摘要
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.
出处
《中国骨质疏松杂志》
CAS
CSCD
北大核心
2016年第11期1481-1484,共4页
Chinese Journal of Osteoporosis
关键词
肿瘤源性骨软化症
低磷血症
Tumor-induced osteomalacia
Hypophosphatemia