肿瘤源性骨软化症1例报道

Tumor-induced osteomalacia:A case report

目的熟悉肿瘤源性骨软化症(tumor induced osteomalacia,TIO)的特征。方法介绍1例低磷性骨软化症的临床表现、实验室检查、影像学和病理检查。结果患者,男,41岁,全身多关节疼痛伴跛行2年余。脊椎后突,肋外翻。血磷0.31mmol/L,血碱性磷酸酶255U/L;全身PET/CT:双侧多根肋骨、骶骨、双侧髋骨骨折;左侧股骨头低密度病灶,放射性摄取增高,肿瘤性病变可能。髋关节MRI:左侧股骨颈局限性骨质缺损,大小约1.0×1.5cm,为良性骨病,肿瘤样病变不除外。区域组织麻醉下行左股骨颈肿瘤切除术,病理报告:间叶源性肿瘤,联系临床考虑考虑为尿磷性间叶肿瘤(Phosphaturic mesenchymal tumor)。术后第7天复查血磷升至0.76mmol/L,碱性磷酸酶降至215U/L,24h尿磷降至8.4mmol/24h。术后一月随访骨痛症状及近端肌肉无力症状均有好转。本例最后诊断肿瘤源性骨软化(TIO)。结论成年发生的无家族史低磷性骨软化症应排除TIO,全身PET/CT功能显像和局部MRI解剖显像可确定肿瘤部位,手术切除肿瘤是治疗的关键。

Objective To clarify the characteristics of tumor-induced osteomalacia（ TIO）. Methods The clinic manifestations,blood biochemistry,imaging studies,and pathologic results of one case of hypophosphatemic malacia were reported. Re sults The41-year-old male patient was presented with polyarthralgia and claudication. Kyphosis and ribs valgus were found in physical examination. Blood phosphate level decreased（ 0. 31 mmol / L） and blood alkaline phosphatase level increased（ 255 U / L）. The whole body PET / CT showed scoliosis,vertebral osteopenia,fractures of bilateral ribs,sarcrum,and hip bone. In addition,a lowdensity tumor-like lesion with high radioactive uptake in the head of the left femur was found. The hip joint MRI displayed a 1. 0 ×1. 5cm local bone defect in the neck of the left femur,which was suspected as benign bone tumor. With local tissue anesthesia the tumor was removed. The pathologic examination reported a mesenchymal tumor. The final diagnosis was tumor-induced osteomalacia（ TIO）. Conclusion An adult patient with hypophosphatemic malacia without family history should be suspected as tumor-induced osteomalacia. The whole body PET / CT function imaging and local MRI anatomical imaging are helpful for localization of the tumor. Surgical resection of the tumor is the first of choice of treatment.