ABSTRACT
Objective To analyze the clinical characteristics and treatment strategy of phosphaturic mesenchymal tumors in hips.Methods From May 2017 to November 2017,five patients with phosphaturic mesenchymal tumors in hips,who treated in our hospital were retrospectively reviewed.The clinical manifestations,laboratory inspection,radiological examination,pathological examination and treatment were analyzed.Results Two male cases (40％) and 3 female (60％) were included.The overall age was 49～63 years old (average 54.40±5.37 years old).The course was 19～101 months (average 51.20±32.41months).Four cases of tumor were located in femoral head and 1 case was in femur intertrochanteric region.The maximum tumor diameter was 0.76～1.83 cm (average 1.28±0.39 cm).The early clinical manifestations of the patients were mainly non-specific bone pain or fatigue.The symptoms of the hip were not obvious.All patients had been misdiagnosed.After pathological frac-ture of the hip,the patient suffered from hip pain,thigh pain,fatigue,etc.,or limited hip function.The severe patients had a systemic multiple pathologic fractures.The serum phosphorus was lower than normal in preoperative period and recovered to normal level in 3-8 days after surgery.The postoperative ALP decreased significantly than preoperative in 4 patients and 1 case was slightly higher than preoperative.Preoperative 1,25-(OH)2-D3 and PTH were in normal range.99Tcm-octreotide (OCT) scan or 68Ga DOTA-TATE PET/CT can detect the disease.X-ray,CT and MRI can identify the lesions.The lesions of femoral head were basically under the joint surface,with a nodular change.Part of the tumor was infiltrating and close to the cortex.The pathology was mainly manifested as a large number of thin-walled vessels in the bone trabeculae.There were dense spindle cells or astrocytes between the blood vessels and the atypia is not obvious.Three patients were treated with total hip arthroplasty and two with segmental resection and bone graft.After surgical removal of the tumor,the patient's systemic pain or anemic symptoms were gradually relieved and the joint function was restored.Meanwhile,the bone density was increased.Conclusion The clinical features of the phosphaturic mesenchymal tumors in hips were not obvious.Comprehensive diagnosis should be carried out in combination with the clinical manifestations,laboratory examination,radiological examination and pathological examination.Total hip arthroplasty or segmental resection with bone graft can effectively remove the tumor and achieve good prognosis.
ABSTRACT
Objective To investigate the X-ray photographic and magnetic resonance imaging (MRI) features of hip pigmented villonodular synovitis (PVNS). Methods A retrospective analysis was carried out in 19 patients with hip PVNS confirmed by operation and pathological examination.The X-ray plain photography in 10 patients and MRI features in 19 patients (of which 9 received enhanced scan) were analyzed.Results (1)The results of X-ray photography were as follows:Of 10 patients,6 showed swollen joint capsule,2 had higher-density masses around the joint;joint space narrowing was found in all of the 10 patients;except 2 patients,8 showed various degrees of bone erosion in the margin area of the joint,in the intertrochanteric area and around neck ,and showed capsule-like clear focus area with sclerotic margin in the joint surface of the bone;bonespur was found in the edge of the joints of 4 patients,of which 3 were complicated with osteoporosis.(2)The manifestations of MRI features:of 19 patients with hip PVNS,17 were differentiated as the diffused and 2 as the focalized.All of 17 diffused hip PVNS showed different degrees of diffuse hyperplasia of synovium,5 of them had intra-articular effusion,13 showed multiple-diffused nodular synovial changes with low signals of T1WI and T2WI,14 showed different degrees of bony erosion and depression in acetabulum,in the head of the femur and around the neck,which signals were similar to those with synovial hyperplasia.Of the 14 patients,8 foci presented circular low signals,capsule-like clear images under the bony joint surface with medium to low signals of T1WI and T2WI,and diffused swelling close to medullar cavities with sheet-like high signals of T2WI/STIR.The results of contrast-enhanced scanning for 8 of the 14 patients showed enhanced signals in the joint synovium and focus area of joint bones.Two focalized PVNS patients showed single mass on the outer flank of the femoral neck with medium to low T1WI signal and with medium to high T2WI signal,and also presented multiple dot-like and nodule-like foci with low T1WI and T2WI signals.One of the 2 focalized PVNS patients showed arc-shaped bone erosion at the outer margin of the femur.Conclusion MRI features of hip pigmented villonodular synovitis exert specific characteristics,which are valuable for the diagosis of PVNS;X-ray plain photography has indicative value for the diagnosis,but it has limitation.