目的：分析肋骨原发恶性骨肿瘤的CT表现，探讨相关的临床影像特点。方法：回顾性分析26例肋骨原发恶性骨肿瘤病例的CT表现，总结肋骨原发恶性骨肿瘤的影像学特征。结果：软骨肉瘤14例，78.5%发生于肋骨与肋软骨交界区，表现为不规则溶骨性骨质破坏伴或不伴软组织肿块，肿块内见软骨基质钙化，多数无明显强化。浆细胞骨髓瘤4例，表现为单发或者多发溶骨性“穿凿样”或“虫蚀样”骨质破坏，其中2例可见病理性骨折。骨肉瘤3例，表现为溶骨性或混合性骨质破坏，其中1例软组织肿块内见团片状高密度瘤骨。尤文肉瘤2例，表现为不规则溶骨性骨质破坏, 其中1例伴较大的软组织肿块。非霍奇金淋巴瘤、脊索瘤、纤维肉瘤各1例。结论：肋骨原发恶性骨肿瘤发病年龄及病种比较广泛，其中以软骨肉瘤最多见。部分病变都有其典型影像表现，而部分肿瘤影像学无特异性，最终诊断仍需临床、影像、病理三方面结合。
Abstract
Objective: To analyze the imaging appearance and to explore the diagnostic value of CT in primary malignant tumors of the ribs. Methods: Twenty-six cases with primary malignant costal tumors proved by operation and pathology were analyzed, and radiographic features were analyzed retrospectively. Results: There were 14 cases of chondrosarcoma with 78.5% arising at the costochondral junction, characterized by irregular and lytic bone destruction with cartilage matrix calcification inside. After intravenous injection, no obvious enhancement was seen. There were 4 cases of plasmacytoma, characterized by solitary or multiple, punched-out or eroded lesions. Osteosarcoma(three cases) appeared as osteolytic or mixed bone destruction, irregular calcific densities were found in one case. Ewing’s sarcoma(two cases) demonstrated as ill-defined, osteolytic lesions with a large soft tissue mass in one case. The rest were one of each of the following: non-Hodgkin’s lymphoma, chordroma, fibrosarcoma, and liposarcoma. Conclusion: The primary malignant tumors of the ribs are a complicated group and rarely encountered, some of which demonstrate the classic radiological features, but some cases with nonspecific radiological features, and the final diagnosis should consider about clinical, imaging and pathology.
关键词
骨肿瘤 /
肋骨 /
体层摄影术 /
螺旋计算机
Key words
Bone neoplasms /
Ribs /
Tomography, spiral computed
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参考文献
[1]Andrianopoulos EG, Lautidis G, Kormas P, et al. Tumours of the ribs: experience with 47 cases[J]. Eur J Cardio-thorac Surg, 1999, 15(5): 615-620.
[2]郭道芳，邢溪萍，郭美红. 肋骨原发性肿瘤的影像学诊断（附18例分析）[J]. 医学影像学杂志，2000，10（2）： 95-96.
[3]范国华，钱铭辉，龚建平，等. 肋骨肿瘤的CT诊断[J]. 临床放射学杂志，2005，24（3）：246-248.
[4]母华国，桑玲，吴德红，等. 肋骨原发性软骨肉瘤的影像表现[J]. CT理论与应用研究，2015，24（4）：595-602.
[5]胡碧莹，徐维敏，文婵娟，等. 肋骨原发性骨肿瘤的影像表现（附14例报告）[J]. 医学影像学杂志，2013，23（11）：1766-1770.
[6]Kim S, Lee S, Arsenault DA, et al. Pediatric rib lesions: a 13-year experience[J]. J Pediatr Surg, 2008, 43(10): 1781-1785.
[7]Ohaba K, Chen F, Date H. Rib chondrosarcoma with intramedullary progression completely resected by magnetic resonance imaging: useful short inversion time inversion recovery sequence[J]. Interact Cardiovasc Thorac Surg, 2011, 12(5): 853-854.
[8]Nam SJ, Kim S, Lim BJ, et al. Imaging of primary chest wall tumors with radiologic-pathologic correlation[J]. Radiographics, 2011, 31(3): 749-770.
[9]Shapeero LG, Vanel D, Couaner D, et al. Extraskeletal mesenchymal chondrosarcoma[J]. Radiology, 1993, 186(3): 819-826.
[10]Athanassiadi K, Kalavrouziotis G, Rondogianni D, et al. Primary chest wall tumors: early and long-term results of surgical treatment[J]. Eur J Cardiothorac Surg, 2001, 19(5): 589-593.
[11]Yaman Bajina I, Kurucu N, Oquz B, et al. Primary osteosarcoma of the rib: a case report and review of the literature[J]. J Pediatr Hematol Oncol, 2018, 40(1): 48-50.
[12]杨旦君，王丰富，戚洪波，等. 肋骨骨肉瘤一例报告[J]. 现代实践医学，2010，22（10）：1190.
[13]Mohanty S, Inchara YK, Crasta JA, et al. An unusual case of primary osteosarcoma of the rib in an adult[J]. Indian J Med Paediatr Oncol, 2010, 31(1): 18-20.
[14]袁敏，江旭，杨继金，等. 成人骨肉瘤的影像诊断（附21例报告）[J]. 实用放射学杂志，2011，27（3）：421-424.
[15]Thomas PRM, Foulkes MA, Gilula LA. Primary Ewing’s sarcoma of the ribs: a report from the intergroup Ewing’s sarcoma study[J]. Cancer, 1983, 51(6): 1021-1027.
[16]Moser RP, Davis MJ, Gilkey FW, et al. Primary Ewing Sarcoma of Rib[J]. RadioGraphics, 1990, 10(5): 899-914.
[17]朱晓峰，徐宗云，张尧杰，等. 肋骨尤文肉瘤并肺转移1例[J]. 黑龙江医药科学，2002，25（3）：104.
[18]贺晓武，张菊蓉. 胸壁脊索瘤误诊为转移瘤1例[J]. 人民军医，2006，49（5）：309.
[19]梁海红，尹全乐. 副脊索瘤1例[J]. 河北医药，2014，36（19）：3036-3037.
[20]Nishiyama N, Nakatani S, Inoue K, et al. Primary lymphoma of bone originating in a rib[J]. Jpn J Thorac Cardiovasc Surg, 2000, 48(3): 180-183.
[21]Purohit S, Bhise R, Jaipal BR, et al. An Unusual Presentation of Primary Rib Non Hodgkins Lymphoma Masquerading as Male Breast Cancer[J]. Indian J Surg Oncol, 2012, 3(4): 308-310.
[22]Teitelbaum SL. Tumors of the chest wall[J]. Surg Gynecol Obstet, 1969, 129(5): 1059-1073.
基金
北京市卫生系统高层次卫生技术人才培养项目（编号：2009-02-03；2013-3-033）。
