溶骨性骨巨细胞瘤1例分析

对溶骨性骨巨细胞瘤1例分析如下。 1病历摘要男，17岁。因右膝部外伤后诉疼痛来我院就诊。查体：右膝关节无红肿，活动可。右胫骨上段有轻压痛，未触及明显包块影。既往无类似疼痛史。X线表现：右胫骨干骺端外侧可见溶骨性偏心性生长不规则骨质破坏区，其外侧骨皮质完全中断，病灶与下缘正常骨分界清，缺损边缘光整，未见硬化边；向上穿透骨骺板达骨骺，未侵犯关节。病变周罔无骨膜反心及软组织肿块影。病理诊断：骨巨细胞瘤（Ⅱ级）。     

骨巨细胞瘤66例影像学诊断分析

目的探讨骨巨细胞瘤的影像学特点,提高对于骨巨细胞瘤的影像学诊断水平。方法通过对66例经病理确诊的骨巨细胞瘤进行归纳、总结,回顾性分析其放射、CT及部分MRI的影像学特点,并与同影异病的相关疾病进行鉴别与比较。结果本组病例发病年龄在15~58岁之间,发病部位为四肢长骨55例,骶骨10例,胸椎1例;骨质破坏区呈典型的肥皂泡样骨质破坏者为13例,而呈溶骨性骨质破坏者为53例。结论骺板软骨已闭合应作为诊断骨巨细胞瘤的可靠条件之一;发生在四肢长骨骨端的骨巨细胞瘤,应与软骨母细胞瘤、骨囊肿相鉴别;发生在骶骨的骨巨细胞瘤应与脊索瘤、神经源性肿瘤相鉴别;发生在胸椎的骨巨细胞瘤,应与血管瘤、骨转移瘤相鉴别。     

髌骨骨巨细胞瘤1例分析

对髌骨骨巨细胞瘤1例分析如下. 1 病历摘要 男,27岁.左膝关节外伤后2 a,左髌骨活检术后9 d入院.患者于2006-10不慎摔伤左膝部,当时在地方医院拍片未见异常,未做其他处理.此后每当天气变化、劳累及上楼时疼痛明显.2008-09-30被人踢伤左膝部,当时疼痛明显,于外院行MRI检查示:左髌骨占位性病变.2008-10-11在外院行左髌骨活检术,术后病理示:左髌骨骨巨细胞瘤.     

怪异型骨巨细胞瘤1例

1　病例报告男 ,16岁。发现左小腿中段肿物 1a余 ,自觉无局部和全身不适 ,站立和行走正常而未作治疗。 1a后发现肿物迅速生长增大并有局部疼痛而到我院就诊。查体 :T36 .5℃ ,P85次 / min,R2 1次 / min,BP110 / 2 5 mm Hg,发育正常 ,心肺正常 ,腹软 ,肝脾未及。全身浅表淋巴结未肿大。专科情况左小腿中段可见隆起 ,无色素沉着及溃烂 ,无红、肿、热 ,表面未发现显露静脉 ,局部可触及一肿物 ,大小约 8cm× 3 cm,有压痛 ,肿物边界不清 ,表面光滑 ,质硬 ,无移动。化验室检查 :Hb12 5 g/ L ,WBC10 .6× 10 9/L,L0 .2 8,N0 .72 ,ARP10 8.7…     

少见部位骨巨细胞瘤17例影像学分析

目的：分析17例经手术病理证实的少见部位骨巨细胞瘤的X线、CT、MRI表现。方法：结合文献对17例经手术病理证实的少见部位骨巨细胞瘤病例的X线、CT、MRI影像学资料进行回顾性分析。结果：（1）骨质破坏以偏心性、膨胀性、囊样为多（11例）;其次为偏一侧性溶骨性破坏（3例）。（2）少部分病例病灶内可见不同形态的分隔（5例）。（3）发生于椎体的骨巨细胞瘤以侵犯单个椎体多见（7例）;部分病例椎体附件亦呈溶骨性、膨胀性破坏（3例）。（4）椎体病理骨折导致椎体压缩变扁或楔形变2例。（5）软组织肿块影6例。（6）MRI的典型表现为T1WI为中等或偏低信号,T2WI为中、高信号混杂。结论：合理应用X线、CT、MRI检查,可提高少见部位骨巨细胞瘤的诊断能力。     

