非典型“硬化性”骨母细胞肿瘤一种生物学潜能介于常见骨母细胞瘤和经典骨肉瘤之间的肿瘤

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  --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
  “侵袭性”骨母细胞肿瘤(osteoblastoma,OB)或OB恶性转化的存在是有争议的。几十年来,我们遇到了1组难以分类的“交界性”硬化性骨母细胞病变,这种病变易于局部复发,尤其是在刮除术后。通过检索3位共同作者对非典型OB、OB的恶性转化、分化良好的骨肉瘤(osteosarcoma,OS)和OB样OS诊断的文献资料,我们发现了8例相似的病例。男性6例,女性2例,年龄为11~55岁(平均,26岁)。发生在跖骨3例,腓骨2例,肱骨、胫骨和股骨各1例。影像学上显示大多数呈膨胀性,从溶解性改变到硬化,边缘有界限或至少部分有硬化缘。病理学上,所有病例均表现出1种与传统OB少量成分相关的、以硬化的片状肿瘤骨为主的生长模式,未发现骨母细胞呈实性片状或渗透周围骨组织。6例病例由1位以上的骨科病理学专家复诊,专家之间意见不一。其中4例最初诊断为OB,2例为低级别OS,1例为高级别OS,1例为非典型硬化性骨母细胞肿瘤。临床随访7例,随访时间为12~138个月(平均,71个月)。4例仅进行刮除术;2例行刮除术和整块切除术且切缘阴性;1例行整块病灶内切除术以及1例截肢。5例出现局部复发,其中3例被“重新分类”为OS。1例局部复发被认为是去分化。这些肿瘤是否代表低级别OS或侵袭性OB尚不清楚。我们建议将这些肿瘤归类为“非典型硬化性骨母细胞肿瘤”,并进行完整的、切缘阴性切除。
  Am J Surg Pathol 2019;43:610–617
美国外科病理学杂志中文版2019年第四期摘要NO.2
(邹子归 翻译 郭凌川 审校)

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