摘要
目的：分析肿瘤源性骨软化症（tumor-induced osteomalacia，TIO）的临床特点、诊断和治疗方法，以提高对本病的认识。方法收集并整理9例TIO患者的临床表现、实验室检查、影像学特点及治疗方法等资料，分析和比较患者手术前后的血生化指标的改变。结果患者均有骨痛、无力及活动受限的表现，实验室检查提示低磷血症，骨扫描提示骨质疏松、骨软化症。9例患者均进行奥曲肽显像（99mTc-OCT），其中8例诊断部位准确，另1例显像定位不准确，后经68Ga-TATE及其他影像学检查确诊病灶部位。8例患者病理诊断为磷酸盐尿性间叶组织肿瘤，1例为胸膜外脂肪瘤样型孤立性纤维性肿瘤。7例患者在明确肿瘤定位后立即接受手术切除治疗，术后血磷恢复正常，并在术后6～12个月保持在正常水平。结论 TIO多见于成人起病、无家族史的低磷骨软化症患者。99mTc-OCT对诊断本病有重要意义，B超、CT、MRI及骨扫描等对辅助定位和诊断病灶有帮助，必要时可进行68Ga-TATE检查。确定肿瘤病灶之后及时进行手术切除，是目前最有效的治疗方法。
Objective To improve the clinical diagnosis and treatment of tumor-induced osteomalacia （TIO）. Method We summarized and analyzed the comprehensive clinical data （including clinical manifestation, manage-ment, radiographic imaging, biochemical testing, peri- and post-operative clinical status） of 9 cases with TIO. Result All the 9 patients presented with bone pain and muscle weakness, hypophosphatemia and phosphaturia. Results of ra-diographic imaging showed that all patients had osteoporosis and the features of metabolic bone diseases. 99mTc-OCT was performed in all 9 patients and 8 of 9 cases showed correct tumor focus, one patient obtained adjusted de-termination for tumor focus with the help of 68Ga-TATE, CT and MRI. The diagnosis of 8 patients was confirmed by histopathology as phosphaturic mesenchymal tumor and 1 as extrapleural lipomatous solitary fibrous tumor after oper-ation or biopsy. Serum Pi level returned and retained to normal after resection for 7 patients. Conclusion TIO is mostly seen in adult osteomalacia cases with hypophosphatemia and without family medical history. 99mTc-OCT and other imaging examinations are very helpful in diagnosing and locating the tumors. In addition, 68Ga -TATE is ap-plied as appropriate. A complete resection targeting definite lesions is the most effective treatment for TIO.
出处
《癌症进展》
2015年第4期439-443,共5页
Oncology Progress
