Izikhalazo zeKnee: Indlela yokuFumanisa indlela yokujonga iziqu neNeeplasms

Iimpawu ze-Bone Neoplasms Izimo ezinjenge-Tumor

• Iineoplasms zamathambo kunye neemeko ezinjenge-tumor ezichaphazelayo emadolweni inokuba buhlungu okanye ibe yingozi. Ubudala kwi-Dx bubalulekile kwi-DDx
• Kwizigulana <40: I-Benign neoplasms yamathambo: I-Osteochondroma, i-Enchondroma zihlala ziqhelekile
• Isiphene se-Fibrous cortical (FCD) kunye ne-non-ossifying fibroma (NOF) ikakhulu ikakhulu ebantwaneni
• I-tumor enkulu ye-cell (GCT) yi-m / c ye-neoplasm ye-knee yegulane kwizigulane phakathi kwe-20-40 ubudala
• Iimpawu ezinobungozi zamathambo <40: m / c Osteosarcoma kunye ne-2 m / c Ukutya i-sarcoma
• Kwizigulane> i-40: i-neoplasms enobungozi: i-m / c i-secondary d/t bone metastasis. Ukonakala kwamathambo okuqala:�the m/c
• IiMyeloma ezininzi (MM). Ngamaxesha amaninzi:�i-2nd�peak ye-Osteosarcoma (emva kokusasazeka kwemitha okanye iPaget), iFibrosarcoma okanye iMalignant�Fibrous�Histiocytoma�(MFH) yethambo.
• Iiklinikhi: ubuhlungu beendolo, ukuphulwa kwesifo
• Ezinye iimeko ezifana nethumba ezifana neFCD/Non-ossifying fibroma azibonakali kakuhle kwaye zinokuhlehla ngokuzenzekelayo. Ngamanye amaxesha i-NOF inokubonisa ngokuphuka kwe-pathologic. QAPHELA naziphi na iintlungu zedolo/amathambo emntwaneni/okwishumi elivisayo kufuneka �iphathwe ngokurhanelwa kwezonyango kwaye iphandwe ngokwaneleyo.
• Ukucinga: I-1st inyathelo: i-radiography
• I-MRI ene-T1 + C ibalulekile ekubonakalisweni kwesilonda / ubungakanani bengingqi, isiteji kunye nokucwangciswa kwangaphambili. I-CT inokunceda ekubhaqweni nge-pathologic Fxs. Ukuba i-neoplasms yamathambo enobungozi iqwalaselwa, i-CXR / CT, i-PET-CT yokuphanda ukusasazeka kwe-metastatic kunye nesiteji kubalulekile.

Ukucinga Ukusondela kweT Bone Neoplasms

• Indlela yokujonga i-Dx yee-neoplasms zamathambo ibandakanya ubudala, indawo yethambo (i-epiphysis vs. metaphysis vs. diaphysis), indawo yenguqu ejikeleze isilonda, impendulo ye-periosteal, uhlobo lwe-matrix, i-permeating okanye i-nundu-etyiwa ukutshatyalaliswa vs. , njl.
• Iimpawu eziphambili ze-x-radiography kwi-DDx enobungozi ngokuchasene ne-neoplasm yamathambo anobungozi:
• Indawo yenguqu: isilonda yijografi esinezowuni emxinwa yotshintsho ngokuchasene.
• Intoni uhlobo lokutshatyalaliswa kwethambo kwenzeka: ukubonakala kwe-sopha ngokubonakalayo kunye ne-osteolytic ne-osteosclerotic changes
• Ingaba ikhona imatrix yeglasi engqukuva? Ngaba kukho umphetho ochazwe kakuhle womda we-sclerotic onokuthi uphakamise ukukhula okucothayo kunye ne-encapsulation njengeenkqubo ezininzi ezinobungozi.
• Periosteal ukwanda: ngokuqinileyo ngokubhekiselele kwintlanzi / i-sunburst / iinwele-ekugqibeleni ekugqibeleni kunye neenxantathu ezithintekayo zendawo kunye neCodman triangle (funda isilayidi esilandelayo)

