摘要
目的探讨上皮样骨母细胞瘤(EOB)与骨母细胞瘤样骨肉瘤(OBOS)的临床特征、影像学表现、病理诊断及鉴别诊断。方法收集22例EOB及11例OBOS,对比分析两者的临床影像学资料、病理形态学特征、免疫表型及分子遗传学改变并复习国内外文献。结果EOB男女比为2.1:1,年龄9~63岁(平均24.2岁),其中中轴骨12例,长骨干骺端6例,另盆骨、距骨、肩胛骨及锁骨各1例。临床多为活动后疼痛,影像学呈膨胀性溶骨性骨质破坏,组织学表现为上皮样细胞及骨样组织,细胞间可见较丰富血窦,未见确切病理性核分裂。OBOS男女比为0.57:1,年龄4~48岁(平均26.8岁),其中长骨7例,颌骨2例,肋骨及坐骨各1例。临床为不能缓解的持续性疼痛伴局部包块,影像学为边界不清的溶骨性或成骨混合性骨质破坏及骨膜反应,组织学为骨母细胞瘤样增生,中度异型性伴不典型核分裂,见浸润骨及软组织。结论EOB与OBOS两者治疗及预后不同,鉴别诊断需结合临床、影像及病理组织形态学进行综合分析。
Objective To explore the clinical characteristics,imaging manifestations,pathological diagnosis,and differential diagnosis of epithelioid osteoblastoma(EOB)and osteoblastoma-like osteosarcoma(OBOS).Methods Twentytwo cases of EOB and eleven cases of OBOS were collected,and a comparative analysis was conducted on their clinical imaging data,pathomorphological features,immunophenotypes and molecular genetic alterations,along with a review of the domestic and international literature.Results The male-to-female ratio in EOB was 2.1∶1,with ages ranging from 9 to 63 years(average 24.2 years).Among them,12 cases involved axial bones,6 cases involved long shafts at the metaphysis,and 1 case involved the pelvis,talus,scapula and clavicle each.Clinically,most patients experienced pain after activity,with imaging showing expansile lytic bone destruction.Histologically,the lesions exhibited epithelioid cells and osteoid tissues,with abundant blood sinuses between cells,but no definitive pathological mitotic figures were observed.The male-to-female ratio in OBOS was 0.57∶1,with ages ranging from 4 to 48 years(average 26.8 years).Among them,7 cases involved long bones,2 cases involved the jawbone,and 1 case involved the ribs and ischium each.Clinically,patients experienced persistent pain that could not be relieved,accompanied by local masses.Imaging showed unclear lytic or mixed osteosclerotic bone destruction with periosteal reaction.Histologically,the lesions exhibited osteoblastomatous hyperplasia with moderate atypia and atypical mitotic figures,showing invasion into bone and soft tissues.Conclusion The treatment and prognosis of EOB and OBOS differ,and the differential diagnosis requires a comprehensive analysis of clinical,imaging and histopathological morphology.
作者
巫娟
曾桔
潘媚
徐钢
WU Juan;ZENG Ju;PAN Mei;XU Gang(Department of Pathology,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,China;Department of Radiology,Sichuan Provincial Orthopedic Hospital,Chengdu 610041,China;Department of Pathology,Sichuan Provincial People's Hospital,Chengdu 610031,China)
出处
《诊断病理学杂志》
2026年第1期96-99,共4页
Chinese Journal of Diagnostic Pathology
关键词
上皮样骨母细胞瘤
骨母细胞瘤样骨肉瘤
侵袭性骨母细胞瘤
临床病理
鉴别诊断
Epithelioid osteoblastoma
Osteoblastoma-like osteosarcoma
Aggressive osteoblastoma
Clinical pathology
Differential diagnosis
