骨嗜酸性肉芽肿的影像诊断

目的探讨骨嗜酸性肉芽肿的影像表现特点。方法回顾性分析10例经手术病理证实的骨嗜酸性肉芽肿的X线、CT及MRI表现。10例患儿均接受CT检查,3例同时接受患部X线平片检查,5例同时接受患部MR检查,其中4例接受MR增强扫描。结果病变单发8例,多发2例。累及颅面骨4例,长骨3例（肱骨1例,胫骨1例,股骨1例）,髂骨2例,锁骨2例,椎体1例,肩胛骨1例。不同部位病变影像学表现有差异,主要表现为骨质破坏,形成软组织肿块,边缘清楚、无硬化。结论综合影像学检查能显示骨嗜酸性肉芽肿的病变形态、范围、特点,有助于诊断及鉴别诊断。     

骨嗜酸细胞肉芽肿激素病灶注射疗效观察

目的：观察骨嗜酸细胞肉芽肿激素病灶注射疗效。方法：33例平均随访8．1年，共51例病灶。以股骨、颅骨多见，病灶注射醋酸曲安缩松50mg平均2．1，结果：48例病灶药获得骨性修复，结论：本法简便、有效、可避免手术。     

脊柱嗜酸性肉芽肿的诊断和治疗

目的 探讨脊柱嗜酸性肉芽肿的诊断和手术适应征及治疗方法的选择。方法 分析经病理证实的11例脊柱嗜酸性肉芽肿的临床表现，X线、CT、MR影像学表现和治疗效果。结果 11例患者随访9个月至12年，10例患者症状缓解，1例复发，行二次手术加放疗，症状缓解。结论手术切除加术后小剂量放疗是治疗脊柱嗜酸性肉芽肿有效的方法。     

局部注射醋酸氢化泼尼松治疗儿童骨的孤立性嗜酸性肉芽肿（附9例报告）

目的：评价用局部注射醋酸氢化泼尼松治疗儿童骨的孤立性嗜酸性肉芽肿的临床应用。方法：9例经病理确诊的单发性骨的嗜酸性肉芽肿,在透视导向下局部注药2-4次,结果：全部病例经一次注药后,1周内肿块和疼痛消除,治疗6-20月骨破坏修复如常,平均治愈期15个月,随访1年-4年5月（平均3年1月）无复发及并发症,结论：本疗法治疗儿童骨的孤立性嗜酸性肉芽肿具有疗效好,无并发症,简便,费用低的特点。     

儿童骨嗜酸性肉芽肿临床分析

目的分析儿童骨嗜酸性肉芽肿的临床特征。方法1995年至2005年共收治4例患者,男1例,女3例,平均年龄5岁,部位:股骨颈1例,髂骨1例,胫骨上段2例,均为单发。结果3例行病灶刮除植骨,1例行病灶刮除植骨内固定术。经病理检查为骨嗜酸性肉芽肿。均在术后3个月愈合,功能完全恢复。结论本病为郎格罕氏细胞增多症,病灶刮除植骨加内固定治疗均取得良好效果。     

重建板骨水泥填充治疗锁骨嗜酸性肉芽肿1例及文献复习

锁骨嗜酸性肉芽肿是一种少见的嗜酸性肉芽肿类型,影像学常表现为溶骨性破坏,临床上容易出现误诊。本文报道1例曾在外院误诊为恶性肿瘤的锁骨嗜酸性肉芽肿病例,并结合文献复习,对其发病特点、诊断与鉴别诊断、治疗方式进行总结,为该病的诊疗常规提出建议。     

腹腔促结缔组织增生性小圆细胞肿瘤4例临床分析

回顾性分析空军军医大学第二附属医院2014至2022年收治的4例腹腔促结缔组织增生性小圆细胞肿瘤患者的临床资料。2例放弃治疗, 随访4～9个月死亡。1例先后接受手术、化疗、靶向、免疫和中药抗肿瘤治疗, 随访12个月死亡。1例接受顺铂、多西他赛化疗并辅以立体定向放疗, 随访至今, 约27个月, 患者仍生存。本研究显示腹腔促结缔组织增生性小圆细胞肿瘤临床症状不典型且预后极差, 手术、化疗、放疗一体化的综合治疗方案可能提高患者的远期生存率。     

原发性甲状腺鳞状细胞癌4例报告

目的 探讨甲状腺鳞状细胞癌的临床特征和综合治疗效果。方法 回顾性分析1985年以来收治的4例原发性甲状腺鳞状细胞癌患者的临床资料。结果 单一手术的1例患者术后4个月死亡;手术加放疗的2例患者术后6－13个月死亡;手术加放、化疗的1例患者术后至今已两年仍存活。结论 甲状腺鳞状细胞癌系罕见的恶性肿瘤,生长速度快,术后易复发,预后差。早期行甲状腺癌联合根治术,并辅以放、化疗可降低复发机率,延长生存时间。     

骨嗜酸性肉芽肿的诊断和治疗

骨嗜酸性肉芽肿的诊断和治疗徐宏光李秀坤靳松陈方满＊⒇嗜酸性肉芽肿为组织细胞增生症Ｘ中的一种，好发于儿童及青年，男多于女，５０％以上发生于颅骨、肋骨和股骨，可单发或多发，单发者多见，本文报告１９８５年以来收治的临床资料完整且经病理证实的１９例，并对其诊...     

