骨巨细胞瘤课件_1.pptVIP

骨巨细胞瘤;肿瘤（tumor）的特点;肿瘤的组织学;1、肿瘤分为良性和恶性，一般所以的恶性肿瘤可以成为癌症（cancer），来源于上皮组织的肿瘤称为癌（carcinoma），来源于间叶组织的称为肉瘤（sarcoma）。 2、一般讲肿瘤，不分良性和恶性，统称为tumor。 3、良性肿瘤和恶性肿瘤并无明显的界限，一些肿瘤在组织形态学和生物学上介于二者之间，称为交界性肿瘤（borderline tumor）。;骨巨细胞瘤（Giant cell tumor of bone）;1、The tumours occur predominantly in the meta - epiphyseal regions of the long bones. 骨巨细胞瘤在成人多侵犯长骨，如股骨下端、胫骨上端，其次是桡骨远端、腓骨小头、股骨近端、肱骨近端。 2、临床主要症状是：疼痛、肿胀、压痛和运动受限。 3、The tumours generally appear on an X-ray film as expansile osteolytic defects, leading eventually to significant local bone destruction. X线：偏心性膨胀性溶骨性改变，无反应性新骨形成，一般没有骨膜反应。病变部皮质变薄，呈现出肥皂泡样改变。但，当出现病理性骨折时可以出现骨膜反应。 4、对于肿瘤病人，摄CT和MRI有助于肿瘤的分期，明确病变。 5、需要与：动脉瘤样骨囊肿、骨肉瘤、骨囊肿作鉴别诊断。 Due to the complex histological composition of GCT,differential diagnosis is required to exclude the diagnosis of other lesions also containing giant cells, such as the variants of aneurysmal bone cysts , fibrous metaphyseal defects,chrondroblastoma（软骨母细胞瘤）, brown tumour in hyperparathyroidism（甲亢） and giant cell -rich variants of osteosarcoma（骨肉瘤）.;1、镜下可见多核细胞均匀分散于短梭形的单核基质细胞中。（多核巨细胞的来源尚有争议） The tumoral tissue consists of three cell types – the neoplastic giant cell tumour stromal cells (GCTSC ), representing the proliferative fraction, secondarily recruited mononuclear histiocytic cells (MNHC) and multinuclear giant cells (MNGC). Mononuclear histiocytic cells (MNHC) and multinucleated giant cells(MNGC) express the CD68- antigen, thus explaining how MNHC and MNGC a reconsidered to belong to the monocytic-histiocytic system. 该文献认为MNHC和MNGC是后来被募集到肿瘤中的，GCTSC才是肿瘤主要的细胞，而且，在肿瘤中，后者的比例各有不同。 2、肿瘤几乎总是侵及到软骨下骨，而关节软骨是正常的。 3、肿瘤的组织学表现和肿瘤的生物学行为之间的联系被证明是不可靠的。 GCTs are seen as tumours with an undefined biological behavior or even as low-grade malignant tumours because their clinical course is not sufficiently predictable on the basis of histological findings.;MNGC：多核细胞均匀的分布在单核细胞中间;MNHC：免疫荧光染色证实CD68抗原阳性;1、The tumours are generally discovered at a relatively clinically advanced stage and, unlike epitheli