手足骨肿瘤和瘤样病变154例临床病理分析

目的探讨手足骨肿瘤和瘤样病变的临床病理特征。方法对1991～2002年间收集的154例手足骨病变进行临床病理的系统分析。结果手足骨病变软骨性肿瘤93例,其中内生性软骨瘤67例,好发于第2～5指、掌骨。软骨母细胞瘤好发于足部不规则骨。骨软骨瘤在手足骨的发生率明显低于长骨。发生于指、趾骨末节的所谓“骨软骨瘤”多是甲下外生性骨疣,手足部瘤样病变是一组与创伤有关的反应性、修复性病变,包括甲下外生性骨疣、巨细胞性修复性肉芽肿,奇异性骨旁骨软骨瘤样增生和旺炽性反应性骨膜炎。良性骨病明显多于恶性(21：1)。在恶性肿瘤中以软骨肉瘤相对多见,但手足骨和长骨、扁骨之间软骨性肿瘤的良恶性特征有明显差异。结论手足骨较易发生与创伤有关的反应性修复性病变,这些病变与多种骨真性肿瘤需进行鉴别诊断。熟悉掌握其临床病理特征是避免误诊的重要环节。

Clinicopathologic analysis of 154 cases of tumors and tumor-like lesions in the bones of hands and feet

OBJECTIVE: To study the clinical and pathologic features of tumors and tumor-like lesions in the bones of hands and feet. METHODS: Clinical, X-ray and pathologic features of 154 cases of tumors and tumor-like lesions in the bones of hands and feet between 1991 and 2002 were investigated. RESULTS: In the bones of hands and feet the frequency and distribution of many lesions were distinctive when compared to those of other skeletal sites. Cartilaginous lesions were most common (60%), and 72% of them were enchondromas. Enchondromas were most often situated in the second to fifth phalanges and metacarpal bones. Chondroblastomas most frequently involved the irregular bones (such as calcaneus, talus and osnaviculare) of the feet. Whereas the occurance of osteochondromas in the bones of the hands and feet was lower than in the long bones. Most "osteochondromas" of the phalanges were subungual exostoses. A group of reactive or reparative lesions, which are related to trauma, such as subungual exostosis, giant cell reparative granuloma, florid reactive periostitis and bizarre parosteal osteochondromatous proliferations typically occurred in the bones of the hands and feet, but these tumor-like lesions were often misdiagnosted. Another feature of lesions in the bones of the hands and feet was that there were much more benign than malignant lesions (21:1), and that chondrosarcomas were common in malignancies. The diagnostic criteria for benign and malignant cartilaginous tumors in the bones of hands and feet were different from those in long bones and flat bones. CONCLUSIONS: Bone tumors of the hands and feet are different from that of long bones, flat bones and axial bones. Because the hands and feet are frequently exposed to trauma, reactive and reparative lesions often occur in these sites. These tumor-like lesions may simulate benign and malignant neoplasia. Knowledge of different types of lesions which commonly affect these sites is of benefit in assessing lesions of the bones of hands and feet.