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A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm

INTRODUCTION: Oncogenic osteomalacia is a rare paraneoplastic syndrome of acquired hypophosphatemic osteomalacia, resulting from a deficit in renal tubular phosphate reabsorption, in which fibroblast growth factor 23 seems to be implicated. CASE REPORT: A 42-year-old male presented with complaints o...

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Autores principales: Shenbaghavalli, T., Harshavardhan, J. K. Giriraj, Menon, P. Gopinath
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Indian Orthopaedic Research Group 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588137/
https://www.ncbi.nlm.nih.gov/pubmed/31245319
http://dx.doi.org/10.13107/jocr.2250-0685.1304
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author Shenbaghavalli, T.
Harshavardhan, J. K. Giriraj
Menon, P. Gopinath
author_facet Shenbaghavalli, T.
Harshavardhan, J. K. Giriraj
Menon, P. Gopinath
author_sort Shenbaghavalli, T.
collection PubMed
description INTRODUCTION: Oncogenic osteomalacia is a rare paraneoplastic syndrome of acquired hypophosphatemic osteomalacia, resulting from a deficit in renal tubular phosphate reabsorption, in which fibroblast growth factor 23 seems to be implicated. CASE REPORT: A 42-year-old male presented with complaints of low back pain for the past 4 years and inability to walk for the past 3 years. Blood investigations showed hypophosphatemia and elevated serum alkaline phosphatase. Radiographs and magnetic resonance imaging revealed features of osteomalacia. DOTONAC PET-computed tomography (CT) showed a lesion in the greater trochanter suggestive of a phosphaturic mesenchymal tumor. CT-guided biopsy of the lesion was done which confirmed the diagnosis. The tumor was resected by intralesional methods (burring and cementation) with correction of hypophosphatemia by oral phosphorus supplementation. Patient clinically improved and was able to walk with support at the time of discharge. CONCLUSION: Phosphaturic tumor was localized to be in the posterior aspect of the right greater trochanter. To find the tumor was a major diagnostic challenge involving various diagnostic modalities. The occurrence of such a condition is rare and it may take even years to correctly diagnose the disease.
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spelling pubmed-65881372019-06-26 A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm Shenbaghavalli, T. Harshavardhan, J. K. Giriraj Menon, P. Gopinath J Orthop Case Rep Case Report INTRODUCTION: Oncogenic osteomalacia is a rare paraneoplastic syndrome of acquired hypophosphatemic osteomalacia, resulting from a deficit in renal tubular phosphate reabsorption, in which fibroblast growth factor 23 seems to be implicated. CASE REPORT: A 42-year-old male presented with complaints of low back pain for the past 4 years and inability to walk for the past 3 years. Blood investigations showed hypophosphatemia and elevated serum alkaline phosphatase. Radiographs and magnetic resonance imaging revealed features of osteomalacia. DOTONAC PET-computed tomography (CT) showed a lesion in the greater trochanter suggestive of a phosphaturic mesenchymal tumor. CT-guided biopsy of the lesion was done which confirmed the diagnosis. The tumor was resected by intralesional methods (burring and cementation) with correction of hypophosphatemia by oral phosphorus supplementation. Patient clinically improved and was able to walk with support at the time of discharge. CONCLUSION: Phosphaturic tumor was localized to be in the posterior aspect of the right greater trochanter. To find the tumor was a major diagnostic challenge involving various diagnostic modalities. The occurrence of such a condition is rare and it may take even years to correctly diagnose the disease. Indian Orthopaedic Research Group 2019 /pmc/articles/PMC6588137/ /pubmed/31245319 http://dx.doi.org/10.13107/jocr.2250-0685.1304 Text en Copyright: © Indian Orthopaedic Research Group http://creativecommons.org/licenses/by-nc/3.0 This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Shenbaghavalli, T.
Harshavardhan, J. K. Giriraj
Menon, P. Gopinath
A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title_full A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title_fullStr A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title_full_unstemmed A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title_short A Rare Case of Phosphaturic Tumor/Oncogenic Osteomalacia - Diagnostic Challenges and Management Algorithm
title_sort rare case of phosphaturic tumor/oncogenic osteomalacia - diagnostic challenges and management algorithm
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6588137/
https://www.ncbi.nlm.nih.gov/pubmed/31245319
http://dx.doi.org/10.13107/jocr.2250-0685.1304
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