Persistent phosphaturic mesenchymal tumor causing tumor-induced osteomalacia treated with image-guided ablation

Phosphaturic mesenchymal tumors (PMTs) can present with vague symptoms of diffuse bone pain with pathologic fractures that often lead to a delayed diagnosis. We present a 60-year-old patient with a PMT that was persistently hypophosphatemic after resection, who was then successfully treated with cry...

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Bibliographic Details
Published in:	Osteoporosis international Vol. 32; no. 9; pp. 1895 - 1898
Main Authors:	Horng, J. C., Van Eperen, E., Tutton, S., Singh, R., Shaker, J. L., Wooldridge, A. N.
Format:	Journal Article
Language:	English
Published:	London Springer London 01-09-2021 Springer Nature B.V
Subjects:	25-Hydroxyvitamin D Ablation Bone tumors Calcitriol Case Report Diagnosis Endocrinology Fibroblast growth factor 23 Fractures Hypophosphatemia Medicine Medicine & Public Health Mesenchyme Orthopedics Osteomalacia Pain Parathyroid hormone Patients Phosphorus Rheumatology Salts Surgery Tumors Tumor-induced osteomalacia Hypophosphatemia Image-guided ablation FGF-23 Phosphaturic mesenchymal tumor
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Summary:	Phosphaturic mesenchymal tumors (PMTs) can present with vague symptoms of diffuse bone pain with pathologic fractures that often lead to a delayed diagnosis. We present a 60-year-old patient with a PMT that was persistently hypophosphatemic after resection, who was then successfully treated with cryoablation of the tumor. Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia characterized by vague symptoms of gradual muscle weakness and diffuse bone pain with pathologic fractures that often lead to a delayed diagnosis. This condition is usually caused by benign phosphaturic mesenchymal tumors (PMTs). Here, we present a case of persistent PMT after surgical resection treated with image-guided ablation. We present the patient’s clinical examinations and laboratory findings (phosphorus, 1,25 (OH) 2 d , FGF-23, Intact PTH). Representative histologic images of a PMT are also presented. A 61-year-old male was evaluated for persistent hypophosphatemia and presumed osteomalacia. Six years earlier, he underwent surgical excision of a left ischial mass after presenting with TIO. The pathology was consistent with a PMT; however, hypophosphatemia persisted suggesting incomplete resection. He was treated with calcitriol and phosphate salts. A PET Ga68 dotatate scan of the patient revealed an avid left ischial mixed lytic and sclerotic lesions with marked amount of radiotracer uptake, suggesting persistent tumor. The patient was resistant to re-excision of the tumor due to the extended recovery period from his prior surgery and was treated instead with cryoablation of the tumor. His biochemical findings of hypophosphatemia and elevated FGF23 resolved after the ablation and have remained normal for 5 months after surgery. In patients with TIO, wide surgical excision is the treatment of choice. When this is not possible, image-guided ablation is an alternative therapeutic option.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	0937-941X 1433-2965
DOI:	10.1007/s00198-020-05795-1