Sun Juan, Zhou Xi, Xia Weibo, Wu Huanwen, Liu Shuzhong, Wang Huizhen, Liu Yong
Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Front Surg. 2022 May 25;9:746623. doi: 10.3389/fsurg.2022.746623. eCollection 2022.
A 30-year-old woman presented to our hospital with an 11-year history of gradually enlarging masses around the left knee and 2-year history of progressively worsening bone pain. Tumor-induced osteomalacia (TIO), a rare paraneoplastic syndrome caused by phosphaturic mesenchymal tumors (PMTs) was suspected, but the postoperative pathology of her two operations was both reported as tenosynovial giant cell tumor (TGCT), making its diagnosis confusing. The possibility of hypophosphatemia, insufficient blood supply, innervation of the left lower limbs, as well as the unclear pathology, make it unreasonable to perform tumor-type knee prosthesis replacement directly. Finally, we placed static polymethylmethacrylate (PMMA) spacer at first, then when the concentration of blood phosphorus level rose to the normal range, the pathology was confirmed to be TIO, the blood supply and innervation was satisfying, tumor-type knee prosthesis replacement was performed. She was discharged post operative day 15 after the prothesis implantation without incident. One and a half years after her surgery, the concentration of blood phosphorus was still in the normal range, the symptom of systemic bone pain had improved significantly, the prosthesis was still in a good position and no recurrence was caught.
一名30岁女性因左膝周围肿物逐渐增大11年、骨痛进行性加重2年就诊于我院。怀疑为肿瘤性骨软化症（TIO），这是一种由排磷性间叶肿瘤（PMT）引起的罕见副肿瘤综合征，但她两次手术的术后病理均报告为腱鞘巨细胞瘤（TGCT），这使得诊断变得混乱。低磷血症、左下肢血供不足、神经支配以及病理不明确等情况，使得直接进行肿瘤型膝关节假体置换并不合理。最后，我们首先置入了静态聚甲基丙烯酸甲酯（PMMA）间隔物，随后当血磷水平升至正常范围，病理确诊为TIO，血供和神经支配良好时，进行了肿瘤型膝关节假体置换。假体植入术后第15天她顺利出院。术后一年半，血磷浓度仍在正常范围内，全身骨痛症状明显改善，假体位置良好，未发现复发。
