Kobayashi Hiroshi, Makise Naohiro, Ushiku Tetsuo, Ito Nobuaki, Koga Minae, Shinoda Yusuke, Tanaka Sakae
Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
Department of Pathology, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
J Orthop Sci. 2019 Sep;24(5):900-905. doi: 10.1016/j.jos.2019.02.005. Epub 2019 Feb 21.
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.
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.
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.
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.
肿瘤诱导的骨软化症是一种罕见的副肿瘤综合征，通常由磷酸尿性间叶肿瘤引起，这些肿瘤常见于骨骼。本研究旨在探讨肿瘤诱导的骨软化症骨病变的放射学特征及其与组织病理学的相关性。
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。对所有患者进行调查以检测导致该病症的肿瘤。在肿瘤切除前获取疑似肿瘤的诊断性影像学检查。我们评估了所有肿瘤的放射学特征，调查了10例接受手术患者的组织病理学结果，并获得了可评估的肿瘤标本。
根据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）。在两例中，溶骨病变通过CT的软组织窗而非骨窗在局部侵犯周围的松质骨。组织病理学显示所有病例均有小梁间侵犯，与放射学特征无关。溶骨型可见破骨细胞，硬化型观察到爬行替代样增厚的小梁骨和钙化。在所有病例中，均可见肿瘤对皮质骨的局部侵犯。
肿瘤诱导的骨软化症骨病变表现出多种多样的放射学特征，并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。这可能提高骨肿瘤诱导的骨软化症病变手术的治愈率。