腘窝腱鞘巨细胞瘤1例

病例女,68岁,2年前发现左腘窝一质韧肿物,无明显疼痛,肿物逐渐增大。体检扪及左侧腘窝处肿物,肿物外侧界为半膜半腱肌边缘,内侧界为腘窝中线,肿物质韧、活动度小。     

溶骨型骨巨细胞瘤X线诊断(附15例报告)

本文报告15例经病理证实的溶骨型骨巨细胞瘤。本瘤好发于长管骨，呈溶骨性破坏，病变区内无其他组织及结构，病变边缘无硬化，皮质变薄，界限清，无骨膜反应及软组织肿块。少数病例病变区内有细条分隔，界限模糊，皮质破坏伴轻度骨膜反应及软组织肿块。文内讨论了病理与临床，X线关系，发生率及诊断等问题。     

骨巨细胞瘤的影像学诊断

目的:探讨骨巨细胞瘤的X线平片、CT和MRI影像学表现,评价其诊断价值。方法:分析76例经病理证实的各种类型骨巨细胞瘤的影像学表现。结果:囊性型29例,表现为骨端膨胀性偏心性骨破坏;溶骨型39例,表现为骨皮质中断,边缘模糊;恶性8例,出现虫蚀样骨破坏,有骨膜反应和生长迅速的软组织肿块;伴动脉瘤样骨囊肿的19例,MRI显示可出现液-液平面;复发9例,植骨区为肿瘤组织代替。结论:大多数骨巨细胞瘤有典型的影像学表现不难作出正确的诊断,CT和MRI能提供更多的信息来提高诊断和鉴别诊断能力。     

小儿骨巨细胞瘤并发动脉瘤样骨囊肿伴病理性骨折1例

病例 女,11岁,因左上臂骨肿瘤伴骨折10d入院.查体：左上肢较右上肢粗,肘关节活动受限,伸肘约135°,于指活动及血运正常,触痛阳性,表面皮肤正常,左手指活动及血运良好.实验室检查：血常规、血沉、C-反应蛋白及凝血五项均在正常范围内.     

不典型胫骨近端骨巨细胞瘤1例

患者男,13岁。3个月前无诱因出现右胫前疼痛,未在意,对症治疗无好转,门诊以右胫前占位收入院。查体:右胫前触及2.0 cm×4.0 cm质韧占位,压痛(+),无活动,右膝活动正常,抽屉试验(-),神经查体(-),全身无其他不适。实验室血、尿常规检查未见异常。X线检查:右胫骨上段见一     

Traumatic giant cell tumor of rib: A case report

BACKGROUNDGiant cell tumor (GCT) of the anterior rib origin is extremely rare. We report the first case of trauma-induced GCT of the rib.CASE SUMMARYA 22-year-old female developed a mass over the right anterior chest wall with pain 3 mo after a falling injury with blunt trauma of the right chest wall. Chest computed tomography (CT) showed a tumor originating from the right 6th rib with bony destruction, and a CT-guided needle biopsy revealed a GCT. We completely resected the tumor with chest wall and performed reconstruction. The pathological diagnosis was GCT of the bone. Twelve months after surgery, no signs of recurrence were observed. CONCLUSIONGCT of the rib after trauma has not been reported. Meticulous history-taking and image evaluation are essential for the differential diagnosis of unusual chest wall tumors.     

