Gaetani P, Tancioni F, Merlo P, Villani L, Spanu G, Baena R R
Department of Surgery, Neurosurgery, IRCCS Policlinico S. Matteo, Pavia, Italy.
Surg Neurol. 1996 Dec;46(6):534-9. doi: 10.1016/s0090-3019(96)00226-1.
Cartilage-forming tumors are benign cartilaginous tumors that rarely affect the spinal canal: they account for 2% of all spinal tumors and 2.6% of all benign bone tumors. Pathologically, they may be classified as chondromas, osteochondromas, chondroblastomas, and chondromyxoid fibromas. This oncotype may remain asymptomatic (it is confined within the vertebral structure) or may present as a hard paravertebral swelling (it invades the paravertebral structures) or more rarely, with a slowly-developing neurologic syndrome (it extends into the vertebral canal).
Thirty-one cases have been reported (including our case) of benign cartilage-forming tumors localized in the lumbar column. Only three cases of chondroma of the lumbar spine presented with lumbar radicular pain. We report a fourth case and review clinical and radiologic characteristics of these lesions.
Eleven out of the 31 cases were diagnosed as chondromas, 17 as osteochondromas, while in three cases the histopathologic diagnosis was not reported. Seventeen cases originated from the neural arch, seven from the vertebral body, two from the spinous process, and in five cases the exact localization was not reported. This tumor is more frequent in males (21 cases out of 31), than in females (five cases); in five cases the sex was not reported. Mean duration of symptoms was 23 +/- 5.1 months (range: 1-96); chondromas have a short clinical history before diagnosis (13.8 +/- 3.4 months) compared to osteochondromas (28.6 +/- 7.6). Clinical presentation with local swelling is reported in 10 cases, in 10 cases local pain without radicular irradiation, in six cases lumbar pain with sciatica, in two cases signs and symptoms of cord compression, one case of cauda syndrome, while in four cases no clinical details are reported. Among the six cases presenting with sciatica, four were chondromas (in all cases the L4 level was involved), and one osteochondroma, while in one case the histopathologic diagnosis was not reported.
Computed tomography is important and indispensable for preoperative diagnosis, giving a precise indication of tumor extent and location and its relationship to the adjacent structures; while MRI is helpful in detecting patterns related to histologic malignancy. It is important to examine the whole tumor histologically because it is known that there may be small areas that show signs of malignancy; thus is more likely in chondromas than osteochondromas.
软骨形成性肿瘤是良性软骨肿瘤，很少累及椎管：它们占所有脊柱肿瘤的2%，所有良性骨肿瘤的2.6%。病理上，它们可分为软骨瘤、骨软骨瘤、成软骨细胞瘤和软骨黏液样纤维瘤。这种肿瘤类型可能无症状（局限于椎体结构内），或表现为椎旁硬性肿块（侵犯椎旁结构），或更罕见地，表现为缓慢发展的神经综合征（延伸至椎管内）。
已报道31例（包括我们的病例）位于腰椎的良性软骨形成性肿瘤。只有3例腰椎软骨瘤表现为腰神经根性疼痛。我们报告第4例，并回顾这些病变的临床和影像学特征。
31例中11例诊断为软骨瘤，17例为骨软骨瘤，3例未报告组织病理学诊断。17例起源于椎弓，7例起源于椎体，2例起源于棘突，5例未报告确切定位。该肿瘤男性（31例中的21例）比女性（5例）更常见；5例未报告性别。症状平均持续时间为23±5.1个月（范围：1 - 96个月）；软骨瘤在诊断前的临床病史较短（13.8±3.4个月），而骨软骨瘤为（28.6±7.6个月）。10例报告有局部肿块表现，10例有局部疼痛但无神经根放射痛，6例有腰痛伴坐骨神经痛，2例有脊髓受压的体征和症状，1例有马尾综合征，4例未报告临床细节。在6例有坐骨神经痛的病例中，4例为软骨瘤（所有病例均累及L4水平），1例为骨软骨瘤，1例未报告组织病理学诊断。
计算机断层扫描对术前诊断很重要且不可或缺，能准确显示肿瘤范围、位置及其与相邻结构的关系；而磁共振成像有助于检测与组织学恶性程度相关的模式。对整个肿瘤进行组织学检查很重要，因为已知可能存在显示恶性迹象的小区域；软骨瘤比骨软骨瘤更可能出现这种情况。
