骨与软组织肿瘤诊治基础.pptVIP

Staging Primary bone tumors Subdivided into : - benign bone neoplasm - latent - active - 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 , osteochondroma Benign active Intracpsular Actively growing Symptomatic Pathological fracture Xrays: - well defind margins - expansile and may thin the cortex e.g : Unicameral bone cyst , osteiod osteoma Benign aggressive Symptomatic Risk 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 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 . Metastases stage 3 Compartments intra-osseous intra-articular superficial to fascia parosseous intra-fascial compartment anatomic regions contained by natural barriers to tumor extension Compartments neurovascular bundles para-articular tissues axilla / antecubital fossa groin / popliteal fossa hand/foot EXTRACOMPARTMENTAL SITES How To Stage Bone Tumors Benign Latent/Active: Local - xray +/- CT/MRI +/- TBBS Benign Aggressive: Local - xray/CT/MRI Systemic - TBBS, CXR Malignant: Systemic - CT Chest Special: Gallium scan, CT Abd + Pelvis, Bone marrow biopsy * * 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 am