骨巨细胞瘤生物学行为的相关因素分析

目的 探讨骨巨细胞瘤的组织发生以及与肿瘤复发、侵袭、恶变等生物学行为相关的因素.方法 从临床、影像学、手术方式、病理形态、免疫表达和随访结果等方面对2005至2011年间收集的123例骨巨细胞瘤进行分析和研究.结果 骨巨细胞瘤的术后复发率与术前骨巨细胞瘤的影像学分级(P=0.032)、CD147 (P=0.034)和p53(P =0.005)的过表达以及手术方式(P =0.048)有明显相关性,但与骨巨细胞瘤的髓内浸润、骨皮质浸润、骨旁软组织浸润、脉管内瘤栓、单核间质细胞的梭形变、核分裂象多少、Ki-67阳性指数、凝固性坏死、继发性动脉瘤样骨囊肿、出现反应性骨等形态学改变均缺乏明显相关性,骨巨细胞瘤中单核间质细胞p63阳性率(79.7％,94/118)明显高于软骨母细胞瘤(44.7％,21/47)、骨肉瘤(22.2％,10/45)等其他富于巨细胞的骨肿瘤.结论 骨巨细胞瘤是一种有低度恶性潜能的肿瘤,形态学特征难以预测其生物学行为.p63阳性、PGM-1阴性的单核间质细胞是其肿瘤成分,此种细胞p53的过表达以及骨巨细胞瘤各种细胞成分(包括反应性单核巨噬细胞和多核巨细胞)CD147的过表达与骨巨细胞瘤的侵袭、复发和恶变有关.术前根据骨巨细胞瘤的影像学分级选择合适的手术方式是减少复发最重要的因素.     

新疆单中心骨巨细胞瘤术后复发的相关因素分析

目的 分析新疆单中心骨巨细胞瘤术后复发情况及其危险因素。方法 回顾性分析2011年2月至2021年11月新疆医科大学附属肿瘤医院75例骨巨细胞瘤患者的临床资料。纳入可能影响术后复发的相关因素：性别、年龄、发生部位、是否病理性骨折、是否有软组织肿块、Campanacci分级情况、不同手术方式以及肿瘤长径是否≥4 cm。采用单因素及多因素分析骨巨细胞瘤术后复发的危险因素。结果 纳入75例骨巨细胞瘤患者中,男女比例为0.83∶1,发病高峰在30～39岁之间,其中有14例患者术后发生复发现象,复发时间为6～49个月,复发率为18.7%。Campanacci分级、不同手术方式及肿瘤长径是否≥4 cm与骨巨细胞瘤的复发有显著相关性（P<0.05）。多因素Cox分析显示肿瘤长径≥4 cm是骨巨细胞瘤术后复发的独立危险因素。结论 Campanacci分级、不同手术方式及肿瘤长径是否≥4 cm与骨巨细胞瘤术后复发有着密切的关系,其中肿瘤长径≥4 cm是骨巨细胞瘤术后复发的独立危险因素。临床上应严格把握不同手术的适应证,避免术后复发。     

硫化氢在骨巨细胞瘤中的检测及其在病情评估中的意义

目的检测骨巨细胞瘤组织硫化氢浓度并研究其临床意义。方法检测骨巨细胞瘤患者肿瘤组织和瘤旁正常组织硫化氢、胱硫醚合成酶(Cystathionine beta synthase,CBS)和胱硫醚裂解酶(Cystathionine gamma synthase,CSE)表达并比较其差异,分析骨巨细胞瘤患者硫化氢浓度与临床病理因素的关系。结果骨巨细胞瘤组织中硫化氢浓度、CBS和CSE的m RNA和蛋白质表达均显著高于瘤旁正常组织(0.05)。骨巨细胞瘤患者肿瘤组织中硫化氢浓度在性别、年龄和肿瘤部位中无明显差异(均0.05),在肿瘤最大径、Jaffe分级和Campanacci分级中差异均具有统计学意义(均0.001),肿瘤最大径越大、Jaffe分级越高及Campanacci分级越高硫化氢浓度越高。结论骨巨细胞瘤中硫化氢浓度显著升高,与临床病理因素密切相关,可能在骨巨细胞瘤病情评估中具有重要意义。     