微血管密度在骨巨细胞瘤中的表达及意义

目的探讨不同组织学分级、放射学分级的骨巨细胞瘤中CD34的表达及与肿瘤复发的相关性,为骨巨细胞瘤生物学行为和预后判断提供依据。方法本实验运用EnV ision法检测CD34在37例骨巨细胞瘤中的表达,分析其与临床病理特征、肿瘤复发的关系。结果骨巨细胞瘤中微血管密度(MVD)平均值为169±33,组织学分级Ⅲ级(202±14)者显著高于Ⅰ级(159±28)者(P<0.01),与Ⅱ级比较差异无统计学意义(P>0.05)。复发组(194±22)明显高于未复发组(155±30),二者比较差异有统计学意义(P<0.01)。结论MVD值与肿瘤复发有关,可作为预后判断的指标。     

CT灌注成像对骨巨细胞瘤潜恶性的识别

目的通过临床骨巨细胞瘤的检查，分析各CT灌注参数、最大强化速率（MER）与肿瘤的微血管密度（MVD）的关系；探讨MER在骨巨细胞瘤诊断中的应用价值；评价边缘-中心血流量差异率（Rrim-cen BF）、边缘-中心血容量差异率（Rrim-cen BV）在良恶性骨巨细胞瘤鉴别诊断中的应用价值。方法对24例病人的骨巨细胞瘤行CT灌注检查，其中恶性骨巨细胞瘤14例，良性骨巨细胞瘤10例。术后病理标本常规组织切片及SP免疫组织化学检查，单克隆抗CD34抗体标记血管，用Weidner技术计算肿瘤MVD。分析BF、BV、MER与肿瘤微血管密度的相关性；分析良恶性骨巨细胞瘤外周区与中央区之间BF、BV有无差异；比较良恶性骨肿瘤之间MER、Rrim-cen BF、Rrim-cen BV的差异。结果24例骨巨细胞瘤均表现为高灌注，BF和BV图像上均可清楚显示肿瘤；骨巨细胞瘤的BF、BV和MER与MVD均呈正线性相关。MER能够准确地反映组织的血管化程度，但MER在良恶性骨巨细胞瘤之间存在较多重叠。Rrim-cen BF和Rrim-cen BV值在良恶性骨巨细胞瘤之间的差异具有最著性意义（P〈0．01）。Rrim-cen BF和Rrim-cen BV鉴别良恶性骨肿瘤的阈值分别为Rrim-cen BF：0．15（敏感度：94．4％；特异度：85．7％）；Rrim-cen BV：0．07（敏感度：88．9％；特异度：78．5％）。结论MER可以客观定量地评估骨巨细胞瘤的血供情况，但不能单独应用作为鉴别良恶性骨巨细胞瘤的指标。Rrim-cen BF和Rrim-cen BV为骨巨细胞瘤良恶性鉴别提供了一种有价值的客观定量的影像学检测指标。     

彩色多普勒超声对骨巨细胞瘤的诊断价值

目的：探讨彩色多普勒超声在骨巨细胞瘤诊断中的价值。方法：回顾性分析39例经病理证实的骨巨细胞瘤的二维及彩色多普勒超声声像图特征、血流分布和血流动力学变化。按照Campanacci分级对血流动力学参数进行统计分析。结果：组间收缩期峰值流速（PSV）的差异不明显（P>0.05）,舒张末期流速（EDV）I级低于III级（P<0.05）。阻力指数（RI）I级与II、III级之间存在差异（P<0.05）,而后两者之间无统计学差异（P>0.05）。结论：通过二维图像及CDFI观察肿瘤形态及血流动力学参数对骨巨细胞瘤的诊断及临床分级的鉴别诊断有一定的意义。     

Three-dimensional-printed custom-made patellar endoprosthesis for recurrent giant cell tumor of the patella: A case report and review of the literature

