3D-SCTA在脑膜瘤诊治中的应用价值

目的探讨螺旋CT三维血管成像(3D-SCTA)在脑膜瘤诊治中的应用价值。方法32例脑膜瘤病人均行CT平扫和增强扫描。图像送至AW4.2工作站进行最大密度投影(MIP)、容积再现(VR)、表面遮蔽法(SSD)后处理观察。结果重建图像显示瘤体充分强化,颅骨、血管、肿瘤三者立体关系显示清楚,以及血管受压或被肿瘤包绕,颅骨受侵犯,肿瘤周围组织移位等均显示清晰。结论3D-SCTA可以充分显示脑膜瘤的影像特征,有助于脑膜瘤的诊断及治疗方案的制订。     

Multifocal osteoblastoma of the hand

Osteoblastoma is a benign bone tumor with uncertain radiologic and typical histologic pattern that, in most cases, can be diagnosed without any problems. Usually, it is a solitary bone tumor. The case presented is a 9-year-old child with multiple osteoblastomas occurring in multiple bones of the right hand. The child had pain in his right hand for several weeks. On physical examination, no swelling or other symptoms were elicited. All lesions noted radiologically were treated by curettage, and in all the pattern of osteoblastoma was diagnosed. Received: 25 February 2000 Revision requested: 28 March 2000 Revision received: 7 June 2000 Accepted: 13 June 2000     

眼眶-中颅窝沟通性脑膜瘤手术颅底重建

目的 探讨经眶上裂沟通眼眶-中颅窝的脑膜瘤手术的颅底重建的方法.方法 总结我院自2007-01至2012-05采用眶-翼点入路显微手术治疗72例通过眶上裂沟通眼眶-中颅窝底的脑膜瘤患者的临床资料,对该类肿瘤颅底重建的方法进行分析.结果 颅底硬脑膜及骨缺损修补效果满意,肿瘤全切率为90.3％.术后无脑脊液漏、局部脑膨出、脑膜炎等并发症的发生;皮下积液12例.结论 对于该类颅眶沟通性脑膜瘤行眶-翼点入路显微手术是较好的手术方式,颅底重建是手术成功的关键之一.     

Sarcomatoid chordoma: chordoma with a massive malignant spindle-cell component

We report a case of chordoma containing a spindle cell sarcomatoid component with a gradual transition from conventional chordoma. Immunohistochemically, many tumor cells in both conventional chordoma and sarcomatoid components were positive for cytokeratins (AE1/AE3, CAM5.2) and epithelial membrane antigen as well as vimentin. This report provides a rare example of sarcomatoid chordoma. Familiarity with this type of bone tumor should help to avoid confusion with dedifferentiated chordoma and other spindle cell sarcomas or carcinomas. Received: 25 February 2000 Revision requested: 28 March 2000 Revision received: 30 May 2000 Accepted: 28 June 2000     

Severe toxic osteoblastoma of the humerus associated with diffuse periostitis of multiple bones

Toxic osteoblastoma is a rare variant of an uncommon primary bone tumour that has been described only once before in the world medical literature. It is characterised by systemic features including fever, weight loss and a striking diffuse periostitis in association with an osteoblastoma, resulting in delayed diagnosis. Early recognition of this condition could prevent inappropriate therapies and reduce morbidity. Received: 7 November 2000 Revision requested: 6 December 2000 Revision received: 9 March 2001 Accepted: 10 March 2001     

Multifocal osteogenic sarcoma in Paget’s disease

The most serious complication of Paget’s disease is sarcomatous degeneration of pagetic bone. Multifocal sarcomatous degeneration occurs mainly in polyostotic Paget’s disease. Multifocal Paget’s sarcoma is uncommon and can arise in any site. We report two cases of synchronous multifocal sarcomatous degeneration. The two patients were elderly women (aged 77 and 86 years, respectively) who developed sarcomatous lesions concomitantly, in the first case report in left ilium, left tibia, and first lumbar vertebra and in the second case report in the skull, right ilium, and sacrum. Whether these cases are due to the simultaneous development of several primaries or to metastases from a single primary remains unclear. Received: 3 August 1998 Revision requested: 14 September 1998 Revision received: 6 March 2000 Accepted: 14 March 2000     

