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右手环指孤立性软骨肉瘤:一例报告

Solitary Chondrosarcoma of the Right Ring Finger: A Case Report.

作者信息

Tomori Yuji, Motoda Norio, Tsunoda Ryu, Ohashi Ryuji, Kitagawa Yasuyuki, Majima Tokifumi

机构信息

Department of Orthopaedic Surgery, Nippon Medical School Hospital.

Department of Diagnostic Pathology, Nippon Medical School Musashikosugi Hospital.

出版信息

J Nippon Med Sch. 2023 Feb 1;89(6):599-605. doi: 10.1272/jnms.JNMS.2022_89-602. Epub 2021 Sep 14.

Abstract

We present a case of solitary chondrosarcoma arising from the proximal phalanx of the ring finger in an elderly man. The chondrosarcoma developed over a period of 14 years, during which the phalanx became progressively more deformed. Several radiographic investigations were carried out, but the patient declined further suggested diagnostic examinations (computed tomography, magnetic resonance imaging, biopsy). Eventually, the lesion became significantly enlarged, and radiographs showed osteolytic lesions in the phalangeal bone. Ray amputation of the finger was required to establish a wide resection of the chondrosarcoma. Most osteochondral tumors arising from the phalanges are benign tumors such as enchondromas, but primary chondrogenic malignant bone tumors (chondrosarcomas) occasionally occur. Chondrosarcoma of the phalanx is difficult to distinguish from enchondroma of the phalanx, because histological investigations of the two neoplasms often produce similar findings. Even with a combination of clinical, biopsy, and imaging findings, differentiating these neoplasms is still challenging, because the characteristic clinical and radiological features of chondrosarcoma do not appear until it becomes aggressive and starts to cause destructive changes. Once that happens, radical expanded resection of the tumor is essential. Therefore, longstanding enchondroma-like lesions should be actively treated in elderly patients, even if a definite diagnosis of chondrosarcoma cannot be made.

摘要

我们报告一例老年男性无名指近节指骨发生的孤立性软骨肉瘤病例。该软骨肉瘤病程长达14年,在此期间指骨逐渐变形。进行了多项影像学检查,但患者拒绝进一步建议的诊断性检查(计算机断层扫描、磁共振成像、活检)。最终,病变显著增大,X线片显示指骨有溶骨性病变。为广泛切除软骨肉瘤,需行手指的截指术。大多数起源于指骨的骨软骨瘤是良性肿瘤,如内生软骨瘤,但原发性软骨源性恶性骨肿瘤(软骨肉瘤)偶尔也会发生。指骨软骨肉瘤很难与指骨内生软骨瘤区分开来,因为这两种肿瘤的组织学检查结果常常相似。即使结合临床、活检和影像学表现,鉴别这些肿瘤仍具有挑战性,因为软骨肉瘤的典型临床和放射学特征直到其变得具有侵袭性并开始引起破坏性改变时才会出现。一旦发生这种情况,肿瘤的根治性扩大切除至关重要。因此,即使不能明确诊断为软骨肉瘤,老年患者中持续存在的内生软骨瘤样病变也应积极治疗。

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