青少年骨髓性肉瘤初期以背痛呈現：病例報告

骨髓性肉瘤(myeloid sarcoma)是很少見的疾病，骨髓性肉瘤也叫做顆粒球性肉瘤(granulocytic sarcoma)或綠色瘤(chloroma)，是少見但惡性的骨髓先質細胞增生造成的腫瘤，特別常見於孩童。在本身沒有白血病的患者中，骨髓性肉瘤很少被放入軟組織腫瘤的鑑別診斷中，因此常常造成誤診或延遲診斷。本篇報告一位女性青少年初期以單純的下背痛求診，經藥物及復健保守治療無效，隨後逐漸出現嚴重之神經功能喪失，包含雙下肢肌力喪失，感覺遲鈍，解尿及排便困難；核磁共振檢查發現多發性胸椎及薦椎之脊椎腫瘤，骨髓病理檢查發現急性骨髓性白血病；經由化學治療後腫瘤完全消失，隨後接受復健治療，患者由原來的雙下肢全癱逐漸恢復至可在監督下獨立行走，排便解尿功能也完全恢復。本報告針對兒童背痛的鑑別診斷和骨髓性肉瘤的臨床表現及治療成效，作相關性探討和文獻回顧，以供臨床醫師參考。

關鍵字

骨髓性肉瘤；青少年背痛

並列摘要

Myeloid sarcoma (MS) is a rare disease. MS is a malignant solid tumor resulting from the extramedullary proliferation of myeloblasts or immature myeloid cells. It is often described in association with acute myeloid leukemia (AML). In the absence of overt leukemia, MS is rarely considered in the differential diagnosis of a soft-tissue mass, and the diagnosis of MS is usually delayed or misdiagnosed. We present the case of a female adolescent who initially complained of back pain. Conservative treatment including medication and rehabilitation was given to her, but in vain, and the symptoms gradually progressed to severe neurological function loss, including paraplegia, paresthesia and numbness of bilateral low limbs, dysuria and difficulty in stool passage. Magnetic resonance imaging revealed multiple spinal tumors in the thoracic and sacral spines, and bone marrow pathology revealed acute myeloid leukemia. The spine tumors disappeared after chemotherapy, and early intervention of rehabilitation programs was offered for motor and gait training. The patient's functional performance improved significantly, and she was able to walk independently without an assistive device under supervision.

並列關鍵字

myeloid sarcoma ； adolescent back pain

國際替代計量

青少年骨髓性肉瘤初期以背痛呈現：病例報告

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