Bertoni F, Bacchini P, Donati D, Martini A, Picci P, Campanacci M
Istituto Ortopedico Rizzoli, Bone Tumor Center, Bologna, Italy.
Mod Pathol. 1993 Nov;6(6):707-16.
A series of 11 osteosarcomas that histologically resembles osteoblastoma was reviewed. The ages of the seven males and four females ranged from 19 to 47 yr (average 29). In six patients the roentgenograms showed cortical destruction and poorly defined borders on the lesion; this roentgenographic presentation was suggestive of malignancy. Histologically, the tumor permeation of the surrounding host tissue allowed us to differentiate osteoblastoma-like osteosarcoma from osteoblastoma. The differential diagnosis can be very difficult or even impossible on a small biopsy. The first diagnosis was considered benign in nine of our cases. Osteoblastoma-like osteosarcoma is a rare variety of osteosarcoma (1.1% of all osteosarcoma). It is a low-grade malignant lesion in which recurrence is the rule when adequate surgical margins were not achieved (five patients). Two of these patients died from tumors after inadequate surgical treatment of the primary tumor as well as of the recurrences. The six patients who were treated with wide surgical margins were alive without recurrence. One of them had lung metastasis, twice, treated with wide-wedge resection. Osteoblastoma-like osteosarcoma is a low-grade variety of osteosarcoma with characteristic histopathologic features. It needs to be recognized by the pathologist to achieve the right treatment which is wide surgical procedure.
回顾了一系列11例组织学上类似骨母细胞瘤的骨肉瘤。7名男性和4名女性的年龄在19至47岁之间（平均29岁）。6例患者的X线片显示皮质破坏，病变边界不清；这种X线表现提示恶性。组织学上，肿瘤对周围宿主组织的浸润使我们能够将骨母细胞瘤样骨肉瘤与骨母细胞瘤区分开来。在小活检时，鉴别诊断可能非常困难甚至不可能。我们的病例中有9例最初诊断为良性。骨母细胞瘤样骨肉瘤是骨肉瘤的一种罕见类型（占所有骨肉瘤的1.1%）。它是一种低级别恶性病变，若手术切缘不充分，复发很常见（5例患者）。其中2例患者在对原发肿瘤及复发灶进行不充分的手术治疗后死于肿瘤。接受广泛手术切缘治疗的6例患者存活且无复发。其中1例发生两次肺转移，接受了广泛楔形切除术。骨母细胞瘤样骨肉瘤是骨肉瘤的一种低级别类型，具有特征性的组织病理学特征。病理学家需要认识到这一点，以便采取正确的治疗方法，即广泛的手术操作。
