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目的探讨放疗后颅骨骨肉瘤的临床病理学特征、发病机制、诊断要点以及治疗与预后。方法对1例右额叶少突胶质细胞瘤术后因放射治疗引起的颅骨骨肉瘤标本进行临床病理学观察,并结合国内外文献进行复习。结果患者男性,42岁。9年前因右额叶占位行肿瘤切除术,病理诊断为少突胶质细胞瘤(WHOⅡ级)。术后给予一个疗程放射治疗,总剂量60Gy/30次(52天)。半年前患者发现右侧额部长一包块,渐进性长大。MRI示肿块位于额骨右侧放射野处,大小4 cm×3 cm,遂行肿瘤切除。镜检:肿瘤细胞呈圆形、短梭形或多边形,核异型明显,病理性核分裂象易见,可见肿瘤性成骨。结论放疗后骨肉瘤是放射治疗的一种少见而严重的并发症,恶性程度高,预后差,手术切除并辅以多药联合化疗是有效的治疗方法。
Objective To investigate the clinicopathological characteristics, pathogenesis, diagnosis points and treatment and prognosis of skull osteosarcoma after radiotherapy. Methods One case of right forebrain oligodendroglioma was observed by pathology after radiotherapy for the treatment of skull osteosarcoma, and reviewed with literature review. Results The patient was male, 42 years old. Nine years ago, the right frontal gyrus was resected for tumor resection and the pathology was diagnosed as oligodendroglioma (WHO grade II). After a course of radiation therapy given a total dose of 60Gy / 30 times (52 days). Six months ago, the patient found a right forehead forehead a mass, progressive growth. MRI showed tumor mass in the right frontal radiation field, the size of 4 cm × 3 cm, resection of the tumor. Microscopic examination: tumor cells were round, short fusiform or polygonal, obvious nuclear atypia, pathological mitosis as easy to see, visible tumor osteogenesis. Conclusion Osteosarcoma after radiotherapy is a rare and serious complication of radiotherapy. It has a high degree of malignancy and poor prognosis. Surgical resection combined with multi-drug combination chemotherapy is an effective treatment.