Clinical application of pathological basis of the nuclear magnetic reaction zone of osteosarcoma

ZHANG Qing-xi; GUO Dong

doi:10.3969/j.issn.2095-252X.2013.09.005

Abstract：Objective To investigate the clinical application of pathological basis of the nuclear magnetic reaction zone of osteosarcoma. Methods 48 cases of osteosarcoma were chosen, with 30 cases in the distal femur and 18 cases in the proximal tibia. There were 26 males and 22 females, with an average age of 15.5 years old ( range;12-25 years ). 22 patients were followed up for an average of 15.5 months ( range;5-24 months ). All the intraoperative specimens were cut into 2 halves along the sagittal longitudinal section, and the tumor invasion and osteotomy surface within the medullary cavity were observed by the naked eye and photographed. In the gross specimen, the tumor area, bleeding and edema area, periosteum congestive area and normal tissue area were pointed out respectively. Samples were taken from the locations above, with half sliced along the sagittal axis and half sliced along the horizontal axis. Samples were taken in the medullary cavity via the vertical axis, and each one was the serialgram from the naked eye border to the osteotomy serial section. The slices were observed under the microscope by 3 pathologists. When bone tumor cells were found to disappear, a pathological diagnosis was made, the slice values were written down and the number of cells was recorded in each slice, until they completely became normal skeletal muscle cells. The length of the reaction zone was the distance between the tumor cells disappearing slice and the normal slice. By using the same method, the actual range of the reaction zone, its cellular structure and the precise scope of the surgery were determined. The maximum distance of tumors was measured. The actual tumor intramedullary invasion range was the sum of the range measured by the naked eye and the range measured under the microscope, and the average value was recorded. The X-ray, MRI and pathological analysis were used to measure the range of tumors. According to the Enneking musculoskeletal tumors postoperative lower extremity function score, the average recovery rate was 85%.Results ( 1 ) The correlation equation between the tumor length and the length of the nuclear magnetic reaction zone was fan=12.1388+0.9698 liu. With the increase of the tumor length, the length of the reaction zone also increased;( 2 ) The correlation equation between the tumor length and the length of the periosteal reaction was fan=20.9262+0.9033 liu. With the increase of the tumor length, the length of the periosteal reaction also increased;( 3 ) In the physical specimens, along the tumor boundary shown in the MRI, there were no tumor cells 4.41 cm outside the tumor. Conclusions It is determined that the security border of the surgery is 4.41 cm outside the nuclear magnetic reaction zone. The characteristics of the reaction zone:occurring more commonly in malignant bone tumors and aggressive benign bone tumors, being located between the tumor tissues and normal tissues and comprising tumor cells, neutrophils, lymphocytes, eosinophils, basophils and ballooning degeneration necrotic cells.