Bone tumors

骨肿瘤
  • 文章类型: Case Reports
    软骨肉瘤是第三大最常见的原发性恶性骨肿瘤。肱骨近端是最常见的部位。因为它对化疗和放疗有抵抗力,治疗的主要手段是手术。由于长骨的广泛参与,它需要用假体植入物或植骨重建。我们介绍了一例43岁的女性,其表现为涉及15厘米肱骨的软骨肉瘤。对患者进行了15厘米的肱骨切除,并在高压灭菌后用相同的切除骨进行了重建。通过长时间固定固定固定,从而导致盂肱关节的关节固定术。对患者进行了一年的随访,并通过超声和计算机断层扫描(CT)扫描发现了愈伤组织形成的证据。
    Chondrosarcoma is the third most common primary malignant bone tumor. The proximal humerus is the most common site. Since it is resistant to chemotherapy and radiotherapy, the mainstay of treatment is surgery. Due to the extensive involvement of long bones, it requires reconstruction with either a prosthetic implant or bone graft. We present a case of a 43-year-old female who presented with chondrosarcoma involving 15 cm of humerus. The patient was managed with the resection of 15 cm of humerus and reconstruction with the same resected bone after autoclaving. It was secured with long fixation resulting in arthrodesis of the glenohumeral joint. The patient was followed for one year and there was evidence of callus formation by ultrasound and computed tomography (CT) scan.
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  • 文章类型: Case Reports
    上皮样血管瘤(EH),一种罕见的良性肿瘤,在医学文献中只有少数案例有记载。上皮样血管瘤的并发症取决于其表现的部位。如果位于眼睛,上皮样血管瘤可能导致弱视;在喉部,它们会导致呼吸问题;如果影响骨骼,它们会导致溶骨性病变。这里,我们介绍了一例40岁男性,他在右锁骨内侧端出现肿胀。经过临床评估和计算机断层扫描,进行了切除活检.切除的病变测量为3x2.5cm,组织病理学检查证实该发现为上皮样血管瘤。
    Epithelioid hemangioma (EH), a rare benign tumor, is documented in only a few cases in the medical literature. The complications of epithelioid hemangioma depend on the site of their presentation. If located in the eye, epithelioid hemangiomas may lead to amblyopia; in the larynx, they can cause respiratory issues; and if affecting bone, they can result in osteolytic lesions. Here, we present a case of a 40-year-old male who presented with swelling in the medial end of the right clavicle. Following clinical evaluation and a computed tomography scan, an excision biopsy was performed. The excised lesion measured 3 x 2.5 cm, and histopathological examination confirmed the finding as an epithelioid hemangioma.
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  • 文章类型: Journal Article
    背景:原发性恶性骨肿瘤最常见的是与残缺的外科手术程序有关,这些手术程序可能会严重干扰年轻患者的运动发育,并且经常与主要的术后并发症有关。不幸的是,尽管有可用的自体组织供体部位,人工材料仍然最常用于切除后缺损的重建。重建显微外科手术越来越被认为是一种有效的功能重建方法,创造了进行保肢手术(LSS)的可能性,同时显着限制了主要的术后并发症。方法:研究组包括9例诊断为四肢原发性恶性骨肿瘤的小儿患者。为了进行微血管重建,9个游离腓骨皮瓣与同种异体骨移植(Capanna方法)结合使用。根据MSTS(肌肉骨骼肿瘤协会评分系统)量表评估重建的功能结果。结果:所提出的分析证明了这种重建程序的有效性,以及在适当的患者资格后以合理的功能结果进行LSS的可能性。在这项研究中,包括所有肢体都幸免。在所有情况下,获得了R0手术切缘,随访期间未报告局部复发.MSTS量表的平均得分为27/30分。结论:微血管重建手术是治疗四肢原发性骨肿瘤患者的个性化和高度有效的方法,并提供令人满意的功能结果。
    Background: Primary malignant bone tumors are most commonly associated with mutilating surgical procedures that can significantly disturb the motor development of a young patient and are frequently affiliated with major postoperative complications. Unfortunately, despite available autologous tissue donor sites, artificial materials are still most commonly used for the reconstruction of post-resection defects. Reconstructive microsurgery is increasingly recognized as an effective method of functional reconstruction, creating the possibility of performing limb-sparing surgery (LSS) with significant limitation of major postoperative complications at the same time. Methods: The study group consisted of 9 pediatric patients diagnosed with primary malignant bone tumor in the limb location. In order to perform microvascular reconstruction, 9 free fibula flaps were used in combination with a bone allograft (Capanna method). The functional outcome of the reconstruction was assessed on the basis of the MSTS (Musculoskeletal Tumor Society Scoring System) scale. Results: The presented analysis proves the effectiveness of this reconstructive procedure and the possibility of performing LSS with reasonable functional outcomes after appropriate patient qualification. In this study, all limbs included were spared. In all cases, the R0 surgical margins were achieved and no reports of local recurrences were reported during the follow-up. The average score on the MSTS scale was 27/30 points. Conclusions: Microvascular reconstructive surgery is an individually personalized and highly effective method of treating patients with primary bone tumors in the limb location and provides satisfactory functional outcomes.
