Tsuneyoshi M, Dorfman H D
Hum Pathol. 1987 Jun;18(6):644-51. doi: 10.1016/s0046-8177(87)80366-0.
In a retrospective radiologic and histologic study of 286 osteosarcomas in files of a metropolitan hospital, four patients (three men and one woman) with osteosarcomas confined to the epiphysis were identified. In this series, there were also 16 metaphyseal osteosarcomas that extended to the epiphysis with penetration through the cartilaginous growth plate, a structure that ordinarily resists tumor growth. All tumors occurred in the femoral condyle. Characteristically, all four patients had histories of knee joint pain, and three reported antecedent trauma. Radiologically, the tumors showed predominantly lytic features. Histologically, three of the tumors were osteoblastic in type, and one was mostly chondroblastic. Purely epiphyseal osteosarcoma has overlapping radiologic features with clear cell chondrosarcoma, epiphyseal chondroblastoma, and epiphyseal enchondroma. The epiphyseal osteosarcomas of the distal femur reported here were characterized by a history of symptoms localized to the knee joint itself as a consequence of their epiphyseal location and joint involvement. This is in contrast to the usual metaphyseal osteosarcomas, which present with lower thigh pain and swelling. Because osteosarcomas may present as lytic tumors confined to the epiphysis, they should be included in the differential diagnosis of such lesions.
在一家大城市医院档案中对286例骨肉瘤进行的回顾性放射学和组织学研究中，确定了4例（3名男性和1名女性）骨肉瘤局限于骨骺的患者。在该系列中，还有16例干骺端骨肉瘤延伸至骨骺，穿透了通常能抵抗肿瘤生长的软骨生长板。所有肿瘤均发生在股骨髁。其特点是，所有4例患者均有膝关节疼痛病史，3例报告有先前外伤史。放射学上，肿瘤主要表现为溶骨性特征。组织学上，其中3例肿瘤为成骨细胞型，1例主要为软骨母细胞型。单纯骨骺骨肉瘤与透明细胞软骨肉瘤、骨骺软骨母细胞瘤和骨骺内生软骨瘤有重叠的放射学特征。本文报道的股骨远端骨骺骨肉瘤的特点是，由于其骨骺位置和关节受累，症状局限于膝关节本身。这与通常的干骺端骨肉瘤不同，后者表现为大腿下部疼痛和肿胀。由于骨肉瘤可能表现为局限于骨骺的溶骨性肿瘤，因此应将其纳入此类病变的鉴别诊断。
