavior, cell dynamics, and nobreak tumorigenesis of SEGAs.All patients (4 men and 3 women; age range, 6–27 years; mean, 13.6 years) had features of tuberous sclerosis complex and obstructive hydrocephalus. One patient had intratumoral bleeding. In two patients, sequential neuroimaging showed a subependymal nodule growing to become a SEGA. All underwent surgical resection without radiation therapy. One tumor recurred and was treated surgically. There were no postoperative deaths. The presence of cytologic atypia, mitoses and vascular proliferation had no implication in terms of the clinical course. MIB-1 labeling indices were low (mean, 0.9), indicating low proliferative potential. Unexpectedly, bcl-2 staining was sparse and bax staining predominated in majority of cases. However, the mean value of terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling index was low. Immunohistochemically, tumors were positive for both glial and neuronal markers. In the majority of our cases, the expression of p53 was low. Only one tumor was focally positive for tuberin.SEGAs have low proliferative potential and apoptotic activity, and exhibit features of mixed glial–neuronal differentiation. In contrast to p53, tuberin is suggested to be the tumor suppressor in this tumor.     

病灶刮除骨水泥填充治疗骨巨细胞瘤

目的 :观察采用刮除、酒精灭活及骨水泥填充相结合治疗骨巨细胞瘤的疗效。方法 :对 1980年 6月～ 1998年 3月 ,经刮除、酒精灭活加骨水泥填充治疗的骨巨细胞瘤 98例进行随访。男 45例 ,女 5 3例。发病部位 ,股骨下端48例、胫骨上端 2 4例、肱骨上端 7例、桡骨远端 8例、股骨上端 3例、髂骨 2例、骶骨 4例、肱骨下端、尺骨各 1例。结果 :术后平均随访时间为 5年 3个月 ,1年内复发率 5 .9% ,3年内复发率 12 .9% ,5年内复发率为 13.9%。结论 :强调手术过程中刮除的精细操作、酒精灭活和骨水泥填充时的再灭活作用 ,提出彻底刮除、酒精灭活和骨水泥填充手术可以使囊内切除手术达到邻界切除手术的效果。