老年原发性骨肉瘤12例临床及病理分析

目的 探讨老年原发性骨肉瘤的临床、影像学、病理学特征及鉴别诊断要点.方法 回顾分析北京积水潭医院1985-2010年间手术治疗的12例年龄>60岁的老年原发性骨肉瘤患者的临床、影像学及病理学资料,并对患者进行随访.结果 发病部位位于四肢长骨7例,髂骨1例,颅面骨2例及软组织2例.影像学显示,10例骨肿瘤患者为混合性骨破坏(既有成骨性又有溶骨性破坏),其中8例有骨膜反应和软组织包块.2例软组织骨肉瘤患者可见软组织内有高密度影.组织学除经典普通型骨肉瘤外,2例以恶性梭形细胞为主要成分,2例以软骨为主要成分,1例为髓内高分化骨肉瘤.选择的免疫组织化学(EnVision法)染色没有特异性的改变.10例患者接受瘤段切除或截肢手术,其中1例术前依据个人情况接受正规辅助化疗.除3例失随访外,对9例进行了跟踪随访,随访时间3个月到6年,平均2.8年,其中3例死于肺转移,1例因心脑血管疾病死亡,5例仍存活.结论 老年人原发性骨肉瘤极罕见,可能漏诊或误诊.确诊需结合临床和影像学的相关证据支持.

Abstract：

Objective To study the clinical manifestations, radiologic findings, pathologic diagnosis and differential diagnosis of primary osteosarcoma in elderly patients. Methods Twelve cases of primary osteosarcoma occurring in patients older than 60 years were encountered during the period from 1985 to 2010. The clinical manifestations, radiologic features and pathologic findings were studied and the follow-up data were analyzed. Results The sites of involvement included long bones (number=7), ilium (number=1), craniofacial bones (number=2) and soft tissue (number=2). Radiologic examination showed a mixture of osteosclerotic and osteolytic lesions in 10 patients, soft tissue lesions with high-density areas in 2 patients and soft tissue lesions with periosteal reaction in 8 patients. Histologically, most cases showed features of conventional osteosarcoma. There were 2 cases of malignant fibrous histiocytoma-like osteosarcoma, 2 cases of chondroblastic osteosarcoma and 1 case of well-differentiated intraosseous osteosarcoma. Immunohistochemical study played little role in pathologic diagnosis. Ten patients had undergone amputation, including one patient who had received adjuvant chemotherapy beforehand. Nine patients had follow-up information available. Three of them died of lung metastasis and 1 died of cardiovascular disease. Conclusions Primary osteosarcoma rarely occurs in elderly patients and can easily be missed. Correlation with clinical, radiologic and histologic features is important for arriving at a correct diagnosis.

Clinicopathologic features of primary osteosarcoma in elderly patients

Objective To study the clinical manifestations, radiologic findings, pathologic diagnosis and differential diagnosis of primary osteosarcoma in elderly patients. Methods Twelve cases of primary osteosarcoma occurring in patients older than 60 years were encountered during the period from 1985 to 2010. The clinical manifestations, radiologic features and pathologic findings were studied and the follow-up data were analyzed. Results The sites of involvement included long bones (number=7), ilium (number=1), craniofacial bones (number=2) and soft tissue (number=2). Radiologic examination showed a mixture of osteosclerotic and osteolytic lesions in 10 patients, soft tissue lesions with high-density areas in 2 patients and soft tissue lesions with periosteal reaction in 8 patients. Histologically, most cases showed features of conventional osteosarcoma. There were 2 cases of malignant fibrous histiocytoma-like osteosarcoma, 2 cases of chondroblastic osteosarcoma and 1 case of well-differentiated intraosseous osteosarcoma. Immunohistochemical study played little role in pathologic diagnosis. Ten patients had undergone amputation, including one patient who had received adjuvant chemotherapy beforehand. Nine patients had follow-up information available. Three of them died of lung metastasis and 1 died of cardiovascular disease. Conclusions Primary osteosarcoma rarely occurs in elderly patients and can easily be missed. Correlation with clinical, radiologic and histologic features is important for arriving at a correct diagnosis.