骨嗜酸性肉芽肿29例误诊分析.DOCVIP

临床医学论文-骨嗜酸性肉芽肿29例误诊分析 ??????????? 作者：郭燕，冯仕庭，张翎，胡美玉，黄兆民 【摘要】? 目的? 分析骨嗜酸性肉芽肿的误诊原因，以期提高本病的诊断水平。方法? 回顾性分析经病理证实的29例骨嗜酸性肉芽肿误诊病例的临床和影像学资料，其中X线平片29例，CT 12例，MRI 10例。结果? 误诊为尤文肉瘤8例，其他原发性骨恶性肿瘤4例，骨转移瘤5例，骨髓炎7例，骨结核3例，骨囊肿2例。误诊的主要原因：对骨嗜酸性肉芽肿缺乏认识占75.9％( 22/29 )；不恰当地应用影像学检查手段占44.8％（13/29）；诊断思维偏差占82.8％（24/29）。结论? 加深对骨嗜酸性肉芽肿影像学表现的认识，正确有效地应用影像学的检查手段，培养正确的诊断思维并结合临床，大多数骨嗜酸性肉芽肿病例能在治疗前做出正确诊断。??? ??? 【关键词】? 嗜酸性肉芽肿；骨骼；误诊??????? 【Abstract】? Objective? To analyze the cause of misdiagnosis of eosinophilic granuloma of bone so as to improve diagnosis accuracy of the disease.Methods? The clinical data and radiological images of 29 cases of eosinophilic granuloma of bone，misdiagnosed initially and eventually proved by pathology，were studied retrospectively.Plain films were obtained in all 29 cases，CT scan was performed in 12 cases，and MRI was done in 10 cases.Results? The eosinophilic granuloma of bone was misdiagnosed as Ewing’s sarcoma in 8 cases； as primary malignancy of bone in 4 cases； as metastatic lesions of bone in 5 cases； as osteomyelitis in 7 cases； as bone tuberculosis in 3 cases； and as bone cyst in 2 cases.The major factors leading to misdiagnosis were： lack of understanding of eosinophilic granuloma of bone in 75.9% (22/29) cases，improper utilization of imaging modalities in 44.8％（13/29）cases； deviated strategies of diagnosis in 82.8％（24/29）cases.Conclusion? By making a further understanding of imaging findings of eosinophilic granuloma of bone，applying suitable imaging modalities，following the right approach of diagnosis，and integrating the clinical data，accurate diagnosis is accessible in most cases of eosinophilic granuloma of bone before the decisions of treatment is made.??? ??? 【Key words】? eosinophilic granuloma；bone；misdiagnosis??? ??? 骨嗜酸性肉芽肿亦称为局限性朗格汉斯细胞组织细胞增生症（localised Langerhans-cell histiocytosis of bone），尽管病因未确立，目前多数认为是一种免疫调控的异常，此种病变中主要的增生成分为朗格汉斯(Langerhans)细胞，是一种见于表皮但来源于骨髓内原始细胞的分支型单核细胞，并由CD34+干细胞分化而成，经血液循环进入皮肤、肺、胸腺和淋巴结。朗格汉斯细胞组织细胞增生症的特征性病理表现，是朗格汉斯细胞的异常增生、浸润和聚集于各种