侵袭性脑膜瘤的MRI表现

目的探讨侵袭性脑膜瘤的MRI表现。方法回顾性分析23例经手术病理证实的侵袭性脑膜瘤的MRI及临床表现。结果3例脑侵袭,肿瘤边界毛糙模糊,边界棘状突起及蘑菇征;15例硬脑膜侵犯,脑膜尾征明显延长大于3cm并结节状改变;12例蛛网膜侵犯,蛛网膜增厚,脑脊液-血管间隙消失;2例骨骼、肌肉受侵犯,颅骨内外板破坏,呈不规则异常信号,邻近肌肉隆起呈结节状。结论MRI可显示侵袭性脑膜瘤的侵袭性特点,为制定手术方案提供依据。     

Epithelioid hemangioma of bone

Epithelioid hemangioma of bone is a rare type of angiomatous tumor. We report a documented case of epithelioid hemangioma occurring in the distal femur of a 35-year-old man. The clinical, radiographic, MR imaging and histologic findings of the tumor are described. Radiographs showed a well-defined expanding, osteolytic lesion in the diaphysis of the femur. MR imaging showed the lesion to have low signal intensity on T1-weighted images and intermediate signal intensity on T2-weighted images. Grossly the lesion was multiloculated with a dark brown, jelly-like content. To characterize the imaging appearances of epithelioid hemangioma, we reviewed the available literature on the subject. Received: 14 February 2000 Revision requested: 28 March 2000 Revision received: 31 May 2000 Accepted: 1 June 2000     

The dural lucent line: characteristic sign of hyperostosing meningioma en plaque

Hyperostosis of the skull associated with en plaque form of meningioma may present a diagnostic challenge, since the intracranial part of the tumor is not visualized by skull radiography, computed tomography (CT), or other neuroradiologic methods. The authors report four cases of hyperostosing meningioma en plaque demonstrating a characteristic feature: a subdural layer of ossification along the hyperostotic bone with a dural lucent interface. Polytomography or high-resolution CT at bone window settings is necessary to identify the dural lucent line. The absence of this sign does not exclude meningioma en plaque.     

脑膜瘤的CT表现与病理对照研究

目的探讨脑膜瘤的CT表现与病理分型之间的关系。方法收集经CT诊断和手术病理证实的脑膜瘤12例,CT检查均采用增强前后常规扫描,病理为手术巨检和切片光镜下所见。结果典型脑膜瘤为过渡型或纤维母细胞型脑膜瘤,密度(信号)均匀,明显均匀强化,15%~20%伴有钙化,无或轻度瘤周水肿。不典型脑膜瘤以合胞体和血管母细胞瘤型脑膜瘤为主,密度(信号)不均匀,无或不均匀强化,瘤周水肿较重。恶性脑膜瘤为混杂密度(信号)肿块,强化不均匀,形状不规则,瘤周水肿明显,伴有骨质破坏。结论CT平扫 增强是诊断脑膜瘤的最主要方法,准确率为95%,在一定程度上可提示脑膜瘤的病理学分型,为术前选择手术方案及判定预后提供信息。     

Pasteurized intercalary autogenous bone graft: radiographic and scintigraphic features

Objective. Pasteurized autogenous bone graft sterilized at a low temperature (60°C) is one option for reconstruction after resection of bone and soft tissue tumors. The purpose of this investigation was to assess the normal and abnormal radiographic and scintigraphic findings of pasteurized intercalary autogenous bone graft after resection of bone and soft tissue sarcomas. Design. This was a retrospective evaluation of the radiography and bone scintigraphy findings in patients after treatment of bone and soft tissue sarcomas using an intercalary pasteurized autogenous bone graft. Patients. Among 10 consecutive patients, eight had intercalary grafts, and they constitute the subjects of this study. All available radiography and bone scintigraphy findings were reviewed for the healing process and the possibility of complications. Results and conclusions. Healing and incorporation of the graft were observed in five patients during the follow-up, but the other three did not heal satisfactorily. Rapid incorporation of pasteurized autogenous bone graft can be demonstrated by means of radiography and bone scintigraphy. Received: 21 December 1999 Revision requested: 16 February 2000 Revision received: 9 March 2000 Accepted: 14 March 2000     

