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Wang F, He W, Ma D, Xu W, Xie J, Yuan G. Sphenoid sinus is a rare site for tumor-induced osteomalacia: A case report and literature review. Front Endocrinol (Lausanne) 2023; 14:1116793. [PMID: 37033241 PMCID: PMC10081489 DOI: 10.3389/fendo.2023.1116793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 01/30/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND In this paper, we present a rare case of tumor-induced osteomalacia (TIO) and a literature review of this rare disease. METHODS A case of TIO of the isolated sphenoid sinus was reported. Furthermore, the clinical features of TIO in the sphenoid sinus and other sinonasal sinuses were also reviewed and summarized. RESULTS A 35-year-old man with muscle weakness and lower back pain came to the Department of Neurology. No obvious neurological disease was found; however, magnetic resonance imaging of the extremities accidentally showed a tumor in the axilla. Bone scintigraphy showed suspicious bone metastasis. Hypophosphatemia was neglected. Interestingly, 2-deoxy-2-[fluorine-18]fluoro-d-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) detected a tumor in the axilla and another in the sphenoid sinus, but only the tumor in the sphenoid sinus had somatostatin receptor (SSTR) expression in 68-gallium 1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid octreotate (Ga-68 DOTATATE) PET/CT. The sphenoid sinus tumor was proven to be a phosphaturic mesenchymal tumor (PMT), and the phosphate levels returned to normal after surgery. The literature review showed only 17 cases of TIOs that occurred in the sphenoid sinus, with an average age of 43.3 ± 13.7 years. Only three cases of TIOs in the sphenoid sinus did not invade the nasal cavity or other paranasal sinuses, which could be identified as isolated sphenoid sinus diseases. We compared the clinical features of sphenoid TIOs with those of non-sphenoid sinonasal TIOs, and it was found that the concentration of 1,25-dihydroxy vitamin D in the group with sphenoid TIOs was much higher than that in the group with non-sphenoid sinonasal TIOs. A total of 153 cases of TIOs in the sinonasal sinus were reviewed. The ethmoid sinus was found to be the major site (64.7%), followed by the nasal cavity (50.3%), maxillary sinus (19.0%), frontal sinus (16.4%), and sphenoid sinus (11.8%). There were 66 patients (43.1%) who showed tumors invading more than one sinus. Most of the tumors (69.3%) were diagnosed as PMTs by pathology, followed by hemangiopericytoma (14.3%). Immunostaining was beneficial in the differential diagnosis of these tumors; however, larger sample sizes are needed for better accuracy. CONCLUSION TIO in the sinonasal sinus, especially in the sphenoid sinus, is rare. Moreover, isolated sphenoid sinus disease can be easily misdiagnosed. When the clinical manifestation of osteomalacia is atypical, associating it with sphenoid sinus disease is even more difficult. Thus, TIO in the sphenoid sinus needs further exploration.
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Affiliation(s)
- Fen Wang
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Wentao He
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Delin Ma
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Weijie Xu
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Junhui Xie
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
| | - Gang Yuan
- Department of Endocrinology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Branch of National Clinical Research Center for Metabolic Diseases, Wuhan, China
- *Correspondence: Gang Yuan,
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Ferrari M, Palleschi A, Bartoli F, Polli F, Armiraglio E, Parafioriti A, Croci GA, Tosi D. Management of intrathoracic phosphaturic mesenchymal tumor by nonintubated uniportal video-assisted thoracic surgery in a fragile patient. Cancer Rep (Hoboken) 2021; 5:e1500. [PMID: 34350733 PMCID: PMC9124498 DOI: 10.1002/cnr2.1500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/22/2021] [Accepted: 05/24/2021] [Indexed: 11/24/2022] Open
Abstract
Background Phosphaturic mesenchymal tumors are rare neoplasms, frequently presenting with osteomalacia. These neoplasms usually grow at a slow rate and are associated with unspecific symptoms. Case In this study, we present the case of a 70‐year‐old woman who had been suffering from musculoskeletal pain, hypophosphatemia, and spontaneous fractures. Positron emission tomography with Gallium showed increase uptake in a subpleural lesion. Conclusion The patient underwent surgical excision of the subpleural lesion with a non‐intubated uniportal video‐assisted thoracoscopic surgery approach.