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  • 文章类型: Journal Article
    软骨母细胞瘤转移,虽然罕见,代表骨肿瘤的临床上有意义且特别重要的方面。了解其流行病学特征,病理特征,和治疗方式,尽管频率不高,全面的患者管理势在必行。这篇综述旨在阐明流行病学,分子机制,诊断挑战,以及与软骨母细胞瘤转移相关的治疗策略。模式,预后因素,并通过对病例研究和临床报告的分析探讨治疗结果.值得注意的是,我们强调了旨在改善患者结局的新兴治疗观点.据我们所知,以前没有累积处理这些问题的审查,突出了现有学术文献中的显著差距。通过阐明软骨母细胞瘤转移的细微差别,这篇综述有助于提高该领域的知识,并为改善患者护理的临床决策提供信息.
    Chondroblastoma metastasis, though rare, represents a clinically significant and notably important aspect of bone tumors. Understanding its epidemiological characteristics, pathological features, and treatment modalities, despite its infrequency, is imperative for comprehensive patient management. This review aims to elucidate the epidemiology, molecular mechanisms, diagnostic challenges, and therapeutic strategies associated with chondroblastoma metastasis. The patterns, prognostic factors, and treatment outcomes were explored through an analysis of case studies and clinical reports. Notably, we highlighted emerging therapeutic perspectives aimed at improving patient outcomes. To the best of our knowledge, there has been no previous review addressing these matters cumulatively, highlighting a significant gap in the existing scholarly literature. By shedding light on the nuances of chondroblastoma metastasis, this review contributes to the advancement of knowledge in this field and informs clinical decision-making for improved patient care.
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  • 文章类型: Case Reports
    骨巨细胞瘤(GCTB)是罕见的肿瘤,通常会影响长骨的骨phy,并在肋骨中不常见。在这里,我们报告一例无症状GCTB直接侵犯肺组织.
    方法:一名36岁男子因左侧胸痛被转诊至急诊科。计算机断层扫描显示左肺尖部有大量异质实性囊性肿块,左第四肋骨后部有无定形钙化和牵张。组织学检查还显示GCTB起源于肋骨。患者接受了整块切除术,在一年的随访中没有复发。
    GCTB的特征是破骨细胞样多核巨细胞,可以表现出侵袭性的局部行为。肋骨中的GCTB很少见,主要见于后弧。影像学特征包括骨重塑的溶解性病变,通常在长骨骨骨上偏心。侵袭性肿瘤可表现为皮质破坏和软组织扩张。GCTB管理通常推荐手术,旨在以足够的手术切缘完全切除。
    结论:缺乏明确的诊断标准阻碍了GCTB的准确诊断,通过放射学和组织学检查进行全面评估至关重要。在体检时,纵隔病变的鉴别诊断应考虑GCTB,不管他们的大小。此外,手术切除可以被考虑作为源自肋骨后弧的肿瘤的主要治疗策略。例如GCTB。
    UNASSIGNED: Giant cell tumors of bone (GCTB) are infrequent tumors that usually impact the epiphyses of long bones and uncommonly manifest in the ribs. Herein, we report a case of asymptomatic GCTB directly invading the lung tissue.
    METHODS: A 36-year-old man was referred to our emergency department with only left chest pain. Computed tomography revealed a large heterogeneous solid cystic mass in the left lung apex and amorphous calcification and distraction in the posterior part of the left fourth rib. Histological examination also exhibited that the GCTB originated from the rib. The patient underwent an en-bloc resection with no recurrence in his one-year follow-up.
