骨肿瘤英文双语精品课件PPT文件格式下载.pptx

骨肿瘤英文双语精品课件PPT文件格式下载.pptx

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,Bone,1,Tumor,TheFirstaffiliatedhospitalofChongQingMedicalUniversityGaoshichang,Epidemiology,2,Incidenceofbonesarcomas骨肉瘤0.2%ofallcancers0.8newcasesper100,000populationperyearinNorthAmericaandEuropeMostcommonbonesarcomas#1:

@#@Osteosarcoma骨肉瘤#2:

@#@Chondrosarcoma软骨肉瘤#3:

@#@Ewingsarcoma尤文肉瘤,Agedistributionisbimodal双峰的Firstpeak:

@#@SeconddecadeoflifeOsteosarcomapredominatesatthisageEwingsarcomaSecondpeak:

@#@60yearsoldChondrosarcomapredominatesSecondaryosteosarcomasPagetsosteosarcomaPostradiationosteosarcoma放疗后骨肉瘤,3,Gerneralprinciples,4,DiagnosticEvaluationAnadequatehistoryandphysicalexaminationarethefirstandmostimportantstepsinevaluatingapatientwithamusculoskeletal肌肉骨骼的tumor.Patientspresenttotheorthopaediconcologist骨科肿瘤医生withpain,amass,orwithanabnormalradiographicfindingdetectedduringtheevaluationofanunrelatedproblem.,Gerneralprinciples,5,Thepaininitiallymaybeactivityrelated,butthepatientwithamalignancy恶性的ofboneoftencomplainsofprogressivepainatrestandatnight.Patientswithbenignbonetumorsalsomayhaveactivity-relatedpainifthelesionislargeenoughtoweakenthebone,Gerneralprinciples,6,Mostnotablyosteoidosteoma骨样骨瘤,mayinitiallycausenightpain.,Gerneralprinciples,7,Agemaybethemostimportantinformationobtainedinthehistorybecausemostmusculoskeletalneoplasms肿瘤,bothbenignandmalignant,occurwithinspecificageranges.Thephysicalexaminationshouldincludeevaluationofthepatientsgeneralhealth,aswellasacarefulexaminationofthepartinquestion.,Gerneralprinciples,8,Amassshouldbemeasured,anditslocation,shape,consistency一致性,mobility,tenderness,localtemperature,andchangewithpositionshouldbenoted.Atrophyofthesurroundingmusculature肌肉组织shouldberecorded,aswellasneurologicaldeficits神经功能缺陷andadequacyofcirculation.,Gerneralprinciples,9,Potentialsitesoflymphnodemetastasesshouldbepalpated触及.,Allsuspectedmusculoskeletalneoplasmsshouldbeevaluatedinitiallywithplainroentgenograms平片.,Gerneralprinciples,10,Often,thepatientsageandplainroentgenographicfindingsaresufficienttoarriveataspecificdiagnosis.,Gerneralprinciples,11,Inactivelesionsusuallyarewellmarginated边缘清晰的,oftenwithasurroundingrim边缘ofreactive反应的boneformation.Aggressivelesionsusuallyhavealesswell-definedzoneoftransition过渡betweenthelesionandthehostbone.Corticalexpansion皮质扩张canbeseenwithaggressivebenignlesions,butfrankcorticaldestructionusuallyisasignofmalignancy.,12,Gerneralprinciples,13,Periosteal骨膜的reactivenewboneformationresultswhenthetumordestroyscortex皮质andmaytaketheformofaCodmanstriangle,“onion-skinning透明片,”ora“sunburst炎爆pattern.Itusuallyisasignofmalignancybutmaybepresentwithinfectionorhistiocytosis组织细胞增多.,14,Gerneralprinciples,15,Computedtomography（CT）ismosthelpfulinassessingossification骨化andcalcification钙化andinevaluatingtheintegrity完整性ofthecortex.CTofthelungsalsoisthemosteffectivestudytodetectpulmonarymetastases.,Gerneralprinciples,16,CTalsoisthebestimagingstudytolocalizethenidusofanosteoidosteoma,todetectathinrimofreactivebonearoundananeurysmalbonecyst动脉瘤样骨囊肿.,Gerneralprinciples,17,Technetiumbonescans锝骨扫描areindicatedtodetectskeletalmetastasesandtodeterminethepresenceofmultiplelesions.Virtually事实上allmalignantneoplasmsofbonedemonstrateincreaseduptake摄取ontechnetiumbonescans.,18,Gerneralprinciples,19,Anormalbonescanisthereforeveryreassuring放心的;@#@however,theconverse相反的statement陈述isnottruebecausemostbenignlesionsofbonealsodemonstrateincreaseduptake.,Gerneralprinciples,20,Magneticresonanceimaging（MRI）hasreplacedCTasthestudyofchoicetodeterminethesize,extent,andanatomicalrelationshipsofbothboneandsofttissuetumors.Itisthemostaccuratetechniquefordeterminingthelimitsofdiseasebothwithinandoutsidebone.,21,Gerneralprinciples,22,MRIisnotveryusefulindifferentiatingbenignfrommalignantlesions.Ingeneral,anysofttissueneoplasmdeeptothefascia筋膜orlargerthan5cminitsgreatestdimension尺寸shouldbeconsideredhighlylikelytobeasarcoma.,Gerneralprinciples,23,Ultrasonographyisusefulfordistinguishingcystic囊肿fromsolidsofttissue.,Gerneralprinciples,24,Bloodandurinetestsrarelyleadtoadiagnosisbutcanbeusefulinselectedsituations.Riskofwound-healingproblemsandinfectionhavebeenshowntobesignificantly显著地greaterinpatientswhoseserumalbumin血清白蛋白islessthan3.5g/dlorwhosetotallymphocytecountislessthan1500/ml.,Gerneralprinciples,25,Acompletebloodcountmaybehelpfultoruleoutinfectionandleukemia白血病.Theerythrocytesedimentationrate红细胞沉降率（ESR）usuallyiselevatedininfection,metastaticcarcinoma,andEwingsarcoma.Aprostate-specific