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Affiliation(s)
- Michele Ferrari
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Alessandro Palleschi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Federico Polli
- Department of Anaesthesia, Critical Care and Emergency Medicine, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Elisabetta Armiraglio
- Department of Pathology, ASST-PINI-CTO Centro Specialistico Ortopedico Traumatologico Gaetano Pini, Milan, Italy
| | - Antonina Parafioriti
- Department of Pathology, ASST-PINI-CTO Centro Specialistico Ortopedico Traumatologico Gaetano Pini, Milan, Italy
| | - Giorgio A Croci
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Division of Pathology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Tosi
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.,Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
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3
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Li D, Zhu R, Zhou L, Zhong D. Clinical, histopathologic, subtype, and immunohistochemical analysis of jaw phosphaturic mesenchymal tumors. Medicine (Baltimore) 2020; 99:e19090. [PMID: 32049812 PMCID: PMC7035060 DOI: 10.1097/md.0000000000019090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Jaw phosphaturic mesenchymal tumors (PMTs) are a rare neoplasm with uncertain histogenesis. This study aimed to clarify the clinical and pathological features of jaw PMTs.We reviewed the clinical records of 39 patients diagnosed with PMTs in the jaws, and investigated clinical and morphologic characteristics, histologic subtypes, and immunophenotypes of all cases.Microscopic analyses revealed 2 major histologic tumor subtypes: "phosphaturic mesenchymal tumors of mixed epithelial and connective tissue" (PMTMECT), and "phosphaturic mesenchymal tumors of mixed connective tissue" (PMTMCT). PMTMECTs and PMTMCTs accounted for 29 and 10 cases of PMTs, respectively. Most PMTMECT diagnoses were made predominantly in males aged <45 years, and the incidence was similar in both the mandible and maxilla. In contrast, patients with PMTMCTs are predominantly females aged ≥45 years, and all tumors were in the mandible. Histologically, PMTMECT had lower cellularity and a more elongated and spindled mesenchymal component with less elaborate intrinsic microvasculature than PMTMCT. Immunohistochemically, the epithelia of all PMTMECTs was immunoreactive for AE1/AE3. Other immunohistochemical staining of PMTMECTs revealed positive expression of vimentin, SATB2, ERG, CD99, Bcl-2, CD56, S-100, D2-40, CD68, SMA, and CD34 in either one or both components. Immunohistochemical staining of PMTMCTs was diffusely positive for vimentin and a varied ratio of positivity for SATB2, ERG, CD99, Bcl-2, CD56, S-100, D2-40, CD68, SMA, and CD34, but negative for AE1/AE3. Most patients were cured by complete resection, except 2 patients who had repeated recurrences, one of which also had multiple metastasis.Jaw PMT can be divided into 2 major histological subtypes. PMTMECTs are more common than are PMTMCTs, and can transform into malignant PMTMCTs during the progression. PMTMECTs were more commonly observed in males and the incidence was similar in both the maxilla and mandible. PMTMCTs were almost always observed in the mandible of females. Compared with PMTMCTs, PMTMECTs have an admixture of epithelial components with less prominent vasculature and lower cellularity. There were no statistically significant differences in the expression of immunohistochemical markers except AE1/AE3 between PMTMECTs and PMTMCTs. However, immunohistochemical markers have great significance for differentiating other mesenchymal tumors.
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Affiliation(s)
- Dongmei Li
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,
| | - Ran Zhu
- Department of Pathology, China-Japan Friendship Hospital,
| | - Lian Zhou
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Dingrong Zhong
- Department of Pathology, China-Japan Friendship Hospital,
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Shah R, Lila AR, Jadhav RS, Patil V, Mahajan A, Sonawane S, Thadani P, Dcruz A, Pai P, Bal M, Kane S, Shah N, Bandgar T. Tumor induced osteomalacia in head and neck region: single center experience and systematic review. Endocr Connect 2019; 8:1330-1353. [PMID: 31505461 PMCID: PMC6790902 DOI: 10.1530/ec-19-0341] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023]
Abstract
Tumor-induced osteomalacia in the head and neck region remains a challenging diagnosis to manage. Literature pertaining to management and outcome details remains sparse. We describe two cohorts: cohort 1 included seven patients from a single center in Western India with tumors located in paranasal sinuses (n = 3), intracranial (n = 2) and maxilla (n = 2). The unique features from our series is the management of persistent disease with radiation therapy (n = 2) and peptide receptor radionuclide therapy (PRRT) (n = 1). Cohort two has 163 patients identified from 109 publications for systematic review. Paranasal sinuses, mandible, intracranial disease, maxilla and oral cavity, in descending order, are reportedly common tumor sites. Within this cohort, mean age was 46 ± 14 years at presentation with 44.1% having local symptoms. Duration of symptoms varied from 1 to 240 months. Pre-surgery mean serum phosphorus was 1.4 ± 0.4 mg/dL and median FGF-23 levels were 3.6 (IQR:1.8-6.8) times of normal upper limit of normal. Majority (97.5%) were managed primarily with surgical excision; however, primary radiotherapy (n = 2) and surgery combined with radiotherapy (n = 2) were also reported. Twenty patients had persistent disease while nine patients had recurrence, more commonly noted with intracranial and oral cavity tumors. Surgery was the most common second mode of treatment employed succeeded by radiotherapy. Four patients had metastatic disease. The most common histopathological diagnosis reported is PMT mixed connective tissue, while the newer terminology 'PMT mixed epithelial and connective tissue type' has been described in 15 patients.
