Brumariu O, Miron I, Cernahoschi I, Maimescu L, Brădăţan L, Vlad A, Maxim E
Clinica a IV-a Pediatrie, Facultatea de Medicină, Universitatea de Medicină şi Farmacie Gr.T. Popa Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2000 Oct-Dec;104(4):67-9.
Osteoarticular changes may occur in up to 23% of the cases with Acute Lymphoblastic Leukemia (ALL) and even more frequent with Acute Myeloblastic Leukemia (AML). Most of the bone and joint pains are due to neoplastic infiltration, radiologically obvious as metaphyseal clear stripes, parietal enlargement, periosteal reaction, osteolysis and diffuse osteoporosis in the long bone. In Malignant Lymphomas (ML) the bone involvement is rarer, usually bone metastases identifiable with Tc scintigraphy being the cause. In Neuroblastoma (Nbl) cases, bone metastases are commonly associated with abdominal tumor beyond one year of age. Of the total ALL, AML, ML and Nbl cases treated in our Oncology Dept, we selected 43 children with osteoarticular involvement. The sex ratio was 24 boys to 19 girls and the specific malignancy was ALL in 25 cases, AML in 5 cases, ML in 2 cases and Nbl in 10 cases. The following biological parameters were monitored: type of onset, the localization and nature of the bone affectation, differential diagnosis, and the response to therapy. The presence of the osteoarticular involvement has proved to be of no prognostic significance. The spectrum of clinical manifestations varied from mild pain to severe disability, in 7% of the cases being the unique symptoms. The type of lesion did not rise important differential diagnosis issues, excepting the cases with unique osteolytic lesion or diffuse osteoporosis, where the rest of the data and the elevated urine vanilmandelic acid helped to establishing the diagnosis. We conclude that the osteoarticular involvement encountered in different malignancies in children is a major sources of diagnostic problems, but it is not associated with a significant outcome.
高达23%的急性淋巴细胞白血病（ALL）病例可能会出现骨关节改变，在急性髓细胞白血病（AML）中更为常见。大多数骨和关节疼痛是由于肿瘤浸润，在放射学上表现为干骺端透亮条纹、骨壁增大、骨膜反应、骨质溶解和长骨弥漫性骨质疏松。在恶性淋巴瘤（ML）中，骨受累较少见，通常是由Tc闪烁显像可识别的骨转移引起。在神经母细胞瘤（Nbl）病例中，一岁以上儿童骨转移通常与腹部肿瘤相关。在我们肿瘤科室治疗的所有ALL、AML、ML和Nbl病例中，我们挑选出43例有骨关节受累的儿童。男女比例为24名男孩对19名女孩，具体恶性肿瘤类型为ALL 25例、AML 5例、ML 2例和Nbl 10例。监测了以下生物学参数：发病类型、骨受累的部位和性质、鉴别诊断以及对治疗的反应。骨关节受累的存在已被证明没有预后意义。临床表现范围从轻度疼痛到严重残疾，7%的病例中骨关节受累是唯一症状。除了仅有溶骨性病变或弥漫性骨质疏松的病例外，病变类型并未引发重要的鉴别诊断问题，在这些病例中，其他数据及尿香草扁桃酸升高有助于确诊。我们得出结论，儿童不同恶性肿瘤中出现的骨关节受累是诊断问题的主要来源，但与显著的预后无关。
