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DOI: 10.1055/a-1487-8182
Osteochondrome und andere knorpelbildende benigne Tumoren der Wirbelsäule
Osteochondroma and benign chondrogenic tumors of the spine
Zusammenfassung
Unter den seltenen Primärtumoren des Skelettsystems zählen die chondrogenen zu den am häufigsten auftretenden. Innerhalb des chondroiden Grundmusters, zeigt sich eine große Bandbreite an radiomorphologischen und histopathologischen Erscheinungsformen mit variierender tumor-biologischer Aktivität. An der Wirbelsäule treten diese Tumoren deutlich seltener auf und klinisch stehen Schmerzen im Vordergrund. Aufgrund ihrer oft dorsalen Lokalisation sind neurologische Defizite nicht selten. CT und MRT sind maßgeblich für die bildgebende Diagnostik. Für das Management gilt das Prinzip der interdisziplinären Entscheidungsfindung und Therapie nach abgeschlossener Diagnostik, die eine suffiziente Biopsie einschließt. Entsprechend der Enneking Klassifikation der Tumoren sind intraläsionale und aggressive Resektionen in Abhängigkeit der zu Grunde liegenden, oft heterogenen tumor-biologischen Aktivität möglich. Entsprechend different sind Lokalrezidiv- und auch sekundäre Entartungsraten. Aufgrund ihres seltenen Auftretens, der notwendigen Diagnostik und der teils komplexen Therapie wird eine Zuweisung an ein spinal tumor-chirurgisches Referenzzentrum mit angeschlossener Infrastruktur empfohlen. Der folgende Artikel soll die Charakteristika, Diagnostik und Therapie benigner chondrogener Primärtumoren der Wirbelsäule aufzeigen und beschreibt exemplarisch Osteochondrome, Enchondrome, Chondro-myxoidfibrome und Chondroblastome der Wirbelsäule.
Abstract
Among primary tumors of the skeletal system, lesions with chondrogenic origin are most frequent. All present with a cartilaginous pattern, broadly varying in radiomorphologic and histopahtological characteristics as well as biological activity. They rarely appear at the spine, clinically presenting with local pain and - based on their often posterior localisation - with neurological deficits. CT- and MRI- scans are essential imaging tools. Following a complete diagnsotic work-up, that includes sufficient biospy, multidisciplinary decision-making is mandatory. Depending on the often heterogeneous biological activity and in accordance to the Enneking staging system, intralesional and aggressive resections are adequate in order to treat this lesions. Likewise, local recurrence and malignant transformation rates are differing. Due to the incidences, necessary diagnostic steps and propability for complex treatment regimens, admission to spinal tumor centers with affiliated oncological networks has to be recommended. This manuscript presents charactersitics, diagnostics and therapy of benign chondrogenic tumors with an examplary characterisation of osteochondroma, enchondroma, chondromyxoid fibroma and chondroblastoma.
Publication History
Article published online:
03 November 2021
© 2021. Thieme. All rights reserved.
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Literatur
- 1 Uhl M, Herget G, Kurz P. [Cartilage tumors : Pathology and radiomorphology]. Radiologe 2016; 56: 476-488 DOI: 10.1007/s00117-016-0112-z. (PMID: 27233920)
- 2 Engel H, Herget GW, Fullgraf H. et al. Chondrogenic Bone Tumors: The Importance of Imaging Characteristics. Rofo 2021; 193: 262-275 DOI: 10.1055/a-1288-1209. (PMID: 33152784)
- 3 Fritzsche H, Schaser KD, Hofbauer C. [Benign tumours and tumour-like lesions of the bone : General treatment principles]. Orthopade 2017; 46: 484-497 DOI: 10.1007/s00132-017-3429-z. (PMID: 28451704)
- 4 Lodwick GS. Radiographic diagnosis and grading of bone tumors, with comments on computer evaluation. Proc Natl Cancer Conf 1964; 5: 369-380 (PMID: 5856167)
- 5 Lodwick GS. A probabilistic approach to the diagnosis of bone tumors. Radiol Clin North Am 1965; 3: 487-497 (PMID: 5846856)
- 6 Batouli A, Gholamrezanezhad A, Petrov D. et al. Management of Primary Osseous Spinal Tumors with PET. PET Clin 2019; 14: 91-101 DOI: 10.1016/j.cpet.2018.08.002. (PMID: 30420225)
