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A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia

A 46-year-old Asian male with history of atraumatic fracture of femur (requiring the use of a walker), muscle cramps and loosening teeth presents to Endocrine clinic. He had elevated parathyroid hormone, severely low phosphorus, elevated bone-specific ALP, with normal serum and urine calcium. He was...

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Autores principales: Shrivastava, Trilok, Hwang, Jessica L, Munshi, Laishiya, Batra, Kumar Kunnal, Ahuja, Kriti
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900011/
https://www.ncbi.nlm.nih.gov/pubmed/33664928
http://dx.doi.org/10.1016/j.radcr.2021.02.002
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author Shrivastava, Trilok
Hwang, Jessica L
Munshi, Laishiya
Batra, Kumar Kunnal
Ahuja, Kriti
author_facet Shrivastava, Trilok
Hwang, Jessica L
Munshi, Laishiya
Batra, Kumar Kunnal
Ahuja, Kriti
author_sort Shrivastava, Trilok
collection PubMed
description A 46-year-old Asian male with history of atraumatic fracture of femur (requiring the use of a walker), muscle cramps and loosening teeth presents to Endocrine clinic. He had elevated parathyroid hormone, severely low phosphorus, elevated bone-specific ALP, with normal serum and urine calcium. He was found to have elevated FGF 23 levels, but initial functional and anatomic imaging was negative for any localizing tumor. With persistent follow-up and serial imaging, after 3 years, a 2.2 cm right scapular mass was found on MRI. Since it was also visualized on PET/CT, this was suspected to be the cause of his severe hypophosphatemia. He underwent surgical excision and pathology revealed a phosphaturic mesenchymal tumor after excision. Tumor induced osteomalacia is a rare, acquired paraneoplastic syndrome in which a tumor that secretes FGF23 leads to decreased renal phosphate reabsorption, resulting in hypophosphatemia, and bone demineralization. Diagnosis is challenging as common presenting symptoms are nonspecific, but when followed up closely with proper diagnostic modalities, identification & removal of the culprit lesion is usually curative.
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spelling pubmed-79000112021-03-03 A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia Shrivastava, Trilok Hwang, Jessica L Munshi, Laishiya Batra, Kumar Kunnal Ahuja, Kriti Radiol Case Rep Case Report A 46-year-old Asian male with history of atraumatic fracture of femur (requiring the use of a walker), muscle cramps and loosening teeth presents to Endocrine clinic. He had elevated parathyroid hormone, severely low phosphorus, elevated bone-specific ALP, with normal serum and urine calcium. He was found to have elevated FGF 23 levels, but initial functional and anatomic imaging was negative for any localizing tumor. With persistent follow-up and serial imaging, after 3 years, a 2.2 cm right scapular mass was found on MRI. Since it was also visualized on PET/CT, this was suspected to be the cause of his severe hypophosphatemia. He underwent surgical excision and pathology revealed a phosphaturic mesenchymal tumor after excision. Tumor induced osteomalacia is a rare, acquired paraneoplastic syndrome in which a tumor that secretes FGF23 leads to decreased renal phosphate reabsorption, resulting in hypophosphatemia, and bone demineralization. Diagnosis is challenging as common presenting symptoms are nonspecific, but when followed up closely with proper diagnostic modalities, identification & removal of the culprit lesion is usually curative. Elsevier 2021-02-17 /pmc/articles/PMC7900011/ /pubmed/33664928 http://dx.doi.org/10.1016/j.radcr.2021.02.002 Text en Published by Elsevier Inc. on behalf of University of Washington. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Case Report
Shrivastava, Trilok
Hwang, Jessica L
Munshi, Laishiya
Batra, Kumar Kunnal
Ahuja, Kriti
A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title_full A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title_fullStr A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title_full_unstemmed A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title_short A case report of mesenchymal scapular FGF secreting tumor: Importance of follow up in tumor induced osteomalacia
title_sort case report of mesenchymal scapular fgf secreting tumor: importance of follow up in tumor induced osteomalacia
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7900011/
https://www.ncbi.nlm.nih.gov/pubmed/33664928
http://dx.doi.org/10.1016/j.radcr.2021.02.002
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