人工全肩胛骨半关节置换术治疗肩胛骨软骨肉瘤

本文报告在全肩胛骨切除后,用自行设计的人工半关节全肩胛骨置换术治疗肩胛骨软骨肉瘤的1例病人,保留了病人的上肢。术后10个月无局部复发,外形近似术前,肩关节稳定无脱位情况,肩关节活动,外展可达80°,前屈45°,后伸40°。并详细介绍假体半关节的设计特点和手术操作要点,和其它手术方法加以比较,认为本方法设计合理,效果良好,具有实用性和优越性,值得推荐。     

肩胛骨巨大软骨肉瘤一例报告

软骨肉瘤是常见的恶性骨肿瘤,占所有原发骨骼肉瘤的10%～25%,肿瘤细胞源自软骨而不是骨样组织。在大宗病例统计中,长管状骨是软骨肉瘤的好发部位,约占全部病例的45%,而肩胛骨是发病较少的部位,约占5%[1]。我院于2007     

间叶性软骨肉瘤的外科治疗及预后分析

  目的  通过研究在本中心治疗的27例间叶性软骨肉瘤患者的临床资料,总结其临床特点,治疗及预后情况,探讨间叶性软骨肉瘤临床治疗的合理方案。  方法  自1997年10月至2011年3月,本院骨肿瘤科共治疗了27例间叶性软骨肉瘤的患者,并对随访的临床资料进行了回顾性研究和统计学相关分析。  结果  在27例间叶性软骨肉瘤中,包括男性患者9例,女性患者18例,平均年龄30.4岁（14~51岁）。平均随访时间42.6个月（6~104个月）。其中22例为骨来源,5例为软组织来源。除2例患者外,其余25例患者均接受了手术治疗,但其中只有17例达到了广泛性切除的外科边界。16例患者接受了辅助化疗;13例患者接受了局部放疗。随访术后3年和5年的总体生存率分别为65.0%和49.5%。  结论  间叶性软骨肉瘤是一种少见的骨与软组织的恶性肿瘤,易于出现远期的局部复发和远处转移。对于间叶性软骨肉瘤的治疗需要制定标准化的治疗方案,目前认为外科手术是否能达到广泛切除的外科边界是肿瘤治疗的金标准,辅助化疗及局部放疗是否能够有效控制肿瘤的局部复发和转移,仍需得到进一步确认。      

去分化软骨肉瘤的诊断及治疗进展*

去分化软骨肉瘤（DDCS）约占所有软骨肉瘤的10% ,预后极差,5 年生存率不到10% 。好发于股骨、肱骨和骨盆。DDCS是软骨肉瘤中的一个独特类型。典型的特点是分化良好的软骨样成分和高度恶性的间充质细胞来源的肉瘤成分并存、毗邻。DDCS的诊断非常复杂,需要详细的影像学和病理学检查及准确的活检。DDCS去分化成分可以是骨肉瘤、恶性纤维组织细胞瘤,甚至是任何级别的未分化肉瘤成分。约1/3 的X 光片,1/3 的MR,一多半的CT扫描,DDCS表现为典型的“双态”征。最近利用微阵列- 比较基因组杂交技术,发现反复发生的5q14.2~q21.3,6q16~q25.3,9p24.2~q12和9p21.3。染色体缺失更多见于高度恶性的软骨肉瘤（3 级和DDCS）,该差异具有统计学意义。9 号染色体的缺失是DDCS最常见的染色体缺失。早期研究发现DDCS的去分化成分有p53和p53杂合性的丢失现象,进一步研究发现同时伴随Rb基因杂合性的丢失。DDCS的两种成分可出现p16INK 4,FHIT和E-cadherin（上皮型钙黏附蛋白）甲基化的异常。手术切除包括合适足够的外科切缘或根治性的切除,是目前DDCS最主要的治疗手段。化疗效果目前仍然不确定。最近针对软骨肉瘤（包括DDCS）发现了一些新的药物靶标,有些已经进入临床Ⅱ期试验阶段,其中包括Apomab、Perifosine （哌立福新）、Dasatinib（达沙替尼）和多烯紫杉醇联合吉西他滨的联合化疗。同时几个Ⅰ期药物临床试验报告针对DDCS新的有效药物,如组蛋白去乙酰酶抑制剂和血管内皮生长因子反义寡合甘酸。DDCS患者预后极差,预后主要由DDCS中的去分化成分决定。因此,早期诊断、早手术对改善患者的预后非常关键。      

肩胛骨肿瘤切除3D打印聚醚醚酮个性化定制假体重建五例报告

目的 探讨3D打印聚醚醚酮(polyetherether-ketone,PEEK)个性化定制假体在肩胛骨肿瘤切除重建中的应用价值和效果.方法 回顾性分析2017年1月至2019年10月,收治的5例肩胛骨肿瘤切除重建患者,其中我院4例,新疆医科大学附属医院1例,男2例,女3例;左侧3例,右侧2例;年龄16～64岁,平均3...     

