154例手足骨肿瘤及肿瘤样病变的临床病理分析

Jiang Zhi-ming, Zhang Hui-zhen, Chen Jie-qing, Liu Liang

Department of Pathology, Shanghai Sixth People's Hospital Attached to Jiao Tong University, Shanghai 200233, China.

Zhonghua Bing Li Xue Za Zhi. 2003 Oct;32(5):417-21.

OBJECTIVE

To study the clinical and pathologic features of tumors and tumor-like lesions in the bones of hands and feet.

METHODS

Clinical, X-ray and pathologic features of 154 cases of tumors and tumor-like lesions in the bones of hands and feet between 1991 and 2002 were investigated.

RESULTS

In the bones of hands and feet the frequency and distribution of many lesions were distinctive when compared to those of other skeletal sites. Cartilaginous lesions were most common (60%), and 72% of them were enchondromas. Enchondromas were most often situated in the second to fifth phalanges and metacarpal bones. Chondroblastomas most frequently involved the irregular bones (such as calcaneus, talus and osnaviculare) of the feet. Whereas the occurance of osteochondromas in the bones of the hands and feet was lower than in the long bones. Most "osteochondromas" of the phalanges were subungual exostoses. A group of reactive or reparative lesions, which are related to trauma, such as subungual exostosis, giant cell reparative granuloma, florid reactive periostitis and bizarre parosteal osteochondromatous proliferations typically occurred in the bones of the hands and feet, but these tumor-like lesions were often misdiagnosted. Another feature of lesions in the bones of the hands and feet was that there were much more benign than malignant lesions (21:1), and that chondrosarcomas were common in malignancies. The diagnostic criteria for benign and malignant cartilaginous tumors in the bones of hands and feet were different from those in long bones and flat bones.

CONCLUSIONS

Bone tumors of the hands and feet are different from that of long bones, flat bones and axial bones. Because the hands and feet are frequently exposed to trauma, reactive and reparative lesions often occur in these sites. These tumor-like lesions may simulate benign and malignant neoplasia. Knowledge of different types of lesions which commonly affect these sites is of benefit in assessing lesions of the bones of hands and feet.

目的

研究手足部骨骼肿瘤及肿瘤样病变的临床及病理特征。

方法

对1991年至2002年间154例手足部骨骼肿瘤及肿瘤样病变的临床、X线及病理特征进行研究。

结果

与其他骨骼部位相比，手足部骨骼中许多病变的发生率及分布具有独特性。软骨性病变最为常见（60%），其中72%为内生软骨瘤。内生软骨瘤最常位于第二至第五指骨及掌骨。软骨母细胞瘤最常累及足部不规则骨（如跟骨、距骨和舟骨）。而手足部骨骼中骨软骨瘤的发生率低于长骨。指骨的大多数“骨软骨瘤”为甲下外生骨疣。一组与创伤相关的反应性或修复性病变，如甲下外生骨疣、巨细胞修复性肉芽肿、 florid反应性骨膜炎和奇异的骨旁骨软骨瘤样增生，典型地发生于手足部骨骼，但这些肿瘤样病变常被误诊。手足部骨骼病变的另一个特点是良性病变远多于恶性病变（21:1），且软骨肉瘤在恶性病变中较为常见。手足部骨骼良性和恶性软骨肿瘤的诊断标准与长骨和平骨不同。