2024年 · 第104卷第25期

The 16-year-old child went to the outpatient clinic of the People's Liberation Army General Hospital for "right hip pain for more than 1 year". One year before admission, I developed right hip pain during sitting and at night, and the symptoms were partially relieved after taking non-steroidal anti-inflammatory drugs and local hot compress. Since the onset of the disease, the pain in the right hip has gradually worsened and the frequency of the disease has increased. The effect of drug and physical therapy has not been good in the past month. The patient's outpatient hip X-ray revealed a lesion on the anteromedial side of the right femoral neck (Figure 1). CT showed that the lesion was located in the cortex bone, with sclerosis of the surrounding bone, a circular low-density shadow inside, and oval sclerotic bone in the center, showing "bull's eye sign" (Figure 2). MRI 2T lipid pressure imaging also showed high-signal annular liquid area in the lesion and low-signal sclerotic bone in the center (Figure 3). It is likely to consider the diagnosis of osteoid osteoma of the femoral neck. He was admitted to the undergraduate department and underwent arthroscopic surgery to completely remove the lesion, and was diagnosed as osteoid osteoma after pathological examination: the bone-like tissue was irregular in shape, and osteoblasts and capillaries were visible in the interstitium. Osteoid osteoma is a single benign tumor that occurs in children and adolescents. It mainly occurs in the long femoral shaft and long bone metaphysis of the limbs. The incidence ratio of male to female is about 2:1. Pain often occurs in the area where the tumor nest is located, and the typical symptom is nocturnal pain, which can be relieved by oral non-steroidal anti-inflammatory drugs. Osteoid osteoma is mainly diagnosed by CT, and the typical "bull eye sign" manifestation can be seen in the cortex of bone. The treatment is to completely remove the tumor nest and its surrounding hardened bone through surgery. The symptoms, imaging and pathological manifestations of this patient were in line with the characteristics of osteoid osteoma of the femoral neck, and the diagnosis was clear and the postoperative effect was good.

A 34-year-old female went to the outpatient clinic of the People's Liberation Army General Hospital for "a mass found in her hip for more than one month". The patient found a buttock mass 2 months ago, about the size of an "egg". There was no pain in the buttock, the mass was inactive when touched, there was no tenderness, and the left lower limb felt numb. Past physical health, no history of chronic diseases such as hypertension and diabetes. Physical examination: A mass about 10 cm ×8 cm in size can be palpable in the left hip, with positive tenderness and tenderness, and numbness in the left lower limb. MRI showed that there was a cystic space-occupying lesion between the gluteus maximus muscle and the quadratus femoris muscle in the left buttock (near the running area of the sciatic nerve), with a maximum diameter of 3.6 cm and a smooth edge, and a flocculate high signal was directly connected to the subcutaneous area through the gluteus muscle, and the surrounding fascial septum was thickened (Figures 1 and 2). After admission, the patient underwent arthroscopic exploration and clearance of left hip joint. Pathological biopsy showed that the tumor size was 4.5 cm ×2.6 cm, the surface envelope was intact, the section was cystic-solid, gray-white and gray-brown, and the texture was soft. Immunohistochemical staining showed tumor cells: CD34 (-), NF (-), S-100 (+ + +) and CD117 (-), and it was diagnosed as peripheral nerve schwannoma of left hip joint. Peripheral nerve schwannoma of the hip joint is a nerve tissue tumor and differentiates from Schwann cells. The clinical manifestation is a painless slowly growing soft tissue mass. Tapping the mass may exhibit a numbness and electric shock sensation. Usually surgical resection, generally speaking, the prognosis is good, but the envelope of schwannoma is a normal nerve sheath tissue, not a part of the tumor body, so the tumor should be completely removed in the envelope to reduce nerve damage and reduce the probability of surgical complications. This patient was diagnosed with peripheral nerve schwannoma of hip joint by combining MRI and surgical pathological biopsy.