Giant cell tumor of the talar neck

We describe a patient with a giant cell tumor in the talar head and neck of the left foot who was diagnosed as having osteochondritis dissecans and treated with arthroscopic drilling in this same location 3 years earlier. Giant cell tumors can be confused with several conditions, including giant cell reparative granulomas, brown tumors, and aneurysmal bone cysts. Giant cell tumors of bone typically occur in the epiphysis of long bones, including the distal femur and proximal tibia. They are uncommonly found in the small bones of the foot or ankle, and talar involvement is rare. Despite this rarity, the radiographic appearance and clinical signs of talar lesions should be considered in the differential diagnosis of nontraumatic conditions in the foot.     

Giant cell tumor of the flexor hallucis longus tendon sheath: a case study

Giant cell tumor of tendon sheath is infrequently documented in the foot and even less near the ankle. This case report involves such a tumor of the flexor hallucis longus tendon presenting at the posterior ankle. Diagnosis was aided by magnetic resonance imaging, and treatment consisted of complete surgical excision. Pathologic examination verified the diagnosis of giant cell tumor of tendon sheath, and follow-up magnetic resonance imaging revealed no remnants or recurrence of tumor 1 year after surgery.     

腱鞘巨细胞瘤47例临床病理分析

目的探讨腱鞘巨细胞瘤的临床病理特征,对其鉴别诊断进行探讨。方法收集47例腱鞘巨细胞瘤,根据临床病理学特点、形态学观察及免疫组化染色进行分析。结果 47例腱鞘巨细胞瘤患者中男15例(31.9%),女32例(68.1%),男女比为1:2.1,平均年龄43岁,≥31岁者35例(74.5%),发生于手部29例(61.7%)、足部18例(38.3%)。肿瘤细胞由数量不等的中等大小滑膜样多形性单核细胞、破骨样多核巨细胞、泡沫样吞噬细胞组成,伴有不同程度的胶原化,另见散在及灶性炎细胞浸润,部分组织细胞内有含铁血黄素颗粒存在。结论腱鞘巨细胞瘤是一种起源于腱鞘和关节滑膜层的良性病变,为较少见的纤维组织细胞肿瘤,免疫组化检查可作为诊断及鉴别诊断的重要参考依据。     

增强扫描CT值在骨巨细胞瘤诊断中的价值

目的探讨增强扫描CT值在骨巨细胞瘤诊断中的价值。方法选取26例我院2013年10月-2014年5月治疗的患者为研究对象,对比患者术前增强CT与术后病理,分析增强扫描CT值在骨巨细胞瘤诊断中的价值。结果术后病理证实,共19例患者为骨巨细胞瘤患者。比较骨巨细胞瘤和非骨巨细胞瘤增强扫描CT值,差异有统计学意义。结论骨巨细胞瘤的增强扫描CT值最佳临界值为98HU,增强扫描CT值可作为诊断骨巨细胞瘤的一个参考标准。     

骨巨细胞瘤的影像学诊断12例

目的 探讨骨巨细胞瘤的影像学特点,以提高对本病的认识。方法 回顾性分析经手术病理证实的12例骨巨细胞瘤的影像学表现。结果 11例发于长骨骨端,1例发于不规则骨。10例影像学表现典型,术前诊断准确。结论 骨巨细胞瘤具有特征性影像学表现,但部分病例不典型,故误诊时有发生,最后诊断需影像、临床和病理三结合。     

Study of 7 Cases of Giant Cell Tumor of Soft Tissue

Background

Primary giant cell tumour of soft tissues is a distinct but uncommon group of neoplasms morphologically identical to osseous giant cell tumor.

Methods

7 patients with painless growing soft tissue mass, having no attachment to underlying bone, were identified in a four years retrospective study from two zonal hospitals of armed forces. Histopathology of these lesions revealed admixture of multinucleated giant cell with mononuclear cells. All patients were treated by surgical resection and followed up for recurrence. Results : There were 5 male and 2 female patients in the age group of 18 to 56 years. All lesions were superficial, circumscribed and involved extremities except one. Histologic transition between benign and malignant lesion was present in only one of the 7 patients that recurred after three months of surgery for which she had to be operated again. 2 of our 7 cases were lost in follow up.

