骨和软组织肿瘤诊治基础课件

1、骨与软组织肿瘤诊治原则301医院骨肿瘤科 贾金鹏原则的重要性骨肿瘤核心知识诊断切除理念活检Jaffe ：A biopsy should be regarded as the final diagnostic procedure, not as a mere short cut to diagnosis活检1982, Mankin 329 patients errors in diagnosis was 18.2%complications was 17.3%Unnecessary amputations were performed in 4.5%. 2019, Mankin 597 pati

2、ents errors in diagnosis in 13.5%Complication rate 15.9unnecessary amputations in 3%.In addition to technical recommendations, it was recommended that if a surgeon or an institution is not equipped to perform accurate diagnostic studies or definitive surgery and adjunctive treatment of musculoskelet

3、al tumors, the patient should be referred to a specialized treating center before the biopsy is performed.活检活检指征:如有疑问= 活检任何有恶性征象的病变均需活检良性侵袭性病变，不能完全确定时其他器官肿瘤，出现孤立性骨破坏穿刺条件:有经验的骨与软组织肿瘤方面的病理科医生协作团队能指导穿刺的影像学检查穿刺不能取代完善的病史/查体/实验室检查及影像学检查穿刺技术FNA（fine needle aspiration）：癌及淋巴结细胞学检查，诊断肉瘤困难Core：选取有代表性的部分活检透视或CT

4、引导Incisional 切取代表性组织，不带来更多污染机会Excisional 小并表浅的病变随手术切除活检原则使用病变累及的间室不要显露NV 结构切口可延伸并与预计手术切口方向一致避免手触及切口内组织尽量使用止血带并在关闭切口前松止血带如需引流，引流出口与切口方向一致具体活检方法选择表浅 5 cm = 分期 + 活检位于骨表面= 分期 + 活检深部病变=分期 + 活检常见区域肱骨头: 股骨远端: 内侧？外侧？前侧？Staging Primary bone tumors Subdivided into : - benign bone neoplasm - latent - active -

5、aggressive - malignant bone neoplasm - low grade - high grade Benign latent Intracpsular Asymptomatic Incidental finding Xrays: - well defined margins - no cortical destruction e.g non ossifying fibroma , enchondroma , osteochondromaBenign active Intracpsular Actively growing Symptomatic Pathologica

6、l fractureXrays: - well defind margins - expansile and may thin the cortex e.g : Unicameral bone cyst , osteiod osteoma Benign aggressive SymptomaticRisk of mets is around 5% Xrays - aggresvise nature - destruction of the cortex - new cortix formation MRI may show a soft tissue mass e.g : Gaint cell

7、 tumors , aneurysmal bone cyst Malignant lesions (Enneking )Low grade tumors are designated as stage 1 - low risk of mets ( 25% ) hist: well differentiated , few mitoses and moderate cytological atypia .High grade tumors are designated as stage 2 - high risk of mets hist: poorly differentiated .Meta

8、stases stage 3Compartmentsintra-osseousintra-articularsuperficial to fasciaparosseousintra-fascial compartmentanatomic regions contained by natural barriers to tumor extensionCompartmentsneurovascular bundlespara-articular tissuesaxilla / antecubital fossagroin / popliteal fossahand/footEXTRACOMPARTMENTAL SITESHow To Stage Bone TumorsBenign Latent/Active: Local - xray +/- CT/MRI +/- TBBSBenign Aggressiv