脊柱多发性骨髓瘤的诊断与治疗———附36例报告

目的:探讨脊柱多发性骨髓瘤(multiple myeloma,MM)的诊断与外科治疗方法选择。方法:回顾性分析收治的脊柱MM患者36例的临床资料,平均年龄为55.5岁(34～78岁)。患者均有局部疼痛;伴有神经功能损害25例。26例行CT引导下穿刺活检,24例病理诊断为骨髓瘤,1例为淋巴瘤,1例为软骨组织;5例手术取得病理;5例通过骨髓穿刺涂片诊断。16例化疗(其中4例有难以控制的骨痛,神经损害轻或进展缓慢者辅以放疗,1例行骨髓移植),其中9例伴神经功能损害,7例脊柱不稳定(因骨质疏松严重或一般状况差而不宜手术);16例神经损害严重或进展迅速、脊柱不稳定者手术治疗(15例行化疗者中3例辅以放疗,1例行骨髓移植;2例行两次手术),其中14例伴神经功能损害,13例脊柱不稳定;2例放弃治疗;2例因失访而治疗不详。结果:32例获随访,平均随访31.5个月(2～108个月),20例存活,12例死亡,死亡者平均存活19.4个月(2～40个月)。化疗者6例死亡,1例失访,9例存活;存活者中3例伴神经功能损害,其中1例仅化疗,神经功能无明显改善;2例放疗+化疗,神经功能均有改善;5例脊柱不稳定,4例仅化疗,其中1例压缩骨折进一步加重,1例行放疗+化疗,症状缓解,但无随访影像学资料;7例患者化疗平均9.1个月后,病灶区未见明显成骨反应。16例手术者4例死亡,1例失访,11例存活,存活者中9例伴神经功能损害,其中77.8%(7/9)有神经功能改善;11例术前脊柱不稳定者,平均随访45.9个月,脊柱保持稳定;一期手术存活者有9例,3例前路,3例后路,3例前后联合入路,随访52个月(5～108个月),各手术入路患者临床效果相似。结论:CT引导下病灶穿刺活检是确诊MM的安全、有效的手段。放疗与手术均可改善MM患者的神经功能,但应严格掌握手术适应证。脊柱不稳定者可考虑手术治疗。     

脊椎嗜酸性肉芽肿（附14例报告）

报道经病理证实的脊椎嗜酸性肉芽肿１４例的治疗结果。其中１２例随访１～１８年，平均４年８个月，９例不全瘫痪者中，７例完全恢复，２例部分恢复；１例完全瘫痪者部分恢复。通过临床资料分析，着重阐述了脊椎嗜酸性肉芽肿的诊断和治疗方法的选择，认为有神经根或脊髓受压者，应以手术治疗为主，结合放疗或化疗；而无神经根或脊髓受压者，以放疗为主，结合化疗。早期诊断和正确的治疗是防止瘫痪发生的关键。     

Eosinophilic granuloma in the temporal bone and skull

Eosinophilic granuloma is a benign lytic lesion of bone, probably arising from an abnormal proliferation of histiocytes. It may occur within the temporal bone and be confused with more common disorders such as aural polyps or chronic suppurative otitis media. If untreated, the disease may destroy the bony labyrinth and spread to the middle and posterior cranial fossas. Temporal bone lesions may represent only one manifestation of a more extensive multifocal disorder (i.e., Hand-Schüller-Christian or Letterer-Siwe disease). From 1967 to 1982, 25 patients with eosinophilic granuloma of the skull were treated in the radiation therapy department of The Methodist Hospital in Houston. Six of these patients had disease involving the temporal bone. After analyzing these cases and reviewing the literature, we conclude that the management of the patient with eosinophilic granuloma in the temporal bone requires a diagnosis based on microscopic examination of the affected tissue, a definition of the extent of disease, therapy consisting of biopsy and low-dosage radiotherapy in the unifocal disease, and careful and continued follow-up.     