    UNASSIGNED: GCTB is characterized by osteoclast-like multinucleated giant cells and can exhibit aggressive local behavior. GCTB in the rib is rare, mainly found in the posterior arc. Radiographic features include lytic lesions with bone remodeling, often seen eccentrically in long bone epiphyses. Aggressive tumors may show cortical destruction and soft tissue extension. Surgery is often recommended for GCTB management, aiming for complete resection with sufficient surgical margins.
    CONCLUSIONS: The absence of well-defined diagnostic criteria hinders the accurate diagnosis of GCTB, making a comprehensive assessment through radiological and histological examinations crucial. Upon physical examination, GCTB should be considered in the differential diagnosis for mediastinal lesions, regardless of their size. Furthermore, surgical removal can be taken into account as the primary treatment strategy for tumors that originate from the posterior arc of the ribs, such as GCTB.
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  • 文章类型: Journal Article
    背景技术头颈部骨病理学涵盖具有不同原因的各种病症。骨髓炎和牙脓肿等感染可以扩散到软组织和骨骼,导致组织死亡,炎症,和系统性影响。良性和恶性肿瘤可以从软组织发展,软骨,或者骨头,对诊断和治疗构成挑战。关于其在当地人群中患病率的研究很少,模糊了我们对区域卫生动态的理解。在这项研究中,我们的目的是评估从2021年到2023年的过去三年中记录的骨病理学的患病率.材料和方法Saveetha牙科学院和医院经组织病理学证实的骨病理学病例,Saveetha医学和技术科学研究所,萨韦塔大学,钦奈,印度,从2021年1月1日至2023年12月31日的机构数据库(DIAS:牙科信息归档软件)中收集。它们被分为感染性和炎症性病变组,纤维骨病变,源自骨的恶性肿瘤,恶性肿瘤侵入骨骼,和杂项条件。然后将数据汇编到谷歌电子表格(谷歌,Inc.,山景,美国)进行进一步分析。创建图形以可视化骨骼病理的患病率,从而能够对时间趋势进行描述性探索。结果共审查了2626份活检记录。其中,242例(9.21%)骨相关病理包括在内,其余2384个(90.79%)未提及骨的实体被排除。总的来说,考虑到这三年,2021年报告了43.8%(100)骨相关病变,2022年报告了30.3%(77),2023年报告了25.9%(65)。在每个类别下,感染性和炎症性病变占40.5%(98),纤维骨性病变占14.9%(36),良性病变为2.9%(7),来源于骨的恶性肿瘤占1.7%(4),恶性肿瘤侵入骨骼占38%(93),报告了1.65%(4)的其他情况。据报道,2021年感染和炎症性病变的数量最多(53%)。在2022年和2023年,在感染和炎症类别下观察到急剧下降。侵入骨骼的恶性肿瘤在所有三年中表现出几乎相似的分布。结论观察到的变化突出了骨病理的不可预测性,涉及颌骨。我们强调持续的观察和分析,以了解骨骼健康的变化规律。
    Background Head and neck bone pathologies cover various conditions with diverse causes. Infections like osteomyelitis and dental abscesses can spread to soft tissues and bones, causing tissue death, inflammation, and systemic effects. Benign and malignant tumors can develop from soft tissue, cartilage, or bone, posing challenges for diagnosis and treatment. Studies on their prevalence in local populations are rare, obscuring our understanding of regional health dynamics. Aim In this study, we aimed to assess the prevalence of bone pathologies documented over the last three years from 2021 to 2023. Materials and methods Histopathologically confirmed cases of bone pathologies at Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India, were gathered from the institutional database (DIAS: Dental Information Archiving Software) from January 1, 2021, to December 31, 2023. They were categorized into groups of infectious and inflammatory lesions, fibro-osseous lesions, malignancies originating from bone, malignancies invading bone, and miscellaneous conditions. The data was then compiled into a Google spreadsheet (Google, Inc., Mountain View, USA) for further analysis. Graphs were created to visualize the prevalence of bone pathologies enabling a descriptive exploration of temporal trends. Results A total of 2626 biopsy records were reviewed. Among these, 242 (9.21%) cases of bone-related pathologies were included, and the remaining 2384 (90.79%) entities without any mention of bone were excluded. Overall, considering all three years, 43.8% (100) bone-related lesions were reported in 2021, 30.3% (77) in 2022 and 25.9% (65) in the year 2023. Under each category, infectious and inflammatory lesions for 40.5% (98), fibro-osseous lesions for 14.9% (36), benign lesions for 2.9% (7), malignancies originating from bone for 1.7% (4), malignancies invading bone for 38% (93), and miscellaneous conditions for 1.65% (4) were reported. The highest number of infectious and inflammatory pathologies (53%) were reported in 2021. A steep fall was observed in 2022 and 2023 under the infectious and inflammatory category. The malignancies invading the bone showed almost similar distribution in all three years. Conclusion The observed variations highlight the unpredictability of bone pathologies, involving the jaw bones. We emphasize continuous observation and analysis to comprehend changing patterns in bone health.