软骨肉瘤的诊疗进展

软骨肉瘤是一种起源于软骨的恶性间充质肿瘤,是继骨肉瘤之后第二高发骨恶性肿瘤,好发于中青年。常见病变部位为中轴骨、骨盆和近端长骨,其不同的病理分型决定不同的治疗方法。本文旨在回顾软骨肉瘤相关文献,强调其早期诊断的重要性以便采取合适的治疗手段来改善预后。     

颅内间叶性软骨肉瘤1例报告并文献复习

颅内间叶性软骨肉瘤(intracranial mesenchymal chondro-sarcoma,IMC)最早由DAHLIN 和HENDERSON 在1962 年报道[1].它是一种罕见的恶性肿瘤,占颅内原发肿瘤的比例不到1％[2],其发病机制尚不清楚.目前,没有明确的手术和治疗指南,也很少有关于IMC患者的临床管...     

软骨肉瘤的影像学分析

目的分析软骨肉瘤X线、CT、MRI的影像学表现,评价不同影像学诊断方法的价值。方法回顾性分析经病理证实的25例软骨肉瘤的影像学特点。25例均行X线平片检查,其中21例行CT检查,13例行MRI检查。结果全部病例X线均显示骨质破坏,显示钙化或骨化21例,显示软组织肿块14例;CT显示钙化或骨化19例,显示软组织肿块17例;13例MRI均可显示病变范围及软组织肿块。结论通过影像学检查,大部分软骨肉瘤术前能够正确诊断;CT较X线平片能更好地显示病变结构、钙化、骨化及邻近软组织的改变;MRI能够精确显示病变的范围。     

透明细胞软骨肉瘤的临床、放射学及病理学特征

目的探讨透明细胞软骨肉瘤(Clear cell chondrosarcoma, CCCS)的临床、放射学、病理学特征及其预后。方法 报道1例股骨近端CCCS, 行HE和免疫组化染色, 结合文献对该病的临床表现、放射学改变、病理形态特点及预后进行探讨。结果 MRI示右股骨头4.8cm×4.5cm×4.2cm类圆形肿块, 边界清楚的溶骨性缺损, 其间可见少许钙化点, 在T1WI上呈低信号, 在T2WI上呈明显高信号, 皮质未见明显破坏, 无骨膜反应, 邻近未见明显软组织肿块。镜下见软骨样区域, 软骨样细胞胞质透明, 伴软骨骨化和钙化, 以及反应性新骨形成, 间质出血伴纤维组织增生形成囊壁结构。免疫组织化学示瘤细胞呈S-100阳性。文献报道该病呈低度恶性, 有局部侵袭性, 可复发, 但转移少见。鉴别诊断包括软骨母细胞瘤、动脉瘤样骨囊肿、普通型软骨肉瘤、毛细血管扩张型骨肉瘤等。结论 CCCS是罕见的低度恶性软骨肉瘤, 具有独特的临床、影像学和病理学特征, 易误诊为软骨母细胞瘤、动脉瘤样骨囊肿、普通型软骨肉瘤、毛细血管扩张型骨肉瘤等。     

Association of Metastasis with Clinicopathological Data in Mexican Patients with Osteosarcoma,Giant Cell Tumor of Bone and Chondrosarcoma

