全髋关节置换术(THA)是骨关节炎的常见治疗方法,也适用于其他疾病,如继发性关节炎由于发育性髋关节发育不良。由于对金属碎片的不良反应,各种THA类型可能会因骨质溶解和炎性假瘤而复杂化。很少,THA与恶性肿瘤有关,但其因果关系尚不清楚。在这个案例报告中,我们描述了一位患有发育性髋关节发育不良的女性患者。她接受了左金属聚乙烯THA,THA髋臼翻修术,左全膝关节置换术.此外,她有血脂异常和眼部毛细血管扩张的病史,贫血,食管裂孔疝,还有胸膜炎.在先前因胸膜炎入院期间检测到与THA相关的肿块(怀疑是假瘤)。她因左下肢肿胀住院,疲劳,还有瘀伤.临床检查显示贫血,血小板减少症,和疑似假瘤的生长。6周内,她出现了口腔粘膜出血,咯血,Melena,对治疗无反应的严重血小板减少症,D-二聚体和C反应蛋白水平升高,剧烈疼痛,骨质溶解增加,和THA周围的骨折。怀疑感染或恶性肿瘤,但两次穿刺活检提示炎性假瘤.由于她的贫血和血小板减少症被认为是由疑似假瘤的炎症过程引起的,她的疑似假瘤和所有THA组件均被手术切除.然而,患者出现严重的肺泡出血和缺氧,术后2周死亡.她的手术和尸检样本的组织病理学分析显示高度恶性的血管肉瘤。尽管已经报道了与THA相关的恶性肿瘤的个别病例,文献中缺乏THA与癌症风险增加之间的明确关联.大多数假瘤是非恶性的。本报告中提出的患者病例说明了THA相关假瘤和罕见血管肉瘤的鉴别诊断面临的挑战。典型的快速肿瘤生长,严重骨质溶解,一般健康状况的恶化表明是恶性疾病。
Total hip arthroplasty (THA) is a common treatment for osteoarthritis and is also performed for other conditions, such as secondary arthritis due to developmental dysplasia of the hip. Various THA types may be complicated by osteolysis and an inflammatory
pseudotumor due to an adverse reaction to metal debris. Rarely, THA has been associated with malignant tumors, but their causality remains unclear. In this case report, we describe a female patient with developmental dysplasia of the hip. She had undergone left metal-on-polyethylene THA, acetabular revision of the THA, and left total knee arthroplasty. In addition, she had a history of dyslipidemia and telangiectasia of the eyes, anemia, hiatal hernia, and pleuritis. A THA-associated mass (suspected to be a
pseudotumor) had been detected during a previous hospital admission due to pleuritis. She was hospitalized due to swelling in her left lower limb, fatigue, and bruises. A clinical examination revealed anemia, thrombocytopenia, and growth of the suspected
pseudotumor. Within 6 weeks, she presented with bleeding of the oral mucosa, hemoptysis, melena, severe thrombocytopenia that did not respond to treatment, elevated D-dimer and C-reactive protein levels, severe pain, increased osteolysis, and fractures around the THA. Infection or malignancy was suspected, but two trocar biopsies suggested an inflammatory
pseudotumor. Since her anemia and thrombocytopenia were considered to have been caused by an inflammatory process within the suspected pseudotumor, her suspected
pseudotumor and all THA components were surgically removed. However, she developed severe alveolar hemorrhaging and hypoxia and died 2 weeks after her surgery. Histopathological analysis of her surgical and autopsy samples revealed highly malignant angiosarcoma. Although individual cases of malignancies associated with THA have been reported, the literature lacks a clear association between THA and increased cancer risk. Most pseudotumors are non-malignant. The patient\'s case presented in this report exemplifies the challenges to the differential diagnosis of a THA-associated pseudotumor and rare angiosarcoma. Atypically rapid tumor growth, severe osteolysis, and deterioration in the general wellbeing suggest a malignant disease.