BACKGROUNDGiant cell tumor (GCT) is a benign lesion and rarely involves the patella. This disease is characterized by a relatively high recurrence rate after primary treatment. En bloc resection has been a predominant option for recurrent GCT. However, total patellectomy can lead to disruption of the knee. Therefore, exploration of functional reconstruction of the extensor mechanism is worthwhile.CASE SUMMARYA 54-year-old woman presented with right knee pain and swelling, and was diagnosed as having a GCT in the patella following curettage and autograft. Medical imaging revealed a lytic and expanded lesion involving the whole patella with focal cortical breaches and pathological fracture. Based on the combination of histological, radiological, and clinical features, a diagnosis of recurrent GCT in the patella was made (Campanacci grade III). After a multidisciplinary team discussion, three-dimensional (3D)-printed custom-made patellar endoprosthesis was performed following en bloc resection for reconstructing the extensor mechanism. The patient was followed for 35 mo postoperatively. No evidence of local recurrence, pulmonary metastasis, or osteoarthritis of the right knee was observed. The active flexion arc was 0°-120°, and no extension lag was detected. A favorable patellar tracking and height (Insall-Salvati ratio 0.93) were detected by radiography.CONCLUSIONWe depict a case of a GCT at the right patella, which was successfully treated by patellectomy and 3D-printed custom-made endoprosthetic replacement. The patella normal reconstruction, the precise-fit articular design, and gastrocnemius flap augmentation could lead to satisfactory knee function and a low rate of complications in the short-term follow-up.     

Management of a rare giant cell tumor of the distal fibula: A case report

BACKGROUNDAggressive giant cell tumor of the distal fibula is so rare that no consensus on a surgical strategy has been reached. Thus, an appropriate treatment strategy is still important to discuss.CASE SUMMARYA 61-year-old man who had been experiencing progressive swelling of the left lateral malleolus accompanied by pain for half a year was presented at our hospital. He had never been treated prior to coming to our hospital. Preoperative imaging revealed a 10 cm × 6 cm mass located in the body of the distal fibula. Pathological biopsies confirmed it was a giant cell tumor. Preoperative examination revealed he had dilated cardiomyopathy with class 3 cardiac function. The cardiologist and anesthesiologist determined that he could tolerate the operation, but the operation should be as short and minimally invasive as possible. With the patient’s consent, we performed a tibiotalar fusion and followed up with him for 2 years, finding no recurrence and a satisfactory recovery.CONCLUSIONTibial talus fusion is an effective method for the treatment of distal fibula tumors.     

肘部腱鞘巨细胞瘤1例

患者男,27岁,发现右肘部肿物半年入院.半年前,无明显诱因发现右肘部有一肿物,逐渐增大,后右肘外侧亦发现一肿物,质地均较硬,如鸽卵大小,局部无红、肿、热、痛,在外院行穿刺病理检查,为右肘部良性病变.     

脊椎骨巨细胞瘤的CT、MRI表现及临床研究

目的分析脊椎骨巨细胞瘤的CT、MRI表现,提高对该病的术前诊断及更好地指导临床。方法回顾性分析经临床病理证实的11例脊椎骨巨细胞瘤的CT和MRI。结果11例中肿瘤位于颈椎2例,胸椎4例,腰椎4例,骶椎1例。CT表现为椎体和/或附件溶骨性破坏区;内见不规则骨嵴分隔;椎旁软组织肿块内部或周边见线样高密度钙化影。MRI信号表现具有多样性,T1WI呈等/低信号;T2WI和STIR上肿瘤实性部分呈中等或稍高信号,囊变和出血区呈高信号;1例可见液-液平面。结论脊椎骨巨细胞瘤具有一定的CT、MRI表现特征,对术前正确诊断、临床分期、手术方式选择和术后处理有重要价值。     

VEGF、MMP-9表达水平与骨巨细胞瘤侵袭性相关性

目的探讨VEGF、MMP-9在良性与侵袭性骨巨细胞瘤组织中的表达差异及临床意义。方法采用免疫组织化学方法检测分析VEGF、MMP-9在13例良性与11例侵袭性骨巨细胞瘤组织表达差异。结果VEGF、MMP-9在侵袭性骨巨细胞瘤组织表达增强,同一肿瘤内部通常边缘较中心部位表达强,两者相比较有明显差别（P〈0．05）。结论VEGF、MMP-9表达增强及其协同作用可能导致骨巨细胞瘤有较强侵袭,可能与骨巨细胞瘤发生、发展、转移密切相关,联合检测VEGF、MMP-9有助骨巨细胞瘤患者治疗和预后判断。