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  • 文章类型: Journal Article
    软组织和骨肿瘤包括广泛类别的肿瘤。它们的多样性经常引发诊断挑战,治疗方案也在不断发展。由于免疫组织化学和分子生物学技术的新进展,患者的治疗成功率和长期预后已大大提高。对这些成就的基本贡献是对肿瘤微环境的研究和新实体的重新分类,并在修订的第5版“软组织肿瘤分类”中更新了分子发病机理,由世界卫生组织编辑。拟议的分子诊断技术包括众所周知的原位杂交和聚合酶链反应方法,但是诸如拷贝数数组之类的新技术,多重探针,单核苷酸多态性,和排序也被提出。这篇综述旨在综合软组织和骨肿瘤的最新病因和分子分类,考虑到这些诊断工具的主要影响,在临床病理实践中变得不可或缺。
    Soft tissue and bone tumors comprise a wide category of neoplasms. Their diversity frequently raises diagnostic challenges, and therapeutic options are continuously developing. The therapeutic success rate and long-term prognosis of patients have improved substantially due to new advances in immunohistochemical and molecular biology techniques. A fundamental contribution to these achievements has been the study of the tumor microenvironment and the reclassification of new entities with the updating of the molecular pathogenesis in the revised 5th edition of the Classification of Soft Tissue Tumors, edited by the World Health Organization. The proposed molecular diagnostic techniques include the well-known in situ hybridization and polymerase chain reaction methods, but new techniques such as copy-number arrays, multiplex probes, single-nucleotide polymorphism, and sequencing are also proposed. This review aims to synthesize the most recent pathogenetic and molecular classifications of soft tissue and bone tumors, considering the major impact of these diagnostic tools, which are becoming indispensable in clinicopathological practice.
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  • 文章类型: Case Reports
    软骨母细胞瘤是一种罕见的良性软骨肿瘤,约占骨肿瘤的1%。但在极少数情况下,它可能与肺转移有关,导致预后不良和死亡。在这里,我们报道了一例19岁男性患者,表现为侵袭性肱骨近端软骨母细胞瘤和双侧肺转移.患者接受了广泛的局部切除术,部分转移瘤切除术,还有Denosumab.Denosumab治疗可有效控制转移进展并预防局部复发。
    Chondroblastoma is a rare benign cartilaginous tumor that accounts for approximately 1% of bone tumors, but it can be associated with lung metastasis in extremely rare cases, leading to a poor prognosis and death. Herein, we report the case of a 19-year-old male patient who presented with an aggressive chondroblastoma of the proximal humerus and bilateral lung metastasis. The patient was treated with wide local resection, partial metastasectomy, and denosumab. Denosumab treatment was effective in controlling metastatic progression and preventing local recurrence.
