Tumor-Induced Osteomalacia in a Patient With FGF23-Amplified Lung Adenocarcinoma and FGF23-Deleted SCLC: Case Report

Abstract

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by ectopic fibroblast growth factor-23 (FGF23) production. We report a unique case of a 78-year-old female patient with refractory hypophosphatemia, ultimately diagnosed as TIO, in the context of two metastatic primary lung cancers: adenocarcinoma and SCLC. Molecular analyses of tumor samples highlighted FGF23 amplification in one adenocarcinoma sample and FGF23 deletion in one SCLC sample, suggesting a potential link between tumor FGF23 molecular alterations and elevated serum FGF23 levels. This case underscores the complexity of diagnoses and management of TIO when associated with solid tumors and highlights the need for awareness of this condition to prevent diagnostic delays. Future research should explore the mechanisms linking FGF23 alterations and cancer progression and evaluate targeted therapies for TIO in the context of resistant metastatic cancers.

Keywords: Case report; Fibroblast growth factor-23; Lung adenocarcinoma; Tumor-induced osteomalacia.

Figure 1

Timeline highlighting key diagnostic and treatment milestones, from initial diagnosis to end-of-life care. This figure was created using Inkscape (inkscape.org). CD, cluster of differentiation; CK, cytokeratin; CNS, central nervous system; EBUS, endobronchial ultrasound; Gy, gray; IHC, immunohistochemistry; Ki, Antigen Kiel; PAX, paired-box; PR, progesterone receptor; SBRT, stereotactic body radiotherapy; TTF, thyroid transcription factor.

Supplementary Figure