存在脊髓压迫症状的脊柱痛风石

Tophaceous gout of spine causing neural compression

目的报告1例发生于胸椎的椎管内痛风石患者的临床特点、病理学特征、诊断与治疗要点，以期提高对该病的认识。方法与结果男性患者，36岁，临床表现为双下肢无力伴麻木2个月、加重2周，胸椎MRI显示T9-10平面椎管内外沟通性占位性病变。手术分块全切除病变。冰冻病理学检查，纤维结缔组织内可见棕色线样结晶，局部累及骨组织，周围异物肉芽肿形成；棕色线样结晶于偏振光显微镜下呈双折光性。手术切除标本病理学检查可见白色不定形物质，其间散在少量残留的棕色线样晶体；白色不定形物质于偏振光显微镜下呈单折光性。最终病理诊断为痛风石形成。随访6个月，可辅助拐杖行走。结论脊柱痛风石为尿酸盐结晶沉积于脊柱关节内所致，应与结核病、中枢神经系统淋巴瘤、转移瘤、脂肪瘤等椎管内硬脊膜外占位性病变相鉴别，穿刺活检术或手术发现尿酸盐结晶可明确诊断。

Objective To investigate the imaging and clinicopathologieal features of spinal tophaceous gout in thoracic vertebra and the key points of its diagnosis and treatment, in order to improve the recognition of this disease. Methods and Results A 36-year-old male was admitted because of weakness and numbness of both lower extremities for 2 months with progressive aggravation for 2 weeks. MRI revealed an extradural mass compressing the spinal cord at T9-10. The tumor was totally removed by piecemeal resection. Histopathologieal examination of the fresh specimen by light microscope demonstrated brown linear crystals, which showed strong birefringence in polarized light microscope, located in fibrous connective tissue, with local bone invasion and foreign body granuloma. However, histopathological examination of the removed specimen demonstrated white amorphous materials, with scatteredly distributed remaining brown linear crystals, which showed single refraction in polarized light microscope. The final pathological diagnosis was tophaceous gout. The patient was followed-up for 6 months. He stopped taking anti-uric acid drugs by himself and could walk with crutch. Conclusions Tophaceous gout of spine is caused by uratic deposition in spinal joints, which needs to be differentiated from other intraspinal extradural space-occupying lesions like tuberculosis, central nervous system lymphoma, metastatic tumors and lipomyoma. A definite diagnosis of tophaceous gout of spine requires histopathological examination detecting uratic crystals.