The Comparison Of Clinical, Imaging And Pathologic Features In Spinal Tumors

Part I Retrospective analysis of clinic and epidemiology of spinal tumorsObjectiveA retrospective analysis was made on the clinical data of 254 cases of spinal tumors from Jan,2005 to Dec,2015. According to the WHO(2013) classification of bone tumors, Determine the pathological pattern, age, sex and clinical feature of spinal tumors, and to provide a reference to epidemiological investigation and imaging diagnosis.Materials and methods1. ObjectFrom Jan.2005 to Dec.2015 254 cases were selected among the patients were diagnosed as spinal tumors by Surgery and/or pathology. According to the WHO(2013) classification of bone tumors, including haematopoietic neoplasm in 50; osteogenic tumor in 15, osteoclastic giant cell-rich tumor in 9, miscellaneous tumor in 4, vascular tumor in 10, chondrogenic tumor in 8, fibrohistiocytic neoplasm in 2, tumor of undefined neoplastic nature in 20, notochordal tumor in 21, metastatic tumor of bone in 115.2. Equipment and methodsSearch the clinical and pathologic data of patients by Nan fang PACS system, from 2005 to 2015. determine the pathological pattern, age, sex and location distribution and clinical feature.Divided the age into groups 0-10,11-20,21-30,31-40,41-50,51-60,61-70, 71-80 and elder than 80.According to the WHO(2013) classification of bone tumors, spinal tumors is classified:haematopoietic neoplasm; osteogenic tumor, osteoclastic giant cell-rich tumor, miscellaneous tumor, vascular tumor, chondrogenic tumor, fibrohistiocytic neoplasm, tumor of undefined neoplastic nature, notochordal tumor, metastatic tumor of bone.Pathological methods:fix materials with 4% methanal, select the pathological changes region and decalcification. Observe the specimen under microscope; carry through the immunohistochemical staining when it’s necessary.Resultpathological pattern and incidence:Totally 254 patients diagnosis by pathology, 28 plasma cell myeloma(about 11%),6 solitary plasma cytoma of bone(about 2.4%), 16 primary non-Hodgkin lymphoma of bone(about 6.3%),1 osteoma(about 0.4%),1 osteoid osteoma(about 0.4%),10 osteoblastoma(about 3.9%),3 osteosarcoma(about 1.2%),9 giant cell tumor of bone(about 3.5%),3 Ewing sarcoma(about 1.2%),1 undifferentiated highgrade pleomorphic sarcoma of bone(about 0.4%),6 haemangioma(about 2.4%),1 epithelioid haemangioma(about 0.4%),3 angiosarcoma(about 1.2%),2 osteochondroma(about 0.8%),3 chondroma(about 1.2%),1 chondromyxiod fibroma(about 0.4%),1 chondrosarcoma, grade I (about 0.4%),1 chondrosarcoma, grade Ⅱ (about 0.4%),2 benign fibrous histocytoma(about 0.8%),1 simple bone cyst(about 0.4%),3 fibrous dysplasia(about 1.2%),1 osteofibrous dysplasia(about 0.4%),1 Rosai-Dorfman disease(about 0.4%), 4 aneurysmal bone cyst(about 1.6%),10 Langerhans cell histiocytosis(about 3.9%), 1 benign notochordal cell tumor(about 0.4%),20 chordoma(about7.8%),115 metastatic tumor of bone(about45.1%).Sex and age:It is more common in males, with a male-to-female ratio of 1.8:1. The age range is between 8 and 83, median age was 49.5, average age is 47.3.Group 0-1 Oyears had 3 cases,20 cases were 11-20years,28 cases were 21-30years,31 cases were31-40years,52 cases were 41-50years,53 cases were 51-60years,52 cases were 61-70years,15 cases were 71-80years and 2cases elder than80 years.Clinical feature:Retrospective analysis of clinic of spinal tumors, malignant, intermediate, and benign tumor, both of them can cause pain in corresponding spine, even neurologic damage like double lower limbs numbed and weak. Malignant tumors like plasma cell myeloma, primary non-Hodgkin lymphoma of bone always show significant weight loss in a short time.Conclusion1. Among this group of spinal tumors, metastatic tumor of bone is the highest in spinal tumors, followed by plasma cell myeloma, chordoma, primary non-Hodgkin lymphoma.2. Spinal tumors is liable to occur in males who were over age of 40, Although spinal tumors can occur in child and old people, but primary non-Hodgkin lymphoma, osteoblastoma, giant cell tumor of bone and Langerhans cell histiocytosis are more common under the age of 40, metastatic tumor of bone, plasma cell myeloma, chordoma, solitary plasma cytoma, haemangioma are more over the age of 40.3. malignant, intermediate, and benign tumor, both of them can cause pain in corresponding spine, even neurologic damage like double lower limbs numbed and weak. Clinical manifestations of the lack of specificity.Part II A Contrast analysis the characteristics of Image with pathology results in each spinal tumors.ObjectiveIn order to realize the Imaging’s characteristics of each pathology type and raise the level of imaging diagnosis, the X-ray, CT, and MRI image of 254 cases with spinal tumors were analyzed retrospectively.Materials and methods1. ObjectFrom Jan.2005 to Dec.2015 254 cases were selected among the patients were diagnosed as spinal tumors by Surgery and/or pathology and had imaging information. All of them had X-ray plain film,86 patients underwent CT scan and MRI examinations were