Conclusion

Primary giant cell tumour of soft tissues usually present as a painless mass and needs to be differentiated from other giant cell rich soft tissue tumors. Benign clinical course is expected if the lesion is excised adequately. Its biological behaviour to have low malignant potential is recognized; but this cannot be predicted and metastasis does occur rarely.Key Words: Giant cell tumour of soft tissue, Giant cell tumour of bone, Malignant fibrous histiocytoma     

异时性多中心骨巨细胞瘤伴腹膜后转移

Giant cell tuenor （GCT）of bone is a benign but locally aggressive tumor that usually involves the epiphysis of long bones.1Rarely,these tumors metastasize to the lung, and these metastases generally have the same benign histological appearance as the primary tumor. Multicentric giant cell tumor （M-GCT） is rarer. We herein report a case of M-GCT involving the left distal radius, with retroperitoneal metastasis, and subsequent lesions in the left proximal and distal femur. The patient and family members were informed that data concerning the case would be submitted for publication, and they consented.     

乳腺原发性软组织巨细胞肿瘤1例及文献复习

软组织巨细胞肿瘤（Giant cell tumour of soft tissue，GCT-ST）是一种原发于软组织而形态学及免疫组化类似于骨巨细胞瘤的一类肿瘤，非常罕见，而发生在乳腺的GCT-ST更是极为罕见。查阅国内外文献，类似报道不足10例，现将作者遇见的1例乳腺GCT-ST报道如下。     

A clinicopathological study of giant cell tumor of small bones

Abstract

Background and purpose. Giant cell tumor (GCT) of the small bones (small-bone GCT) is usually rare and considered somewhat different from conventional GCT. The purpose of this study was to investigate and report the clinicopathological features of 11 cases with small-bone GCT.

Materials and methods. Patient information was obtained with the help of questionnaires. X-rays and paraffin blocks obtained from several institutions were clinically, radiographically, and histologically evaluated.

Results. Small-bone GCT was observed in younger patients compared to conventional GCT; 5 of the 11 (45%) patients were below 20 years of age, whereas the corresponding figure for all GCT patients is 16% in Japan. Excessive cortical bone expansion is a special feature. There were two cases of recurrence and one case of lung metastasis; the primary lesion was in the hand for all three cases. In contrast, no primary lesion of the foot recurred or metastasized. Varying degrees of positive p63 immunostaining were observed in all examined cases (n = 9) of small-bone GCT but were negative in case of giant cell reparative granuloma (GCRG) and solid variant of aneurysmal bone cyst (ABC). One case that demonstrated high-intensity positive staining had two episodes of recurrence.

Conclusion. Small-bone GCT tends to develop in younger patients than does conventional GCT. Primary GCTs of the hand may be biologically more aggressive than those of the feet. The p63 immunostaining may be useful not only for differential diagnosis but also for prognostication of small-bone GCT.     

骨巨细胞瘤复发并肺转移4例报告

目的 探讨骨巨细胞瘤复发并肺转移病例复发情况和治疗方法.方法 运用文献资料法、临床分析法,搜集和整理有关我院收治的骨巨细胞瘤复发并肺转移临床病例资料.结果 采用通常的刮除法复发率甚高,少数病例可出现局部恶变或肺转移.结论 骨巨细胞瘤复发并肺转移的病程较慢,即使不切除,或部分切除,患者也可能生存很长甚至痊愈.对肺转移如有可能应争取手术治疗,否则应行放疗,大多数肺转移采用病灶切除疗效良好.     

Granular cell tumor of the breast: report of a case

A case of granular cell tumor of the breast in a 43-year-old woman is described. The patient presented with a painless mass in the upper-outer quadrant of her right breast. Mammography showed a spiculated tumor and ultrasonography demonstrated a hypoechoic mass with an irregular border. Magnetic resonance (MR) mammography revealed a homogeneous enhanced mass in T1-weighted images using Gd-DTPA and a ringed high-intensity area around the mass in T2-weighted images. Fine-needle aspiration cytology failed to show any malignant cells. A partial resection of the breast was performed and histological examination revealed a granular cell tumor. Granular cell tumors are generally always benign, but they may be misdiagnosed as malignant tumors because of their mammographic and ultrasonographic findings. MR mammography did not reveal a typical breast cancer in either T1- or T2-weighted images in the present case. This case illustrates the need for care in preoperative examinations in order to avoid overdiagnosis of breast cancer.     