I-FCD kunye neNOF

• I-FCD kunye neNOF okanye ngokufanelekileyo ngakumbi i-Fibroxanthoma yethambo ziinkqubo zamathambo ezinobungozi ezibonwa kubantwana. I-DDx esekelwe kubukhulu kunye ne-FCD ebonisa njenge <3-cm kunye ne-NOF> i-3cm isilonda esenziwe nge-fibrous heterogeneous matrix. I-FCD ayinazimpawu kwaye inokurhoxa kwiimeko ezininzi. Abanye banokuqhubela phambili kwi-NOF. Indawo: ichongiwe kummandla wamadolo njenge-eccentric cortical based lesion.
• I-FCD kufuneka ibeyi-DDx kwi-avulsive irregularity d/t yoxinzelelo oluphindaphindiweyo ecaleni kwe-Linea aspera ngezihlunu ze-extensors
• Dx: i-radiography
• Ulawulo: inxeba lokushiya ndedwa. Ngamanye amaxesha i-NOF inokuqhubela phambili kwaye ikhokelele kwi-pathologic fracture efuna ukubonisana nodokotela wamathambo

Osteochondroma

• Osteochondroma: m/c neoplasm yethambo elibi. Idolo yindawo ye-m/c. Iqulethe zonke izinto zethambo kunye ne-cartilaginous cap. Ibonakaliswe njenge-pedunculated okanye i-sessile bone exostosis ekhomba kude nomdibaniso.
• I-1% ukuchithwa kakubi kwi-chondrosarcoma ukuba i-lesion yodwa kunye ne-10-15% kwiimeko ze-HME
• Ezinye iingxaki: ukwaphuka (umfanekiso ophezulu ekhohlo) ipseudoaneurysm ye-Popliteal artery, i-adventitious bursa formation.
• I-Hereditary Multiple Exostosis (HME)- i-autosomal inkqubo ephezulu. Ihambisa ii-osteochondromas ezininzi (uhlobo lwe-sessile lulawula). Inokukhokelela ekutshatyalaliswa kweenyawo (iMadelung deformity, coxa valga) uxinzelelo lwe-ST osebenzayo, ukuchithwa kakubi
• Dx: i-radiografi, i-MRI inceda kwi-Dx ukonakala okungalunganga kwi-chondrosarcoma ngotshintsho kubungakanani kunye nomsebenzi we-capilaginous cap (> 2-cm kubantu abadala banokubonakalisa ukonakala okugwenxa). I-MRI iyakunceda nakwi-Dx yeengxaki zengingqi

I-HME kunye ne-Knee Pain

I-37-yo indoda ene-HME kunye neentlungu zedolo. I-Axial T1, i-T2 kunye ne-STIR MRI izilayi kwindawo ye-popliteal. I-cartilaginous cap enkulu kunye nokunyanzeliswa okunokwenzeka kwe-popliteal artery yi-osteochondroma. I-MRA yenziwa ukuvavanya i-popliteal A. pseudoaneurysm (utolo olukhulu). Isampulu ye-pathology efunyenwe kwi-cartilaginous cap ibonise ukwanda kweselula okucebisa ukonakala okuyingozi. Ukhathalelo lotyando lwacetywa