Intraosseous glomus tumor of the fibula

Glomus tumor is a rare, benign vascular tumor and intraosseous glomus tumor, which arises primarily within bone, is even rarer. Fewer than 20 cases have been reported in the literature. We present the case of a 34-year-old woman with glomus tumor primarily in the midshaft of the fibula that radiologically mimicked chondromyxoid fibroma, aneurysmal bone cyst or adamantinoma, together with a review of other reported cases. Received: 5 July 2000 Revision requested: 10 August 2000 Revision received: 28 August 2000 Accepted: 28 August 2000     

Bilateral metachronous periosteal tibial amyloid tumors

Localized primary periosteal amyloid tumors are extremely rare. A case of bilateral tibial amyloid tumor is presented. A 62-year-old woman initially presented with a painful mass in the anterior aspect of the right leg. There was no evidence of underlying systemic disease, including chronic infection or malignancy. Based on the results of resistance with Congo red staining to treatment with potassium permanganate and positivity for kappa light chain, we classified this particular case as AL-type amyloidosis. The patient noticed a swelling in the opposite leg 2 years later. The second tumor was also an AL-type amyloidoma. Amyloid tumors are generally solitary. This is the first case of bilateral periosteal amyloid tumors of the AL-type occurring in the tibiae. Received: 10 November 1999 Revision requested: 15 November 1999 Revision received: 6 March 2000 Accepted: 9 March 2000     

De novo malignant transformation of giant cell tumor of bone

Two cases of malignant lesions are reported, both of which arose secondary to an originally benign giant cell tumor (GCT) of bone. The first case was a typical benign GCT, which occurred in the left proximal tibia of a 31-year-old woman. The tumor was treated by curettage and bone grafting. However, it recurred twice during 15 years of follow-up. The second recurrence showed that the lesion histologically had turned into malignant fibrous histiocytoma. The second case also started as an initially benign GCT that arose in the left distal femur of a 41-year-old man. The patient underwent curettage and bone grafting. The lesion recurred 13 years postoperatively. The histological appearance of the recurrent tumor showed it to be an osteogenic sarcoma. In both patients, radiation had never been given. Malignant transformation has rarely been reported in patients with GCT of bone who have not received radiation treatment. Received: 12 June 2000 Revision requested: 17 August 2000 Revision received: 13 October 2000 Accepted: 18 October 2000     

Ossification of the ligamentum flavum associated with osteoblastoma: a report of three cases

We report three cases of spinal osteoblastoma with ossification of the ligamentum flavum (OLF) adjacent to the tumor. The patients in this report, all young adults, had no symptoms except for back pain. Computed tomography (CT) demonstrated a typical radiolucent nidus in the spinal pedicle/lamina with a dense sclerotic rim. In addition, ectopic bone formation at the insertion point of the ligamentum flavum adjacent to the tumor was clearly illustrated. Magnetic resonance imaging (MRI) revealed the tumor and surrounding inflammatory responses, but OLF was not detected clearly. Histological examination revealed endochondral ossification of the ligamentum flavum that is quite unusual for normal young adults. Immunohistochemical assays in one case demonstrated that bone morphogenetic protein (BMP)-2/4 was expressed in the osteoblastic tumor cells. This case raises the possibility that BMPs secreted from the tumor cells triggered ectopic ossification in the spinal ligament. Received: 7 August 2000 Revision requested: 15 November 2000 Revision received: 15 December 2000 Accepted: 19 December 2000     

前颅凹底脑膜瘤的影像诊断与病理对照研究

目的:探讨前颅凹底脑膜瘤的影像学和病理组织学之间的关系.材料和方法:病理证实的前颅凹底脑膜瘤27例,男8例,女19例.年龄13～79岁,平均62岁.均行MRI检查(增强16例);15例行CT检查(增强8例).分析CT、MRI影像,并与手术病理对照.结果:27例前颅凹底脑膜瘤,起源于嗅沟15例,前颅凹底6例,眶顶4例,鞍结节向前生长2例.多数水肿明显,均匀增强;少数不均匀增强,并出现脑膜尾征,少数伴钙化、坏死、囊变和出血.累及邻近颅骨时引起骨质增生.结论:前颅凹底脑膜瘤具有典型的影像学表现.CT和MRI具有诊断价值,MRI优于CT ,但CT观察钙化和骨质改变优于MRI.     

