Dedifferentiated Chondrosarcoma of Tibial Bone with Knee Pain: A Case Report

脛骨的去分化型軟骨肉瘤併膝痛：病例報告

張惠雯(Hui-Wen Chang) ； 徐友春(Yo-Tsun Shu) ； 張啓原(Chi-Yuan Chang) ； 賴鈺嘉(Yu-Jia Lai)

《內科學誌》 20卷2期 (2009/04) Pp. 181-186

https://doi.org/10.6314/JIMT.2009.20(2).11

摘要

老年人常抱怨膝痛。我們提出一個七十五歲女性膝痛，最後診斷爲脛骨的去分化型軟骨肉瘤的案例。病患於2003年6月27日主訴右膝疼痛來門診求助。由X光片發現脛骨近端不規則鈣化，無皮質破壞或骨膜增厚，也無骨膜反應。鑑別診斷包括脛骨骨梗塞、軟骨瘤。追蹤第三年，患者因意外發生右股骨骨折。直到2007年4月患者因肺炎住院時，右膝出現紅腫熱痛。安排核磁共振攝影，發現有軟組織增生。轉介骨科，進一步安排骨穿刺細胞學檢查，結果爲高度惡性肉瘤。骨骼同位素掃瞄及肺部電腦斷層檢查懷疑肋骨轉移，並無肺部轉移。患者先接受術前放射線治療，於2007年6月進行膝蓋以上截肢手術，病理診斷爲去分化型軟骨肉瘤。手術後發現有右腹股溝淋巴結、骨及肺部轉移。病患於術後6個月死亡。因骨腫瘤的惡性度難以從組織學及放射線學檢查區分。我們學習到當X光片發現不規則鈣化且大於五公分時，應及早轉介骨科，做完整的腫瘤評估。

並列摘要

We report the case of a 75-year-old woman having knee pain later diagnosed with dedifferentiated chondrosarcoma (DDCS) of the proximal tibial metaphysis. The patient complained of pain in the right knee. Plain radiographs of the right tibia showed irregular sclerotic calcification but no focal cortical thickening or periosteal reaction. In the third year of follow-up, she fractured the right femur in an accident. She developed a swelling of the right knee while admitted for pneumonia in April 2007. MRI revealed an extraosseous soft tissue mass extending into the anterior muscular compartment. Bone biopsy showed high-grade spindle cell sarcoma. Bone scan and chest CT revealed suspicious rib metastases but no pulmonary metastases. She underwent an above-knee amputation in June 2007 after neoadjuvant radiotherapy. She died of metastatic lymphadenopathy, and lung and bone metastases within six months after surgery.
We should have referred the patient to an orthopedic surgeon soon after the ill-defined calcification with a mineralized chondroid matrix and a size of more than 5 cm (radiographically) was noted.

並列關鍵字

Dedifferentiated chondrosarcoma ； Knee pain