右桡骨远端骨巨细胞瘤1例误诊分析
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摘要
患者,男,30岁。主诉:右腕部加重疼痛13年余,劳累后疼痛加剧伴局部肿胀和关节活动受限3个月。影像学检查提示良性骨肿瘤。既往体健,无急、慢性疾病史及外伤史。临床表现:右腕部疼痛肿胀和活动受限,右腕关节背侧可触及一囊性物,质软,活动度差。组织病理示:肿瘤组织由圆形、多角形或梭形单核细胞及分布其间的破骨样巨细胞。诊断:右桡骨远端骨巨细胞瘤。5年前因疼痛加剧就诊外院,以"右腕关节软组织损伤"予盐酸氨基葡萄糖片口服治疗8周,未见好转。提示临床医生要加强对本病的鉴别诊断,避免误诊漏诊。
A 30 year old male. Chief complaint: aggravated pain in the right wrist for more than 13 years, aggravated pain after fatigue with local swelling and limited joint movement for 3 months. Imaging examination suggested a benign bone tumor. Previous healthy, no history of acute or chronic disease or trauma. Clinical manifestations: pain, swelling and limited movement of the right wrist. A cystic mass with soft texture and poor mobility can be touched on the dorsal side of the right wrist. Histopathology showed that the tumor tissue was composed of round, polygonal or spindle mononuclear cells and the osteoclast-like giant cells were distributed in it. Diagnosis: right distal radial giant cell tumor. Five years ago,he was admitted to another hospital due to the severe pain. "Right wrist soft tissue injury" was treated with glucosamine hydrochloride tablets orally for 8 weeks, and no improvement was found. It is suggested that the clinician should strengthen the differential diagnosis of the disease and avoid misdiagnosis and missed treatment.
A 30 year old male. Chief complaint: aggravated pain in the right wrist for more than 13 years, aggravated pain after fatigue with local swelling and limited joint movement for 3 months. Imaging examination suggested a benign bone tumor. Previous healthy, no history of acute or chronic disease or trauma. Clinical manifestations: pain, swelling and limited movement of the right wrist. A cystic mass with soft texture and poor mobility can be touched on the dorsal side of the right wrist. Histopathology showed that the tumor tissue was composed of round, polygonal or spindle mononuclear cells and the osteoclast-like giant cells were distributed in it. Diagnosis: right distal radial giant cell tumor. Five years ago,he was admitted to another hospital due to the severe pain. "Right wrist soft tissue injury" was treated with glucosamine hydrochloride tablets orally for 8 weeks, and no improvement was found. It is suggested that the clinician should strengthen the differential diagnosis of the disease and avoid misdiagnosis and missed treatment.
引文
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[13]Chaiyawat P,Pruksakorn D,Pipatwattana P,et al.Endoplasmic reticulum protein 29(ERp29)as a novel prognostic marker and tumor suppressor in osteosarcoma[J].J Bone Oncol,2019,doi:10.1016/j.jbo.2019.100233.
[14]韦凯云,王大健.软骨母细胞瘤的X线、CT及MRI影像学表现分析[J].广西医科大学学报,2018,35(2):261-264.
[15]巫娟,徐钢,陈婷婷.骨良性纤维组织细胞瘤及非骨化性纤维瘤临床病理分析及对比研究[J].四川医学,2018,39(8):865-868.
[16]刘铭.细胞性良性纤维组织细胞瘤临床病理特征[J].吉林医药学院学报,2016,37(3):210-212.
[17]孙柏寒,郑柏,郭开今,等.脊柱骨母细胞瘤的临床研究进展[J].中国矫形外科杂志,2018,26(3):283-241.
[18]Wan Y,Zhao W,Jiang Y,et al.β-catenin is a valuable marker for differential diagnosis of osteoblastoma and osteosarcoma[J].Hum Pathol,2014,45(7):1459-1465.
[19]方三高,马强,杜娟,等.富于巨细胞的骨肉瘤4例临床病理观察[J].现代肿瘤医学,2014,6(17):1423-1426.