performed in 108cases(X-ray254cases, X-ray+CT 65 cases, X-ray +CT+MRI 21 cases, X-ray +MRI 87 cases).2. Equipment and methodsX-ray examination:SIEMENS Aristos MX digital X-ray machine underwent frontal and lateral X-ray films. CT examination:GE Lightspeed 16 mufti-detector helical CT and SIEMENS SOMATOM Definition dual source CT, non-ionic contract agent was iohexol(300mgI/ml). MRI examination:GE 3.0T MRI scanner and SIEMENS 1.5T MRI machine. Choose the coils according to lesions. Contract materials were Gd-DTPA.According to the WHO(2013) classification of bone tumors, divide these spinal tumor in three groups as malignant tumors, intermediate tumors and benign tumors, compare each group of spinal tumors’imaging features; Small round cell tumors including plasma cell myeloma, solitary plasma cytoma of bone, primary non-Hodgkin lymphoma and Ewing sarcoma; imaging feature in metastatic tumors of bone were complex, so discussion of which were not including.The images were diagnosis with two experienced doctor form radiology department. The data were blinded. If there were any opinions differ in sign observed, the verdict given by the superior doctor. According to the location can be divided into cervical vertebrae, thoracic vertebrae, lumbar vertebrae, Sacrococcygeal vertebrae. Location was divided into two groups:Vertebral body and attachment; single vertebra and multi-vertebra. The observation of X-ray and CT include type of soft tissue mass, tumor, sclerotic margins, expansion, compression fracture and MR signal of soft tissue.3. Statistical analysisAnalysis was carried on by using the SPSS 20.0, significant level is 5%, P-valueless than 5 % was defined as had statistical significant. Compare the sign amongdifferent pathology type with chi-square test.Resultlocation distribution:38 cases of them had attacked cervical vertebrae (11.5%), 111 thoracic vertebrae (about 33.6%),115 lumbar vertebrae(about 34.6%),67 Sacrococcygeal vertebrae(about 20.3%); 95 single vertebra and 159 multi-vertebra;78 Vertebral attachment principally.X-ray and CT:plasma cell myeloma, solitary plasma cytoma of bone, primary non-Hodgkin lymphoma of bone, Ewing sarcoma, osteosarcoma, undifferentiated highgrade pleomorphic sarcoma, angiosarcoma, chondrosarcoma, osteoblastoma, giant cell tumor of bone were varying degrees of osteolytic bony destruction, metastatic tumors of bone were mainly osteolytic bony destruction, following mixed and osteogenic. Small round cell tumor of bone(Plasma cell myeloma, Solitary plasma cytoma of bone, Primary non-Hodgkin lymphoma of bone and Ewing sarcoma) were not expansive obviously, intermediate tumor as Langerhans cell histiocytosis was also not expansive obviously.MRI:Most of spinal tumors showed inhomogeneous and low to intermediate signal intensity on T1WI, a few were isointense intensity on T1W1.1 Osteoid osteoma shows inhomogeneous and intermediate to high signal intensity on T1WI. On T2-weighted images, most of spinal tumors were inhomogeneous and intermediate to high signal intensity, a few showed low to intermediate signal intensity,1 each in Plasma cell myeloma, Benign fibrous histocytoma and Osteofibrous dysplasia were isointense intensity, most spinal malignant and intermediate tumors showed uneven enhancement.Statistical analysis result:①The incidence rate of soft tissue mass between malignant tumors and intermediate tumors reach statistical significance; ②There were statistical significance among these three type tumors in sclerotic rim; There were no statistical significance between intermediate tumors and benign tumors.these three type tumors in sclerotic rim. ③There were no statistical significance in bony expansibility among these three type tumors, There were statistical significance in expansibility between small round cell tumor of bone and non-small round cell tumor of bone. ④There were statistical significance among these three type tumors in compression fractures. There were no statistical significance between malignant tumors and intermediate tumors in compression fractures. ⑤There were no statistical significance in MR enhancement signal among these three type tumors.Conclusion1. The tumor has a predilection to the thoracic vertebrae and lumbar vertebrae, primary non-Hodgkin lymphoma always involved multi-vertebra, like the metastatic tumor of bone and plasma cell myeloma, the tumors can be jumpy, intermediate tumor as Langerhans cell histiocytosis and benign tumor as haemangioma also can be jumpy. A few spinal tumors like osteoblastoma was more often in Vertebral attachment.2. The incidence rate of soft tissue mass in Malignant tumors were higher than intermediate tumors; The incidence rate of sclerotic rim in intermediate tumors and benign tumors were not statistically significant, Malignant tumors rarely appeared sclerotic rim; In malignant tumors, small round cell tumors of bone were not expansive obviously; The incidence rate of in malignant tumors and intermediate tumors were more common appeared compression fractures, benign tumors rarely appeared compression fractures.