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| 肿瘤源性骨软化症1例报道 |
| Tumor-induced osteomalacia：A case report |
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| DOI：10.3969/j.issn.1006.7108.2016.11.024 |
| 中文关键词: 肿瘤源性骨软化症 低磷血症 |
| 英文关键词:Tumor-induced osteomalacia Hypophosphatemia |
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| 中文摘要: |
| 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 ?l. 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。 |
| 英文摘要: |
| 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. Results The 41-year-old male patient was presented with polyarthralgia and claudication. Kyphosis and ribs valgus were found in physical examination. Blood phosphate level decreased (0. 31mmol/L) and blood alkaline phosphatase level increased (255U/L). The whole body PET/CT showed scoliosis, vertebral osteopenia, fractures of bilateral ribs, sarcrum, and hip bone. In addition, a low density 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. |
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