Ohashi K, Ohnishi T, Ishikawa T, Tani H, Uesugi K, Takagi M
Department of Radiology, St. Marianna University Hospital, Kawasaki City, Kanagawa, Japan.
Skeletal Radiol. 1999 Jan;28(1):46-8. doi: 10.1007/s002560050471.
We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. Patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.
我们报告了一名患有双侧胫骨应力性骨折的患者，该患者随后表现出肿瘤性骨软化症的典型生化特征。传统X线片正常。磁共振成像显示双侧对称的带状低信号病变，垂直于胫骨内侧皮质，且与随后骨扫描中所见的唯一病变相对应。随后检测到上颌窦病变并通过手术切除，症状迅速缓解，低磷血症和低1,25-(OH)₂维生素D₃恢复正常。该病变经病理诊断为血管外皮细胞瘤样肿瘤。肿瘤性骨软化症患者可能会出现如运动员中所见的仅局限于胫骨的应力性骨折。真正诊断的线索在于密切关注血清磷酸盐水平，尤其是对于那些有全身无力症状且没有进行异常体育活动的患者。
