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目的探讨骨转移癌临床病理学特征以及免疫组织化学染色技术在确定原发肿瘤部位中的意义。方法回顾性研究1998年至2004年间141例骨转移癌的临床表现、放射学改变以及病理形态学表现,并对原发部位不明确的肿瘤,采用细胞角蛋白系列标记物以及前列腺特异性抗原(PSA)、甲状腺球蛋白(TG)、甲状腺转录因子(TTF)1、囊泡病液体蛋白(GCDFP)15单克隆抗体,行免疫组织化学(EnVision法)染色。结果在141例骨转移肿瘤患者中,男∶女为1·7∶1,发病年龄23~86岁,平均年龄56·5岁,中位年龄57岁。患者主要临床表现为病变部位的疼痛及功能障碍。骨转移瘤发生部位依次为:脊柱58例,骨盆骨46例,长管状骨34例,其他部位3例;其中23例为多发骨病变。放射学特征显示99例(70·2%)的骨转移癌病例可通过X线平片发现病灶,其中85例(85·9%)表现为溶骨性病变。有90例(63·8%)通过临床病史及典型的组织形态学特征可以明确其原发病灶,另有51例来源不能确定,经免疫组织化学染色后,其中的40例可以确定其组织来源。最终有130例(92·2%)骨转移癌可以确定原发部位,原发病变部位依次为:肺37例,女性生殖系统及乳腺25例,肾脏18例,胃肠道17例,肝脏12例,甲状腺11例,前列腺7例,膀胱2例,皮肤1例。结论骨转移癌好发于老年男性患者。中轴骨(脊柱及骨盆)为转移癌好发部位。骨转移癌最常见的原发部位是肺及女性生殖系统(包括乳腺)。免疫组织化学染色对于确定不明来源的骨转移癌的原发部位有帮助。
Objective To investigate the clinicopathological features of bone metastases and the significance of immunohistochemical staining in the determination of primary tumor sites. Methods The clinical manifestations, radiological changes and pathomorphological features of 141 cases of bone metastases from 1998 to 2004 were retrospectively studied. The cytokeratin series markers and prostate-specific antigen PSA, thyroglobulin, thyroid transcription factor 1 and GCDFP 15 monoclonal antibody were detected by immunohistochemistry (EnVision staining). Results In 141 patients with bone metastases, the male and female were 1.7-1: 1 respectively. The age of onset was 23-86 years. The average age was 56.5 years. The median age was 57 years. The main clinical manifestations of patients with lesion pain and dysfunction. Bone metastases occurred in the order of: 58 cases of spine, 46 cases of pelvic bone, 34 cases of long tubular bones, and other parts of the 3 cases; 23 cases of multiple bone lesions. Radiographic features showed that in 99 (70.2%) cases of bone metastases, lesions were found on plain radiographs, of which 85 (85.9%) showed osteolytic lesions. In 90 cases (63.8%), the primary lesion was identified by clinical history and typical histopathological features. Another 51 cases could not be identified. After immunohistochemical staining, 40 of them could be identified as tissue sources . In the final analysis, there were 130 cases (92.2%) of primary bone metastases. The primary lesion sites were: lung 37 cases, female reproductive system and breast 25 cases, kidney 18 cases, gastrointestinal tract 17 cases, liver 12 For example, thyroid 11 cases, prostate 7 cases, bladder 2 cases, skin 1 case. Conclusion Bone metastases occur in elderly male patients. Axial bone (spine and pelvis) is a predilection site for metastatic carcinoma. The most common primary sites of bone metastases are the lungs and the female reproductive system (including the breast). Immunohistochemical staining for the identification of unknown origin of bone metastases helpful.