骨肿瘤课件全.pptVIP

骨肿瘤Tumor of bone and soft tissue Chapter 1 SummaryConception：凡发生在骨内或起源于骨各种组织成分的肿瘤，不论原发性，还是继发性或转移瘤，统称为骨肿瘤。The incidence of primary malignant bone neoplasm(excluding myeloma) is about 1 case per 100,000 individuals per year.True benign bone tumors at about half this frequency. Classification 目前的分类皆基于细胞来源. 我国自已的骨肿瘤分类特点是:1.将骨肿瘤分为良性、中间性和恶性三类.2.将骨巨细胞归纳于组织细胞来源内.3.采用临床、病理和X线三结合. Histological classification of bone tumorsDifferentiation or histogenesisbenignLow-grade malignanthigh-grade malignantFibrous and histiocyticGiant cell tumorHistiocytic fibromaGrade 1 and 2 fibrosacomaGrade 3 and 4 fibrosacomaCartilaginousChondromaChondroblastomaPeripheral CSPeriosteal CSDefferentiated CSMesenchymal CSOsseousOsteoblastomaLow-grade central OSSmall cell OSNervousNeurofibromaPeripheral neuroectodermic tumor神经外胚层 CS=chondrosarcoma, OS=Osteosacoma Tumor-like Space-Occupying lesion(瘤样病损) 1.Simple cyst (孤立性骨囊肿) 2.Aneurysmal bone cyst (动脉瘤性骨囊肿) 3.Eosinnophilic granuloma 嗜酸性肉芽肿 4.Fibrous dysplasia of bone骨纤维异样增殖症. 5.Synovial chondromatosis滑膜肉瘤 6.Pigmented villonodular synovitis色素沉着绒毛结节性滑膜炎 Tumors:benign versus malignantPatient with bone tumors usually present with pain;however,they may present with a painful mass or even with a painless mass.The symptoms and signs depend on the indolence or aggressiveness of a tumor and its interaction with a given host.The most characteristic symptom associated with bone tumors is pain present at night.As this pain becomes more progressive,it is usually severe enough to wake patients from their sleep. In certain tumors,the onset and relief of pain is characteristic enough to make a specific diagnosis.For example,in osteoid osteoma,aspirin usually relieves the nocturnal（夜间的） pain associated with the tumor.This is believed to be releted to the unique innervation(神经支配) of this lesion combined with its biosynthesis of prostaglandins. Growth patternsMalignant bone tumors possess characteristics growth patterns that help