移植腓骨中骨巨细胞瘤复发1例

患者女，32岁，因左桡骨远端瘤段切除术后2年，左腕部疼痛1月入院。患者2年前因左腕部疼痛，在外院X线片诊断为左桡骨远端骨巨细胞瘤，随后在外院臂丛麻醉下行左桡骨远端瘤段切除，自体右侧不带血供近段腓骨移植术。术后病理诊断为骨巨细胞瘤I级(图2a)。术后2年再次出现左腕部疼痛。X线片提示左侧再造桡骨远端骨巨细胞瘤，肿瘤生长于移植腓     

骨巨细胞瘤84例临床病理分析

报道84例骨巨细胞瘤(GCT),20～39岁患者占75%,95.2%位于长骨,其中膝关节附近占64.3%。X线表现为长骨骺端偏心位溶骨性病变。63例随访1～16年,33例复发(52.4%)。按照Jaffe病理分级,Ⅰ、Ⅱ、Ⅰ～Ⅱ和Ⅲ级的复发率各为66.7%、40%、44.4%和50%。Ⅰ～Ⅱ级和Ⅲ级肺转移各为2例和1例。结果表明分级与预后无明确关系。     

不典型部位软骨母细胞瘤

目的 探讨长骨骨骺和骨突以外不典型部位软骨母细胞瘤的临床、影像学和病理形态学特征,分析误诊原冈。方法 收集上海市5家大型综合性医院近12年内经病理证实的18例不典型部位软骨母细胞瘤的临床、X线和病理资料,作回顾性分析。肿瘤细胞的软骨分化倾向作S-100标记证实。结果18例中10例位于足部跗骨和小管状骨(55．6％),单骨发病最常见的是跟骨和距骨,平均发病年龄27．8岁,年龄＞25岁的成年人占55．6％。X线大多表现为膨胀性,多房性边界清楚的溶骨性骨质破坏。5例(28％)有局部骨皮质破坏,1例骨外软组织浸润,10例(55．6％)合并动脉瘤性骨囊肿或单纯性骨囊肿。术前临床无1例确诊,病理2例误诊,大多误诊为动脉瘤性骨囊肿或巨细胞瘤。结论 应综合考虑临床表现、X线特征以及病理形态改变进行不典型部位软骨母细胞瘤的诊断,避免误诊。     

胰腺破骨细胞样巨细胞瘤1例并文献复习

目的探讨胰腺破骨细胞样巨细胞瘤(osteoclast-like giant cells of tumor,OGCT)的临床病理特征、免疫表型、治疗及预后。方法回顾性分析1例胰腺OGCT的临床病理特征和免疫表型,并复习相关文献。结果 OGCT患者CT示胰体尾部囊实性包块,伴广泛出血坏死,由多种形态的单核细胞和破骨细胞样多核巨细胞构成。免疫表型:瘤细胞vimentin、CD68均阳性,CKpan、CEA均阴性,Ki-67增殖指数5%～10%。结论 OGCT属于胰腺罕见肿瘤,病理形态类似骨的巨细胞瘤;治疗以手术完整切除为主,分析其临床病理特征、治疗及预后,有助于提高对该肿瘤的认识水平。     

多排螺旋CT在诊断骨巨细胞瘤中的应用

目的探讨多排螺旋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扫描的原始轴住图像传至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CT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。     