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Affiliation(s)
- Ravikumar Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Anurag R Lila
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
- Correspondence should be addressed to A R Lila:
| | - Ramteke-Swati Jadhav
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Virendra Patil
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Abhishek Mahajan
- Department of Radiodiagnosis and Imaging, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sushil Sonawane
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Puja Thadani
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Anil Dcruz
- Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Prathamesh Pai
- Department of Head Neck Surgery, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Munita Bal
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Subhada Kane
- Department of Pathology, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nalini Shah
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
| | - Tushar Bandgar
- Department of Endocrinology, Seth GS Medical College & KEM Hospital, Parel, Mumbai, India
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Tang D, Wang XM, Zhang YS, Mi XX. Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the femur: A case report. World J Clin Cases 2019; 7:2081-2086. [PMID: 31423441 PMCID: PMC6695531 DOI: 10.12998/wjcc.v7.i15.2081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 06/04/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Oncogenic osteomalacia caused by phosphaturic mesenchymal tumors is very difficult to detect. We report a case of tumor-induced osteomalacia caused by a phosphaturic mesenchymal tumor of the left femur in a middle-aged woman after medical imaging and biopsy.
CASE SUMMARY A 57-year-old woman presented with progressive bone pain for five years. She was diagnosed with hypophosphatemic osteomalacia, as her laboratory data showed low serum phosphorus and low serum calcium. Her knee joint radiography revealed an osteolytic lesion of the left femur. A computed tomography scan showed mixed density shadows in the left femur. Magnetic resonance imaging of the left femur showed the presence of an oval area with a hypointense signal in T1-weighted magnetic resonance imaging (MRI) and high-low mixed signal in T2-weighted MRI. Biopsy samples revealed the presence of short spindle cells, vascularization, and characteristics of phosphaturic mesenchymal tumors. Tumor resection was performed, and the clinical presentations and laboratory abnormalities were reversed.
CONCLUSION Diagnosis of oncogenic osteomalacia is difficult due to the varieties and localization of source tumors and absence of pathognomonic biomedical signs. Our case highlights the importance of a combination of medical imaging and biopsy in the diagnosis of oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor.
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Affiliation(s)
- Dong Tang
- Department of Medical Imaging (Radiology), The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Xiao-Man Wang
- Department of Ultrasound, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
| | - Yong-Sheng Zhang
- Department of Radiology, Hangzhou Hospital of Traditional Medicine, Hangzhou 310015, Zhejiang Province, China
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310015, Zhejiang Province, China
| | - Xiao-Xiao Mi
- Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, Hangzhou 310015, Zhejiang Province, China
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Wu H, Bui MM, Zhou L, Li D, Zhang H, Zhong D. Phosphaturic mesenchymal tumor with an admixture of epithelial and mesenchymal elements in the jaws: clinicopathological and immunohistochemical analysis of 22 cases with literature review. Mod Pathol 2019; 32:189-204. [PMID: 30206408 DOI: 10.1038/s41379-018-0100-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 01/01/2023]
Abstract
Information on the heterogeneity of phosphaturic mesenchymal tumor, a rare entity associated with tumor-induced osteomalacia, is limited. In this retrospective analysis of 222 phosphaturic mesenchymal tumors, 22 cases exhibited mixed mesenchymal and epithelial elements, which we propose to term "phosphaturic mesenchymal tumor, mixed epithelial, and connective tissue type." Phosphaturic mesenchymal tumor of the mixed epithelial and connective tissue type showed a distinctive and significant male predominance (male:female = 2.67:1), with most patients diagnosed at <40 years old. Moreover, all tumors were mainly located in the alveolar bone with focal invasion into surrounding soft tissue and oral mucosa, which could be detected preoperatively by oral examination. The mesenchymal component, composed of spindled cells resembling fibroblasts or myofibroblasts arranged in a storiform or fascicular pattern, exhibited a less prominent vasculature and lower cellularity than the typical phosphaturic mesenchymal tumor (mixed connective tissue type). The epithelial component was typically haphazardly and diffusely distributed throughout the tumor, forming small, irregular nests resembling odontogenic epithelial nests. All cases were immunoreactive for fibroblast growth factor-23, somatostatin receptor 2A, and NSE in both components. Mostly also demonstrated positive staining for CD99 (21/22, 96%), CD56 (16/22, 73%), Bcl-2 (21/22, 96%), and D2-40 (19/22, 86%) in one or both components. S100 was positive in both components in one of seven cases. Interestingly, immunoreactivity was typically stronger and more diffuse in the epithelial than in the paired mesenchymal components. The mesenchymal component was also diffusely positive for CD68 (17/17, 100%) and showed variable focal staining for SMA (15/22, 68%) and CD34 (9/19, 47 %). These results indicate that phosphaturic mesenchymal tumor of the mixed epithelial and connective tissue type has distinctive clinicopathological characteristics and a polyimmunophenotypic profile.
