摘要
肿瘤性低磷骨软化症(tumor-induced hypophosphatemia osteomalacia,TIO)是一种罕见的肿瘤引起的低磷骨软化症,1947年被首次报道,全世界报道仅300余例。TIO患者多青春期后起病,典型临床表现为骨痛,呈进行性,多以负重部位为主,其肿瘤位置隐匿,诊断困难,误诊率高。本文就1例磷酸盐尿性间叶瘤继发低磷骨软化症的病例来分析TIO的诊断及鉴别诊断思路,并通过文献复习,以提高对TIO的认识。
This case report concerns a 34-year-old woman who had been diagnosed with ankylosing spondylitis(AS),fibromyalgia syndrome(FMS),osteoarthritis(OA),lumbar disc herniation and the like in different hospitals during the past 18 months.She had progressive osteoarthrosis,significant muscle weakness,gait abnormalities in weight-bearing areas,however without typical inflammatory low back pain,while the treatment with non-steroidal anti-inflammatory drugs(NSAIDs)was invalid,with normal inflammation index,negative results for rheumatic factor(RF)and human leukocyte antigen(HLA)-B27,and normal erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP).She had hyphosphatemia,normal serum calcium,1,25-(OH)2-D3 reduction,elevated alkaline phosphatase(ALP)and normal parathyroid hormone(PTH),however with elevated urinary phosphorus.Finally,the medial thigh nodule was found in the subcutaneous of her inner leg by careful examination and imaging scans including B-ultrasound and PET/CT.The final pathology confirmed that the nodule was phosphate urinary mesenchymal tumors.After the tumor was removed,the patient was treated with anti-osteoporosis and phosphorus supplementation.The symptoms of bone pain and muscle weakness were alleviated,and hypophosphatemia was corrected.It was confirmed that the patient had low-phosphorus osteomalacia due to tumor.Tumor-induced hypophosphatemia osteomalacia(TIO)was a rare paraneoplastic syndrome which was caused by excessive phosphorus excretion induced by the tumor,and was thus categorized as an acquired hypophosphatemic osteomalacia.TIO had an occult onset and was associated with a high rate of misdiagnosis,although TIO has some typical clinical features.Early diagnosis,correctly positioning of the tumor,and surgical resection can achieve good outcomes.
作者
魏慧
刘蕊
王占辉
姚中强
WEI Hui;LIU Rui;WANG Zhan-hui;YAO Zhong-qiang(Department of Rheumatology,Peking University Third Hospital,Beijing 100191,China)
出处
《北京大学学报（医学版）》
CAS
CSCD
北大核心
2019年第6期1169-1172,共4页
Journal of Peking University:Health Sciences
关键词
骨软化症
低磷血症
间叶瘤
Osteomalacia
Hypophosphatemia
Mesenchymoma