骨的恶性巨细胞瘤临床病理观察

目的 探讨骨的恶性巨细胞瘤临床病理学特征及其诊断和鉴别诊断.方法 对13例恶性巨细胞瘤的临床及病理学资料进行回顾性分析.结果 13例恶性巨细胞瘤中原发性恶性巨细胞瘤6例,发病年龄21-71岁,平均年龄39.5岁.复发后继发性恶性巨细胞瘤7例,发病年龄27-52岁,平均年龄36.7岁.6例原发性恶性巨细胞瘤除可见到骨巨细胞瘤区域外,还可见到高度恶性的梭形细胞肉瘤区域,7例继发性恶性巨细胞瘤其原发性肿瘤均为骨巨细胞瘤,而复发性肿瘤则呈恶性纤维组织细胞瘤/未分化肉瘤形态.结论 诊断恶性巨细胞瘤时需将临床、影像及病理结合,并除外其他肉瘤如富含巨细胞的骨肉瘤、富含巨细胞的恶性纤维组织细胞瘤等.     

假体置换、植骨内固定及骨水泥填充治疗骨巨细胞瘤

背景：人工关节置换或同种异体骨内固定及骨组织替代材料填充是修复骨巨细胞瘤刮除后骨缺损的常见方式,那么哪一种更理想呢？ 目的：通过查阅关于骨巨细胞瘤治疗方面的中英文文献,了解骨巨细胞瘤的分期标准并比较以植骨内固定、骨水泥填充及假体置换为主的治疗方法。 方法：中国知网数据库输入中文检索词“肿瘤型假体,骨巨细胞瘤,植骨内固定,骨水泥”, Elesvier Science和Springer-Link 数据库输入英文检索词“giant cell tumor of bone、therapy 、tumor-type prosthesis”,纳入与骨巨细胞瘤人工假体置换、植骨内固定及骨水泥填充治疗骨巨细胞瘤的相关文献,共检索到346篇文献。保留26篇做进一步分析。 结果与结论：传统的骨巨细胞瘤治疗方法相对复发率较高,刮骨植骨时植骨量不一定能够充填满整个骨腔,骨水泥材料又不容易融合吸收,在众多治疗方法当中肿瘤型假体显示出了良好的效果,但尚有不足,而特制假体置换根据关节部位缺损需要能够个体化的治疗骨巨细胞瘤,是一种疗效可靠的手术方法,也是未来治疗骨巨细胞瘤的主要研究方向。     

Fine-needle aspiration diagnosis of giant cell tumour of bone presenting at unusual sites

Giant cell tumour (GCT) of bone is a distinctive neoplasm, which has only recently been included within the diagnostic purview of the cytopathologist. Four cases of GCT of bone diagnosed primarily and exclusively by fine needle aspiration cytology (FNAC), presenting at unusual sites, are presented with a view to highlight the cytomorphologic features of this tumour and its differential diagnosis on FNAC. Each of these cases were distinctive by virtue of their localisation, but presented as classical expansile osteolytic lesions roentgenologically. Despite the paucity of literature regarding the cytodiagnosis of these lesions, the authors nevertheless recommend FNAC as a primary tool in the diagnosis of these lesions.     

Secondary malignant giant cell tumour of bone--a study of five cases with short review of literature

Secondary malignant giant cell tumour of bone occurs as a result of previous attempts at local control of a benign giant cell tumour of bone (GCT). Out of the total 445 conventional benign GCT of bone, therapeutic irradiation was given in 39 cases as the lesions were located in the vertebrae and pelvic bones where debulking surgery was not possible and the tumours were pressing on the spinal cord. The patients were followed up for 21 years. Out of 39 cases, 5 patients developed sarcomas of which 3 were fibrosarcomas, 1 was malignant fibrous histiocytoma while 1 was an osteosarcoma. All the patients developing post-radiation sarcomas died within a few months due to lung metastasis. In conclusion, all the patients with benign GCT of bone treated with radiation must be followed life long as they are prone to develop sarcomas.     

