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. 2025 Apr 2;26(1):324.
doi: 10.1186/s12891-025-08557-4.

Orthopedic surgical treatment of osteomalacia induced by culprit soft tissue tumor in the hip region: a single-center retrospective study

Shuzhong Liu #  1 , Xi Zhou #  1 , Jinyi Xing  1 , Annan Liang  1 , Yong Liu  2 , Weibo Xia  3
Affiliations

Orthopedic surgical treatment of osteomalacia induced by culprit soft tissue tumor in the hip region: a single-center retrospective study

Shuzhong Liu et al. BMC Musculoskelet Disord. .

Abstract

Background: Due to its occult position, complex anatomical structure, and spatial relationships, the causative tumor of Tumor-Induced Osteomalacia (TIO) in the hip region is quite difficult to detect and qualitatively diagnose in clinical practice. In this regard, clinicians often lack sufficient knowledge about such tumors, leading to frequent missed diagnoses, misdiagnoses, and unreasonable treatment.

Objective: This study aimed to investigate the clinical characteristics of TIO patients with culprit soft tissue tumors in the hip region and evaluate the effect of surgical treatment on these individuals to improve clinicians' understanding of the rare phenomenon.

Methods: The clinical data of all patients, from January 2013 to January 2023, who underwent surgical treatment for hip located culprit soft tissue tumors by the subspecialty group on bone and soft tissue tumors at our institution, were retrospectively analysed. Specifically, the clinical characteristics and therapeutic effects were examined and the patients' clinical experience was summarized.

Results: Twenty-two patients, who met the inclusion criteria, were included. All patients experienced varying degrees of bone pain, commonly accompanied by weakness (16/22) and limited mobility (21/22), and 10 patients (45.5%) experienced a significant reduction in body height during the course of the disease. All patients underwent orthopedic surgery in the hip region, as hypophosphatemia occurred in all of them. Pathological diagnosis was confirmed to be consistent with causative tumors of TIO. All patients experienced a gradual increase in serum phosphorus postoperatively during short-term follow-up. The follow-up period was between 1 and 10 years, and the postoperative serum phosphorus levels were monitored at our hospital or other facilities close to the patients.

Conclusions: Oncogenic soft tissue tumors for TIO in the hip region are occult, making clinical misdiagnoses or missed diagnoses highly likely. Therefore, enhancing the clinician's understanding of this rare condition is imperative. Notably, for TIO patient whose culprit tumor can be located, complete surgical resection of the causative tumor is the best treatment option. Furthermore, close postoperative monitoring of serum phosphorus is necessary, and patients should be subjected to long-term follow-up for prompt detection of recurrent conditions.

Keywords: Diagnosis; Hip region; Hypophosphatemia; Phosphaturic mesenchymal tumor; Surgical treatment; Tumor-Induced osteomalacia.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Peking Union Medical College Hospital (approval number S-K1658). This study was conducted in accordance with the principles of the Declaration of Helsinki. All data were anonymized, and the requirement for informed consent was waived by the Institutional Review Board due to the retrospective nature of the study design. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Diagram of time to diagnosis distribution for all patients included in this study
Fig. 2
Fig. 2
Distribution map of fracture sites in 19 patients with fractures/pseudofractures
Fig. 3
Fig. 3
Classification of surgical types unrelated to the causative tumor for TIO during the course of the disease
Fig. 4
Fig. 4
The chart illustration of post-surgery trends in the level of serum phosphorus in all patients involved in this study. Note: “0d” represents “Early morning on the day of surgery”; “1–22” represents Patient serial number; P: Phosphorus
Fig. 5
Fig. 5
Case 1 (A) The 99Tcm-octreo-SPECT showing local bone metabolism was active in left inguinal region. (B) PET/CT revealing the increased expression in the inguinal region. (C) CT revealing the mass, which was highly indicative of the culprit tumor. (D) The mass in the left inguinal region was completely excised. (E) Pathologic histology of tumor specimens was consistent with the diagnosis of phosphaturic mesenchymal tumor. (F) Serum phosphorus levels significantly elevated to the normal range after the operation
Fig. 6
Fig. 6
Case 2 (A) The Dopple ultrasonography showed the soft tissue tumor was in the right hip region. (B) The 99Tcm-octreo-SPECT showing local metabolism was active in right hip region. (C) The first-line 68Ga DOTATE PET/CT scan showed the lesion with high intake. (D) Pathologic histology of tumor specimens confirmed the diagnosis of phosphaturic mesenchymal tumor. (E) Serum phosphorus levels significantly elevated to the normal range after the operation
Fig. 7
Fig. 7
Case 3 (A) MRI of the pelvis revealing the pathogenic tumor. (B) The first-line 68Ga DOTATE PET/CT showed high intake in the left hip region. (C) Serum phosphorus levels significantly elevated to the normal range after the operation
See this image and copyright information in PMC

References

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