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山东大学学报(医学版) ›› 2017, Vol. 55 ›› Issue (5): 108-111.doi: 10.6040/j.issn.1671-7554.0.2016.1435

• 临床医学 • 上一篇    下一篇

肿瘤相关性骨软化症3例分析并文献复习

蒋洁,张晓黎,董明,刘金波,蒋玲   

  1. 山东大学齐鲁医院内分泌科, 山东 济南 250012
  • 收稿日期:2016-11-03 出版日期:2017-05-10 发布日期:2017-05-10
  • 通讯作者: 蒋玲. E-mail:1911482077@qq.com张晓黎. E-mail:sallyzh66@sina.com E-mail:1911482077@qq.com

Tumor-induced osteomalacia: a report of 3 cases and review of literature

JIANG Jie, ZHANG Xiaoli, DONG Ming, LIU Jinbo, JIANG Ling   

  1. Department of Endocrinology, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China
  • Received:2016-11-03 Online:2017-05-10 Published:2017-05-10

摘要: 目的 探讨肿瘤相关性骨软化症(TIO)并进行相关文献复习。 方法 选取2015年6月至2016年2月收治的3例TIO患者临床资料,随访至2016年10月,并行相关文献复习。 结果 3例均表现为进行性加重骨痛、肌痛。3例均显示低血磷、高尿磷以及碱性磷酸酶升高,影像学检查示骨软化。2例查见体表肿物,1例查见牙龈肿物,3例均行诊断性治疗手术切除肿物,病理为磷酸盐尿性间叶肿瘤(PMT),诊断为TIO。术后随访生化指标及临床症状均明显改善。 结论 TIO是一种罕见的副肿瘤综合征,一般生长缓慢且位置隐匿,临床易误诊或漏诊,但手术切除肿瘤后,患者预后良好。由此可见,临床及时发现肿瘤非常重要。

关键词: 肿瘤相关性骨软化症, 低血磷, 高尿磷, 手术治疗

Abstract: Objective To explore tumor-induced osteomalacia(TIO)and review relevant literature. Methods The clinical information of 3 TIO cases treated in our hospital in Feb. 2016 were retrospectively analyzed and relevant literatures were retrieved. Result All 3 cases manifested progressive ostalgia and myalgia. The laboratory readings indicated hypophosphatemia, hyperphosphaturia and elevated alkaline phosphatase. Imaging examinations showed osteomalacia. Masses on the body surface were observed in 2 cases, and a mass on the gum was detected in 1 case. All masses were removed, and the postoperative pathological results were phosphaturic mesenchymal tumor. The follow-up showed improvements of biochemical indexes and clinical symptoms. Conclusion TIO is a rare paraneoplastic syndrome. As tumors usually grow slowly and are not easy to be observed, they are likely to be misdiagnosed or underdiagnosed. However, resection of tumors shows good prognosis. Therefore, it is very important to find the tumors promptly.

Key words: Tumor-induced osteomalacia, Hypophosphatemia, Hyperphosphaturia, Operation

中图分类号: 

