Welkerling H, Werner M, Delling G
Abteilung Osteopathologie, Pathologisches Institut, Universität, Hamburg.
Pathologe. 1996 Jan;17(1):18-25. doi: 10.1007/s002920050130.
Chondrosarcomas are frequent malignant bone tumors. Aside from different subtypes, such as dedifferentiated, mesenchymal and clear-cell chondrosarcoma, chondrosarcomas (classical chondrosarcoma) show different grades of differentiation. The borderline between chondroma and classical chondrosarcoma is not clearly defined. The same chondrosarcoma can be graded differently at different institutes. Standardized therapy concepts are currently in preparation. As the Hamburg Bone Tumor Registry is often consulted for chondrogenic tumors, the histological criteria are based on a series of 74 chondrosarcomas recorded there. The emphasis has been laid on a classification which can be used in daily routine and which is reproducible and in agreement with the classifications of other international groups. Grade I chondrosarcomas (50%) can be distinguished only by growth criteria. The nuclei are small and show high chromatin density. Grade II chondrosarcomas (42%) have medium-sized, regular nuclei with loose chromatin structure. The chondrocytes of grade III cases (8%) show polymorphic nuclei. Binucleas forms, the number of mitoses and cellularity all show considerable overlap for all three grades. So far there are no immunohistological and molecular biological methods for reliable differentiation. The therapeutic consequences of the classification into grades are thorough curettage, in the case of grade I tumors, or complete resection, for grade II and III cases. The long-term results, however, need to be confirmed by a larger number of cases. From 1991 to 1995 the method was applied and proved to be easily practicable in daily diagnostic routine. Some 104 cases of classical chondrosarcomas (grade I 53%, grade II 39%, grade III 8%) were analyzed. Two pathologists both assigned the same grade in 90% of cases.
软骨肉瘤是常见的恶性骨肿瘤。除了不同的亚型，如去分化型、间叶型和透明细胞软骨肉瘤外，软骨肉瘤（经典型软骨肉瘤）还表现出不同程度的分化。软骨瘤与经典型软骨肉瘤之间的界限并不明确。同一软骨肉瘤在不同机构可能会有不同的分级。目前正在制定标准化的治疗方案。由于汉堡骨肿瘤登记处经常被咨询有关软骨源性肿瘤的问题，其组织学标准基于在那里记录的一系列74例软骨肉瘤。重点在于一种可用于日常工作、可重复且与其他国际组织的分类一致的分类方法。I级软骨肉瘤（50%）只能通过生长标准来区分。细胞核小，染色质密度高。II级软骨肉瘤（42%）有中等大小、规则的细胞核，染色质结构松散。III级病例（8%）的软骨细胞显示核多形性。双核形式、有丝分裂数量和细胞密度在所有三个级别中都有相当大的重叠。到目前为止，还没有可靠的免疫组织学和分子生物学方法用于鉴别。分级分类的治疗结果是，I级肿瘤进行彻底刮除，II级和III级病例进行完整切除。然而，长期结果需要更多病例来证实。1991年至1995年应用了该方法，证明在日常诊断工作中易于实施。分析了约104例经典型软骨肉瘤（I级53%，II级39%；III级8%）。两位病理学家在90%的病例中给出了相同的分级。