- 7 Purandare NC, Puranik A, Shah S. et al. Can 18F-FDG PET/CT diagnose malignant change in benign chondroid tumors?. Nucl Med Commun 2019; 40: 645-651 DOI: 10.1097/MNM.0000000000001015. (PMID: 30921251)
- 8 Choi JH, Ro JY. The 2020 WHO Classification of Tumors of Bone: An Updated Review. Adv Anat Pathol 2021; 28: 119-138 DOI: 10.1097/PAP.0000000000000293. (PMID: 33480599)
- 9 Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. Clin Orthop Relat Res 1980; 153: 106-120 DOI: 10.1097/01.blo.0000093891.12372.0f. (PMID: 14612624)
- 10 Boriani S, Weinstein JN, Biagini R. Primary bone tumors of the spine. Terminology and surgical staging. Spine (Phila Pa 1976) 1997; 22: 1036-1044 DOI: 10.1097/00007632-199705010-00020. (PMID: 9152458)
- 11 Schaser KD, Melcher I, Luzzati A. et al. Bone sarcoma of the spine. Recent Results Cancer Res 2009; 179: 141-167 DOI: 10.1007/978-3-540-77960-5_10. (PMID: 19230539)
- 12 Fisher CG, Saravanja DD, Dvorak MF. et al. Surgical management of primary bone tumors of the spine: validation of an approach to enhance cure and reduce local recurrence. Spine (Phila Pa 1976) 2011; 36: 830-836 DOI: 10.1097/BRS.0b013e3181e502e5. (PMID: 20714276)
- 13 Winkler D, Fritzsche H, Schaser KD. et al. Biopsy of musculoskeletal tumors : Complications and avoidable errors. Orthopade 2020; 49: 88-97 DOI: 10.1007/s00132-020-03875-y. (PMID: 32025742)
- 14 Sciubba DM, Macki M, Bydon M. et al. Long-term outcomes in primary spinal osteochondroma: a multicenter study of 27 patients. J Neurosurg Spine 2015; 22: 582-588 DOI: 10.3171/2014.10.SPINE14501. (PMID: 25793467)
- 15 Yakkanti RI, Onyekwelu L, Carreon Y. et al. Solitary Osteochondroma of the Spine-A Case Series: Review of Solitary Osteochondroma With Myelopathic Symptoms. Global Spine J 2018; 8: 323-339 DOI: 10.1177/2192568217701096. (PMID: 29977716)
- 16 Sharma MC, Arora R, Deol PS. et al. Osteochondroma of the spine: an enigmatic tumor of the spinal cord. A series of 10 cases. J Neurosurg Sci 2002; 46: 66-70 (PMID: 12232551)
- 17 Disch AC, Kleber C, Redemann D. et al. Current surgical strategies for treating spinal tumors: Results of a questionnaire survey among members of the German Spine Society (DWG). Eur J Surg Oncol 2020; 46: 89-94 DOI: 10.1016/j.ejso.2019.08.019. (PMID: 31506180)
- 18 Gille O, Pointillart V, Vital JM. Course of spinal solitary osteochondromas. Spine (Phila Pa 1976) 2005; 30: E13-19 (PMID: 15626967)
- 19 Srikantha U, Bhagavatula ID, Satyanarayana S. et al. Spinal osteochondroma: spectrum of a rare disease. J Neurosurg Spine 2008; 8: 561-566 DOI: 10.3171/SPI/2008/8/6/561. (PMID: 18518678)
- 20 Guo J., Gao JZ, Guo LJ. et al. Large enchondroma of the thoracic spine: a rare case report and review of the literature. BMC Musculoskelet Disord 2017; 18: 155 DOI: 10.1186/s12891-017-1519-z. (PMID: 28407736)
- 21 McLoughlin GS, Sciubba DM, Wolinsky JP. Chondroma/Chondrosarcoma of the spine. Neurosurg Clin N Am 2008; 19: 57-63 DOI: 10.1016/j.nec.2007.09.007. (PMID: 18156048)
- 22 Gutierrez-Gonzalez R, De Reina L, Saab A. et al. Chondromyxoid fibroma of the lumbar spine: case report and literature review. Eur Spine J 2012; 21: S458-462 DOI: 10.1007/s00586-011-2078-x. (PMID: 22094389)
- 23 Konishi E, Nakashima Y, Mano M. et al. Chondroblastoma of extra-craniofacial bones: Clinicopathological analyses of 103 cases. Pathol Int 2017; 67: 495-502 DOI: 10.1111/pin.12586. (PMID: 28971570)
- 24 Chen W, DiFrancesco LM. Chondroblastoma: An Update. Arch Pathol Lab Med 2017; 141: 867-871 DOI: 10.5858/arpa.2016-0281-RS. (PMID: 28557595)
- 25 Jia Q, Liu C, Yang J. et al. Clinical features, treatments and long-term follow-up outcomes of spinal chondroblastoma: report of 13 clinical cases in a single center. J Neurooncol 2018; 140: 99-106 DOI: 10.1007/s11060-018-2935-0. (PMID: 29968040)
- 26 Schaser KD, Melcher I, Druschel C. et al. Surgical management of thoracolumbar spinal sarcoma. Orthopade 2012; 41: 659-673 DOI: 10.1007/s00132-012-1911-1. (PMID: 22825054)