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  • 文章类型: Journal Article
    简介:骨肿瘤,以不同的位置和形状为特征,通常需要手术切除,然后进行定制的植入物放置,以促进有针对性的骨骼重建。利用增材制造,患者特定的植入物可以精确地定制复杂的几何形状和所需的刚度,增强它们对骨骼向内生长的适应性。方法:在这项工作中,有限元模型用于评估股骨中患者特定的晶格植入物。使用从动物研究获得的实验数据(n=9)验证我们的模型。结果:结果证明了所提出的有限元模型在预测植入物力学行为方面的准确性。该模型用于研究将固体Ti6Al4V植入物的弹性模量降低十倍的影响,揭示了在最大压缩和扭转载荷下,这种减少对骨骼行为没有显着影响。这一发现表明了降低内置假体模量而不损害骨完整性的潜在途径。讨论:我们的研究表明,采用完全网格植入物不仅有助于骨骼向内生长,而且有可能降低整体植入物的刚度。这种减少对于防止与应力屏蔽相关的显著骨重建至关重要。通常与完全固体植入物的高刚度相关的挑战。该研究强调了在植入物设计中利用晶格结构来增强患者预后的机械优势。
    Introduction: Bone tumors, characterized by diverse locations and shapes, often necessitate surgical excision followed by custom implant placement to facilitate targeted bone reconstruction. Leveraging additive manufacturing, patient-specific implants can be precisely tailored with complex geometries and desired stiffness, enhancing their suitability for bone ingrowth. Methods: In this work, a finite element model is employed to assess patient-specific lattice implants in femur bones. Our model is validated using experimental data obtained from an animal study (n = 9). Results: The results demonstrate the accuracy of the proposed finite element model in predicting the implant mechanical behavior. The model was used to investigate the influence of reducing the elastic modulus of a solid Ti6Al4V implant by tenfold, revealing that such a reduction had no significant impact on bone behavior under maximum compression and torsion loading. This finding suggests a potential avenue for reducing the endoprosthesis modulus without compromising bone integrity. Discussion: Our research suggests that employing fully lattice implants not only facilitates bone ingrowth but also has the potential to reduce overall implant stiffness. This reduction is crucial in preventing significant bone remodeling associated with stress shielding, a challenge often associated with the high stiffness of fully solid implants. The study highlights the mechanical benefits of utilizing lattice structures in implant design for enhanced patient outcomes.
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  • 文章类型: Journal Article
    上肢骨肿瘤是老年人和年轻人群中骨痛和病理性骨折的常见原因。尽管由于需要广泛的骨切除和周围软组织的参与,这种手术具有挑战性,但手术重建和肢体抢救已成为这些患者的有效选择。计算机辅助技术可帮助外科医生进行术前计划和设计定制植入物。这项研究的目的是调查上肢肿瘤重建中定制假体的手术结果和并发症,以及它们是否是患有侵袭性肿瘤的患者的可靠选择。在PubMed上进行电子搜索,谷歌学者,并进行了WebofKnowledge,以确定所有有关在上肢肿瘤切除术中使用定制假体的可用文章。21项研究被纳入审查,共145名患者,平均年龄33.68岁。93例患者的肱骨受累,36例患者累及桡骨。只有6例涉及尺骨近端,三例涉及肩胛骨,七例涉及肘部及其周围软组织。最常见的原发性肿瘤是巨细胞瘤,36例,其次是骨肉瘤25例,尤因肉瘤17例,软骨肉瘤共7例。40例患者受骨转移(如肾细胞癌,乳腺癌,黑色素瘤,和直肠癌)或涉及骨骼的血液系统疾病(淋巴瘤,骨髓瘤,或非霍奇金病)。定制的假体对于患有上肢恶性肿瘤的患者是可行的选择。在广泛切除的情况下,它们是外科医生的可靠帮助。
    Bone tumors of the upper limb are a common cause of bone pain and pathological fractures in both old and young populations. Surgical reconstruction and limb salvage have become valid options for these patients despite this kind of surgery being challenging due to the need for wide bone resection and the involvement of surrounding soft tissues. Computer-assisted technology helps the surgeon in pre-operative planning and in designing customized implants. The aim of this study was to investigate the surgical outcomes and complications of custom-made prostheses in oncologic reconstruction of the upper limb and if they are reliable options for patients suffering from aggressive tumors. An electronic search on PubMed, Google Scholar, and Web of Knowledge was conducted to identify all available articles on the use of custom-made prostheses in oncological resections of the upper limb. Twenty-one studies were included in the review, comprising a total of 145 patients with a mean age of 33.68 years. The bone involved was the humerus in 93 patients, and the radius was involved in 36 patients. There were only six cases involving proximal ulna, three cases involving the scapula, and seven cases involving the elbow as well as soft tissues around it. The most frequent primary tumor was the giant cell tumor, with 36 cases, followed by osteosarcoma with 25 cases, Ewing Sarcoma with 17 cases, and Chondrosarcoma with 7 total cases. Forty patients were affected by bone metastases (such as renal cell cancer, breast cancer, melanoma, and rectal cancer) or hematologic diseases involving bone (lymphoma, myeloma, or non-Hodgkin disease). Custom-made prostheses are a viable option for patients who suffer from malignant tumors in their upper limbs. They are a reliable aid for surgeons in cases of extensive resections.
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