骨巨细胞瘤的诊断与治疗

,100035,,,CTMRI,X,,,R73811ADiagnosisandtreatmentofgiantcelltumorofboneNiuXiaohuiDepartmentofOsteosarcomaBeijingJishuitanHospital,Beijing100035,ChinaAbstractGiantcelltumor(GCT)ofboneisahyperinvasionprimarybenignbonetumor.GCTsmostlyoccurintheyoungadultsandlocatedattheendoflongtubularbone.Thetypicalimaginecharacteristicsaretotallyosteolyticandexpensivelesionwithlittlesofttissuemassandreactivenewboneformation.Plainfilmhasthemostdiagnosticvalue.GCThistologicallycomposesofstromacellsandmulti2nucleargiantcells.CurettageisthemostcontemporaryproceduretotreatGCTssurgicallyandthemostproblemislocalrecurrenceandadju2vantcouldreducetherelapserate.Radiationisonlyusedfornon2operatablepatientsandchemotherapyisuse2lessforGCT.MetastasisandmalignancychangeofGCTmayberelatedwithpriorsurgicalorotherprocedures.KeywordsgiantcelltumorofbonediagnosistreatmentOncolProg,2005,3(4),(),,2040Enneking,3,3162005734ONCOLOGYPROGRESS,July2005,Vol13,No14©1995-2006TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.1,16%,2040,,5614%20,,72%,,,,,,,,,,2211X,XX,,,,,;,,,,X,,,,,212CTCTX,,CT,,CT,CT,213MRI,(MRI),,,,(T1)(T2)(T1),(T2)T1,T2CT,MRI,CT,MRI214,,99mTc,,,,,,,,,3ONCOLOGYPROGRESS,July2005,Vol13,No142005734317©1995-2006TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,,,,,,,,,,,,,,,,,43,Enneking,,,,40%60%,,,,;(),,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,3182005734ONCOLOGYPROGRESS,July2005,Vol13,No14©1995-2006TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.,,,,,,,,,,,,,(),,,,,,,,,,,,,;,3/4,,,,,,,,,,,,,,,,,34,,,,,,,1.AthanasianEA.Aneurysmalbonecystandgiantcelltumorofboneofthehandanddistalradius.HandClin,2004,20(3)2692.LeggonRE,ZloteckiR,ReithJ,ScarboroughMT.Giantcelltumorofthepelvisandsacrum:17casesandanalysisofthelite2rature.ClinOrthop,2004,(423)1963.SzendroiM.Giant2celltumourofbone.JBoneJointSurgBr,2004,86(1)54.WurapaRK,WhippleR.Distalradioulnarallograftreconstruc2tionaftergiantcelltumorresection.AmJOrthop,2003,32(8)3975.MondalA,KunduB,GuptaS,etal.Secondarymalignantgi2antcelltumourofbone:Astudyoffivecaseswithshortreviewofliterature.IndianJPatholMicrobiol,2002,45(3)273(398)ONCOLOGYPROGRESS,July2005,Vol13,No142005734319©1995-2006TsinghuaTongfangOpticalDiscCo.,Ltd.Allrightsreserved.4.LuckmanSP,HughesDE,CoxonFP,etal.Nitrogen2contain2ingbisphosphonatesinhibitthemevalonatepathwayandpreventpost2translationalprenylationofGTP2bingdingproteins,includingRasJBoneMinerRes,1998,135815.RogersMJ,GordonS,BenfordHL,etal.Cellularandmolec2ularmolecularmechanismsofactionofbisphophonates.Cancer,2000,88(Suppl)29616.BenfordHL,HelfrichMH,SebtiS,etal.InhibitionofproteingeranylationbybisphosphonatesandGGTI298causesactivationofcaspase23likeproteasesinosteoclasts.CalcifTissueInt,1999,64(Suppl)457.GreenJR,MullerK,JaeggiKA.PreclinicalpharmacologyofCGP429446,anew,potent,heterocyclincbisphosphonatecompound.JBoneMinerRes,1994,97458.BodyJJ,LortholaryA,romieuG,etal.Adose2findingstudyofzoledronateinhypercalcemiccancerpatients.JBoneMinerRes,1999,1415579.RosenL,GordonD,TchekmedyianS,etal.Zoledronicacidversusplacebointhetreatmentofskeletalmetastasesinpatientswithlungcancerandothersolidtumors:Aphase,double2blind,randomizedtrial.TheZoledronicAcidLungCancerandOtherSolidTumorsStudyGroup.JClinOncol,2003,21315010.SaadF,GleasonDM,MurrayR,etal.Arandomized,pla2cebo2controledtrialofzoledronicacidinpatientswithhormone2refractorymetastaticprostatecarcinoma.JNatlCancerInst,2002,94145811.RosenL,GordonD,TchekmedyianS,etal.zoledronicacidsignificantlyreduceskeletal2relatedevents(SREss)inpatientswithbonemetastasesfromsolidtumors.ProcAmSocClinOn2col,2002,21295A12.RosenL,GordonD,KaminskiM,etal.Zoledronicacidver2suspamidronateinthetreatmentofskeletalmetastasesinpa2tientswithbreastcancerofosteolyticlessonsofmultiplemy2eloma:Aphase,double2blind,comparativetrial.Cancer,2001,737713.GreenJR,SeltenmeyerY,JaeggiKA,etal.Renaltolera2bilityprofileofnovel,potentisphosphonatesintwoshort2termratmodels.PharmacolToxicol,1997,80225(319)6.YaskoAW.Giantcelltumorofbone.CurrOncolRep,2002,4(6)5207.Boutou2BredakiS,AgapiosP,PapachristouG.Prognosisofgi2antcelltumorofbone:Histopathologicalanalysisof15casesandreviewoftheliterature.AdvClinPath,2001,5(3)718.MaruiT,YamamotoT,YoshiharaH,etal.Denovomalig2nanttransformationofgiantcelltumorofbone.SkeletalRadiol,2001,30(2)1049.AlvarezRamosA,ValverdeGarciaJA,GarciaAlonsoMG.Gi2antcelltumorofthefootphalangesinchildren:Acasereporu.JPediatrOrthopB,1999,8(2)13210.MalawerMM,BickelsJ,MellerI,etal.Cryosurgeryinthetreatmentofgiantcelltumor:Along2termfollowupstudy.ClinOrthop,1999,(359)17611.SchwartzHS.Updateongiantcelltumorofbone.ComprTher,1998,24(10)48812.RouxS.Giantcelltumorsofbone.RevRhumEnglEd,1998,65(2)13913.MolinieV,PouchotJ,VinceneuxP,BargeJ.Osteoclastoma2likegiantcelltumoroftherenalpelvisassociatedwithpapillarytransitionalcellcarcinoma.ArchPatholLabMed,1997,121(2)16214.SanjayBK,YoungeDA.Giantcelltumourofmetacarpalwithpulmonaryandskeletalmetastases.JHandSurg,1996,21(1)12615.KayRM,EckardtJJ,SeegerLL,etal.Pulmonarymetastasisofbenigngiantcelltumorofbone.Sixhistologicallyconfirmedcases,includingoneofsp