Objective: To investigate the clinical, imaging, histological, and molecular features and the differential diagnosis of radiation-associated sarcomas of bone and soft tissue. Methods: Forty-six cases of radiation-associated sarcomas of the bone and soft tissue in Beijing Jishuitan Hospital from January 2010 to January 2022 were retrospectively analyzed; and the imaging, histological features and immunophenotype were examined. Results: There were 33 females and 13 males, aged from 18 to 74 years, with a mean of 52 years. The most common site of radiation-associated sarcomas were the limbs and spine (15 cases), followed by the chest (9 cases). The primary diseases included epithelial tumors (15 breast cancer, 6 cervical cancer, and 5 bowel cancer), hematolymphoid tumors, bone and soft tissue tumors and infectious lesions. The latent period of radiation-associated sarcomas ranged from 2-22 years, with an average of 11.6 years. Histopathologically, the morphology was divergent from the primary tumor. The most common malignant tumor type was undifferentiated sarcoma (22 cases), followed by osteosarcoma (16 cases). The immunophenotype of radiation-related sarcoma was almost the same as the corresponding soft tissue sarcoma. Conclusions: Radiation-induced sarcoma has a wide range of primary tumor types and its imaging, morphology and immunohistochemical features are similar to those of the primary sarcoma of bone and soft tissue. Clinical correlation is often recommended for the differential diagnosis.
目的： 探讨骨与软组织放射相关肉瘤的临床、影像学特征、组织学形态、诊断及鉴别诊断。 方法： 收集北京积水潭医院2010年1月至2022年1月被诊断为放射治疗后的放射相关肉瘤46例，分析其临床及影像学特征。术后标本经光镜观察、免疫组织化学染色检测分析。 结果： 46例患者中，女性33例，男性13例，年龄18~74岁，平均年龄52岁。发生部位以四肢及脊柱最多见（15例），其次为胸部（9例）。原发肿瘤包括上皮性肿瘤：乳腺癌最多见（15例），其次为宫颈癌（6例）和肠癌（5例）；也包括淋巴造血系统肿瘤、骨与软组织肿瘤及感染性病变。放射相关肉瘤出现的潜伏期2~22年，平均11.6年。镜下形态与原发肿瘤差异较大，以未分化肉瘤多见（22例），其次为骨肉瘤（16例）。免疫组织化学显示放射相关肉瘤免疫表型与相应软组织肉瘤大致相同。 结论： 放射相关肉瘤的原发肿瘤类型广泛，影像学、组织形态、免疫组织化学特征与骨和软组织原发肉瘤相似，诊断需结合病史与原发性肉瘤相鉴别。.