摘要
目的研究骨巨细胞瘤(GCT)肿瘤组织与其周边组织的关系,探讨手术后复发及良性GCT远隔转移的病理学基础。方法收集1998年至2005年第四军医大学西京医院手术切除的12例良性GCT瘤段标本,对GCT肿瘤组织及周边组织进行病理学研究。肿瘤部位:股骨远端6例、胫骨近端3例、胫骨远端1例、腓骨小头1例、髌骨1例。放射影像学Campanacci’s分级Ⅰ级2例,位于腓骨小头和髌骨;Ⅱ级2例;Ⅲ级8例,2例合并病理性骨折,3例病灶突入软组织内形成软组织内肿物。6例为复发的GCT。Enneking外科分期:ⅠA5例、ⅠB7例。光镜下观察GCT肿瘤与周围组织(包括皮质骨、松质骨、软骨、软组织、周边血管、瘤内血管)多个边界的关系。结果与皮质骨交接处可见9例肿瘤组织侵蚀皮质骨,以形成骨吸收陷窝的行为进行侵蚀;2例肿瘤组织呈现为"指状突起"的生长行为,深入到周围正常骨组织内。与松质骨交接处5例可见一层反应性硬化骨或编织骨存在,2例病灶外正常松质骨内有跳跃病灶存在。与软骨交接处肿瘤组织边界较整齐,全部标本的关节软骨面完整。与软组织交接处7例肿瘤组织突破骨性界限,4例可见两层正常的纤维组织间夹有肿瘤组织;9例肿瘤组织周围软组织内血管增多、扩张、血管壁增厚。与周边血管交接处1例肿瘤组织周围完整的骨壳外扩张的血管内有肿瘤组织存在;与瘤内血管交接处微动脉较微静脉厚,微静脉壁薄,2例可见血管平滑肌被多核巨细胞侵袭而变薄、不完整甚至血管壁破溃,多核巨细胞进入血管中。结论 GCT肿瘤组织的边缘生物学行为与术后复发、转移密切相关,其特征性表现为手术治疗方法的选择提供了参考依据。
Objective To explore the relations between giant cell tumor （GCT） tissues and their peripheral tissues, and to discuss the oncobiological basis of postoperative recurrence and remote metastasis of benign GCT which may provide information for the selection of GCT surgical therapy. Methods From 1998 to 2005, 12 benign GCT specimen were collected in Xijing Hospital of the Fourth Military Medical University. Oncopathology of the tumor focus and the peripheral tissues were analyzed. Tumor position： 6 cases in distal femur, 3 cases in proximal tibia, 1 case in distal bibia, 1 case in fibular capitulum and 1 case in patella. According to Campanacci＇s radiological image classification, 2 cases at the fibular capitulum and patella were classified grade I, 2 cases grade II, and 8 cases grade III of which 2 cases were complicated with pathological fractures and tumors in 3 cases had invaded into soft tissues and formed neoplastic masses. Six cases were GCT recurrence. According to Enneking＇s surgical classification, 5 cases were class I A and 7 cases were I B. Borderlines among GCT tumors and their peripheral tissues （including cortical bone, cancellous bone, cartilage, soft tissues, peripheral vessels as well as vessels inside the tumor） were observed through light microscope. Results At the borderline between GCT and cortical bone, cortical bone erosion by GCT tissues could be found in 9 cases and cutting cones were formed. Tumor growth as digitationes invaded into normal bone tissues could be found in 2 cases. At the borderline between tumor and cancellous bone, reactive stiffened bone or woven bone could be found in 5 cases. There were 2 cases of skip tumor focuses in normal cancellous bone. To be connected to the cartilage, the borderlines of GCT tissue were well-arranged and the articular cartilage surfaces were in integrity. Tumor tissues had invaded osseous tissue limitation in 7 cases, and tumor tissues could be found between two layers of normal fibrous tissues at the borderline between tumor and soft tissues in 4 cases. The wall of blood vessels thickened, the vascular lumen expanded and the increased proliferation in 9 cases in the soft tissues arotmd the tumor. In one case, GCT cells could be seen in expanded vessels outside the integrated bone shells surrounding the tumor. The wall of the arteriole was a little thicker than that of the veinule, and the wall of the veinule was thinner. Vascular smooth muscle was found invaded by mutil-nucleated cells in 2 cases made the wall of the veinule thinner, incomplete or even discontinued, and the muti-nucleated cells entered into the veinules. Conclusion Closely related to postoperative recurrence and metastasis, the distinctive representation of oncobiological behavior at the peripheral tissues of GCT can provide reference for the choice of surgical methods.
出处
《中国骨科临床与基础研究杂志》
2012年第1期36-41,共6页
Chinese Orthopaedic Journal of Clinical and Basic Research
关键词
巨细胞瘤
骨
肿瘤转移
肿瘤复发
局部
生物学行为
Giant cell tumor of bone
Neoplasm metastasis
Neoplasm recurrence, local
Biological behaviour
