妊娠期原发性甲状旁腺功能亢进伴多发棕色瘤一例报告并文献复习  

Primary hyperparathyroidism during pregnancy with multiple brown tumors:a case report and literature review

作　　者：叶尔旦·孜牙提 闫飞飞[1] 雷军[1] 蔡林[1] YE Erdan-ziyati;YAN Fei-fei;LEI Jun;CAI Lin(Department of Spine and Bone Tumor,Zhongnan Hospital,Wuhan University,Wuhan,Hubei,430071,China)

机构地区：[1]武汉大学中南医院脊柱与骨肿瘤科,湖北省430071

出　　处：《中国骨与关节杂志》2024年第7期546-551,共6页Chinese Journal of Bone and Joint

摘　　要：目的 报道我院经治的 1 例妊娠期棕色瘤病例并结合复习文献报道的 5 例妊娠期棕色瘤病例分析其临床资料。方法 回顾 1 例妊娠期棕色瘤患者的临床资料,检索中英文数据库,查阅检索到的 5 例文献资料进行综合分析。结果 29 岁孕妇在右下肢骨肿瘤刮除和骨移植手术后 2 个月来我院复查,膝关节 MRI 显示右股骨内侧髁、胫腓骨上段和髌骨内侧有异常高信号。此后 3 天患者终止妊娠,终止妊娠后 2 周出现左前臂病理性骨折。实验室及影像学检查诊断为双侧甲状旁腺腺瘤。行双侧甲状旁腺腺瘤切除术,术后2 个月病理性骨折处清晰可见新的骨痂,随着骨再矿化,多发纤维囊性骨炎逐渐消退。检索到 5 篇 (5 例) 妊娠期棕色瘤病案报道。5 例均行甲状旁腺切除术,术后 4 例症状消失,骨骼再矿化,1 例结果不详。结论 妊娠期棕色瘤极易被误诊为骨巨细胞瘤或恶性骨肿瘤。由于原发性甲状旁腺功能亢进伴棕色瘤可引起四肢多发性溶骨性病变,在研究这些病变时应定期进行血清钙和甲状旁腺激素测定。及时适当的治疗可以降低母亲和胎儿在怀孕期间的风险。Objective To report one case of gestational brown tumor treated in our hospital and analyze its clinical data,along with 5 cases of gestational brown tumor reported in literature review.Methods The clinical data of a patient with gestational brown tumor were reviewed,and the Chinese and English databases were searched.The literature data of 5 cases retrieved were reviewed for comprehensive analysis.Results A 29-year-old pregnant woman came to our hospital for a follow-up examination 2 months after the right lower limb bone tumor resection and bone transplantation.Magnetic resonance imaging of the knee joint showed abnormal high signal in the medial condyle of the right femur,upper tibia and fibula,and medial patella.Three days later,the patient terminated the pregnancy and developed a pathological fracture of the left forearm two weeks after termination.Laboratory and imaging examinations diagnosed bilateral parathyroid adenoma.Bilateral parathyroid adenoma resection was performed,and new bone callus was clearly visible at the pathological fracture site 2 months after the surgery.As the bone remineralized,multiple fibrocystic osteoarthritis gradually subsided.Five cases of gestational brown tumor were retrieved.All 5 cases underwent parathyroidectomy.Symptoms disappeared in 4 cases and bone remineralization occurred,while the results of 1 case were unknown.Conclusions Brown tumors during pregnancy are easily be misdiagnosed as giant cell tumors or malignant bone tumors.Hyperparathyroidism accompanied by brown tumors can cause multiple osteolytic lesions in the limbs,regular serum calcium and parathyroid hormone measurements should be conducted when studying these lesions.Timely and appropriate treatment can reduce the risk during pregnancy for both mother and fetus.

关 键 词：甲状旁腺功能亢进 原发性 妊娠 纤维囊性骨炎 骨疾病 内分泌性 棕色瘤 

分 类 号：R736.2[医药卫生—肿瘤]