囊内刮除术与瘤段切除术治疗肱骨近端骨巨细胞瘤的多中心回顾性研究

目的 探讨肱骨近端骨巨细胞瘤不同手术方式治疗的疗效,分析肿瘤复发及影响肩关节功能的危险因素。方法 采用回顾性病例对照方法。纳入2002年1月—2015年6月内蒙古医科大学第二附属医院、中国人民解放军第九六○医院、天津医院、河北医科大学附属第三医院等4个骨肿瘤治疗中心临床资料完整、初次接受手术治疗、随访时间超过36个月的27例肱骨近端骨巨细胞瘤患者,其中男15例,女12例;首诊时年龄18~55 (33.1±12.2)岁。Campanacci分级 Ⅱ级17例,Ⅲ级10例。其中17例发生病理性骨折,14例合并移位,3例有骨折线、无移位。14例采用囊内刮除术治疗,其中3例刮除、11例切刮;骨缺损采用自体植骨2例、自体加异体植骨1例,异体骨植骨3例,骨水泥填充8例,其中10例患者采用钢板螺钉内固定。13例采用瘤段切除肩关节重建术治疗,其中半肩关节置换10例,大段异体骨关节移植髓内钉固定3例。术后定期随访。末次随访时,采用国际骨与软组织肿瘤协会(MSTS)评分标准评估不同手术方式患者术后肩关节功能。应用SPSS 22.0统计学软件进行数据分析,比较不同手术方式之间复发和并发症发生率、上肢MSTS评分,对手术方式选择的影响因素和肿瘤复发危险因素进行单因素分析。结果 患者术后均获随访36～180 (92.4±38.9)个月。刮除术和瘤段切除术中各有1例局部复发,复发率为1/14和2/13(P=1.000)。4例瘤段切除患者术后发生并发症,总的并发症发生率14.8%(4/27),其中2例大段异体骨吸收(1例伴肿瘤复发)行半肩关节置换术,1例半肩关节置换后肩关节半脱位,1例术后5年假体松动外露再次手术更换骨水泥型假体进行翻修;囊内刮除术的并发症发生率低于瘤段切除术,差异有统计学意义(P=0.041)。有无病理性骨折与手术治疗方案的选择无相关性(r=-0.037, P=1.000),Campanacci分级与手术治疗方案的选择有相关性 (r=0.482, P＜0.05);有无病理性骨折、不同Campanacci分级、不同手术方式的患者局部复发率差异均无统计学意义(P值均＞0.05);刮除术术后肩关节功能明显优于瘤段切除术(P＜0.01)。结论 肱骨近端骨巨细胞瘤相比较于其他部位容易发生病理性骨折,采用刮除术或瘤段切除术后复发率较低,刮除术后肩关节功能明显优于瘤段切除。由于瘤段切除术后并发症的发生率较高,尤其是瘤段切除大段异体骨关节移植后骨吸收等问题,建议尽可能地选择囊内刮除手术作为肱骨近端骨巨细胞瘤的治疗方案。     

骨巨细胞瘤TIMP-3启动子甲基化的研究

目的 检测骨巨细胞瘤(GCT)中TIMP—3启动子甲基化及其蛋白表达，探讨该肿瘤组织TIMP—3蛋白表达缺失的原因和TIMP-3启动子甲基化与GCT分级和复发的关系。方法 用免疫组织化学SP法和蛋白免疫印迹检测TIMP—3在GCT组织中的表达，用甲基化特异的PCR(MSP)法检测TIMP—3基因启动子的甲基化状态。结果 TIMP—3主要在单核基质细胞和多核巨细胞的胞质表达，后者的表达具有明显的极向性。17例GCT中有5例(29．4％)TIMP—3蛋白丢失，其中4例的TIMP—3启动子发生异常甲基化，且均为组织学分级为Ⅱ级的病例。结论 GCT的局部骨质破坏，可能与TIMP—3丢失有关；而TIMP—3启动子的异常甲基化，是TIMP—3基因失活和蛋白丢失的重要机制。     

Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification

Sassa N, Tsuzuki T, Fukatsu A, Majima T, Kimura T, Nishikimi T, Yoshino Y, Hattori R & Gotoh M (2012) Histopathology 61 , 620–628 Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification Aims: The prognosis of urothelial carcinoma of the renal pelvis (UCRP) is heterogeneous, especially in pT3 patients. The degree of tumour parenchymal invasion is not considered for pathological tumour (pT) staging. The aim of this study was to investigate whether quantitative assessment of invasion provides a better estimation of prognosis for UCRP in pT3 patients. Methods and results: We reclassified pT3 cases into two subcategories: pT3a, in which UCRP extended only into the renal medulla; and pT3b, in which UCRP extended into the renal cortex and/or in which UCRP exhibited peripelvic fat invasion. We examined our proposed pT classification and other pathological parameters, including necrosis, lymph–vascular invasion (LVI), 1973 World Health Organization (WHO) grading, WHO/International Society of Urological Pathology grading, adjuvant chemotherapy, and pathological lymph node metastasis (pN). The study included 275 patients. Among 96 patients with pT3, there was a statistically significant difference between the pT3a and pT3b subcategories in cancer‐specific survival (P < 0.001). Our proposed pT classification, as well as necrosis, LVI, 1973 WHO grading, and pN, demonstrated prognostic differences in univariate analysis, whereas in multivariate analysis, only our proposed classification (P = 0.008) and pN (P = 0.002) were statistically significant. Conclusions: The pT3b subcategories should be regarded as true pT3, having the established features of that stage, whereas pT3a has a better prognosis.     

Giant-cell tumor of bone,stage II,displaying translocation t(12;19)(q13;q13)

Summary A new case of giant-cell tumour (GCT) of bone with benign histological features, clinical stage II, has been reviewed with immunohistochemistry and electron microscopy. After short-term tissue culture the karyotype, using G-banding techniques, presented a consistent translocation t(12;19)(q13;q13). Nude mice xenografts of the tumour were unsuccessful after 6 months of follow-up. Presence of such chromosomal rearrangement may be related to locally aggressive, histologically benign giant-cell tumors of bone.Supported by Grant N. 88/0146 of the FIS, Madrid     

Granular cell tumour of the colon with extensive sclerosis

Granular cell tumour (GCT) is a rare, usually benign, mesenchymal lesion that can occur in nearly any organ, but has a proclivity for the oral cavity, skin and subcutaneous tissue. They occasionally arise in the gastrointestinal tract (GIT) where the oesophagus is most commonly involved. Occurrence in the colorectum is unusual. We report a case of a 73 year-old man with an incidentally discovered GCT with extensive sclerosis in the caecum. Microscopically, a well-circumscribed, paucicellular nodule was identified in the submucosa with prominent hyalinisation and focal myxoid change. Scattered, finely granular cells expressing S100, inhibin and calretinin were identified. CD117 and DOG-1 were negative. This case was made challenging by the prominent sclerosis with only focally visible granular cells, however, the overall features were those of a GCT of the colon. We highlight the morphological and immunohistochemical features of this rare entity in the colon, and discuss the differential diagnosis. In this era where incidental polyps and submucosal lesions are increasingly being detected by endoscopy, knowledge and recognition of GCT in the colon is important as they are generally benign with a good prognosis following complete excision.     

