Bücker A, Schneider G
Universitätsklinikum des Saarlandes und Medizinische Fakultät, Universität des Saarlandes, Kirrbergerstr. 1, 66421, Homburg, Deutschland.
Orthopade. 2017 Jun;46(6):477-483. doi: 10.1007/s00132-017-3424-4.
Benign bone tumors are of special clinical importance because they might be confused with malignant bone tumors.
The aim of this article it to present the characteristics of benign bone tumors. The focus is orientated towards conventional x‑ray as the essential pillar for primary diagnosis. Consequently, the description of signal intensities of benign bone tumors in magnetic resonance images or less helpful clues like male-female ratios are deliberately omitted.
The classification of bone tumors introduced by Lodwick allows the identification of benign growth patterns. Growth patterns will not help, for example, in case of dedifferentiation of benign chondroid tumors towards chondrosarcomas. Therefore, each diagnosis has to incorporate the patient's clinical scenario. Furthermore, benign bone tumors might also cause aggressive growth patterns. Tumors classified as Lodwick Ic or higher should not be automatically regarded as malignant. Naturally, further clarification is mandatory for these tumors.
Differentiation between definitely benign bone tumors and those which need further work up is a critical diagnostic step. In the majority of cases, this is possible based on the appearance in conventional x‑ray images. In case of possibly malignant lesions, both the patient's symptoms and the x‑ray morphology have to be considered by orthopedic surgeons, pathologists, and radiologists to determine the optimal diagnostic strategy.
良性骨肿瘤具有特殊的临床重要性,因为它们可能与恶性骨肿瘤相混淆。
本文旨在介绍良性骨肿瘤的特征。重点以传统X线作为初步诊断的重要支柱。因此,故意省略了磁共振成像中良性骨肿瘤信号强度的描述或诸如男女比例等不太有用的线索。
Lodwick提出的骨肿瘤分类有助于识别良性生长模式。例如,在良性软骨样肿瘤向软骨肉瘤去分化的情况下,生长模式并无帮助。因此,每次诊断都必须结合患者的临床情况。此外,良性骨肿瘤也可能呈现侵袭性生长模式。分类为Lodwick Ic或更高的肿瘤不应自动被视为恶性。自然地,对于这些肿瘤必须进一步明确诊断。
区分明确良性的骨肿瘤和需要进一步检查的骨肿瘤是关键的诊断步骤。在大多数情况下,这可以根据传统X线图像的表现来实现。对于可能为恶性的病变,骨科医生、病理学家和放射科医生必须综合考虑患者的症状和X线形态,以确定最佳诊断策略。