Background: Bone tumors are neoplasias with a high overall mortality; one of the main factors that reduce survival is their high capacity to develop metastases. It has been reported that finding lung metastases at diagnosis of osteosarcoma (OS), chondrosarcoma (CS) and giant cell tumor of bone (GCTb) is quite common. In this study, we inquire the relationship of metastases caused by these tumors with different clinical and pathological aspects, in order to guide medical personnel in the diagnosis and opportune treatment of metastases or micro metastases. Materials and Methods: We collected data of 384 patients with clinical, radiological and histopathological diagnosis of OS, GCTb and CS that attended the National Rehabilitation Institute (INR) during 2006 to 2014. Chi-square and Fisher’s exact tests were performed for data analysis. Results: In the three tumor types, the presence of metastases at diagnosis was variable (p=0.0001). Frequency of metastases was 36.7%, 31.7% and 13.2% for OS, CS and GCTb respectively. The average age had no significant difference (p>0.05) in relation to metastases, even so, patients with OS and GCTb and metastases, were older while patients with CS and metastases were younger, in comparison to patients without metastases. Males had a higher frequency of metastases (68.2%, p = 0.09) in contrast to CS and GCTb, in which the metastases was more frequent in women with 51.9% (p = 0.44) and 57.9% (p = 0.56) respectively. Broadly, metastasis was associated with primary tumors located in the femur (44.4%), followed by the tibia (15.6%); metastases was more frequent when primary tumor of GCTb and OS were in the same bones, but were located in the hip (26.3%) for CS. Conclusions: The frequency of metastases in OS, GCTb and CS is high in our population and is determined by different clinicopathological variables related to the kind of tumor. Further studies are needed in order to evaluate metastases subsequent to diagnosis and associations with survival and clinicopathological factors , as well as to determine the sensitivity and specificity of current methods of detection.     

Periosteal chondrosarcoma: A case series in a referral center with survivorship analysis

BackgroundPeriosteal chondrosarcomas are among the rarest types of chondrosarcomas dealt with in few small series of cases. In this study, we aimed to present our experience with this chondrosarcoma, seek for prognostic factors for OS and DFS and survey the status of IDH1 and IDH2.Results55 periosteal chondrosarcomas were retrospectively identified. Median age was 37 years, there was a male predominance (62%). The great majority of cases involved the metaphysis of long bones of the extremities. The median size of the tumors was 7.5 cm. Thirty patients underwent to subtotal surgical resection, 22 to tangential resection and the remaining 3 to amputation. The margins, reported in 54 cases, were wide/radical in 38 patients (70.4%), marginal in 9 (16.7%) and intralesional in 7 (12.9%). Histologically, 23 (42%) were grade 1; 27 (49%), grade 2; 3 (5%), grade 3 and 2 (4%) were dedifferentiated.A third of cases in which mutational analysis was feasible harbored heterozygous mutations in codon 132 of IDH1. Fifty-four cases were included for follow-up (median, 137 months). Four patients had local recurrences and six patients developed metastasis to the lungs. All patients that developed metastasis died of disease, two died of unrelated causes and 46 were alive without disease. OS and DFS was not found to be statistically associated with clinical and pathological parameters considered.Conclusionsperiosteal chondrosarcomas exhibit a low-grade behavior that can be adequately treated with marginal excisions. Clinical and morphologic parameters do not seem to predict their outcome.     

病灶残腔灭活治疗软骨肉瘤的近远期效果分析

目的 探讨病灶残腔灭活治疗软骨肉瘤的近远期效果.方法 收治软骨肉瘤患者72例,根据治疗方法的不同分为观察组与对照组各36例,对照组采用手术治疗,观察组采用病灶残腔灭活治疗,观察与记录两组的近远期预后.结果 对照组平均手术时间为(290.42±56.24)min,出血量为(1622.94±451.92) ml;而观察组平均手术时间为(182.44±44.92) min,出血量为(432.11±111.84)ml,观察组均明显低于对照组(P＜0.05).观察组术后3个月的深部感染、深静脉血栓、血肿、皮缘坏死等并发症发生率为8.3％,对照组为36.1％,观察组明显低于对照组(P＜0.05).观察组与对照组术后3个月的肢体功能优良率分别为36.1％和8.3％,观察组的优良率明显高于对照组(P＜0.05).随访至今,观察组与对照组的中位生存时间分别为(78.24±11.48)个月和(59.24±10.42)个月,观察组的中位生存时间明显长于对照组(P＜0.05).结论 病灶残腔灭活治疗软骨肉瘤具有很好的微创性,在近期能提高肢体功能,降低并发症的预防,在远期能延长患者的生存时间,有很好的应用价值.     

