79例脊柱骨转移癌临床病理学研究

目的 探讨脊柱骨转移癌临床病理学特征及如何提高原发肿瘤的诊断率。方法　回顾性研究宁波市第二医院1998年至2008年间79例脊柱骨转移癌的临床资料以及病理形态表现，其中29例原发部位不明的肿瘤行免疫组织化学染色。 结果　本组79例，男43例，女36例，发病年龄35～87岁，平均年龄55.8岁。患者主要临床表现为病变部位的疼痛及脊髓神经损害。脊柱骨转移癌发生部位依次为: 颈椎5例，胸椎30例，腰椎43例，骶椎1例。根据临床资料及病理组织学检查，50例可以明确其原发病灶，另有29例不能确定原发部位，经免疫组织化学染色后，其中的21例可以确定其组织来源。原发病变部位依次为:肺28例，女性生殖系统及乳腺19例，胃肠道11 例，前列腺6例，甲状腺3例，肝脏2 例，肾脏及膀胱各1例。结论 脊柱骨转移癌多见于老年男性，腰椎为脊柱转移癌最好发部位，最常见的原发部位是肺及女性生殖系统及乳腺。免疫组织化学染色对确定来源不明脊柱骨转移癌的原发部位有帮助。【关键词】　脊柱骨；转移癌；免疫组织化学

Clinicopathologic analysis of 79 cases of vertebral metastatic carcinoma

【Abstract】Objective To study the clinicopathologic features of vertebral metastatic carcinoma and to discuss how to improve the diagnostic rate of primary carcinoma. Methods Seventy-nine cases of vertebral metastatic carcinoma encountered in Ningbo NO.2 Hospital during the period from 1998 to 2008 were reviewed retrospectively. The clinical information and pathologic findings were analyzed. Immunohistochemistry staining was performed in 29 cases with metastasis of unknown primary. Results Seventy-nine cases (43 male and 36 female, aged from 35 to 87 years, mean age=55.8) were involved in the study. The presenting symptoms included pain and neurologic deficit. The locations of vertebral metastasis were as follows: cervical vertebrae (5), thoracic vertebrae (30), lumbar vertebrae(43), sacral vertebrae(1). The primary sites of the tumor could be determined by clinicopathologic correlation in 50 cases and were unknown in the remaining 29 cases. Upon immunohistochemical study, the primary sites were finally determined in another 21 cases. The primary sites were as follows :lung(28), female genital system and breast(19), gastrointestinal system(11), prostate(6), thyroid(6),liver(2),kidney(1) and bladder(1). Conclusions The vertebral metastatic carcinoma most likely occurs in elderly males and affects lumbar vertebrae. Lung and female genital system are frequent the primary sites. Immunohistochemistry is beneficial to detect the primary sites of vertebral metastasis.【Key words】vertebral; metastatic carcinoma; Immunohistochemistry