Isifo seSeli esikhulu (GCT) aka Osteoclastoma

• I-GCT- yinto eqhelekileyo yokuqaqanjelwa kwamathambo. Ubudala 25-40. M> F kancinci.
• Indawo ye-M / C: I-femur ekude> i-tibia ehamba phambili> i-distal radius> i-sacrum
• I-GCT yi-M / C ene-benign sacral tumor. Kwi-50% yamatyala, i-GCT iyenzeka malunga nedolo.
• I-GCT ayinabungozi ngokwembali, kodwa i-Lung Mets inokukhula ngakumbi. ukuba kwiradiyasi ekude kunye nezandla, ihlala ibizwa ngokuba yiMalignant GCT
• <1% ye-GCTs engaphenduliyo / ephindaphindiweyo inokuthi iqhube utshintsho olubi kwi-high-grade bone sarcoma
• I-Pathology: histologically yakhiwe osteoclasts-multinucleated iiseli giant kunye iiseli stromal ethathwe precursors uhlobo monocyte-macrophage. Ivelisa i-cytokines kunye ne-osteolytic enzymes. I-GCT inokuqulatha igazi kwaye inxulumene ne-Aneurysmal Bone Cyst yesibini (ABC)
• Klinikhi: ubuhlungu beedolo abuphendulanga ukunyamekela. I-Fx yePathologic inokwenzeka
• iMifanekiso: ihlala iqala nge-radiography elandelwa yi-MRI kunye ne-biopsy yokugada ebaluleke kakhulu kwi-Dx.
• Rx: xa isetyenziswa nge-curettage kunye nesamente, isixhobo sotyando sinokusetyenziswa ukuba ngaba i-pathological fx ikhona kunye ne-cortical breach. Kwiimeko ezinzima ngakumbi ezinye iinketho ezikhoyo

I-Radiologic-Pathologic Dx

• I-Radiologic-pathologic Dx: i-osteolytic kunye ne-soap-bubbly lesion ngokuqhelekileyo ibandakanya i-metaphysis kunye ne-epiphysis (isici esibalulekileyo se-classic) kunye nokwandiswa kwe-subarticular. Ummandla wotshintsho umxinwa kodwa ngamanye amaxesha kwizilonda ezinobundlobongela indawo ebanzi yotshintsho inokubonwa.
• I-MRI: i-T1 ephantsi, i-highT2 / STIR, iindawo eziqhelekileyo zamanzi ezichanekileyo ezikhoyo kwi-GCT ne-ABC. I-Histology ibalulekile kwiDx.
• I-DDx: i-ABC, i-Brown cell tumor ye-HPT (osteoclastoma), i-Telangiectatic Osteosarcoma
• Umgaqo we-radiological: ukuba ipleyiti yokukhula kwe-physeal ikhona i-Dx ye-GCT ikhutshwe kuluhlu ngokuthanda i-chondroblastoma kunye nokunye.

Ukubonakala kwe-Soap-Ukubonakala ngokubonakalayo kweGCT

ICoronal, iFat-Sat Sagittal kunye nee-Axial MRI Slices ze-GCT

• I-T1 coronal, i-T2 i-sagittal kunye ne-T2 axial i-MRI tincetu ze-GCT. Ngokuqhelekileyo: i-T1 ephantsi, i-highT2 / STIR kunye namanqanaba omlambo

Imbonakalo ye-MRI yeGCT

• Amanqanaba e-flux-fluid d / t ukwakheka okwehlukeneyo kwemveliso yehlazo lwegazi
• I-DDx ebalulekileyo: ABC

Iimpawu ezixhatshazayo malunga neKnee

• Kubantwana kunye nabantu abadala abancinci, i-m / c i-primary malignant neoplasm iphakathi kwe-aka intramedullary (osteogenic) osteosarcoma (OSA). Incopho yesibini ye-OS: >70 yo d/t Paget�s (1%) kunye/okanye i-OSA yokuphuma kwemitha.
• Idolo yindawo ye-m / c ye-OSA (i-distal femur, prox. Tibia)
• Iprayimari yabantwana ye-2nd m/c eyingozi yi-Ewing sarcoma.
• Kubantu abadala> 40 yo m / c zaseprayimari yiMultiple Myeloma (MM) okanye iSolitary Plasmacytoma
• Ngokubanzi i-m / c i-neoplasms yamathambo kubantu abadala d / t ithambo I-Mets esuka kwimiphunga, isifuba, i-prostate, i-renal cell, i-thyroid (ixoxiwe)
• I-Dx: iiklinikhi kunye ne-radiological nge-biopsy yokugada
• Ukucinga kubalulekile kwiDx. 1st inyathelo x-i-radiography. I-MRI+ gad C ibalulekile
• I-CT ukuskena ngamanye amaxesha kunceda ukuvavanya ukuphulwa komzimba

