Department of Pathology, University of Washington Medical Center, Seattle, Washington 98195, USA.
Semin Diagn Pathol. 2011 Feb;28(1):102-12. doi: 10.1053/j.semdp.2011.02.011.
Reactive lesions of bone and soft tissue can appear alarming on histologic examination because they are often cellular and have atypical (activated) cytologic features, such as distinct nucleoli and mild hyperchromasia, and mitotic activity. Reactive lesions of bone and periosteum also produce bone and cartilage matrix, resulting in confusion with osteosarcoma or chondrosarcoma. Careful attention to key cytomorphological features such as the pattern of bone formation, uniform appearance of cells, and absence of atypical mitoses should help identify the reactive nature of a lesion. Correlation with clinical and radiological findings is also imperative to avoid misclassification of the tumor because reactive lesions often arise at sites where osteosarcoma and chondrosarcoma are rare (e.g., the hand) and lack aggressive radiological features. In this review we discuss reactive lesions of bone that are commonly confused with malignant neoplasms and that the practicing pathologist is likely to encounter at some point. Several of these lesions have had characteristic chromosomal translocations documented in recent years, but continue to be included as reactive lesions based on their overall clinicopathological features.
骨和软组织的反应性病变在组织学检查时可能看起来很严重，因为它们通常具有细胞性和非典型（激活）细胞学特征，例如明显的核仁、轻度的嗜碱性和有丝分裂活性。骨和骨膜的反应性病变也会产生骨和软骨基质，导致与骨肉瘤或软骨肉瘤混淆。仔细注意关键的细胞形态学特征，如骨形成模式、细胞均匀外观和无非典型有丝分裂，有助于确定病变的反应性。与临床和影像学发现的相关性也是必不可少的，以避免因反应性病变通常发生在骨肉瘤和软骨肉瘤罕见的部位（例如手）且缺乏侵袭性影像学特征而导致肿瘤的错误分类。在这篇综述中，我们讨论了一些常见的易与恶性肿瘤混淆的骨反应性病变，这些病变可能是病理医生在某个时候会遇到的。近年来，这些病变中的一些已经记录到了特征性的染色体易位，但根据其整体临床病理特征，它们仍然被归类为反应性病变。