Solitary eosinophilic granuloma of the skull

Solitary eosinophilic granuloma of the skull is a rare lesion, the natural history of which has not been defined completely. By a retrospective chart review, 26 patients were identified as having a solitary eosinophilic granuloma of the skull at first presentation to our institution between 1946 and 1982. Characteristically, the patient noted an enlarging, tender skull mass during the several weeks to several months before the initial assessment. Laboratory findings were normal except for 1 case of eosinophilia. Radiographically, the abnormality consisted of a punched-out, well defined, lytic lesion most commonly seen in the parietal or frontal bone. Whole body bone scans or bone surveys were used to rule out further lesions. The definitive diagnosis was made by histological examination, which showed the characteristic histiocytes, eosinophils, and multinucleated cells of eosinophilic granuloma. The usual treatment consisted of a craniectomy or curettage perhaps followed by local, moderate dose radiation therapy. The follow-up period ranged from 1 month to 25 years and averaged 8 years; in that time, 8 patients (31%) developed additional lesions. Of these 8 patients, only 3 were older than 3 years at the time of the first recurrence. Based on a review of our own patients and those reported in the literature, we stress that a solitary eosinophilic granuloma of the skull may foreshadow future disease elsewhere and is not an easily dimissed local disease, especially in children. After the initial treatment, we recommend careful long term follow-up and treatment of additional lesions with radiation therapy.     

颅骨嗜酸性肉芽肿切除15例报告

目的探讨颅骨嗜酸性肉芽肿（skull eosinophilic granuloma,SEG）手术治疗的效果。方法2011年1月～2012年9月对15例SEG,术中根据病变浸润、破坏颅骨骨质程度和病灶范围大小,分别采用病灶刮除和切除术,对于颅骨缺损直径〉3cm者,行一期颅骨修补。结果10例单纯手术切除,5例病灶刮除;7例行钛网修补。术后未辅助放、化疗。手术时间95～160min,（127．8±32．5）min;术中出血93～118ml,（105±13）ml。术后住院8～10d。术后病理：黄色肉芽肿,属于嗜酸性肉芽肿黄色肿块期。术后门诊随访1年,头颅CT、MRI检查均未见复发病灶。结论SEG经单纯病灶清除术后患者恢复良好,复发率低。单发、局限性病灶,无明显全身症状者,可不辅助放、化疗。     

Bone lesions in histiocytosis X.

Sixty-two patients with histiocytosis X were followed for an average of 5 years. The patients were classified into three groups: general visceral types (14 cases), multiple eosinophilic granulomas (nine cases), and solitary eosinophilic granulomas (39 cases). One hundred bony lesions were noted in 60 of the 62 patients. The bone lesions showed progressive improvement in single and multiple eosinophilic granulomas independent of treatment type. After biopsy, patients received no treatment unless there was a dangerous extension into the soft tissues because of its site, i.e., in the skull. In the general visceral types, chemotherapy was effective in visceral sites and in extensions of the tumor outside the bone but did not alter the natural history of the bony lesion.     

Eosinophilic granuloma of spine in adults: a report of 30 cases and outcome

Background

Eosinophilic granuloma (EG) of the spine is rare, especially in adults. There had been few large and long-term studies reported in the literature. The management goals of this disease in adults are preservation of neurologic function, relief of pain and reconstruction of spinal stability. However, there are still controversies over appropriate management modality of eosinophilic granuloma.

Methods

Clinical manifestations, radiographic presentations, therapeutic outcomes and follow-up findings of 30 adults who were histiologically diagnosed with spinal eosinophilic granuloma, including 28 patients who received surgical treatment at our institutions from 1985 to 2008 were reviewed retrospectively.

Results

There were 25 males and five females with a mean age of 34.5 years (range, 18–71 years). The post-operative follow-up period ranged from 2 to 22.4 years (mean, 8.3 years). Neurologic deficits developed in 21 patients, apparent kyphosis developed in four cases. In contrast to the classic feature of vertebra plana in children, we found that more severe lesions often led to asymmetric collapse in adult patients and only three patients presented with vertebra plana. Thirty-three vertebral lesions distributed throughout the spine column. Twenty-one lesions were in cervical spine, seven in the thoracic spine and five in the lumbar spine. Twenty-eight adult patients underwent surgical resection with or without chemotherapy or radiotherapy, and four (13.3%) patients had recurrence after surgery. No patient in our series died.

Conclusions

The onset of spinal EG is insidious and mainly presents as osteolytic destruction. There is a particular high prevalence of lesions in the cervical spine and more severe lesions often led to asymmetric collapse. As the skeleton of adults is well-developed and the epiphysis has stopped growing, individualized management including surgical intervention should be considered in adult patients with spinal EG who present with neurological damage and spinal instability.     

Cranial unifocal Langerhans cell histiocytosis in children

Purpose

The present study presents 22 cases of pediatric patients harboring an eosinophilic granuloma (EG) of the skull.