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Affiliation(s)
- Huanwen Wu
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Marilyn M Bui
- Department of Anatomic Pathology, H Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Lian Zhou
- Department of Stomatology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Dongmei Li
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Hui Zhang
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Dingrong Zhong
- Department of Pathology, Molecular Pathology Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
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Xiao X, Sun X, Ni P, Huang Y, Xie T. Phosphaturic mesenchymal tumor and related wound problem. Medicine (Baltimore) 2018; 97:e12507. [PMID: 30290606 PMCID: PMC6200523 DOI: 10.1097/md.0000000000012507] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/29/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Phosphaturic mesenchymal tumor mixed connective tissue type (PMT/MCT) is the most common type (up to 90%) of phosphaturic mesenchymal tumor (PMT), a rare clinicopathologic entity. Besides overproduction of fibroblast growth factor 23 (FGF23), there is a big variation of immunohistochemical characteristic across types of PMT, which makes it difficult to obtain an early diagnosis of PMT/MCT. As a benign tumor, PMT/MCT usually happens in subcutaneous tissues and leads to nonhealing of wound. A complete excision of PMT/MCT facilitates wound healing. CONCLUSIONS Review of the existing evidence indicates that early diagnosis of PMT/MCT is critically important when treating PMT/MCT wound. Hence standardization of early diagnosis for PMT/MCT is mandated.
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Affiliation(s)
- Xian Xiao
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Xiaofang Sun
- Department of Dermatology, The Second Hospital Affiliated to Jiaxing University, Jiaxing, Zhejiang, China
| | - Pengwen Ni
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Yao Huang
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Ting Xie
- Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai
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Villepelet A, Casiraghi O, Temam S, Moya-Plana A. Ethmoid tumor and oncogenic osteomalacia: Case report and review of the literature. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 135:365-369. [PMID: 30026073 DOI: 10.1016/j.anorl.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Oncogenic osteomalacia is a very rare disease usually caused by a phosphaturic mesenchymal tumor, particularly the "mixed connective tissue type", secreting FGF-23 hormone. OBJECTIVE The authors report a case of ethmoid tumor associated with oncogenic osteomalacia and discuss management based on a review of the literature. CASE SUMMARY A 41-year-old woman with multiple fractures causing major disability was diagnosed with early-onset osteoporosis. CT scan followed by MRI, performed due to the concomitant presence of nasal obstruction, showed a right ethmoid tumor in contact with the dura mater and periorbital tissues, but with no signs of invasion. Endoscopic resection was performed with reconstruction of the defect of the cribriform plate by a nasoseptal flap. Nasal and bone symptoms subsequently resolved. Histological examination revealed a phosphaturic mesenchymal tumor. DISCUSSION Twelve cases of mesenchymal tumor of the ethmoid sinus associated with oncogenic osteomalacia have been reported to date. FGF-23 assay and whole-body MRI with STIR sequence are useful for the diagnosis. A very favorable outcome is observed after surgical treatment in the majority of cases.
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Affiliation(s)
- A Villepelet
- Service d'ORL et de chirurgie cervicofaciale, hôpital Tenon, Université Paris Sorbonne, Paris, Assistance Publique-Hôpitaux de Paris, 4, rue de la Chine, 75020 Paris, France.
| | - O Casiraghi
- Département d'anatomopathologie, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - S Temam
- Département de cancérologie cervicofaciale, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - A Moya-Plana
- Département de cancérologie cervicofaciale, Gustave Roussy Cancer Campus, Université Paris-Saclay, 114, rue Edouard-Vaillant, 94800 Villejuif, France
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Qari H, Hamao-Sakamoto A, Fuselier C, Cheng YSL, Kessler H, Wright J. Phosphaturic Mesenchymal Tumor: 2 New Oral Cases and Review of 53 Cases in the Head and Neck. Head Neck Pathol 2016; 10:192-200. [PMID: 26577211 PMCID: PMC4838976 DOI: 10.1007/s12105-015-0668-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/04/2015] [Indexed: 01/03/2023]
Abstract
Phosphaturic mesenchymal tumor (PMT) is a rare neoplasm that secretes fibroblast growth factor-23 (FGF-23) and causes oncogenic osteomalacia. It occurs in adults with equal gender distribution and the most common location is the lower extremities, followed by the head and neck. Besides osteomalacia, the clinical presentation includes bone pain and multiple bone fractures. Microscopic features consist of spindle cells, multinucleated giant cells, and calcifications embedded in a chondromyxoid matrix. Laboratory findings indicate normal calcium and parathyroid levels, hypophosphatemia, and increased levels of FGF-23 that usually revert to normal after surgical removal. Due to its rarity, the purpose of the study was to report 2 new oral cases of PMT and to review the literature in the head and neck. The first case occurred in the gingiva and had been present for 6 years. The second case was a recurrence of a previously diagnosed PMT in the right mandible that metastasized to the lung and soft tissue. The literature review included 53 cases in the head and neck. There was a predilection for extra-oral sites (76%) compared to intra-oral sites (24%) with paranasal sinuses considered the most common location (38%) followed by the mandible (15%). There were 9 recurrences that included 3 malignant cases indicating a potentially aggressive tumor. Due to the indeterminate biological behavior of PMT and its rarity, a comprehensive evaluation of medical, laboratory, radiographic, and histological findings are crucial for a definitive diagnosis and treatment.