Immunoglobulin D myeloma presenting as an extraosseous soft tissue tumor

We report a 69-year-old man who suffered an extraosseous tumor of immunoglobulin D myeloma (lambda type) in the shoulder girdle, mimicking a primary soft tissue sarcoma. The tumor was isointense with adjacent muscle on T1-weighted MR images, and hyperintense on T2-weighted images. No continuity with the neighboring bone was noted. After administration of gadolinium, the central part of the tumor showed marked contrast enhancement. Although the tumor showed a complete response to the initial chemotherapy, the patient died of the disease 31 months after its initial manifestation. Several bone marrow aspirations and biopsies of the ilium and sternum had shown no increase in plasma cells (range 0.6–1.2%) until the disease became advanced 19 months after its initial manifestation. Received: 1 September 2000 Revision requested: 9 October 2000 Revision received: 11 November 2000 Accepted: 15 November 2000     

Intra-osseous meningioma of the orbit: an unusual presentation (2007: 5b)

Primary calvarial or intra-osseous meningiomas are uncommon lesions often confused preoperatively with other primary or secondary bone tumors of the skull. We present details of a patient with a primary calvarial meningioma involving the frontal, zygomatic, sphenoid and temporal bones that was radiographically diagnosed as fibrous dysplasia and initially treated conservatively for many years. Progressive vision loss and significant proptosis, with difficulty of eye closure, prompted surgical removal with cranioplasty and a 3D reconstructed prosthetic flap. Histological examination revealed intra-osseous meningioma. The clinical and radiological findings of intra-osseous meningiomas are discussed, together with a review of the literature.     

Collagenous fibroma of the arm: a report of two cases

A recently proposed addition to fibrous tumors in soft tissue was first described as desmoplastic fibroblastoma and later renamed collagenous fibroma. This tumor is clinically and morphologically distinct and benign. However, only a few series have been reported, and the clinicopathologic features are not widely recognized. We present two cases of collagenous fibroma of the arm. Both patients presented with an enlarging, well-circumscribed and mobile soft tissue mass. Magnetic resonance imaging showed areas of low signal intensity on both T1- and T2-weighted sequences. Needle aspiration cytology revealed nondiagnostic samples because of the low cellularity of the tumors. Each of the resected tumors was composed of low-cellular spindle- to stellate-shaped cells in a fibrous matrix with clear margination. After the marginal excisions, no recurrences were observed. Clinicians should be aware of this entity to prevent overtreatment, because imaging findings and cytologic features are similar to those of desmoid tumor. Received: 15 December 1999 Revision requested: 12 January 2000 Revision received: 31 March 2000 Accepted: 17 March 2000     

Juxtacortical chondromyxoid fibroma arising in an apophysis

We present a rare case of juxtacortical chondromyxoid fibroma arising in the lesser trochanter of the right femur which corresponds to an apophysis. Radiography showed a well-defined expansive lesion with a sclerotic margin measuring 5×3.5 cm in diameter in the lesser trochanter. On spin echo T1-weighted images, the lesion revealed low signal intensity similar to muscle. On spin echo T2-weighted images, the lesion revealed high heterogeneous signal intensity, which after gadolinium injection showed heterogeneous enhancement. The inner margin of the cortex was intact and adjacent bone marrow was of normal signal intensity. The outer margin of the lesion was also clearly defined and extension into adjacent soft tissue beyond the exophytic cortical outgrowth was not evident. Received: 1 March 2000 Revision requested: 28 March 2000 Revision received: 1 May 2000 Accepted: 8 May 2000