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病史:男55岁,背部疼痛已3年,已知患Paget氏病,曾用光辉毒素(Mithramycin)和Calcitonin治疗,自觉见效。因走路困难,左下肢运动减弱,大小便机能障碍而入院。行小脑延髓池脊髓造影,发现在第2腰椎体上缘有完全性硬膜外梗阻。腰椎有广泛性Paget氏病,在L_2、L_3的附件上有溶骨性破坏。行第2、3腰椎椎板切除术。诊断:畸形性骨炎合并第2、3腰椎巨细胞瘤。首先应与Paget氏病的肉瘤恶变鉴别,此外需与Paget氏病、多发性骨髓瘤甚至不常见感染疾病等引起的骨转移鉴别。讨论:在行L_2和L_3椎板切除术时,发现在L_2和L_3的硬膜外有一肿物,延伸到L_4平面。通过椎板切除将肿物亦一并切除,证实为骨巨细胞瘤和
History: 55 years old male, 3 years back pain, known Paget’s disease, once treated with Mithramycin and Calcitonin, consciously effective. Due to difficulty in walking, the movement of the left lower extremities was weakened, and the urine was disabled and admitted to the hospital. Cerebellomedullary spinal cord angiography revealed complete epidural obstruction at the upper edge of the second lumbar vertebrae. There is extensive Paget’s disease in the lumbar spine and osteolytic destruction on the attachments of L_2 and L_3. The second and third lumbar laminectomy were performed. Diagnosis: Abnormal osteitis combined with 2nd and 3rd lumbar giant cell tumors. First of all, should be identified with the Paget’s disease sarcoma malignant transformation, in addition to Paget’s disease, multiple myeloma and even common infectious diseases such as bone metastasis. Discussion: During laminectomy of L_2 and L_3, a tumor outside the epidural area of L_2 and L_3 was found extending to the L_4 plane. The tumor was also removed by laminectomy and confirmed as giant cell tumor of bone and