A clinicopathological study of giant cell tumor of small bones

Background and purpose

Giant cell tumor (GCT) of the small bones (small-bone GCT) is usually rare and considered somewhat different from conventional GCT. The purpose of this study was to investigate and report the clinicopathological features of 11 cases with small-bone GCT.

Materials and methods

Patient information was obtained with the help of questionnaires. X-rays and paraffin blocks obtained from several institutions were clinically, radiographically, and histologically evaluated.

Results

Small-bone GCT was observed in younger patients compared to conventional GCT; 5 of the 11 (45%) patients were below 20 years of age, whereas the corresponding figure for all GCT patients is 16% in Japan. Excessive cortical bone expansion is a special feature. There were two cases of recurrence and one case of lung metastasis; the primary lesion was in the hand for all three cases. In contrast, no primary lesion of the foot recurred or metastasized. Varying degrees of positive p63 immunostaining were observed in all examined cases (n = 9) of small-bone GCT but were negative in case of giant cell reparative granuloma (GCRG) and solid variant of aneurysmal bone cyst (ABC). One case that demonstrated high-intensity positive staining had two episodes of recurrence.

Conclusion

Small-bone GCT tends to develop in younger patients than does conventional GCT. Primary GCTs of the hand may be biologically more aggressive than those of the feet. The p63 immunostaining may be useful not only for differential diagnosis but also for prognostication of small-bone GCT.     

不规则骨骨巨细胞瘤影像诊断探讨

目的探讨不规则骨骨巨细胞瘤影像表现及鉴别诊断。方法回顾性分析经手术病理证实的17例不规则骨骨巨细胞瘤的CT、MRI表现。结果CT主要表现为膨胀性病变、溶骨性骨质破坏和软组织肿块。MRI检查病变在T1WI呈等或低信号,T2WI为低到高不均匀信号,病变边缘比较清楚。结论CT结合MRI扫描对不规则骨骨巨细胞瘤的诊断和鉴别诊断具有明显的价值并为临床手术提供可靠的资料。     

颅骨巨细胞瘤(附二例报告)

颅骨巨细胞瘤实属罕见.本文报告了2例,其中男女各1例.位于蝶骨1例.颞骨1例,均经手术治疗并得到病理证实.对其病因、病理、临床表现及治疗问题进行了讨论.     

骶骨肿瘤的影像学表现分析

目的分析骶骨肿瘤的影像表现,以期进一步提高对该部位肿瘤的认识。方法回顾性分析69例经病理证实的骶骨肿瘤的影像表现。58例行X线检查,32例行CT检查,47例行MRI检查。结果 69例骶骨肿瘤中,转移瘤23例,脊索瘤22例,神经源性肿瘤9例(神经鞘瘤7例、神经纤维瘤、神经母细胞瘤各1例),骨髓瘤6例,淋巴瘤及骨巨细胞瘤各3例,甲状腺滤泡癌、恶性纤维组织细胞瘤及韧带状纤维瘤各1例。骶骨恶性肿瘤表现为骶骨溶骨性骨质破坏,软组织肿块及骶髂关节受侵犯易见。脊索瘤表现为中心性、溶骨性骨质破坏,骨巨细胞瘤多为偏心膨胀性骨质破坏,转移瘤、骨髓瘤及淋巴瘤为多骨多发病变;神经源性肿瘤多伴有骶孔扩大、破坏。结论骶骨肿瘤的种类繁多、影像表现多样,结合病变的临床及影像学表现,可提高病变的诊断率。     

骨巨细胞瘤的诊断与治疗

骨巨细胞瘤(GCT)是一种高侵袭性良性骨肿瘤,主要发生于年轻人中,骨端发病典型的影像学是骨端完全溶骨的膨胀性改变,多不伴有骨膜反应及软组织包块;CT、磁共振可以很好地显示肿瘤的侵及范围;X线平片最具诊断意义。圆形及卵圆形基质细胞及多核巨细胞是GCT的基本结构成分。刮除术是治疗GCT的基本外科手段,但其复发率较高。行刮除术的同时应用高速磨钻处理髓腔或用液氮冷冻、石碳酸烧灼、50%氯化锌液体浸泡以及放疗等辅助方法处理刮除后的病灶,可明显降低复发率。     

