肱骨骨梗死Sarcoma Associated with a Bone Infarct

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1. These radiographs were taken four years apart. What has happened?

   上图中两张X线片拍摄时间相隔4年。有什么变化？

2. Who is at risk for developing this complication?

骨梗死这种改变好发于什么样的人群？

3. What is the histology of the neoplasms?

骨梗死恶变的肿瘤一般是什么组织类型？

4. Is this lesion common? When does this complication occur?

该病是否常见？骨梗死这种并发症一般什么时候发生？

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Sarcoma Associated with a Bone Infarct

骨梗死合并肉瘤

1. Malignant transformation of a bone infarct.

   骨梗死发生了恶变。

2. Men in the fifth to seventh decades.

50-70岁男性。

3. Malignant fibrous histiocytoma and osteosarcoma.

恶性纤维组织细胞瘤，骨肉瘤

4. No, it is rare. After many years; there is a long latent period between bone infarction and malignant transformation.

骨梗死恶变非常少见。一般骨梗死后很多年才发生恶变，骨梗死到恶变之间的潜伏期很长。

References

Galli SJ, Weintraub HP, Proppe KH: Malignant fibrous histiocytoma and pleomorphic sarcoma in association with medullary bone infarcts. Cancer41:607–619,1978.

Mirra JM, Gold RH, Marafiote R: Malignant (fibrous) histiocytoma arising in association with a bone infarct in sickle-cell disease: Coincidence or cause-and-effect?Cancer39:186–194, 1977.

Cross-Reference

Musculoskeletal Imaging: THE REQUISITES, 3rd ed, pp 472–474.

Comment

The radiographicappearance of a mature bone infarct is distinctive and is seldom a cause forconcern. Infarcts are intramedullary lesions that have a characteristicserpentine rim of dense sclerosis surrounding a variably calcified centralarea. Occasionally, one must differentiate an infarct from an enchondroma butseveral observations, including internal or central calcifications and the lackof peripheral sclerosis in the latter, are sufficient to avoid confusionbetween these two entities.

成熟期骨梗死的影像学表现非常典型，较少引起关注。骨梗死为骨髓腔内骨质钙化伴病灶周边不规则形硬化边。有时骨梗死需要与内生性软骨瘤相鉴别，但后者一般为病灶中心钙化但周围无硬化边，这一征象足以鉴别诊断。

An infarct canundergo two processes that may alter its appearance and both are rare. Cystformation occurs most frequently in the humerus, followed by the tibia, femur,ilium, and calcaneus. These cysts may erode the endosteal cortex. Malignanttransformation also may alter the appearance of an infarct. The majority ofcases involve the femur, tibia, and humerus. The lesions are poorlydifferentiated, containing fibrous, osteoid, or cartilaginous tissue, and havea poor prognosis. The radiographic diagnosis is not challenging and this caseof a malignant fibrous histiocytoma arising in association with an infarct inthe proximal humerus is fairly typical. There is elevation of the periosteumand a change in the appearance of the infarction indicating infiltration of themarrow. In some patients, the sarcomatous proliferation may eventuallyobliterate all evidence of a preexistent infarction. This process isoften accompanied by cortical destruction and a soft tissue mass.

骨梗死可以有两种转归途径，其影响表现也有所不同，但这两者都不多见。囊性变好发于肱骨，其次是胫骨、股骨、髂骨、跟骨，可侵蚀骨质内膜。恶变好发于股骨、胫骨和肱骨，也可以改变骨梗死的原有表现。骨梗死恶变一般为低分化，包含纤维、骨样组织和软骨组织，预后较差，影像学诊断一般不难。

本例患者为典型的肱骨近端骨梗死合并恶性纤维组织细胞瘤，可见骨膜增厚，原有骨梗死的表现发生改变，提示骨髓浸润。部分患者，肉瘤增生甚至可以最终完全改变原有的骨肉瘤的表现，这一过程通常伴随骨皮质破坏和软组织肿块。