  • R589
[1] Dadoniene J, Miglinas M, Miltiniene D, et al. Tumour-induced osteomalacia: a literature review and a case report[J]. World J Surg Oncol, 2016, 14(1): 4. doi: 10.1186/s12957-015-0763-7.
[2] Meng T, Zhou W, Li B, et al. En bloc resection for treatment of tumor-induced osteomalacia: a case presentation and a systematic review[J]. World J Surg Oncol, 2015, 13(8): 176. doi: 10.1186/s12957-015-0589-3.
[3] Chong WH, Molinolo AA, Chen CC, et al. Tumor-induced osteomalacia[J]. Endocr Relat Cancer, 2011, 18(3): 53-77.
[4] 张欣, 钟定荣, 邢荣格. 磷酸盐尿性间叶肿瘤 12 例临床病理分析[J]. 临床与实验病理学杂志, 2015, 31(4): 426-430. ZHANG Xin, ZHONG Dingrong, XING Rongge. Phosphaturic mesenchymal tumor: clinicopathological analysis of 12 cases[J]. Chinese Journal of Clinical and Experimental Pathology, 2015, 31(4): 426-430.
[5] McCance RA. Osteomalacia with Looser's nodes(Milkman's syndrome)due to a raised resistance to vitamin D acquired about the age of 15 years[J]. Q J Med, 1947, 16(1): 33-46.
[6] Amblee A, Uy J, Senseng C, et al. Tumor-induced osteomalacia with normal systemic fibroblast growth factor-23 level[J]. Clin kidney J, 2014, 7(2): 186-189.
[7] de Beur SMJ. Tumor-induced osteomalacia[J]. Jama, 2005, 294(10): 1260-1267.
[8] 马文杰, 易茜璐, 于明香. 肿瘤相关性低磷性骨软化症(TIO)1例[J]. 复旦学报(医学版), 2012, 39(6): 680-681.
[9] White KE, Evans WE, O'Riordan JLH, et al. Autosomal dominant hypophosphataemic rickets is associated with mutations in FGF23[J]. Nat Genet, 2000, 26(3): 345-348.
[10] 郭丛丛, 郭可武, 汪华. 成纤维细胞生长因子-23 与肿瘤源性骨软化症[J]. 国际骨科学杂志, 2009,30(3): 188-190.
[11] Fathalla H, Cusimano M, Di Ieva A, et al. Osteomalacia-inducing tumors of the brain: a case report, review and a hypothesis[J]. World Neurosurg, 2015, 84(1): 189. doi: 10.1016/j.wneu.2015.02.030.
[12] Jain AS, Shelley S, Muthukrishnan I, et al. Diagnostic importance of contrast enhanced 18F-fluorodeoxyglucose positron emission computed tomography in patients with tumor induced osteomalacia: Our experience[J]. Indian J Nucl Med, 2016, 31(1): 14-19.
[13] Seufert J, Ebert K, Müller J, et al. Octreotide therapy for tumor-induced osteomalacia[J]. N Engl J of Med, 2001, 345(26): 1883-1888.
[14] Hautmann AH, Hautmann MG, Kölbl O, et al. Tumor-induced osteomalacia: an up-to-date review[J]. Curr Rheumatol Rep, 2015, 17(6): 1-6.
[15] Hu FK, Yuan F, Jiang CY, et al. Tumor-induced osteomalacia with elevated fibroblast growth factor 23: a case of phosphaturic mesenchymal tumor mixed with connective tissue variants and review of the literature[J]. Chin J Cancer, 2011, 30(11): 794-804.
[16] 潘婷婷, 王小菊, 冯正平, 等. 肿瘤相关性骨软化症一例并文献复习[J]. 中华关节外科杂志(电子版), 2015, 9(6): 94-95.
[17] Sun XF, Zhang HB, Li XP, et al. A case of adefovir dipivoxil induced hypophosphataemic osteomalacia and literature review[J]. Chin J Joint Surg(Electronic Edition), 2011, 50(9): 754-757.
[18] Yu WJ, He JW, Fu WZ, et al. Reports of 17 Chinese patients with tumor-induced osteomalacia[J]. J Bone Miner Metab, 2017, 35(3): 298-307.
[19] Yavropoulou MP, Gerothanasi N, Frydas A, et al. Tumor-induced osteomalacia due to a recurrent mesenchymal tumor overexpressing several growth factor receptors[J]. Endocrinol Diabetes Metab Case Rep, 2015:150025. doi: 10.1530/EDM-15-0025.
[20] 郑燕芳, 陆菊明. 肿瘤相关性低磷骨软化病 13 例临床分析[J]. 疑难病杂志, 2012, 11(8): 630-632.
[21] Fukumoto S. Anti-fibroblast growth factor 23 antibody therapy[J]. Curr Opin Nephrol Hypertens, 2014, 23(4): 346-351.
[22] Higley M, Beckett B, Schmahmann S, et al. Locally aggressive and multifocal phosphaturic mesenchymal tumors: two unusual cases of tumor-induced osteomalacia[J]. Skeletal Radiol, 2015, 44(12): 1825-1831.
[23] Jiang Y, Xia W, Xing X, et al. Tumor-induced osteomalacia: An important cause of adult-onset hypophosphatemic osteomalacia in China: report of 39 cases and review of the literature[J]. J Bone Miner Res, 2012, 27(9): 1967-1975.
[24] Chazal T, Khanine V, Lidove O, et al. Tumor-induced osteomalacia caused by a late-revealing phosphaturic mesenchymal tumor[J]. Rev Med Interne, 2016. doi: 10.1016/j.revmed.2016.08.020.
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