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Affiliation(s)
- Hiba Qari
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA.
| | - Aya Hamao-Sakamoto
- Oral and Maxillofacial Surgery Division, Department of Surgery, UT Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9109, USA
| | | | - Yi-Shing Lisa Cheng
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
| | - Harvey Kessler
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
| | - John Wright
- Department of Diagnostic Sciences, Texas A&M University Baylor College of Dentistry, 3302 Gaston Avenue Room # 214, Dallas, TX, 75246, USA
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Ellis MB, Gridley D, Lal S, Nair GR, Feiz-Erfan I. Phosphaturic mesenchymal tumor of the brain without tumor-induced osteomalacia in an 8-year-old girl: case report. J Neurosurg Pediatr 2016; 17:573-7. [PMID: 26722864 DOI: 10.3171/2015.9.peds14617] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Phosphaturic mesenchymal tumor (mixed connective tissue variant) (PMT-MCT) are tumors that may cause tumor-induced osteomalacia and rarely appear intracranially. The authors describe the case of an 8-year-old girl who was found to have PMT-MCT with involvement of the cerebellar hemisphere and a small tumor pedicle breaching the dura mater and involving the skull. This was removed surgically in gross-total fashion without further complication. Histologically the tumor was confirmed to be a PMT-MCT. There was no evidence of tumor-induced osteomalacia. At the 42-month follow-up, the patient is doing well, has no abnormalities, and is free of recurrence. PMT-MCTs are rare tumors that may involve the brain parenchyma. A gross-total resection may be effective to cure these lesions.
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Affiliation(s)
| | | | | | - Geetha R Nair
- Pathology, The University of Arizona College of Medicine-Phoenix, Maricopa Medical Center, Phoenix, Arizona
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Jain AS, Shelley S, Muthukrishnan I, Kalal S, Amalachandran J, Chandran S. Diagnostic importance of contrast enhanced (18)F-fluorodeoxyglucose positron emission computed tomography in patients with tumor induced osteomalacia: Our experience. Indian J Nucl Med 2016; 31:14-9. [PMID: 26917888 PMCID: PMC4746834 DOI: 10.4103/0972-3919.172344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims and Objectives: To assess the diagnostic utility of contrast-enhanced 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-ceCT) in localization of tumors in patients with clinical diagnosis of tumor-induced osteomalacia (TIO), in correlation with histopathological results. Materials and Methods: Eight patients (five male and three female) aged 24–60 (mean 42) years with a clinical diagnosis of TIO were included in this prospective study. They underwent whole body (head to toe) FDG PET-ceCT following a standard protocol on Philips GEMINI TF PET-CT scanner. The FDG PET-ceCT results were correlated with postoperative histology findings and clinical follow-up. Results: All the patients had an abnormal PET-ceCT study. The sensitivity of PET-ceCT was 87.5%, and positive predictive value was 100%. The tumor was located in the craniofacial region in 6/8 patients and in bone in 2/8 patients. Hemangiopericytoma was the most common reported histology. All patients underwent surgery, following which they demonstrated clinical improvement. However, one patient with atypical findings on histology did not show any clinical improvement, hence, underwent 68Gallium-DOTANOC PET-ceCT scan for relocalization of the site of the tumor. Conclusion: The tumors causing TIO are small in size and usually located in obscure sites in the body. Hence, head to toe protocol should be followed for FDG PET-ceCT scans with the inclusion of upper limbs. Once the tumor is localized, regional magnetic resonance imaging can be performed for better characterization of soft tissue lesion. Imaging with FDG PET-ceCT plays an important role in detecting the site of the tumor and thereby facilitating timely management.
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Affiliation(s)
- Avani S Jain
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | - Simon Shelley
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Shilpa Kalal
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
| | | | - Sureshkumar Chandran
- Department of Nuclear Medicine and PET-CT, Apollo Hospitals, Chennai, Tamil Nadu, India
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Arnaoutakis D, Naseri I. Sinonasal Phosphaturic Mesenchymal Tumor: A Rare and Misinterpreted Entity. J Neurol Surg Rep 2015; 76:e233-8. [PMID: 26623233 PMCID: PMC4648724 DOI: 10.1055/s-0035-1562852] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/28/2015] [Indexed: 01/10/2023] Open
Abstract
Objectives Oncogenic osteomalacia is a paraneoplastic syndrome in which the tumor secretes a peptide-like hormone, fibroblast growth factor, resulting in urinary loss of phosphates. Methods We present the case of a 50-year-old woman with a benign phosphaturic mesenchymal tumor (PMT) involving the ethmoid sinus with obstruction of the ostiomeatal complex causing unilateral nasal airway obstruction. Results The tumor was initially thought to be an esthesioneuroblastoma based on primary pathology interpretation and on clinical and radiographic appearance. However, a benign PMT was later confirmed by further testing. Conclusion The tumor was removed entirely by the endoscopic transnasal approach, leading to a full resolution of symptoms.
