Bloem J L, van der Heul R O, Schuttevaer H M, Kuipers D
Department of Radiology, University Hospital Leiden, The Netherlands.
AJR Am J Roentgenol. 1991 May;156(5):1017-23. doi: 10.2214/ajr.156.5.2017924.
Differentiation between benign fibrous dysplasia and malignant adamantinoma of the tibia is challenging because of the impact the diagnosis has on the choice of treatment (none or extensive surgery). The histologic and pathologic similarities of the lesions and the controversial relationship between fibrous dysplasia, osteofibrous dysplasia, and adamantinoma complicate the matter. We found a large overlap of histologic features in lesions considered either fibrous dysplasia or osteofibrous dysplasia on the basis of the radiologic findings. The purpose of this study was to determine the value of the plain radiograph of the lower leg in combination with clinical findings to differentiate the benign from the malignant condition. The clinical symptoms, radiographs, and histologic slides of 46 patients with fibrous dysplasia and 22 with adamantinoma in the tibia were reviewed retrospectively. In only one of 12 patients with radiologic or histologic characteristics of osteofibrous dysplasia were both radiologic and histologic criteria for the diagnosis present. A linear discriminant analysis was performed on six clinical (age, spontaneous pain, pain after trauma, swelling only, pain and swelling, and bowing deformity) and 25 radiologic signs. Fibrous dysplasia and its variant osteofibrous dysplasia could be identified correctly in 87% (40 of 46 patients) and adamantinoma in 95% (21 of 22 patients) by using the patient's age and four radiologic signs. When results from the discriminant analysis of a randomized subgroup of patients (32) were used on the other subgroup (36 patients), fibrous dysplasia was correctly identified in 84% (21 of 25) and adamantinoma in 82% (nine of 11). Fibrous dysplasia is more prevalent than adamantinoma in a young patient, when radiographs show a ground-glass appearance and anterior bowing and when there is no multilayered periosteal reaction and moth-eaten destruction. When radiologic signs and the patient's age are combined, fibrous dysplasia and adamantinoma can be discriminated in a high percentage of patients.
由于诊断结果对治疗方案的选择（不进行手术或进行广泛手术）有影响，因此区分胫骨的良性纤维结构不良和恶性造釉细胞瘤具有挑战性。病变的组织学和病理学相似性以及纤维结构不良、骨纤维结构不良和造釉细胞瘤之间存在争议的关系使问题变得更加复杂。我们发现，根据放射学表现被认为是纤维结构不良或骨纤维结构不良的病变，其组织学特征有很大重叠。本研究的目的是确定小腿平片结合临床 findings 来区分良性和恶性病变的价值。回顾性分析了 46 例胫骨纤维结构不良患者和 22 例胫骨造釉细胞瘤患者的临床症状、X 线片和组织学切片。在 12 例具有骨纤维结构不良放射学或组织学特征的患者中，只有 1 例同时具备诊断的放射学和组织学标准。对六个临床指标（年龄、自发疼痛、创伤后疼痛、仅肿胀、疼痛和肿胀、弓形畸形）和 25 个放射学征象进行了线性判别分析。通过患者年龄和四个放射学征象，87%（46 例中的 40 例）的纤维结构不良及其变异型骨纤维结构不良和 95%（22 例中的 21 例）的造釉细胞瘤能够被正确识别。当将随机分组的患者亚组（32 例）的判别分析结果应用于另一亚组（36 例患者）时，84%（25 例中的 21 例）的纤维结构不良和 82%（11 例中的 9 例）的造釉细胞瘤被正确识别。在年轻患者中，当 X 线片显示磨玻璃样外观和前弓畸形且无多层骨膜反应和虫蚀状破坏时，纤维结构不良比造釉细胞瘤更常见。当结合放射学征象和患者年龄时，可以在高比例的患者中区分纤维结构不良和造釉细胞瘤。
