1 case of spinal cytoblast osteosarcoma.

Giant cell osteosarcoma (GCRO) is a rare type of osteosarcoma, which is easily misdiagnosed as osteoblastoma in imaging and histology, and is extremely rare in spinal GCRO, which has not been reported in the literature at home and abroad.
is now the hospital surgery pathology confirmed diagnosis of GCRO1 cases reported below.
, 45, six months ago due to lower back pain, swelling, rest can be alleviated, 1 month ago due to lower back pain aggravated hospital admission, no history of trauma.
Examination body: the patient reclining spine physiological bending exists, T12 ratchets have pressure pain, the rest of the ratchets have no obvious pressure pain, slack pain, no obvious feeling of loss of the lower limbs, muscle strength V. level, straight leg elevation test and strengthen the test negative, feminine nerve pull test negative, with hip test negative, "4" word test and knee test negative.
combined with CT (Figures 1 to 3) and MRI (Figures 4 to 6) images, consider: T12 pathological compression fractures associated with spinal tube pressure, T12 and L1 bone damage.
Figure 1 to 3 CT cross-section, coronary and yam surface show T12 vertebral compression flattening, T12 vertebral and vertebral root bone-soluble bone damage; , non-continuous, the inner edge can be seen thick and large bone , the edge did not see hardened edge, forming a soft tissue lump next to the vertebrae, the lesions of the speckled high-density bone shadow figure 4 yam-shaped surface T1WI T12 vertebrae compression flattened, the corresponding horizontal vertebral tube pressure narrowed, T12/L 1 vertebrae gap slightly narrower, T12 and L1 bone damage and the formation of soft tissue lumps around, lesions show a low signal figure 5 vector surface T2WI pressure fat sequence shows that the lesions show a high signal, the signal is more uniform; Tissue lump formation, a slightly higher signal, the corresponding horizontal vertebral tube pressure narrowing surgery after: after the back path T12, L1 vertebral removal titanium mesh reconstruction vertebral arch nail rod system fixation, the operation can be seen T12, L1 vertebrae under the skin full of fish-like tumor lesions, rich blood vessels, Easy bleeding, vertebral plate, vertebral bow root have tumor lesions invasion.
pathological diagnosis: GCRO (Figure 7).
Figure 7 under the mirror shows tumor cells diffuse, irregular arrangement, bone matrix thyme and multi-core macrocells scattered among them, and it can be seen that bone-breaking cell-like multinucleocytes (HE x 100 low magnification) to discuss GCRO is a rare type of osteosarcoma, imaging and histological easily misdiagnosed as osteoblastoma.
, such as Haslan, account for only 4% of primary osteosarcoma, while Bathurst and others report that GCRO accounts for about 3% of all osteosarcomas, so GCRO in primary spine is extremely rare.
Osteosarcoma mainly occurs in the dryends and backbones of the long bones of the limbs, to the far end of the feline bone and the near end of the tibia, the two peaks of the disease are 10 to 25 years old and 50 years of age, the incidence of osteosarcoma occurred in the limb bones is higher than in women, and the ratio of male to female primary spinal sarcoma is about 1:1, the average age is slightly larger, common in the cervical spine,
has collected 198 cases of primary spinal osteosarcoma, including 95 cases of men, 103 cases of women, aged 8 to 80 years, an average of 34.5 years old, occurred in the cervical spine 27 cases (13.6%), 66 cases of thoracic vertebrae (33.3%), 64 cases of lumbar spine (32.3%),vertebrae 41 cases (20.7%).
Schoenfeld and others collected 26 cases of primary spinal osteosarcoma confirmed by Massachusetts General Hospital from 1982 to 2008, including 15 cases for men and 11 cases forwomen;
this example is a woman, 45 years old, in line with the literature reported good hair age.
the disease site is T12 and L1 vertebrae, is a common good site of spinal osteosarcoma.
primary spinal sarcoma is common in vertebrae and can affect the vertebrae alone, as well as the vertebral arch roots and attachments.
when a typical lumpy, "brush-like" tumor bone appears in the spinal lesions, the possibility of osteosarcoma is highly considered.
osteosarcoma is seen in soft tissue next to the vertebrae, especially in young patients, suggesting that osteosarcoma may, compared to other good malignant vertebral tumors, osteosarcoma often affects consecutive vertebrae.
GCRO's imaging performance is similar to osteoblastoma, visible expansion-soluble bone damage, soap bubble-like, bone-like bone damage is rare, bone cortical not obvious damage, easy misdiagnosis.
The literature reports that the typical GCRO is good in young people's feline backbone and tibia backboneend, the main image is shown as bone-soluble bone damage, bone damage area edge blurred, usually do not form soft tissue lumps, bone membrane reaction is not obvious.
Sato and others think that long bone GCRO is more manifested as bone-soluble bone damage, expansion changes, bone corty thinning, no obvious damage.
cases have been reported in GCRO in the upper jaw, which is manifested as an expansionary non-homogeneity lump, extensive destruction of the bone cortical cortical, speckled calcification in the lesions, misdiagnosed as cartilage sarcoma.
Single or multiple vertebral and vertebral arch root expansion bone-soluble bone damage, bone cortical hair brown, non-continuous, the inner edge of the rough large bone
with long osteosarcoma, spinal osteosarcoma has no typical stratular or "onion-like" osteoblast reaction and Codman triangle, which is difficult to diagnose.
when a typical lumpy, "brush-like" tumor bone appears in the spinal lesions, osteosarcoma should be highly considered.
the identification of spinal GCRO and spinal osteoblastoma is more difficult and requires pathological diagnosis.
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