141例骨转移癌的临床病理分析

Shen Dan-hua, Guo Wei, Yang Yi, Yu You-zhi, Sun Kun-kun

Department of Pathology, People's Hospital, Peking University, Beijing 100044, China.

Zhonghua Bing Li Xue Za Zhi. 2006 Jun;35(6):324-7.

OBJECTIVE

To study the clinicopathologic features of metastatic carcinoma in bone and to evaluate the role of immunohistochemistry in delineation of possible primary sites.

METHODS

One hundred and forty-one cases of metastatic carcinoma in bone encountered during the period from 1998 to 2004 in People's Hospital, Peking University, were reviewed retrospectively. The clinical information, radiographic features and pathologic findings were analyzed. Immunohistochemical study for antigens including cytokeratins, prostatic specific antigen, thyroglobulin, thyroid transcription factor 1 and gross cystic disease fluid protein 15, was performed in 51 cases possessing skeletal metastasis with unknown primary.

RESULTS

Skeletal metastasis occurred more commonly in males (male to female ratio = 1.7:1). The age of patients ranged from 23 to 86 years (mean age = 56.5). The presenting symptoms included pain and dysfunction in the affected bones. The locations of skeletal metastasis were as follows: spine (58), pelvic bone (46), long bone (34) and others (3). Twenty-three cases harbored multiple bony lesions. Radiographically, 99 cases (70.2%) of skeletal metastasis were detected by X-rays, including 85 cases (85.9%) showing lytic changes. The primary sites of the tumor could be determined by clinicopathologic correlation in 90 cases (63.8%) and were unknown in the remaining 51 cases. Upon immunohistochemical study, the primary sites were determined in another 40 cases. Overall, the primary sites were identified in 130 cases (92.2%), which included lung (37), female genital system and breast (25), kidney (18), gastrointestinal system (17), liver (12), thyroid (11), prostate (7), bladder (2) and skin (1).

CONCLUSIONS

Skeletal metastasis occurs more often in elderly males. Axial bones (spine and pelvis) are usually affected. Lung and female genital system are frequent the primary sites. Immunohistochemical study is useful in cases with occult primary.

目的

研究骨转移性癌的临床病理特征，并评估免疫组化在确定可能的原发部位中的作用。

方法

回顾性分析1998年至2004年期间北京大学人民医院收治的141例骨转移性癌病例。分析其临床资料、影像学特征及病理表现。对51例原发部位不明的骨转移病例进行了包括细胞角蛋白、前列腺特异性抗原、甲状腺球蛋白、甲状腺转录因子1和巨大囊肿病液体蛋白15等抗原的免疫组化研究。

结果

骨转移在男性中更为常见（男女比例=1.7:1）。患者年龄范围为23至86岁（平均年龄=56.5岁）。主要症状包括受累骨骼的疼痛和功能障碍。骨转移部位如下：脊柱（58例）、骨盆（46例）、长骨（34例）及其他部位（3例）。23例有多处骨病变。影像学检查中，99例（70.2%）骨转移通过X线检查发现，其中85例（85.9%）表现为溶骨性改变。90例（63.8%）肿瘤的原发部位可通过临床病理相关性确定，其余51例不明。经免疫组化研究，又确定了40例的原发部位。总体而言，130例（92.2%）确定了原发部位，其中包括肺（37例）、女性生殖系统和乳腺（25例）、肾（18例）、胃肠道系统（17例）、肝（12例）、甲状腺（11例）、前列腺（7例）、膀胱（2例）和皮肤（1例）。