[20]贺军,林杨景,向登,等.棕色瘤的鉴别诊断与外科治疗[J].川北医学院学,2015,30(4):462-465.
[21]王慧明,王仁法.棕色瘤误诊一例[J].临床放射学杂志,2015,4(14):668-668.
[2]Marshall DC,Bartolotta RJ,Garcia RA,et al.Giant cell tumor of distal radius after open reduction internal fixation for distal radius fracture[J].J Am Acad Orthop Surg Glob Res Rev,2017,1(7):e043-e043.
[3]李文军,张友乐,陈山林,等.桡骨远端骨巨细胞瘤患者的不同方式腓骨近端移植治疗[J].中国骨与关节杂志,2016,5(1):24-28.
[4]Mozaffarian K,Modjallal M,Vosoughi AR.Treatment of giant cell tumor of distal radius with limited soft tissueinvasion:curettage and cementing versus wide excision[J].J Orthop Sci,2018,23(1):174-179.
[5]郭卫,李建民,沈靖南,等.骨巨细胞瘤临床循证诊疗指南[J].中华骨与关节外科杂志,2018,11(4):41-52.
[6]柯晋,张余,陈玲玲,等.微波消融治疗桡骨远端骨巨细胞瘤的疗效[J].实用医学杂志,2018,34(4):682-684.
[7]张军,汪家雷,李俊,等.非血管化自体腓骨移植重建术治疗桡骨远端骨巨细胞瘤的临床疗效[J].现代肿瘤医学,2018,26(23):115-119.
[8]王涛,郝林,张清,等.自体髂骨移植融合在桡骨远端骨巨细胞瘤手术治疗中的应用[J].中华骨与关节外科杂志,2018,11(7):508-511.
[9]王冬,曾桃英,唐维娇.p63和S-100蛋白在骨巨细胞瘤鉴别诊断中的作用[J].中国医药指南,2013,11(33):437-438.
[10]Dubory A,Missenard G,Domont J,et al.Interest of denosumab for the treatment of giantcells tumors and aneurysmal bone cysts of the spine[J].Spine(Phila Pa 1976),2016,41(11):E654-E660.
[11]贾维维.骨巨细胞瘤影像学表现特点分析[J].临床研究,2018,26(11):135-137.
[12]杨邵敏,由江峰,齐双双,等.USP6基因重排检测在动脉瘤样骨囊肿病理诊断中应用的初步探讨[J].中国微创外科杂志,2018,18(2):151-158.
[13]Chaiyawat P,Pruksakorn D,Pipatwattana P,et al.Endoplasmic reticulum protein 29(ERp29)as a novel prognostic marker and tumor suppressor in osteosarcoma[J].J Bone Oncol,2019,doi:10.1016/j.jbo.2019.100233.
[14]韦凯云,王大健.软骨母细胞瘤的X线、CT及MRI影像学表现分析[J].广西医科大学学报,2018,35(2):261-264.
[15]巫娟,徐钢,陈婷婷.骨良性纤维组织细胞瘤及非骨化性纤维瘤临床病理分析及对比研究[J].四川医学,2018,39(8):865-868.
[16]刘铭.细胞性良性纤维组织细胞瘤临床病理特征[J].吉林医药学院学报,2016,37(3):210-212.
[17]孙柏寒,郑柏,郭开今,等.脊柱骨母细胞瘤的临床研究进展[J].中国矫形外科杂志,2018,26(3):283-241.
[18]Wan Y,Zhao W,Jiang Y,et al.β-catenin is a valuable marker for differential diagnosis of osteoblastoma and osteosarcoma[J].Hum Pathol,2014,45(7):1459-1465.
[19]方三高,马强,杜娟,等.富于巨细胞的骨肉瘤4例临床病理观察[J].现代肿瘤医学,2014,6(17):1423-1426.
[20]贺军,林杨景,向登,等.棕色瘤的鉴别诊断与外科治疗[J].川北医学院学,2015,30(4):462-465.
[21]王慧明,王仁法.棕色瘤误诊一例[J].临床放射学杂志,2015,4(14):668-668.