Nakamura Tomoki, Kusuzaki Katsuyuki, Seto Masashi, Matsumine Akihiko, Uchida Atsumasa
Department of Orthopaedic Surgery, Mie University Faculty of Medicine, Tsu city, Edobashi 514-8507, Mie Prefecture, Japan.
Oncol Rep. 2003 Nov-Dec;10(6):1957-60. doi: 10.3892/or.10.6.1957.
We recently encountered a case with local recurrence of malignant fibrous histiocytoma (MFH) in the bone after wide resection, caused by minute intravenous tumor emboli which were retrospectively detected in MR imaging. The patient was a 69-year-old woman who initially noticed a mass in her left thigh. The tumor was diagnosed to be MFH, therefore a wide resection was performed; although the tumor was closely attached to the periosteum, it was not difficult to dissect the tumor subperiosteally from the cortex of the femur. The patient received postoperative brachytherapy, but no chemotherapy. Two years later, the tumor recurred with bony destruction of the femur. We reviewed the pre-operative films obtained by various imaging modalities, as well as the histology of the primary tumor, and found minute intravenous tumor emboli in the MR imaging obtained before surgery. Tumor emboli were also observed histologically in the small vessels of the surgically resected tumor. Such intravenous tumor emboli have recently been implicated in the development of regional bone metastasis near the site of the primary lesion in cases of malignant soft tissue tumors. Therefore, we concluded that the tumor recurrence in our case was caused by small tumor emboli invading the perforating veins of the femur. It is therefore emphasized that MR images should be carefully reviewed for the presence of such intravenous tumor emboli before surgery in cases of high-grade malignant sarcomas. As at the time of writing, our patient remains alive and disease-free, with no evidence of any local recurrence or distant metastasis after wide tumor resection for the recurrent tumor.
我们最近遇到一例恶性纤维组织细胞瘤（MFH）患者，在广泛切除术后出现骨局部复发，复发原因是在磁共振成像（MR成像）中回顾性检测到的微小静脉肿瘤栓子。患者为一名69岁女性，最初发现左大腿有肿块。肿瘤被诊断为MFH，因此进行了广泛切除；尽管肿瘤与骨膜紧密相连，但从股骨皮质骨膜下剥离肿瘤并不困难。患者接受了术后近距离放疗，但未进行化疗。两年后，肿瘤复发并伴有股骨骨质破坏。我们回顾了通过各种成像方式获得的术前影像以及原发肿瘤的组织学检查，发现在手术前获得的MR成像中有微小静脉肿瘤栓子。在手术切除肿瘤的小血管中也在组织学上观察到肿瘤栓子。最近研究表明，在恶性软组织肿瘤病例中，此类静脉肿瘤栓子与原发灶附近区域骨转移的发生有关。因此，我们得出结论，本例肿瘤复发是由侵入股骨穿通静脉的小肿瘤栓子引起的。因此，强调对于高级别恶性肉瘤病例，术前应仔细检查MR图像以确定是否存在此类静脉肿瘤栓子。截至撰写本文时，我们的患者仍然存活且无疾病，在对复发性肿瘤进行广泛切除后，没有任何局部复发或远处转移的迹象。
