摘要
目的探讨原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)所致棕色瘤的误诊原因及影像学特点。方法回顾性分析误诊为其他疾病的4例棕色瘤的临床资料。结果本组4例分别因右上肢疼痛伴活动受限、右下肢跛行伴疼痛、右足疼痛、左上肢疼痛就诊,3例首诊于骨科,1例首诊于泌尿外科。根据症状、体征及影像学检查,误诊为骨巨细胞瘤2例,纤维组织细胞瘤、骨囊肿各1例,误诊时间3~18个月,平均9.75个月。后进一步观察发现99m Tc-MDP全身骨骼显像呈PHPT骨病改变,术前99m Tc-MIBI甲状旁腺显像准确定位、定性并行手术切除,术后病理检查亦证实为PHPT,确诊为棕色瘤,术后电话随访患者疼痛逐渐缓解并消失,部分患者已能从事一定体力劳动。结论棕色瘤临床表现不典型,若遇及原因不明的骨质疏松、骨折、骨痛等骨关节病的患者时,应及早行99m Tc-MDP全身骨骼显像,同时99m Tc-MIBI甲状旁腺显像能够定位、定性甲状旁腺致病灶,其与99m Tc-MDP全身骨骼显像联合检查有助于棕色瘤的诊断及鉴别诊断。
Objective To investigate the causes of misdiagnosis and imaging features of brown tumors caused by primary hyperparathyroidism(PHPT).Methods Retrospectively analysis was conducted on the clinical data of 4 patients with brown tumors misdiagnosed as other diseases.Results These 4 patients presented to our hospital due to pain in right upper limb along with limitation of movement,lameness in right lower limb along with pain,pain in right foot and pain in left upper limb,respectively.Three patients initially visited the Department of Orthopedics and one visited Urology Department.Based on the symptoms,signs and imaging examination,two cases were misdiagnosed as giant cell tumor of bone,one as fibrous histiocytoma and one as bone cyst.The misdiagnosis lasted 3 to 18 months,and the average duration of misdiagnosis was 9.75 months.The 99m Tc-MDP bone scintigraphy following further observation showed PHPT-associated osteopathia changes.The 99m Tc-MIBI scintigraphy displayed accurate positioning and characterization of the lesions,and surgical resection was performed.PHPT was confirmed by the postoperative pathological examinations.Telephone follow-up showed that patients'pains gradually relieved and disappeared,and some patients had been able to engage in some physical labor.Conclusion Given atypical clinical manifestations of brown tumor,early 99m Tc-MDP bone scintigraphy should be performed in patients with osteoarthropathy with unknown etiologies such as osteoporosis,bone fracture,and ostealgia.Meanwhile,99m Tc-MIBI scintigraphy can locate and characterize the lesions of PHPT.Therefore,the combination of 99m Tc-MDP bone scintigraphy and 99m Tc-MIBI scintigraphy is helpful for the diagnosis and differential diagnosis of brown tumors.
作者
陈正国
吴春燕
赵玲
魏俊阳
何川东
CHEN Zheng-guo;WU Chun-yan;ZHAO Ling;WEI Jun-yang;HE Chuan-dong(Department of Nuclear Medicine,Central Hospital of Mianyang,Mianyang,Sichuan 621000,China)
出处
《临床误诊误治》
2020年第6期13-16,共4页
Clinical Misdiagnosis & Mistherapy
