Biscaglia R, Gasbarrini A, Böhling T, Bacchini P, Bertoni F, Picci P
Orthopedic Clinic, University of Verona, Italy.
Mayo Clin Proc. 1998 Sep;73(9):842-7. doi: 10.4065/73.9.842.
To evaluate the frequency of osteosarcoma involving the foot and determine the clinical outcome of affected patients.
We retrospectively reviewed the cases of osteosarcoma encountered between 1911 and 1992 at the Rizzoli Orthopedic Institute. In particular, we analyzed whether common clinical, radiographic, or histologic features could lead to a correct diagnosis of osteosarcoma of the foot.
The bones of the foot were the primary site of osteosarcomas in 12 cases--0.6% of the entire series of such tumors at our institution during the study period. The mean age of the patients was 33 years. Initial symptoms were usually pain and swelling. Late diagnosis was common; the mean time interval between the first symptoms and diagnosis was 28 months. Misdiagnoses occurred in 6 of the 12 cases (50%): osteoblastoma, chondroblastoma, chondrosarcoma, osteoid osteoma, desmoid fibroma, and osteomyelitis were, respectively, the initial diagnoses. Histologically, 5 of the 12 tumors (42%) were low-grade lesions. Four of the seven patients with a high-grade tumor died of metastatic disease after a mean survival of 50 months. Eight patients are alive with no evidence of disease after a mean follow-up of 162 months.
When a painful swelling in a bone of the foot is observed, even if numerous benign conditions (such as fractures, infections, or benign bone tumors) are far more likely to occur, osteosarcoma must be ruled out to avoid delays in the treatment. Osteosarcomas of the foot may easily be misdiagnosed, especially because they almost always occur in adults, in contrast to osteosarcomas in general. High-grade tumors of the foot are as aggressive as other osteosarcomas and should be managed accordingly--with use of a safe-margins surgical procedure and chemotherapy.
评估足部骨肉瘤的发病率，并确定受影响患者的临床结局。
我们回顾性分析了1911年至1992年间在里佐利骨科研究所遇到的骨肉瘤病例。特别地，我们分析了常见的临床、影像学或组织学特征是否能导致对足部骨肉瘤的正确诊断。
足部骨骼是12例骨肉瘤的原发部位，占研究期间我们机构此类肿瘤总数的0.6%。患者的平均年龄为33岁。初始症状通常为疼痛和肿胀。诊断延迟很常见；首次症状出现至诊断的平均时间间隔为28个月。12例中有6例（50%）误诊：初始诊断分别为骨母细胞瘤、软骨母细胞瘤、软骨肉瘤、骨样骨瘤、硬纤维瘤和骨髓炎。组织学上，12例肿瘤中有5例（42%）为低级别病变。7例高级别肿瘤患者中有4例在平均生存50个月后死于转移性疾病。8例患者在平均随访162个月后仍存活且无疾病证据。
当观察到足部骨骼出现疼痛性肿胀时，即使众多良性情况（如骨折、感染或良性骨肿瘤）更易发生，也必须排除骨肉瘤以避免治疗延误。足部骨肉瘤很容易误诊，特别是因为与一般骨肉瘤不同，它们几乎总是发生在成年人中。足部高级别肿瘤与其他骨肉瘤一样具有侵袭性，应采用安全切缘的手术和化疗进行相应治疗。
