《骨肉瘤-正修科技大学》由会员分享，可在线阅读，更多相关《骨肉瘤-正修科技大学（115页珍藏版）》请在金锄头文库上搜索。
1、肌肉與骨骼系統相關癌症之 症狀與原因,蔣安仁主治醫師/博士 正修科技大學 2015.10.01,Bone Tumors 骨腫瘤,Pathology,Bone-forming tumors Osteoma, Ostoid osteoma(Osteoblastoma), Osteosarcoma Cartilage-forming tumors Osteochondroma, Chondroma(Enhondroma), Chondroblastoma, Chondromyxoid fibroma, Chondrosarcoma Fibrous and fibro-osseous tumors F
2、ibrous Non-ossifying fibroma, fibrous dysplasia, Malignant fibrous histiocytoma Miscellaneous Tumors Giant cell tumor, Ewings sarcoma and primitive neuroectodermal tumor,Common Primary Bone Tumors,Malignant bone tumors Multiple Myeloma 多發性骨髓瘤(同惡性漿細胞瘤). Osteosarcoma (osteogenic sarcoma) 骨肉瘤;骨癌. Chond
3、rosarcoma 軟骨肉瘤(惡性,見長骨末端及盆骨). Ewings sarcoma Benign Non-ossifying fibromaunicameral (simple) bone cyst Osteochondroma 骨軟骨瘤(骨瘤與軟骨瘤融合) Giant cell tumor 巨大細胞瘤 Enchondroma 內生性軟骨瘤(軟骨瘤生於骨幹后端,常見於手足) Fibrous dysplasia 纖維性發育不良(骨質增厚纖維化).,骨腫瘤的發病率 38959例骨腫瘤發病率及性質 原發良性骨腫瘤 55.7% 原發惡性骨腫瘤 43.69% 瘤樣病變 11.3% 轉移癌 5.4%,
4、原發良性骨腫瘤,骨軟骨瘤 （。） 骨巨細胞瘤 （。） 軟骨瘤 （。）,原發惡性骨腫瘤,骨肉瘤 44.6% 軟骨肉瘤 14.2% 纖維肉瘤 . 骨髓瘤 依汶氏肉瘤 . 惡性骨巨細胞瘤 ,發病年齡,發病部位 股骨下端、脛骨上端（多惡性） 脊柱、骨盆、肩胛骨（轉移性骨腫瘤） 膝關節和肘關節以遠骨骼（多良性）,骨腫瘤的臨床表現 疼痛 .良性腫瘤一般無痛或輕度。 .疼痛是惡性腫瘤早期症狀，進持性加重。 .休息時疼痛反而加重，考慮惡性病損。 .夜間疼痛是骨腫瘤的重要特徵。 腫脹 根據腫瘤的性質、部位不同，骨腫瘤的腫脹程度不同。 損傷 損傷可誘發骨腫瘤症狀的出現或加重骨腫瘤症狀。,追蹤病患病史 骨結核-骨轉
5、移、骨肉瘤 急性骨髓炎-依汶氏肉瘤 Brodis骨膿腫-軟骨肉瘤 其它部位原發性腫瘤-骨轉移 局部檢查 1.骨腫瘤邊界、質地、活動度和光滑程度 2.疼痛、壓痛和腫脹程度 3.表面皮膚發紅發熱、淺表靜脈怒張、動脈博動,骨腫瘤的臨床表現,生化檢查 血常規、血鈣、血磷、鹼性磷酸酶、性能磷酸酶、總蛋白濃度 活組織檢查 穿針活檢、切開活檢 實驗室檢查 .HB下降 .血沉加快 .鹼性磷酸酶增高 .酸性磷酸酶 .血清總蛋白增加 血沉和鹼性磷酸酶可作為觀察骨腫瘤療效的動態指標 病理學檢查 .常規組織學切片 .組織化學檢查 .免疫組織化學 X光檢查(影像學檢查),骨腫瘤的診斷,Multiple Myeloma多
6、發性骨髓瘤,most common primary bone cancer. malignant tumor of bone marrow. 20 people per million each year. Most cases are seen in patients between the ages of 50 and 70 years old. Any bone can be involved.,Osteosarcoma 惡性骨肉瘤,second most common bone cancer (20%). production of osteoid or immature bone b
7、y the malignant cells 2-3 new case per million people each year. Most cases occur in teenagers (75%20y/o). Most common primary malignancy of bone in children and adolescents,Osteosarcoma,Most arise from metaphyseal region of long bone of extremities Most occur around the knee. Other common locations
8、 include the hip and shoulder.,骨肉瘤（成骨型）,骨肉瘤（溶骨型）,混合型骨肉瘤,Ewings sarcoma 依汶氏肉瘤,Malignant small round cell tumor of bone 6-10% of primary bone cancer 2nd most common sarcoma of children Youngest of all bone sarcoma, Most in 10-15 y/o (80% 20 y/o) Most arise in diaphyses of long tubular bone especially
