Keel S B, Jaffe K A, Petur Nielsen G, Rosenberg A E
The James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
Mod Pathol. 2001 Oct;14(10):969-77. doi: 10.1038/modpathol.3880420.
Sarcoma developing in association with a metallic orthopaedic prosthesis or hardware is an uncommon, but well recognized complication. We review 12 cases of sarcomas arising in bone or soft tissue at the site of orthopaedic hardware or a prosthetic joint. Nine patients were male, and three were female. Their ages ranged from 18 to 85 (mean 55) years at the time of diagnosis of the malignancy. Five patients had undergone hip arthroplasty for degenerative joint disease, four had been treated with intramedullary nail placement for fracture, two had staples placed for fixation of osteotomy, and one had hardware placed for fracture fixation followed years later by a hip arthroplasty. The time interval between the placement of hardware and diagnosis of sarcoma was known in 11 cases and ranged from 2.5 to 33 (mean 11) years. The patients presented with pain, swelling, or loosening of hardware and were found to have a destructive bone or soft tissue mass on radiography. Two sarcomas were located primarily in the soft tissue and 10 in bone. Seven patients developed osteosarcoma, four malignant fibrous histiocytoma, and one a malignant peripheral nerve sheath tumor. All sarcomas were high grade. Three patients had metastatic disease at the time of diagnosis. Follow-up was available on eight patients: five patients died of disease 2 months to 8 years (mean 26 months) after diagnosis; two patients died without evidence of disease 7 and 30 months after diagnosis; and one patient is alive and free of disease 8 years after diagnosis. Sarcomas that occur adjacent to orthopaedic prostheses or hardware are of varied types, but are usually osteosarcoma or malignant fibrous histiocytoma. They behave aggressively and frequently metastasize. Clinically, they should be distinguished from non-neoplastic reactions associated with implants, such as infection and a reaction to prosthetic wear debris.
与金属骨科假体或植入物相关的肉瘤是一种罕见但已得到充分认识的并发症。我们回顾了12例发生于骨科植入物或人工关节部位的骨或软组织肉瘤病例。9例为男性，3例为女性。诊断恶性肿瘤时，他们的年龄在18至85岁（平均55岁）之间。5例患者因退行性关节疾病接受了髋关节置换术，4例因骨折接受了髓内钉固定治疗，2例因截骨固定使用了吻合钉，1例因骨折固定使用了植入物，数年后又接受了髋关节置换术。11例患者已知植入物放置与肉瘤诊断之间的时间间隔，范围为2.5至33年（平均11年）。患者表现为疼痛、肿胀或植入物松动，影像学检查发现有破坏性骨或软组织肿块。2例肉瘤主要位于软组织，10例位于骨。7例患者发生骨肉瘤，4例发生恶性纤维组织细胞瘤，1例发生恶性周围神经鞘瘤。所有肉瘤均为高级别。3例患者在诊断时已有转移性疾病。8例患者有随访资料：5例患者在诊断后2个月至8年（平均26个月）死于疾病；2例患者在诊断后7个月和30个月无疾病证据死亡；1例患者在诊断后8年存活且无疾病。发生在骨科假体或植入物附近的肉瘤类型多样，但通常为骨肉瘤或恶性纤维组织细胞瘤。它们行为侵袭性强，常发生转移。临床上，应将它们与与植入物相关的非肿瘤性反应，如感染和对假体磨损碎片的反应区分开来。
