摘要目的 探讨骨巨细胞瘤的组织发生以及与肿瘤复发、侵袭、恶变等生物学行为相关的因素.方法 从临床、影像学、手术方式、病理形态、免疫表达和随访结果等方面对2005至2011年间收集的123例骨巨细胞瘤进行分析和研究.结果 骨巨细胞瘤的术后复发率与术前骨巨细胞瘤的影像学分级(P=0.032)、CD147 (P=0.034)和p53(P =0.005)的过表达以及手术方式(P =0.048)有明显相关性,但与骨巨细胞瘤的髓内浸润、骨皮质浸润、骨旁软组织浸润、脉管内瘤栓、单核间质细胞的梭形变、核分裂象多少、Ki-67阳性指数、凝固性坏死、继发性动脉瘤样骨囊肿、出现反应性骨等形态学改变均缺乏明显相关性,骨巨细胞瘤中单核间质细胞p63阳性率(79.7％,94/118)明显高于软骨母细胞瘤(44.7％,21/47)、骨肉瘤(22.2％,10/45)等其他富于巨细胞的骨肿瘤.结论 骨巨细胞瘤是一种有低度恶性潜能的肿瘤,形态学特征难以预测其生物学行为.p63阳性、PGM-1阴性的单核间质细胞是其肿瘤成分,此种细胞p53的过表达以及骨巨细胞瘤各种细胞成分(包括反应性单核巨噬细胞和多核巨细胞)CD147的过表达与骨巨细胞瘤的侵袭、复发和恶变有关.术前根据骨巨细胞瘤的影像学分级选择合适的手术方式是减少复发最重要的因素.

abstractsObjective To study the histogenesis of giant cell tumor (GCT) and factors related to tumor recurrence,invasiveness and malignant transformation.Methods The clinical features,radiologic classification,surgical approach,pathologic findings,immunophenotypes and follow-up data of 123 cases of GCT were analyzed.Results There was a significant correlation between tumor recurrence and radiographic classification (P =0.032),over-expression of CD147 (P =0.034) and p53 (P =0.005),and surgical approach (P =0.0048) in GCT.The biologic behavior showed no correlation with intramedullary infiltration,cortical bone involvement,parosteal soft tissue extension,tumor thrombi,fusiform changes of mononuclear tumor cells,mitotic count,Ki-67 index,coagulative tumor necrosis,secondary aneurysmal bone cyst formation,and adjoining bony reaction.The positive rate of p63 in stromal cells of GCT (79.7％,94/118) was significantly higher than that in chondroblastoma (44.7 ％,21/47),osteosarcoma (22.2％,10/45) and other giant cell-rich tumors.Conclusions GCT is a bone tumor of low malignant potential.It is sometimes characterized by locally invasive growth,active proliferation,coagulative necrosis,secondary aneurysmal bone cyst and surrounding bony reaction.It is difficult to predict the biologic behavior of GCT.Over-expression of p53 in the tumor cells and CD147 in all components of GCT correlate with tumor invasiveness,recurrence and malignant transformation.Selection of suitable surgical approach with reference to radiologic classification is considered as an important factor in reducing the recurrence rate.