Wada Keiji, Murata Yasuaki, Kato Yoshiharu
Department of Orthopedic Surgery, Tokyo Women's Medical University, Tokyo, Japan.
Asian Spine J. 2015 Apr;9(2):194-9. doi: 10.4184/asj.2015.9.2.194. Epub 2015 Apr 15.
A retrospective study.
To clarify the features useful for the differential diagnosis of spinal canal tumoral lesions in patients undergoing hemodialysis.
Tumoral lesions in the spinal canal are rarely found in hemodialysis patients. Therefore, the differential diagnosis of tumoral lesions in the spinal canal in hemodialysis patients has been very difficult.
Spinal canal tumors in 17 patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis were investigated. Histopathological analysis was conducted for all specimens obtained during surgery. The tumoral lesions were categorized into 3 groups on the basis of histopathology: spinal cord tumor, amyloidoma, and other. Patient medical history and diagnostic images of each group were reviewed.
Eight of 17 cases were histopathologically diagnosed as spinal cord tumors and were neurinomas, 6 were amyloidomas, and 3 were classified as other. The rate of spinal cord tumors was 47.1% (8 of 17 cases), which revealed the most frequent lesion type. The rate of amyloidomas and other types was 35.3% (6 of 17 cases) and 17.6% (3 of 17cases), respectively. In the amyloidoma group, the mean duration of hemodialysis (24.3 years) was longer than that of spinal cord tumors and other types (9.2 years and 8.6 years, respectively). All spinal cord tumors were intradural extramedullary, whereas all amyloidomas and other types were extradural.
The rate of each tumoral lesion, the duration of hemodialysis, and the tumoral localization are important features for the differential diagnosis of tumoral lesions in the spinal canal in hemodialysis patients.
一项回顾性研究。
阐明有助于对接受血液透析患者椎管肿瘤性病变进行鉴别诊断的特征。
血液透析患者很少发生椎管肿瘤性病变。因此，对血液透析患者椎管肿瘤性病变进行鉴别诊断非常困难。
对17例接受血液透析或持续性非卧床腹膜透析的患者的椎管肿瘤进行了研究。对手术中获取的所有标本进行组织病理学分析。根据组织病理学将肿瘤性病变分为3组：脊髓肿瘤、淀粉样瘤和其他类型。回顾了每组患者的病史和诊断图像。
17例患者中，8例经组织病理学诊断为脊髓肿瘤，均为神经鞘瘤；6例为淀粉样瘤；3例归为其他类型。脊髓肿瘤的发生率为47.1%（17例中的8例），是最常见的病变类型。淀粉样瘤和其他类型的发生率分别为35.3%（17例中的6例）和17.6%（17例中的3例）。在淀粉样瘤组中，血液透析的平均时长（24.3年）长于脊髓肿瘤组和其他类型组（分别为9.2年和8.6年）。所有脊髓肿瘤均为硬膜内髓外肿瘤，而所有淀粉样瘤和其他类型肿瘤均为硬膜外肿瘤。
每种肿瘤性病变的发生率、血液透析时长以及肿瘤定位是血液透析患者椎管肿瘤性病变鉴别诊断的重要特征。