Ephakathi (Intramedullary) i-Osteosarcoma (OSA)

• m / c yobudala: 10-20. m / c indawo: idolo, amadoda> amabhinqa. Ukwanda komngcipheko kwezinye
• i-syndromes yomntwana kunye nokuguquka komzimba we-retinoblastoma: i-Rothmund-Thompson AR isifo.
• I-Dx yokuqala ibalulekile i-d / t i-10-20% ikhona kunye neLung Mets kwi-Dx. I-prognosis ixhomekeke kwizigaba. Amanqanaba okuqala kunye nokuhlasela kwethambo lendawo kwaye akukho
• imida 76% yokusinda.
• I-Rx: iinkqubo zokulondoloza amalungu ezikhethiweyo kunye neeveki ze-8-12 ze-chemo, ukunqunyulwa ukuba kufakwe izicubu ze-neurovascular, indlela Fx, njl.
• Ukucinga: i-radiography kunye neMRI.
• Ngokonyango: iintlungu zamathambo, Inc. Alkaline Phosphatase
• Isifuba CT ukuba imiphunga Mets kuqwalaselwa

I-Classic Rad Features ze-OSA

• I-Osteoid yenza i-sclerotic mass kunye neenwele ezinobundlobongela-ekupheleni / eziqikelelweyo / ze-sun-burst periosteal reaction, unxantathu we-Codman kunye nokuhlasela kwezicubu ezithambileyo. Oda i-MRI yeqonga kunye nobungakanani. I-Chest CT ibalulekile kwiLung Mets dx.

I-MRI ibaluleke kakhulu kwi-Dx / Stage

• Qaphela i-sagittal T1 (ekhohlo) kunye ne-STIR (ekunene) izilayi ze-MR: ubunzima obukhulu obusuka kwi-distal femoral metaphysis ukuya kwi-shaft eseleyo. Isignali ephantsi kwi-T1 kwaye iphezulu kwi-STIR d/t yokuhlasela umongo nge-edema, i-hemorrhaging kunye ne-tumor invasion. Uhlaselo lwe-ST lwasekuhlaleni lubonwa (iintolo ezimhlophe). Ukuphakanyiswa kwePeriosteal kunye nonxantathu weCodman (utolo oluhlaza) ziimpawu ezongezelelweyo zeneoplasm enoburhalarhume.
• Qaphela into enomdla yokuba i-epiphysis igcinwe kwi-d / t physeal plate ekhonza okwexeshana njengesithintelo esongezelelweyo sokusasazeka kwethumba.

Ewing Sarcoma

Ewing sarcoma: ubudala: 2-20, ingaqhelekanga kwizigulane ezimnyama. I-2nd m/c i-neoplasm yethambo enobungozi kakhulu ebantwaneni edla ngokuvela kwi-medullary cavity (Iithumba zeeseli ezijikelezayo). Uphawu oluphambili: iintlungu zethambo ezinokulinganisa usulelo (ESR/CRP/WBC) Kuthathelwa ingqalelo i-PNET Iqhosha Rad Dx: Izilonda ezidliwe linundu/ezinobunewunewu kwishafti yamathambo amade anohlaselo lwezicubu ezithambileyo ezinobungakanani/isiqhelo se-onion skin periostitis. Ingavelisa isoso Inokuthi ichaphazele amathambo asicaba. Inokubonakala njenge-sclerotic kwi-33%. I-Early lung Mets (25-30%) ithambo ukuya kwithambo i-Mets I-prognosis embi ukuba ilibazisekile iDx. Amanyathelo omfanekiso: Inyathelo le-1 x-rad, i-MRI i-v. ibalulekile ilandelwa yi-biopsy. CXR / CT PET-CT Rx: ukudibanisa i-rad-chemo, esebenzayo.

