Diagnosis and surgical treatment of tumor-induced osteomalacia—a literature review and a case report
Tóm tắt
Tumor-induced osteomalacia (TIO) is a rare condition with fewer than 500 cases reported in the literature although described. Phosphaturic mesenchymal tumor (PMT) is often unrecognized cause of hypophosphatemia. This case report aims to highlight such a rare association which warrants clinical and radiologist attention. A 51-year-old man had pain in his feet 2 years prior to the most recent presentation in our clinic. The patient experienced increasingly severe body aches and pain, which affected the feet, hips, knees, ribs, waist, and shoulders. MRI and CT led to the diagnosis of multiple insufficiency fractures. Laboratory tests showed that inorganic phosphate (IP) levels had decreased to 0.52 mmol/L(0.81–1.45 mmol/L), while alkaline phosphatase (ALP) had increased to 216 U/L(38.0–126.0 U/L). Positron emission tomography computed tomography showed tumor-derived hypophosphate osteomalacia of the right iliac wing; surgical resection was performed. markers of bone metabolism and bone density returned normal postoperative, after 9 months follow-up. The possibility of tumor-induced osteomalacia should be considered if unexplained joint pain, decreased bone mineral density, increased ALP and insufficiency fractures, and no similar family history are found in adult patients. Surgical resection of the tumor is the key to the treatment.
Tài liệu tham khảo
Dadoniene J, Miglinas M, Miltiniene D, Vajauskas D, Seinin D et al (2016) Tumour-induced osteomalacia: a literature review and a case report. World J Surg Oncol 14(1):4. https://doi.org/10.1186/s12957-015-0763-7
Richardson AL, Richardson OK (2019) Phosphaturic mesenchymal tumor: Case report. Radiol Case Rep 14(12):1518–1524. https://doi.org/10.1016/j.radcr.2019.09.027
Mc CR (1947) Osteomalacia with Looser's nodes (Milkman’s syndrome) due to a raised resistance to vitamin D acquired about the age of 15 years. Q J Med 16(1):33–46
Kumar S, Diamond T (2020) Lessons learnt from delayed diagnosis of FGF-23-producing tumour-induced osteomalacia and post-operative hungry bone syndrome. Bone Rep 12:100276. https://doi.org/10.1016/j.bonr.2020.100276
Folpe AL, Fanburg-Smith JC, Billings SD, Bisceglia M, Bertoni F et al (2004) Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol 28(1):1–30. https://doi.org/10.1097/00000478-200401000-00001
Feng J, Jiang Y, Wang O, Li M, Xing X et al (2017) The diagnostic dilemma of tumor induced osteomalacia: a retrospective analysis of 144 cases. Endocr J 64(7):675–683. https://doi.org/10.1507/endocrj.EJ16-0587
Wu N, Zhang Z, Zhou X, Zhao H, Ming Y et al (2020) Mutational landscape and genetic signatures of cell-free DNA in tumour-induced osteomalacia. J Cell Mol Med 24(9):4931–4943. https://doi.org/10.1111/jcmm.14991
Obo T, Koriyama N, Tokito A, Ogiso K, Nishio Y (2020) Neurofibromatosis type 1 associated with hypophosphatemic osteomalacia due to hypersecretion of fibroblast growth factor 23: a case report. J Med Case Rep 14(1):56. https://doi.org/10.1186/s13256-020-02381-1
Tantisattamo E, Ng RC (2011) Dual paraneoplastic syndromes: small cell lung carcinoma-related oncogenic osteomalacia, and syndrome of inappropriate antidiuretic hormone secretion: report of a case and review of the literature. Hawaii Med J 70(7):139–143
Leaf DE, Pereira RC, Bazari H, Juppner H (2013) Oncogenic osteomalacia due to FGF23-expressing colon adenocarcinoma. J Clin Endocrinol Metab 98(3):887–891. https://doi.org/10.1210/jc.2012-3473
Mak MP, da Costa e Silva VT, Martin RM, Lerario AM, Yu L et al (2012) Advanced prostate cancer as a cause of oncogenic osteomalacia: an underdiagnosed condition. Support Care Cancer 20(9):2195–2197. https://doi.org/10.1007/s00520-012-1474-z
Xie Y, Li HZ (2013) Oncogenic osteomalacia caused by renal cell carcinoma. J Clin Endocrinol Metab 98(12):4597–4598. https://doi.org/10.1210/jc.2013-3335
Reyskens M, Sleurs K, Verresen L, Janssen M, van den Bergh J et al (2015) Hypophosphatemic osteomalacia: an unusual clinical presentation of multiple myeloma. Osteoporos Int 26(7):2039–2042. https://doi.org/10.1007/s00198-015-3090-5
Pal R, Agrawal K, Gupta S, Bhansali A, Behera A et al (2020) Worsening of unrecognized tumour-induced osteomalacia with inadvertent use of recombinant human parathyroid hormone. Endokrynol Pol 71(1):102–103. https://doi.org/10.5603/EP.a2019.0045
Singh D, Chopra A, Ravina M, Kongara S, Bhatia E et al (2017) Correction to Oncogenic osteomalacia: role of Ga-68 DOTANOC PET/CT scan in identifying the culprit lesion and its management. Br J Radiol 90(1079):20160811e. https://doi.org/10.1259/bjr.20160811.e
Li B, Dong Y, Liu D, Yao Q, Guo S et al (2020) Left maxillary sinus tumour-induced hypophosphataemic osteomalacia and combined with thyroid papillary carcinoma: a case report and literature review. Intern Med J 50(6):755–761. https://doi.org/10.1111/imj.14864
Zhou Z, Yue H, Xu J, Xu X, Guo Q et al (2018) A case with tumour-induced osteomalacia misdiagnosed as axial spondyloarthritis. Rheumatology (Oxford) 57(12):2242–2243. https://doi.org/10.1093/rheumatology/key255
Bhavani N, Reena Asirvatham A, Kallur K, Menon AS, Pavithran PV et al (2016) Utility of Gallium-68 DOTANOC PET/CT in the localization of Tumour-induced osteomalacia. Clin Endocrinol (Oxf) 84(1):134–140. https://doi.org/10.1111/cen.12822
Minisola S, Peacock M, Fukumoto S, Cipriani C, Pepe J et al (2017) Tumour-induced osteomalacia. Nat Rev Dis Primers 3:17044. https://doi.org/10.1038/nrdp.2017.44
Khosravi A, Cutler CM, Kelly MH, Chang R, Royal RE et al (2007) Determination of the elimination half-life of fibroblast growth factor-23. J Clin Endocrinol Metab 92(6):2374–2377. https://doi.org/10.1210/jc.2006-2865