Ilaslan Hakan, Sundaram Murali, Unni K Krishnan, Shives Thomas C
Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA.
Radiology. 2004 Mar;230(3):697-702. doi: 10.1148/radiol.2303030226. Epub 2004 Jan 28.
To evaluate patient age and sex and location and imaging appearances of primary vertebral osteosarcoma (PVOS) compared with histologic subtypes.
Retrospective review (1915-2001) of imaging findings in patients with histologically proved primary osteosarcoma of vertebral column was performed. Two radiologists in consensus reviewed findings for location, origin site, matrix pattern, and spinal canal invasion and compared them with histologic subtypes. Radiation-induced, Paget, metastatic, and multifocal osteosarcoma were excluded.
Of 4,887 osteosarcoma cases, 198 (4%) were PVOS arising from vertebral column. There were 103 female and 95 male patients (age range, 8-80 years; median age, 34.5 years). Involvement included cervical (27 patients), thoracic (66 patients), lumbar (64 patients), and sacral (41 patients) spine. Adequate imaging findings were available in 69 patients, and involvement of two levels was seen in 12 (17%). In nonsacral spine, most tumors (44 cases) arose from posterior elements, with partial involvement of vertebral body. Lesions confined to vertebral body were less frequent (12 cases). Sacral tumors involved body and sacral ala. The most common histologic subtypes were osteoblastic (47 patients), chondroblastic (12 patients), telangiectatic (four patients), fibroblastic (four patients), small cell (one patient), and epithelioid (one patient). The majority (55 cases) demonstrated osteoid matrix mineralization; 17 showed marked mineralization. Five cases with marked mineralization were confined to vertebral body, with "ivory vertebra" appearance. Purely lytic pattern was seen in 14 (20%) cases. Lytic pattern was seen in four (100%) telangiectatic, three (75%) fibroblastic, three (25%) chondroblastic, three (6%) conventional osteoblastic, and one (100%) small-cell subtypes. Invasion of spinal canal was common (84% of cases). Appearance simulating osteoblastoma without soft-tissue mass was present (seven cases). Pathologic compression fractures were identified (seven patients).
This study provides age and sex distribution and location and imaging features in a large series of PVOS.
评估原发性脊柱骨肉瘤（PVOS）患者的年龄、性别、病变部位及影像学表现，并与组织学亚型进行比较。
对经组织学证实的脊柱原发性骨肉瘤患者的影像学表现进行回顾性研究（1915 - 2001年）。两位放射科医生共同回顾病变部位、起源部位、基质形态及椎管侵犯情况，并与组织学亚型进行比较。排除放射性、佩吉特氏病、转移性及多灶性骨肉瘤。
在4887例骨肉瘤病例中，198例（4%）为起源于脊柱的PVOS。其中女性103例，男性95例（年龄范围8 - 80岁；中位年龄34.5岁）。受累部位包括颈椎（27例）、胸椎（66例）、腰椎（64例）和骶椎（41例）。69例患者有充分的影像学表现，12例（17%）累及两个节段。在非骶椎脊柱，大多数肿瘤（44例）起源于后部结构，椎体部分受累。局限于椎体的病变较少见（12例）。骶椎肿瘤累及椎体和骶骨翼。最常见的组织学亚型为成骨细胞型（47例）、软骨母细胞型（12例）、毛细血管扩张型（4例）、纤维母细胞型（4例）、小细胞型（1例）和上皮样型（1例）。大多数（55例）表现为骨样基质矿化；17例表现为明显矿化。5例明显矿化的病例局限于椎体，呈“象牙椎”表现。14例（20%）表现为单纯溶骨型。4例（100%）毛细血管扩张型、3例（75%）纤维母细胞型、3例（25%）软骨母细胞型、3例（6%）传统成骨细胞型和1例（100%）小细胞型表现为溶骨型。椎管侵犯常见（84%的病例）。出现类似骨母细胞瘤而无软组织肿块的表现（7例）。发现病理性压缩骨折（7例患者）。
本研究提供了大量PVOS患者的年龄、性别分布、病变部位及影像学特征。