Methods

Twenty-two patients (13 males, 9 females; mean age, 7.5 years; range, 3-14 years) with a suspected diagnosis of a cranial EG were enrolled in the study. They all had been preoperatively evaluated by skull x-ray and computed tomography, whereas 10 patients additionally underwent magnetic resonance imaging. To rule out a multifocal disease, scintigraphy was performed in all cases preoperatively. Surgical excision of the lesions was performed, and EG was proven histopathologically.

Results

There was a male predominance. Frontal bone was the most common affected bone. One patient had a multifocal disease. Total excision of the lesion was performed in 19 of 22 patients. No patient received postoperative radiotherapy. In the remaining 3 cases because of the periorbital localization of the EG and the subsequent risk of disfigurement, only a biopsy was performed. These patients were treated with sulfamethoxazole and trimethoprim for 6 months. All 3 lesions were resolved. The follow-up examinations ranged from 6 months to 17 years, with a mean follow-up of 6.2 years, and no tumor recurrence was noted.

Conclusions

We conclude that EG is a benign disease. At the time of diagnosis, a bone scan should be performed to rule out a multifocal disease. Surgical resection is the treatment of choice. Nevertheless, for lesions in which excision can cause cosmetic defects, administration of sulfamethoxazole and trimethoprim after biopsy appeared to be an effective alternative treatment.     

Eosinophilic granuloma of the spine

The contribution to the clinical picture of eosinophilic granuloma of the spine. This tumor-like, osteolytic bone lesion presents both diagnostic and therapeutic problems. Solitary eosinophilic granuloma of the spine is not common. Compared to the multiple manifestation of eosinophilic granuloma, which seldom spares the spine, vertebral involvement is rare in cases of solitary eosinophilic granuloma (about 10 p.c.). Spinal involvement of this disease is mainly characterized by an undramatic, uneventful clinical course, even in cases of extensive osteolytic bone defects, varying laboratory findings as well as partial or complete collapse of a vertebra, mostly in form of a true vertebrae plana. Open biopsy is recommended instead of needle aspiration biopsy in solitary eosinophilic granuloma of the spine in order to exclude Ewing's sarcoma, neuroblastoma, or bony manifestations of leukemia. In cases of solitary eosinophilic granuloma various therapeutic methods have been tried. Some authors have registered good results by means of prolonged immobilization, similar to fracture treatment. Others have used radiation therapy in moderate doses. We suggest operative treatment of solitary eosinophilic granuloma. Our procedure comprises open biopsy, frozen section examination, and curettage of the affected vertebral body, taking care not to destroy the epiphyseal plate or the intervertebral disc. Vertebral body replacement is achieved by means of a bone graft, taken from the iliac crest. The original height of the vertebra is thus restored and immediate stability of the involved area guaranteed. Undisturbed bone growth of the end plated of the vertebral body can be observed. This technique is to prevent disturbances of spinal growth and permanent deformities.(ABSTRACT TRUNCATED AT 250 WORDS)     

颈椎孤立性浆细胞瘤的外科干预及放疗结果分析

目的 探讨颈椎孤立性浆细胞瘤的临床特点、治疗方法及结果.方法 回顾性分析我科1995年1月至2007年12月收治的23例颈椎孤立性浆细胞瘤患者的临床资料,其中男性16例,女性7例,年龄32～76岁,平均56岁.23例患者除2例仅行单纯放疗外,余21例均行手术治疗.依据脊柱肿瘤WBB分期,采取全椎体切除6例,附件切除4例,矢状切除3例,全椎节切除8例,手术病例采用前路、后路或前后联合入路.脊柱重建方式采取自体髂骨植骨和颈前路钛板、钛网骨水泥内固定或前后联合植骨融合内固定,术后均行辅助放疗.结果 23例患者获得随访,随访时间24.0～143.0个月,平均64.7个月.患者术后颈部疼痛症状明显好转,神经压迫症状消失或得到不同程度的改善,术后3个月患者神经功能Frankel分级平均有1～2个级别的改善.内固定位置及颈椎稳定性良好,无脊柱失稳现象,植骨融合率100%.随访期内有6例局部复发,且进展为多发性骨髓瘤(MM),死亡3例.2例未手术者分别于确诊后1年及1.5年进展为MM,转血液科进一步化疗.15例患者术后辅助放疗后一般情况良好,随访期内复查M蛋白、骨髓穿刺等检查均未见明显异常,单光子发射计算机断层扫描或PET-CT检查未发现其他部位骨骼有新发病灶.结论 颈椎孤立性浆细胞瘤临床较为少见,对于骨质破坏明显、椎节不稳或神经功能障碍者,首选手术治疗;术后辅助放疗能明显降低局部复发率及进展为MM的可能性,进展为MM者应根据相应化疗方案进行化疗,预后相对较差.