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Review
. 2023 Dec;15(12):3342-3352.
doi: 10.1111/os.13901. Epub 2023 Nov 7.

Tumor-induced Osteomalacia: A Case Report and Etiological Analysis with Literature Review

Zhenhao Zhang  1 , Jiaxin Li  1 , Zhicai Zhang  1 , Zengwu Shao  1
Affiliations
Review

Tumor-induced Osteomalacia: A Case Report and Etiological Analysis with Literature Review

Zhenhao Zhang et al. Orthop Surg. 2023 Dec.

Abstract

Background: Tumor-induced osteomalacia (TIO) belongs to a rare disease of the paraneoplastic syndrome. Phosphate uric mesenchymal tumor (PMT) is the most common cause of TIO, while the possibility of other tumors cannot be excluded.

Case presentation: We present a case of a 36-year-old female patient with systemic skeletal abnormalities. The woman complained of low back pain with mild motor dysfunction for 2 years. Laboratory examination showed abnormalities in markers of bone metabolism, parathyroid hormone (PTH), vitamin D and serum phosphorus. Pooled imaging examination indicated extension abnormalities in the skeletal system and a single lesion in the right femoral head. The lesion of the right femoral was imaging with somatostatin receptor-positive, which was highly suggestive of a single neuroendocrine tumor. CT guided right femoral tumorectomy and bone grafting were performed when medical treatment failed. Postoperative pathological diagnosis was phosphate urinary mesenchymal tumor secreting fibroblast growth factor 23 (FGF23), which accorded with pre-operative expectations. The postoperative symptoms were effectively relieved, and indicators returned to normal.

Conclusion: The tumors causing TIO exhibited significant heterogeneity in terms of tissue origin, pathological characteristics and biological behavior, but the unique common characteristic is the secretion of FGF23. With significant progress in diagnosis and treatment, the clinical follow-up of most TIO patients shows a good prognosis, but the prognosis of those with malignant tumors is relatively poor.

Keywords: Etiology; Literature review; Phosphate uric mesenchymal tumor; Treatment; Tumor induced osteomalacia.

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Conflict of interest statement

All the authors declared that they had no conflict of interest in this case report.

Figures

Fig. 1
Fig. 1
The MRI image of the spine showed: the upper thoracic spine Th3 was with a slightly right lateral curvature of the central cervical thoracic spine; multiple thoracic and lumbar vertebrae widely presented a double concave sign; thoracolumbar spine was with multiple compressibility fractures.
Fig. 2
Fig. 2
The SPECT Whole Body Bone Scanning indicated: the skeletal system was presented extensive regions with abnormally active bone metabolism; a single lesion in the right femoral head was with mild active bone metabolism.
Fig. 3
Fig. 3
ECT of parathyroid gland showed multiple imaging regions with low density, but they were not typical methoxyisobutylisonitrile (MIBI) positive lesions.
Fig. 4
Fig. 4
68Ga‐DOTA‐TATE PET indicated: the single lesion of the right femoral was imaging with somatostatin receptor‐positive.
Fig. 5
Fig. 5
The preoperative X‐ray scan and CT scan showed a patchy increase in density below the articular surface of the right femoral head.
Fig. 6
Fig. 6
Pathological staining of tumor tissue removed by surgery was accorded with PMT.
Fig. 7
Fig. 7
Postoperative X‐ray after 3 months did not show any significant abnormalities.
See this image and copyright information in PMC

References

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Supplementary concepts