Khanna Monica, Delaney David, Tirabosco Roberto, Saifuddin Asif
Department of Clinical Radiology, The Royal National Orthopaedic Hospital NHS Trust, Stanmore, Middlesex, HA7 4LP, UK.
Skeletal Radiol. 2008 Dec;37(12):1077-84. doi: 10.1007/s00256-008-0553-1. Epub 2008 Aug 9.
The aim of this study was to correlate the imaging features with surgical histology for tibial osteofibrous dysplasia (OFD), osteofibrous dysplasia-like adamantinoma (OFD/LA) and classical adamantinoma and to determine the additional role of imaging in suggesting a correct diagnosis in cases of needle biopsy misdiagnosis.
This is a retrospective audit of 24 patients presenting over a 9-year period to a specialist orthopaedic oncology unit. Radiographic and axial magnetic resonance imaging (MRI) characteristics were recorded for each patient. The needle biopsy diagnosis and resection specimen histological diagnoses were retrospectively reviewed and compared with the imaging findings.
The 24 cases comprised five OFD, 11 OFD/LA and eight adamantinoma based on surgical resection histology. The mean length of OFD was 6.1 cm (range 2-8.5 cm), for OFD/LA was 6.5 cm (range 2-13 cm) and for adamantinoma was 13.2 cm (range 6.5-26 cm). Seven of eight adamantinomas had moth-eaten margins compared to five of 11 OFD/LA and two of five OFDs. Three of eight adamantinomas demonstrated cortical destruction, with seven of eight cases completely involving the marrow cavity. In comparison, only one of 11 OFD/LA cases and one of five OFD cases demonstrated cortical destruction, and complete marrow involvement was rare. Four of 19 cases had a different needle biopsy result compared to the final histology, three cases being upgraded from an OFD/LA or OFD to classical adamantinoma. The radiological features of these three cases were more in keeping with a diagnosis of adamantinoma.
A diagnosis of classical adamantinoma is suggested by an extensive lesion with moth-eaten margins and complete involvement of the medullary cavity on axial MR imaging. Misdiagnosis on needle biopsy may occur in up to one fifth of cases, and radiological features can assist in making the correct diagnosis.
本研究旨在将胫骨骨纤维发育不良（OFD）、骨纤维发育不良样造釉细胞瘤（OFD/LA）和经典造釉细胞瘤的影像学特征与手术组织学进行关联，并确定在针吸活检误诊的病例中，影像学在提示正确诊断方面的额外作用。
这是一项对在9年期间就诊于一家专业骨科肿瘤科室的24例患者进行的回顾性分析。记录了每位患者的X线和轴向磁共振成像（MRI）特征。对针吸活检诊断和切除标本的组织学诊断进行回顾性分析，并与影像学结果进行比较。
根据手术切除组织学，24例病例包括5例OFD、11例OFD/LA和8例造釉细胞瘤。OFD的平均长度为6.1cm（范围2 - 8.5cm），OFD/LA为6.5cm（范围2 - 13cm），造釉细胞瘤为13.2cm（范围6.5 - 26cm）。8例造釉细胞瘤中有7例边缘呈虫蚀状，相比之下，11例OFD/LA中有5例，5例OFD中有2例。8例造釉细胞瘤中有3例显示皮质破坏，8例中有7例完全累及骨髓腔。相比之下，11例OFD/LA病例中只有1例，5例OFD病例中只有1例显示皮质破坏，完全累及骨髓腔的情况很少见。19例中有4例针吸活检结果与最终组织学结果不同，3例从OFD/LA或OFD升级为经典造釉细胞瘤。这3例的放射学特征更符合造釉细胞瘤的诊断。
轴向MRI上广泛的病变、边缘呈虫蚀状且骨髓腔完全受累提示经典造釉细胞瘤的诊断。针吸活检误诊率可达五分之一，放射学特征有助于做出正确诊断。
