Infiltrative nature of tumor-induced osteomalacia lesions in bone: Correlation between radiological and histopathological features
Infiltrative nature of tumor-induced osteomalacia lesions in bone: Correlation between radiological and histopathological features
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DOI：
10.1016/j.jos.2019.02.005
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发表时间：
2019-09-01
影响因子：
1.7
通讯作者：
Tanaka, Sakae
中科院分区：
文献类型：
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作者：
Kobayashi, Hiroshi;Makise, Naohiro;Tanaka, Sakae
目的：肿瘤诱导的骨软化症是一种罕见的副肿瘤综合征，通常由磷酸盐尿性间叶肿瘤引起，此类肿瘤常见于骨骼。本研究旨在探讨骨骼中肿瘤诱导的骨软化症病变的影像学特征及其与组织病理学的相关性。
材料与方法：本研究纳入了2000年1月至2018年4月在我院接受治疗的13例肿瘤诱导的骨软化症患者。对所有患者进行检查以找出引发该病症的肿瘤。在肿瘤切除术前获取疑似肿瘤的诊断性影像学检查结果。我们评估了所有肿瘤的影像学特征，对10例接受手术并获得可评估肿瘤标本的病例进行了组织病理学研究。
结果：通过CT将肿瘤分为以下三种类型：硬化型（n = 4）、溶骨型（n = 7）和混合型（n = 2）。在2例病例中，溶骨性病变局灶性侵犯周围松质骨，此情况通过CT软组织窗而非骨窗发现。组织病理学显示，无论影像学特征如何，所有病例均存在小梁间侵犯。溶骨型可见破骨细胞，硬化型可见类似爬行替代的增厚小梁骨和钙化。所有病例均可见肿瘤局灶性侵犯皮质骨。
结论：骨骼中肿瘤诱导的骨软化症病变具有多种影像学特征，且倾向于侵犯松质骨和皮质骨。这些发现表明，可能需要对变薄的皮质骨进行扩大刮除或切除。这或许能提高骨骼中肿瘤诱导的骨软化症病变的手术治愈率。（C）2019日本骨科学会。爱思唯尔出版社出版。保留所有权利。
Objective: Tumor-induced osteomalacia is a rare paraneoplastic syndrome usually caused by phosphaturic mesenchymal tumors, which commonly occur in bone. This study aimed to investigate the radiological features of tumor-induced osteomalacia lesions in bone, and their correlation with its histopathology.Materials and methods: This study included 13 patients with tumor-induced osteomalacia treated between January 2000 and April 2018 at our hospital. All patients were surveyed to detect the tumor causing the condition. Diagnostic imaging studies of the suspected tumors were obtained before tumor removal. We evaluated the radiological features of all tumors, investigated histopathological findings in 10 cases that underwent surgery, and obtained evaluable tumor specimens.Results: The tumors were classified into the following three types by CT: sclerotic (n = 4), lytic (n = 7), and mixed (n = 2). In two cases, lytic lesions focally invaded the surrounding cancellous bone, detected by the soft tissue-window of CT, not the bone-window. Histopathology revealed inter-trabecular invasion in all cases, regardless of radiological features. Osteoclasts were seen in lytic types, and creeping substitution-like thickened trabecular bone and calcification were observed in sclerotic types. In all cases, focal invasion of the tumor into cortical bone was seen.Conclusions: Tumor-induced osteomalacia lesions in bone showed a wide variety of radiological features, and tended to invade into cancellous and cortical bone. These findings suggest that extended curettage or resection of thinned cortical bone may be necessary. This might improve the cure rate of surgeries for tumor-induced osteomalacia lesions in bones. (C) 2019 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.