Nontraumatic Ankle Pain with Marked Calf Muscle Atrophy Caused by Hemagiopericytoma

一位45歲男性病人，自從14歲起，因左小腿近外踝上後部的局部疼痛併肌肉萎縮現象，開始到處求醫，歷經骨科、神經外科、傳統中醫治療仍無效，甚至因小腿萎縮及背痛，曾至某醫院以電腦斷層檢查，診斷爲腰椎間盤凸出症而開刀治療，疼痛仍持續。民國80年9月，病人於複健科就診時，針對不尋常部位之疼痛，接受核磁共振檢查，顯示踝關節有一顆約半公分大的塊狀物；住院手術切除，化驗證實爲血管外皮細胞瘤(hemangiopericytoma)。血管外皮細胞瘤是一種源自小靜脈及微血管外皮細胞罕見的腫瘤，最常見於下肢及後腹腔，可能複發，臨術上約有一半會轉移至肺部、骨頭及肝，甚至於波及局部淋巴組織。所以術後，病人接受建議於整形外科追蹤治療，並且持續門診複健，症狀目前逐漸地改善。吾人殷切地建議，當病患於不尋常部位忍受長期疼痛時，應對病人詳細病史詢問，然後配合正確的理學檢查，醫師或病從才不至於被誤導而採取或接受不適當醫療處置；本病例就是鑑別診斷很好的例子。

關鍵字

血管外皮細胞瘤；肌肉萎縮

並列摘要

A 45-year-old man had had frequent clinic visits for left retro-malleolar pain with marked calf muscle atrophy since he was 14 years old. He underwent surgery after a lumbar herniated disc was diagnosed by a computed tomography scan in a local hospital; however, it was not effective at relieving his symptoms. Magnetic resonance imaging was arranged for his left ankle pain at the department of physical medicine and rehabilitation. A 0.5 cm mass was found at his left ankle and surgically removed. The pathology showed that it was a hemangiopericytoma, a rare tumor originating from either capillary or venule epithelia cells. This tumor is often found in lower extremities or retro-peritoneum. The incidence of recurrence is high and metastasis to lung, bone and liver has been reported in about 50% of patients. The patient is now regularly monitored at the Department of Plastic Surgery. The symptoms and signs have improved with continuous physiotherapy at the outpatient unit. Detailed medical history along with comprehensive physical evaluation in patients with long-term pain at unusual locations is highly recommended to keep both physicians and patients from being misled or receiving improper medical treatment.

並列關鍵字

hemagiopericytoma ； muscle atrophy

國際替代計量

Nontraumatic Ankle Pain with Marked Calf Muscle Atrophy Caused by Hemagiopericytoma

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