9、femur and flat bone of pelvis The most common locations are the upper and lower leg, pelvis, upper arm, and ribs.,Chondrosarcoma 軟骨肉瘤, frequency as osteosarcoma, 2nd matrix producing cancer of bone most commonly in patients between 40 and 70 years of age. (usually 40y/o) Central portion of skeleton
10、Most cases occur around pelvis, shoulder, hip, ribs. Rarely involve distal extremities.,Giant cell tumor (GCT)巨大細胞瘤,Multinucleated osteoclast-type giant cell osteoclastoma Most in adults between the ages of 20 to 40 years. rare in children or in adults older than 65 years of age. Involve both epiphy
11、ses and metaphyses Relatively uncommon benign but locally invasive Most arise around knee (distal femoral and proximal tibia), Any bone can be involved Location at the end of bone and relate to arthritic symptoms,巨大細胞瘤,巨大細胞瘤,Osteochondroma 骨軟骨瘤,Exostosis (外生骨疣 ) most common noncancerous bone tumor.
12、35-40 % of all benign bone tumors. osteochondroma may grow in a child or adolescent. Its growth usually stops at maturity diagnosed in patients aged 10 to 30,骨軟骨瘤的組織學切片,骨軟骨瘤的大體外觀,良性骨腫瘤 骨軟骨瘤（外生骨疣）,Simple bone cyst 骨囊腫,Non-ossifying fibromaunicameral (simple) bone cyst usually found in patients younge
13、r than 20 years of age. Location: most common-upper arm (proximal humerus) or thighbone (proximal femur). Less common locations include the pelvis, ankle (talus), or heel (calcaneus).,Chondroma and Enchondroma 軟骨瘤和內生軟骨瘤,Chondromas are benign tumors of hyaline cartilage most arise In modullary cavity
14、 Enchondroma often found in patients between 10 and 20 years of age often occur in the small bones of the hand and feet. Sometimes in the long bones of the upper arm and thigh. the most common tumor of the hand.,內生軟骨瘤,Fibrous dysplasia 纖維性發育不良,Benign Any bone may be affected. The most common bones i
15、nvolved are the thighbone, shinbone, ribs, skull, upper arm bone, and pelvis. Monostotic (70%, Usually, only one bone is involved) Polyostotic (27%) Polyostotic+ caf au lait skin pigmentation and endocrinopathies (3%) McCune-Albright syndrome,轉移性骨癌,骨癌的治療,以下治療方式之介紹，以惡性骨肉瘤與依汶氏肉瘤此兩種骨癌為主。 治療目標 目前惡性骨肉瘤的治
16、療目標，不但要治癒病患，使其存活下來，而且還需盡量保持肢體及外觀的完整，以更進一步改善其日後的生活品質。,惡性骨肉瘤的治療方式,根除性外科切除術密集的化學治療 依據腫瘤部位開刀截除患肢，通常需切除至腫瘤邊緣近側之上7.5公分（3吋）或者是受侵犯骨骼近側關節之上，以免癌細胞已侵犯鄰近組織而復發。手術後，使用高劑量化療藥物，如：Methotrexate（MTX，滅殺除癌）、Epirubicin（艾黴素注射劑）、Cisplatin（愛寧達）、Ifosfamide（好克癌注射劑）、VP-16（滅必治）等藥物進行化學治療，為期約10個月至1年的療程。許多研究證實，完整的化學治療，可明顯提高存活率。,惡性骨肉瘤的治療方式,新式輔助化學治療 目前較常用的治療方式是在手術前先使用約2個月的化學治療，之後進行原發性腫瘤部位廣泛切除，並
