Chondroblastic Osteosarcoma: Cytomorphologic Characteristics and Differential Diagnosis on FNA
Chondroblastic Osteosarcoma: Cytomorphologic Characteristics and Differential Diagnosis on FNA
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DOI：
10.1002/cncy.21715
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发表时间：
2016-07-01
影响因子：
3.4
通讯作者：
Ali, Syed Z.
中科院分区：
文献类型：
--
作者：
VandenBussche, Christopher J.;Sathiyamoorthy, Srividya;Ali, Syed Z.
背景：软骨母细胞骨肉瘤（COS）是一种如果没有及时诊断和适当治疗的话，通常是致命的骨恶性肿瘤。骨病变的细针抽吸（FNA）在主要医疗中心常规进行。肿瘤的适当特征将显着影响患者的治疗和结果。方法：对 2 个大型三级医疗中心 15 年期间（2001-2015 年）的细胞病理学档案进行回顾性审查，发现 16 名患者中有 17 例 COS（9 例原发性病例、6 例复发性病例和 2 例转移性病例）。对临床结果和组织病理学随访进行了回顾和关联。结果：男9例，女7例（男女比例约为1：1），年龄12～70岁（平均年龄29.2岁）。骨肉瘤多累及经典部位，如膝关节周围长骨4例，肱骨近端1例。然而，其他“非经典”部位也常受累，包括远端胫骨或腓骨（4 例）、骶髂区（4 例）、下颌骨（3 例）和颅骨（1 例）。细胞形态学特征为高细胞结构；主要是离散的单细胞；小组织碎片；背景类骨质和软骨样基质；梭形细胞和浆细胞样细胞，具有中等至丰富的嗜碱性空泡细胞质，偶尔有多个细胞质突起；细胞核呈圆形至椭圆形，无核细胞增多症；和小到突出的核仁。可见散在的双核和多核破骨细胞样巨细胞。具有高级形态学的病例表现出明显的多形性和丰富的有丝分裂。结论：COS的鉴别诊断包括软骨母细胞瘤、软骨肉瘤和软骨样脊索瘤。通过临床和放射学相关性可以做出明确的诊断。 (C) 2016 年美国癌症协会。
BACKGROUND: Chondroblastic osteosarcoma (COS) is a uniformly fatal bone malignancy if not diagnosed and treated appropriately in a timely manner. Fine-needle aspiration (FNA) of osseous lesions is routinely performed in major medical centers. Appropriate characterization of the tumor will significantly influence patient management and outcomes. METHODS: A retrospective review of the cytopathology archives of 2 large tertiary care centers for a 15-year period (2001-2015) revealed 17 cases of COS (9 primary, 6 recurrent, and 2 metastatic cases) in 16 patients. Clinical outcome and histopathologic follow-up were reviewed and correlated. RESULTS: There were 9 male and 7 female patients (male-to-female ratio of approximately 1: 1), ranging in age from 12 to 70 years (mean age, 29.2 years). The classic locations for osteosarcoma were commonly involved, such as the long bones around the region of the knee in 4 cases and the proximal humerus in 1 case. However, other "nonclassic" sites also were noted to be commonly involved, including the distal tibia or fibula (4 cases), sacroiliac region (4 cases), mandible (3 cases), and skull (1 case). Cytomorphologic characteristics were high cellularity; predominantly discohesive, single cells; small tissue fragments; background osteoid and chondroid matrix; spindled cells and plasmacytoid cells with moderate to abundant basophilic vacuolated cytoplasm and occasional multiple cytoplasmic processes; round to oval nuclei with anisonucleosis; and small to prominent nucleoli. There were scattered binucleated and multinucleated osteoclast-like giant cells. Cases with high-grade morphology demonstrated marked pleomorphism and abundant mitoses. CONCLUSIONS: The differential diagnosis of COS includes chondroblastoma, chondrosarcoma, and chondroid chordoma. A definitive diagnosis can be made with clinical and radiological correlation. (C) 2016 American Cancer Society.