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Affiliation(s)
- Demetri Arnaoutakis
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Iman Naseri
- Department of Otolaryngology-Head and Neck Surgery, University of Florida College of Medicine, Jacksonville, Florida, United States
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13
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Deep NL, Cain RB, McCullough AE, Hoxworth JM, Lal D. Sinonasal phosphaturic mesenchymal tumor: Case report and systematic review. ALLERGY & RHINOLOGY 2015; 5:162-7. [PMID: 25565053 PMCID: PMC4275463 DOI: 10.2500/ar.2014.5.0100] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We report a case of sinonasal phosphaturic mesenchymal tumor (PMT) and conduct a systematic review of the literature to highlight a unique paraneoplastic syndrome associated with PMT. We used English language publications from Medline and Cochrane databases (1970-2013) as data sources. A systematic review of the literature was conducted. All reported cases of head and neck PMTs were included. The presence or absence of the associated paraneoplastic syndrome was noted. We found 33 cases of PMT in the head and neck reported in the literature, 17 of which occurred in the sinonasal area. Approximately 5% of all PMTs are located in the head and neck. Just greater than half are concentrated in the sinonasal area, and the remaining involve various bony and soft tissue structures of the head and neck. PMT is sometimes associated with a paraneoplastic syndrome of tumor-induced (oncogenic) osteomalacia (TIO) causing bone pain, muscle weakness, and pathologic fractures. We present the 18th reported case of sinonasal PMT. A smooth mucosa-covered midline intraseptal mass filling the posterior nasal cavity with destruction and erosion of the skull base was found in an adult male. The patient underwent successful endoscopic resection with wide negative margins and is without recurrence at 24-month follow-up. PMT is a benign, locally aggressive tumor with rare malignant transformation. Knowledge of the bony invasion and destruction caused by this tumor is essential in planning surgical resection with wide negative margins. Familiarity with the associated TIO is essential to investigate for and manage any associated bony morbidity.
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Affiliation(s)
- Nicholas L Deep
- Department of Otorhinolaryngology, Mayo Clinic, Phoenix, Arizona, USA
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14
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Honda R, Kawabata Y, Ito S, Kikuchi F. Phosphaturic mesenchymal tumor, mixed connective tissue type, non-phosphaturic variant: Report of a case and review of 32 cases from the Japanese published work. J Dermatol 2014; 41:845-9. [DOI: 10.1111/1346-8138.12602] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/18/2014] [Indexed: 12/01/2022]
Affiliation(s)
- Rie Honda
- Divisions of Dermatology; Hitachi General Hospital; Ibaraki Japan
| | - Yuka Kawabata
- Divisions of Dermatology; Hitachi General Hospital; Ibaraki Japan
| | - Shusaku Ito
- Divisions of Dermatology; Hitachi General Hospital; Ibaraki Japan
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15
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Abstract
Phosphaturic mesenchymal tumors (PMTs) are rare and found to be commonly associated with phosphaturia and oncogenic osteomalacia. They commonly affect middle-aged adults and are located mostly in the extremities. Most of them are benign with only a few metastatic cases described in the literature. PMT-mixed connective tissue (PMTMCT) type is the most common PMT. Though most cases of PMTMCT have been associated with oncogenic osteomalacia and phosphaturia, there have been many reports of nonphosphaturic variants of this tumor with no clinical or laboratory evidence of tumor-induced osteomalacia. However, most of these nonphosphaturic variants previously described were not metastatic. We describe an unusual case of PMTMCT with widespread osseous metastases and without evidence of tumor-induced osteomalacia or phosphaturia.