少见部位骨巨细胞瘤的X线诊断（附20例报告）

目的提高X线检查对少见部位骨巨细胞瘤的认识。方法对经手术病理证实的20例少见部位骨巨细胞瘤X线表现进行回顾性分析。20例均行常规X线检查,其中5例行CT检查。结果枕骨斜坡1例,下颌骨3例,跟骨2例,耻骨2例,肋骨4例,脊柱8例。X线主要表现为多房型溶骨性膨胀性破坏13例,单房型溶骨性膨胀性破坏5例,病灶内可见皂泡样改变,无钙化,病灶边缘无硬化,病灶周围骨质可见钻孔样改变6例。结论平片仍是本病诊断的首先方法,解剖结构复杂的部位,需行CT和MRI检查,以提供更多的信息,提高诊断准确率。     

骨盆巨大单发性骨软骨瘤的影像学表现

目的探讨骨盆巨大单发性骨软骨瘤的X线征象及其诊断价值.方法对经病理及临床综合确诊的7例骨盆骨软骨瘤的X线表现及CT表现进行回顾性分析,发生于髂骨3例、耻骨2例、坐骨1例及股骨颈1例.结果表现为骨盆骨菜花状骨性突起,基底与骨盆骨相连,边界清楚,肿块内见骨皮质及小梁与骨盆骨相延续,其内可见钙化;恶变表现为软骨帽钙化模糊、密度变淡或中断,伴骨质破坏及软组织肿块形成.结论骨盆单发性骨软骨瘤的X线表现具有一定特征性,结合临床具有较高诊断价值.     

足踝部腱鞘巨细胞瘤的临床分型、分期与治疗

目的总结足踝部腱鞘巨细胞瘤临床特点与治疗、预后之间的关系,建立一种能指导诊断、治疗、预测预后的临床分型、分期方法。方法回顾性分析1984～2009年期间21例足踝部腱鞘巨细胞瘤住院患者的临床资料及随访结果,据此对足踝部腱鞘巨细胞瘤进行临床分型、分期。结果 21例患者以男性居多,患者平均年龄为38.0岁,肿瘤好发于右足(71.4%)以及滑膜关节周围(81.0%),半数以上患者以无痛性肿物为主要症状(61.9%),X线检查对关节受肿瘤侵犯的检出率低(66.7%),但MRI非常敏感(100%),病理检查提示大部分肿瘤细胞增生活跃(52.4%)。根据肿瘤的生物学行为可将其分为两型:A型位于足踝部腱鞘周围;B型位于足踝部大关节周围。其中B型又划分为Ⅰ期:局限于包膜内;Ⅱ期:突破包膜局部浸润;Ⅲ期:弥漫侵袭并进入关节腔。21例病例中A型4例,B型17例(Ⅰ期6例,Ⅱ期9例,Ⅲ期2例)。对A型和B型Ⅰ期患者行边缘切除,B型Ⅱ期给予灶内切除和术后放疗,Ⅲ期在扩大切除的基础上辅以放疗。对所有病例经过平均119.6个月的随访,仅1例B型Ⅲ期患者于术后9月复发并恶性变,其余患者功能恢复满意。结论足踝部的腱鞘巨细胞瘤包含生物学行为特点不同的两种亚型,根据临床资料对肿瘤进行分型、分期,可以很好地指导治疗和改善预后。     

64排螺旋CT在诊断骨巨细胞瘤中的应用

目的探讨64排螺旋CT在诊断骨巨细胞瘤中的应用价值。方法回顾性分析11例经手术及病理证实的骨巨细胞瘤的CT影像表现。将64排CT扫描的原始轴位图像传至ADW工作站,采用容积再现（VR）多平面重建（MPR）技术处理图像。结果VR三维重建对病变的定位和空间关系理解,更直观、立体、准确,MPR对病灶细节显示满意,可以多平面观察骨的密度、形态、大小变化及发现邻近软组织改变。结论多排螺旋Cr在诊断骨巨细胞瘤中有重要应用价值,对临床手术方案的选择具有重大的指导意义。