进展期直肠癌侵犯邻近脏器手术治疗184例分析

目的：探讨直肠癌侵犯邻近脏器手术切除的疗效。方法：回顾性分析我院1974年至1998手术治疗184例直肠癌侵犯邻近脏器临床资料,根治性切除124例,姑息性切除42例,单纯结肠造瘘18例。结果：术后总的1、3和5年生存率分别为85．9％、64．4％和47．9％。其中根治性切除组1、3和5年生存率分别为93．4％、80．7％和63．7％;姑息性切除组为71．7％、42．8％和25．0％;单纯造瘘组为62．5％、30．0％和12．0％。根治性切除组5年生存率显高于姑息性切除和造瘘组（P＜0．05）。结论：对直肠癌侵犯邻脏器的患,只要没有肝脏弥漫性转移、腹膜肿植和淋巴结广泛转移等不能治愈的因素,都应将直肠癌和受侵犯脏器一并切除,以达到根治的目的;对有不能治愈因素存在,则应急取切除直肠癌原发灶,术后辅以化疗和放疗,以提高生存质量和延长生存期。     

Cell Density-Dependent Proliferative Effects of Transforming Growth Factor (TGF)-β1, β2, and β3 in Human Chondrosarcoma Cells HCS-2/8 Are Associated with Changes in the Expression of TGF-β Receptor Type I

In this study, the growth properties of the human chondrosarcoma cell line HCS- 2/8, its response to transforming growth factor (TGF)-β isoforms 1, 2, and 3, and its expression of TGF-β receptors I and II were examined. We demonstrated that these tumor cells are not contact-inhibited and that they can proliferate in the absence of additional serum growth factors. In sparse cultures, all TGF-β forms inhibited the growth of HCS-2/8 cells, whereas they induced a 2-fold increase of DNA synthesis in serum-fed confluent cultures. In serum-free confluent conditions only TGF-β1 stimulated the proliferation rate, whereas TGF-β2 was without effect and TGF-β3 was rather inhibitory. This bimodal effect of TGF-β forms was associated with a greater level of TGF-β receptor I mRNA in confluent HCS-2/8 than in sparse cultures, suggesting that the growth response to TGF-β forms is dependent on the receptor profile expressed.     

Tumour Volume and Dose Influence Outcome after Surgery and High-dose Photon Radiotherapy for Chordoma and Chondrosarcoma of the Skull Base and Spine

AimsTo evaluate the long-term outcomes of patients with chordoma and low-grade chondrosarcoma after surgery and high-dose radiotherapy.Materials and methodsHigh-dose photon radiotherapy was delivered to 28 patients at the Neuro-oncology Unit at Addenbrooke's Hospital (Cambridge, UK) between 1996 and 2016. Twenty-four patients were treated with curative intent, 17 with chordoma, seven with low-grade chondrosarcoma, with a median dose of 65 Gy (range 65–70 Gy). Local control and survival rates were calculated using the Kaplan–Meier method.ResultsThe median follow-up was 83 months (range 7–205 months). The 5 year disease-specific survival for chordoma patients treated with radical intent was 85%; the local control rate was 74%. The 5 year disease-specific survival for chondrosarcoma patients treated with radical intent was 100%; the local control rate was 83%. The mean planning target volume (PTV) was 274.6 ml (median 124.7 ml). A PTV of 110 ml or less was a good predictor of local control, with 100% sensitivity and 63% specificity. For patients treated with radical intent, this threshold of 110 ml or less for the PTV revealed a statistically significant difference when comparing local control with disease recurrence (P = 0.019, Fisher's exact test). Our data also suggest that the probability of disease control may be partly related to both target volume and radiotherapy dose.ConclusionOur results show that refined high-dose photon radiotherapy, following tumour resection by a specialist surgical team, is effective in the long-term control of chordoma and low-grade chondrosarcoma, even in the presence of metal reconstruction. The results presented here will provide a useful source for comparison between high-dose photon therapy and proton beam therapy in a UK setting, in order to establish best practice for the management of chordoma and low-grade chondrosarcoma.     

33例局部晚期肺癌扩大切除手术预后的临床分析

目的：分析局部晚期非小细胞肺癌扩大切除手术的预后．探索其合理的手术适应证。方法：对33例扩大切除的NSCLC患者进行随访并回顾性研究。Kaplan—meier法计算生存率，Cox回归计算风险比率〈HR）、判定预后因素。结果：5例患者发生严重的围手术期并发症（15．2％），2例患者因并发症死亡（6．1％）。1、3年生存率分别为60．6％和17．7％，中位生存期15个月。N2患者中位生存期为13个月，N0-1患者为24个月（P〈0.05）。Cox回归分析显示，腺癌（HR=2．5）和N2（HR=2．9）是独立的预后因素。结论：扩大切除手术是对局部晚期NSCLC可选择的治疗手段之一，但是鉴于手术危险性大、并发症严重，对其手术适应证应谨慎选择。由于预后不良，对腺癌和N2患者不宜首选扩大切除手术．