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16
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Uno T, Kawai K, Kunii N, Fukumoto S, Shibahara J, Motoi T, Saito N. Osteomalacia caused by skull base tumors: report of 2 cases. Neurosurgery 2013; 69:E239-44; discussion E244. [PMID: 21796068 DOI: 10.1227/neu.0b013e31821867f7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Tumor-induced osteomalacia (TIO) is an uncommon paraneoplastic syndrome rarely encountered in neurosurgical practice. We report on 2 cases of TIO caused by skull base tumors. Although the diagnosis of TIO is difficult to make and often is delayed because of the insidious nature of the symptoms, mostly systemic pain and weakness, it is curable once it is diagnosed and properly treated. CLINICAL PRESENTATION Both patients presented with severe pain developing in the lower extremities and moving out to the entire body, as well as difficulty moving. They were diagnosed with TIO several years after onset. A high level of serum FGF23 was confirmed, and whole-body imaging studies demonstrated tumors in the middle and anterior cranial base, respectively. The patient with the anterior cranial base tumor had a history of hemorrhage into the frontal lobe and partial resection. En bloc resection of tumor with surrounding skull bone was performed. The histological diagnosis for both cases was phosphaturic mesenchymal tumor, mixed connective tissue variant. CONCLUSION The level of FGF23 normalized immediately after surgery. Both patients experienced a dramatic relief of pain and recovery of muscle power. Although reports of osteomalacia caused by tumors in the neurosurgical field are extremely rare in the literature, its true incidence is unknown. We emphasize the importance of recognition of this syndrome and recommend total resection of tumors when possible.
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Affiliation(s)
- Takeshi Uno
- Department of Neurosurgery, The University of Tokyo Hospital, Tokyo, Japan.
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17
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Luo L, Low N, Vandervord J. Mandibular phosphaturic mesenchymal tumor-mixed connective tissue variant in a young girl. Cleft Palate Craniofac J 2013; 50:751-3. [PMID: 23394315 DOI: 10.1597/12-085] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Phosphaturic mesenchymal tumor-mixed connective tissue variant (PMTMCT) is an extremely rare tumor associated with tumor-induced osteomalacia. The majority occur in middle age and arise from the extremities. This report describes a young girl with PMTMCT arising in the mandible and with no evidence of paraneoplastic syndrome.
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18
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Dahodwala MQ, Husain Q, Kanumuri VV, Choudhry OJ, Liu JK, Eloy JA. Management of sinonasal hemangiopericytomas: a systematic review. Int Forum Allergy Rhinol 2013; 3:581-7. [PMID: 23389865 DOI: 10.1002/alr.21139] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 08/17/2012] [Accepted: 11/17/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hemangiopericytomas are typically found in soft-tissue, but only rarely found in the sinonasal tract. Sinonasal hemangiopericytomas have been reported mostly through case studies, and optimal treatment is considered surgical excision. Classically, open surgical methods of tumor extirpation have been considered standard of care. With the wider use of endoscopic methods, an updated systematic review in terms of treatment is warranted. METHODS Cases were identified using a MEDLINE and PubMed search. Relevant studies were identified, and data was extracted regarding patient demographics, presenting symptoms, tumor characteristics, treatment, and outcomes. RESULTS A total of 128 cases were collected from 56 articles, consisting of case reports and series. The most common presenting symptoms were epistaxis, nasal obstruction, and facial pain/swelling/pressure. Computed tomography (CT) and X-ray were the most common modes of imaging during diagnosis and operative planning. The tumor often occupied multiple locations in the sinonasal tract at initial presentation. Surgical resection was the mainstay of treatment in 126 of the 128 cases (98.4%), either through open resection or endoscopic techniques. Surgical removal resulted in no recurrence in 79.7% of the cases. The use of endoscopic techniques increased significantly in the past decade. This review found no significant difference in terms of recurrence between endoscopic and open treatment groups, age, gender, and unilocality vs multilocality of tumor. CONCLUSION Surgical management remains the mainstay of treatment for hemangiopericytomas. Endoscopic resection of these lesions has increased over the last few decades and has become a safe, viable, and reasonable alternative to open resection.
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Affiliation(s)
- Mufaddal Q Dahodwala
- Department of Otolaryngology-Head and Neck Surgery, University of Medicine and Dentistry of New Jersey-New Jersey Medical School, Newark, NJ 07103, USA
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19
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Jiang Y, Xia WB, Xing XP, Silva BC, Li M, Wang O, Zhang HB, Li F, Jing HL, Zhong DR, Jin J, Gao P, Zhou L, Qi F, Yu W, Bilezikian JP, Meng XW. Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: Report of 39 cases and review of the literature. J Bone Miner Res 2012; 27:1967-75. [PMID: 22532501 DOI: 10.1002/jbmr.1642] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Tumor-induced osteomalacia (TIO) is an acquired form of hypophosphatemia. Tumor resection leads to cure. We investigated the clinical characteristics of TIO, diagnostic methods, and course after tumor resection in Beijing, China, and compared them with 269 previous published reports of TIO. A total of 94 patients with adult-onset hypophosphatemic osteomalacia were seen over a 6-year period (January, 2004 to May, 2010) in Peking Union Medical College Hospital. After physical examination (PE), all patients underwent technetium-99m octreotide scintigraphy ((99) Tc(m) -OCT). Tumors were removed after localization. The results demonstrated that 46 of 94 hypophosphatemic osteomalacia patients had high uptake in (99) Tc(m) -OCT imaging. Forty of them underwent tumor resection with the TIO diagnosis established in 37 patients. In 2 patients, the tumor was discovered on PE but not by (99) Tc(m) -OCT. The gender distribution was equal (M/F = 19/20). Average age was 42 ± 14 years. In 35 patients (90%), the serum phosphorus concentration returned to normal in 5.5 ± 3.0 days after tumor resection. Most of the tumors (85%) were classified as phosphaturic mesenchymal tumor (PMT) or mixed connective tissue variant (PMTMCT). Recurrence of disease was suggested in 3 patients (9%). When combined with the 269 cases reported in the literature, the mean age and sex distribution were similar. The tumors were of bone (40%) and soft tissue (55%) origins, with 42% of the tumors being found in the lower extremities. In summary, TIO is an important cause of adult-onset hypophosphatemia in China. (99) Tc(m) -OCT imaging successfully localized the tumor in the overwhelming majority of patients. Successful removal of tumors leads to cure in most cases, but recurrence should be sought by long-term follow-up.
