临床与病理
临床:骨瘤可发生于各个年龄组,其中以 11~30 岁多见,男性多于女性。骨瘤好发于颅骨,其次为颌骨,多见于颅骨外板和鼻窦壁;也可见于软骨内成骨的骨,如股骨、胫骨和手足骨等。发生于膝关节及踝关节附近的骨瘤,常为两侧对称性并有遗传性,又称为遗传性多发性外生骨疣。发生于关节附近骨端的骨瘤称为骺生骨软骨瘤,位于趾末节趾骨的骨瘤称为甲下骨疣。骨瘤可在观察期内长期稳定不增大或缓慢增大。较小的骨瘤可无症状,较大者随部位不同可引起相应的压迫症状。
Clinical: osteoma can occur in all age groups, most of which are 11 to 30 years old, more males than females. Osteoma mainly occurred in the skull, followed by the jaw, and mostly appeared in the outer skull plate and sinus wall. Osteoblasts can also be seen in cartilage, such as the femur, tibia, and foot bones. Occurs in the knee joint and the ankle joint near the osteoma, is often bilateral symmetry and hereditary, also known as hereditary multiple exophytic warts. An osteoma occurring near the bone end of the joint is called an epiphyseal osteochondroma, and an osteoma located in the metatarsal toe bone is called a subthyroid osteoma. Osteomas may be stable or slowly enlarged during the observation period. Small osteomas may be asymptomatic, and large ones may cause compression symptoms depending on the site.
病理:骨瘤又名外生骨疣,是一种成骨性良性肿瘤,最为常见,占骨良性肿瘤的 8%。根据病变数目可分为单发性及多发性两种,单发性多见,多发性较少见。骨瘤起源于膜内成骨,多见于膜内化骨的骨骼,也可见于其他骨骼有膜内成骨的部分,常合并骨骼发育异常。骨瘤质硬,有骨膜覆盖,基底与骨组织相连,可有宽广基底或带蒂。切面为骨组织。根据骨密度不同又分为象牙骨型(即致密骨型)及海绵骨型(即疏松骨型),以前者多见。致密型骨瘤主要由成熟的板层骨构成,疏松型骨瘤由成熟的板层骨和编织骨构成髓内骨瘤周围无骨质破坏,而由正常骨小梁包绕。镜下观察骨瘤的结构简单,可含有骨板和少许哈氏管,疏松骨型者可有骨髓组织。
Pathology: osteoma, also known as exophytic osteoma, is a benign bone tumor, the most common, accounting for 8% of benign bone tumors. According to the number of lesions can be divided into single and multiple types, single more common, more rare multiple. Osteomas originate from intramembrane osteoblasts, and are more common in the bones of membrane-internalized bones, as well as in other bones with intrambrane osteoblasts, often associated with skeletal dysplasia. Osteomas are hard, covered with periosteum, with a base attached to bone tissue, and may have a broad base or pedicle. The cut surface is bone tissue. According to the difference of bone density, it is divided into ivory bone type (compact bone type) and sponge bone type (loose bone type). Dense osteoma is mainly composed of mature lamellar bone, while loose osteoma is composed of mature lamellar bone and woven bone to form intramedullary osteoma. Under the microscope, the structure of osteoma is simple, which may contain bone plate and a few harborian canals, and loose bone type may have bone marrow tissue.
CT:不同部位的骨瘤其CT 表现有所不同,根据其密度不同,可分为致密型和疏松型两型。颅面骨骨瘤大多为单发,少数为多发。致密型大多突出于骨表面,表现为半球状、分叶状边缘光滑的高密度影,内部骨结构均匀致密,基底与颅外板或骨皮质相连。疏松型较少见,自颅板呈半球状或扁平状向外突岀,边缘光滑,密度似板障或呈磨玻璃样改变。起于板障者可见内外板分离,外板向外突岀较明显,内板多有增厚。骨瘤突起时其表面的软组织也随之凸起,但不受侵蚀、不增厚。位于鼻窦的骨瘤多为致密型,常呈分叶状突出于鼻窦腔内,并可由一窦向其他窦腔生长。四肢骨骨瘤多为致密型,突出于骨表面,基底部与骨皮质外表面相连,肿瘤表面光滑,邻近软组织受推移
CT: the CT manifestations of osteomas in different parts are different. According to their different densities, they can be divided into two types: dense type and loose type. Craniofacial osteomas are mostly solitary and a few are multiple. The dense type mostly protrudes on the bone surface, presenting as hemispherical, lobulated edges with smooth dense shadows, and the internal bone structure is uniform and dense, with the base connected with the extracranial plate or bone cortex. Loose type is rare, presenting hemispherical or flattened outward pressions from the cranial plate, margin smooth, density like barrier or ground glass change. From the barrier can be seen inside and outside the plate separation, outside the plate to outward chu is more obvious, more thickened inside the plate. When an osteoma protrudes, the soft tissue on its surface bulges, but is not eroded or thickened. Osteomas located in the sinuses are usually dense, often lobulated, and can grow from one sinus cavity to another. Osteomas of the four limbs are mostly compact, protruding on the bone surface, and the basal part is connected with the outer surface of the bone cortex. The tumor surface is smooth, and the adjacent soft tissues are pushed
MR:致密型骨瘤与疏松型的骨瘤的MR 表现有所不同。致密型骨瘤在T1W和 T2W 上均呈低信号或无信号影,其信号强度与邻近骨皮质一致,边缘光滑。疏松型骨瘤的MR 信号强度与致密型骨瘤的MR信号强度不同,在T1W和 T2W 上均呈等或稍高信号影。同时,同样为硫松型骨瘤,其信号强度也不同,这取决于疏松型骨瘤的疏松程度。
MR: the MR appearance of dense osteoma is different from that of loose osteoma. The dense osteoma presented low signal or no signal shadow on T1W and T2W, and its signal strength was consistent with the adjacent cortical bone, with smooth edges. The MR signal intensity of loose osteoma was different from that of dense osteoma, showing equal or slightly higher signal intensity at T1W and T2W. At the same time, the signal intensity of the same thiasone osteoma also varies, depending on the degree of osteoporosis of the osteoporosis osteoma.