I-M / C I-Malignant Knee Neoplasms kwi-Adults

• I-66-yo indoda buhlungu
• Qaphela intshutshiso yefuthe le-ostolytic lesion in the femalur metaphysis kwi-epiphysis. Akukho mpendulo ye-periosteal. Ukulandela ukuqhubeka komsebenzi kunye nesifo se-CT yesisu nesifuba, i-Dx ye-Renal cell carcinoma yasungulwa
• I-Distal Mets ukuya kwindawo esezantsi ixhaphake kakhulu kwimiphunga, iseli yezintso, i-thyroid kunye ne-CA yebele.
• Iseli yezintso kunye neThyroid ziya kuthi ziveze ubukhulu be-osteolytic expansile mass aka �blowout Mets.
• Ngokubanzi, indlela yokucinga kufuneka iquka i-Radiographic knee series, ilandelwa yi-MRI ukuba i-x-ray ayivuzi.
• I-TC99 I-scintigraphy ye-Bone yindlela yokukhetha yokuhlola isifo se-metastatic disease

I-Soft Tissue Neoplasms Nge-Knee

I-hertiocytoma e-Malignant fibrous (MFH) yafakwa kwakhona njengePleomorphic Undifferentiated Sarcoma (PUS) yim/c ST sarcoma. I-MFH inamandla ngokwebhayoloji kunye ne-prognosis embi M>F (1.2:1) 30-80 kunye nencopho kwishumi le-6. I-25-40% yabo bonke abantu abadala be-sarcomas m / c iziphelo. I-Retroperitoneum elandelayo (i-prognosis embi kakhulu d / t emva kwexesha le-Dx kunye nokukhula okukhulu kweempawu ze-w / o) Klinikhi: buhlungu, ubunzima obunzima ngokuqhelekileyo malunga nedolo okanye ithanga. I-Histology: i-fibroblasts engafanelekanga / engabonakaliyo engafanelekanga, i-myofibroblasts, kunye nezinye iiseli ze-mesenchymal Ukucinga: I-MRI yindlela yokukhetha kunye ne-T1, T2, T1 + C. Ngokuqhelekileyo ibonakala njengobunzima obunobundlobongela obuphakathi ukuya kwisignali ephantsi kwi-T1 kunye nesignali ephezulu kwi-T2 eneendawo ze-necrosis kunye nophuculo kwi-T1+C. Ingabonakala ifakwe ngokulahlekisayo w/o yokwenyani capsule Ulawulo: ukusebenza ngeradiation kunye nechemotherapy. Ubunzulu bethumba bubalulekile kwi-prognosis. I-80% iminyaka eyi-5 yokuphila ukuba i-<5cm inzulu kwi-ST kunye ne-50% ukuba> i-5-cm enzulu kwi-ST.

Synovial Sarcoma

Synovial sarcoma: eqhelekileyo embi ST neoplasm esp. kwizigulane ezincinci okanye kubantwana abadala / abafikisayo. I-M / C ifunyenwe kwindawo yamadolo Ngonyango: inokubonisa ngokukhawuleza njengobunzima obucacileyo kwisigxina esihlala singanakwa d / t ukukhula okucothayo Ukucinga ngundoqo: i-radiography inokutyhila i-ST. ukuxinana/ubunzima. Ezinye i-synovial sarcomas zinokubonisa ukubala kwaye ziphosakele Myositis Ossificanse okanye ukubunjwa kwamathambo e-heterotopic i-MRI ene-T1, i-T2 kunye ne-T1 + C yi-Dx indlela yokuzikhethela. Ezinye iindlela: I-US, i-CT ayithethi ngokuthe ngqo i-DDx: Ulawulo lwe-MFH: ukusebenza, i-chemo-radiation Prognosis: ukuguquguquka ngokuxhomekeke kubukhulu, ukuhlasela, i-metastasis

Uluhlu olupheleleyo lweethambo kunye neethishu zeeTissue Neoplasms

• bonetumor.org
• Ukufunda okuqhubekayo:
• emedicine.medscape.com/article/988516-differential
• www.ajronline.org/doi/10.2214/AJR.16.17434
• Ukuphonononga kwakhona okuthe ngqo kwezigwenxa eziqhelekileyo zobuntana kubhekisela ku:
• www.aafp.org/afp/2000/0401/p2144.html

Neoplasms of the Knee