Expression of CD147, PCNA,VEGF, MMPs and their clinical significance in the giant cell tumor of bones

Background: Giant cell tumor of bone (GCT) is a potentially malignant tumor. CD147 is a multifunctional protein, which expresses itself in many tumors. In this study, we have investigated the correlation between CD147 and PCNA, VEGF, MMPs expression in giant cell tumor of bones. We have also explored the relationship between its clinical pathology and prognosis. Results: A significant difference of the expression level of CD147, MMPs was found in cases of GCT with Jaffe grading and prognosis (P<0.05). But, it was not in accordance with the patient’s age and sex. An expression of CD147 was positively correlated with MMP-9, VEGF, MVD, PCNA (r=0.271, P=0.025; r=0.411, P=0.000; r=0.872, P=0.000; r=0.394, P=0.001). Conclusion: The expression level of CD147 in giant cell tumors of bones is correlated with the development of cancers and relapse. There was a positive correlation between expressions of CD147 and MMP-9, VEGF, MVD, PCNA, and CD147. This is an important indicator in evaluating the malignant degree and prognosis of giant cell tumors of bone. It may be the new target for ensuring chemopreventive strategies.     

Oestrogen receptors in human breast cancer

Summary Histopathological factors which might explain inconsistency in published data attempting to correlate oestrogen receptor content (ER) and pathological features in primary breast tumours have been investigated in 194 cases. It was found, that unequal assessment of tumour type and of histological grading between observers is one important factor. In terms of grading, however, heterogeneity of growth pattern within the same tumour seems to be of greater significance. No significant correlation was found between histological type of tumour and ER content. However, a trend towards a correlation between the extent of tubule formation (as an indication of differentiation) and ER content was observed.Sponsored by The Danish Cancer Society     

四肢骨巨细胞瘤的外科治疗分析

目的 探讨四肢骨巨细胞瘤(GCT)的外科治疗方法及其临床疗效,评估影响复发的因素及辅助治疗的必要性。方法 回顾性分析2004年1月—2017年1月西安交通大学医学院附属红会医院骨病肿瘤科收治的154例四肢GCT患者的临床资料。其中男79例,女75例;年龄16～68岁。Campanacci影像学分级:Ⅰ级16例,Ⅱ级106例,Ⅲ级32例。Enneking外科分期:1期56例、2期61例、3期37例。根据患者年龄、GTC病灶部位、Campanacci影像学分级、Enneking外科分期采用不同手术方式,其中病灶刮除+植骨/骨水泥填充(A组)64例、病灶刮除+辅助治疗+植骨/骨水泥填充(B组) 48例、病灶段切除+缺损部位重建(C组)42例。观察患者术后骨愈合情况,并发症发生情况。定期复查X线片,观察病灶转移、复发情况。术后6个月根据骨骼肌肉系统肿瘤协会(MSTS)制定术后重建功能评定标准评定临床疗效。采用χ²检验分析GCT术后复发情况。结果 所有患者手术顺利完成,术后伤口一期愈合,围手术期未出现异常及手术相关并发症。手术时间80～240 min,平均130 min;术中出血量150～800 mL,平均350 mL。154例患者随访10～84个月,平均40个月。术后随访X线片示植骨病例均融合,融合时间4～8个月,平均6个月。随访期间未发现内植物松动、断裂以及内植物周围感染等相关并发症,未发现肺转移者。局部复发16例(10.4%,16/154),复发时间为术后6～36个月,平均18个月。A组复发率10.9%(7/64),B组复发率10.4%(5/48),C组患者复发率9.5%(4/42)。不同性别、年龄段、肿瘤部位、Campanacci影像学分级、Enneking外科分期的患者术后局部复发率差异均无统计学意义(P值均＞0.05);采用辅助治疗的B组与无辅助治疗A组比较,术后复发率差异无统计学意义(χ²=0.008, P＞0.05)。术后6个月按MSTS术后重建功能评定标准评定疗效:优84例,良43例,中19例,差8例,满意率94.8%(146/154)。结论 根据Enneking外科分期以及Campanacci影像学分级选择合适手术方式治疗四肢GCT能够获得满意的疗效。患者性别、年龄、肿瘤部位、Campanacci影像学分级、Enneking外科分期及手术方式不能准确预测GCT患者术后病灶是否复发,术中辅助治疗的必要性有待进一步证实。