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Affiliation(s)
- Yan Jiang
- Department of Endocrinology, Key Laboratory of Chinese Health Ministry, Peking Union Medical College Hospital, Academy of Medical Science, Shuaifuyuan 1, Dong Cheng, Beijing, China
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20
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Suryawanshi P, Agarwal M, Dhake R, Desai S, Rekhi B, Reddy KB, Jambhekar NA. Phosphaturic mesenchymal tumor with chondromyxoid fibroma-like feature: an unusual morphological appearance. Skeletal Radiol 2011; 40:1481-5. [PMID: 21533894 DOI: 10.1007/s00256-011-1159-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 03/15/2011] [Accepted: 03/17/2011] [Indexed: 02/02/2023]
Abstract
Phosphaturic mesenchymal tumor (PMT) is a rare and distinctive tumor almost always associated with oncogenic osteomalacia. This tumor is often misdiagnosed due to its widely varied histomorphological spectrum. More recently the term PMT or its variants has been used whatever the histomorphological features. Herein, we present a case of a 32-year-old woman who presented with a 2-year history of oncogenic osteomalacia. The clinical examination failed to detect any tumor. The F-18 FDG PET scan and subsequent MRI revealed a tumor in the soft tissues of the right popliteal fossa. The histological features resembled a chondromyxoid fibroma (CMF), a feature documented only in two cases so far.
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Affiliation(s)
- Pallavi Suryawanshi
- Department of Pathology, Tata Memorial Hospital, E. Borges Marg, Parel, Mumbai, India
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21
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Abstract
Tumor-induced osteomalacia (TIO) is a rare and fascinating paraneoplastic syndrome in which patients present with bone pain, fractures, and muscle weakness. The cause is high blood levels of the recently identified phosphate and vitamin D-regulating hormone, fibroblast growth factor 23 (FGF23). In TIO, FGF23 is secreted by mesenchymal tumors that are usually benign, but are typically very small and difficult to locate. FGF23 acts primarily at the renal tubule and impairs phosphate reabsorption and 1α-hydroxylation of 25-hydroxyvitamin D, leading to hypophosphatemia and low levels of 1,25-dihydroxy vitamin D. A step-wise approach utilizing functional imaging (F-18 fluorodeoxyglucose positron emission tomography and octreotide scintigraphy) followed by anatomical imaging (computed tomography and/or magnetic resonance imaging), and, if needed, selective venous sampling with measurement of FGF23 is usually successful in locating the tumors. For tumors that cannot be located, medical treatment with phosphate supplements and active vitamin D (calcitriol or alphacalcidiol) is usually successful; however, the medical regimen can be cumbersome and associated with complications. This review summarizes the current understanding of the pathophysiology of the disease and provides guidance in evaluating and treating these patients. Novel imaging modalities and medical treatments, which hold promise for the future, are also reviewed.
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Affiliation(s)
- William H Chong
- Skeletal Clinical Studies Unit, Craniofacial and Skeletal Diseases Branch, National Institute of Dental and Craniofacial Research, Hatfield Clinical Research Center, National Institutes of Health, Bethesda, Maryland 20892, USA
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22
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Battoo AJ, Salih S, Unnikrishnan AG, Jojo A, Bahadur S, Iyer S, Kuriakose MA. Oncogenic osteomalacia from nasal cavity giant cell tumor. Head Neck 2010; 34:454-7. [PMID: 22311466 DOI: 10.1002/hed.21562] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2010] [Revised: 06/26/2010] [Accepted: 06/28/2010] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by osteomalacia, which occurs as a result of excess renal phosphate excretion caused by fibroblast growth factor-23 secreted by mesenchymal tumors. This entity is rare in head and neck cancers. We report a rare case of oncogenic osteomalacia in a patient with an anterior skull base giant cell tumor. METHODS AND RESULTS A 34-year-old woman presented with a 5-year history of progressive weakness in both lower limbs and the trunk. Hypophosphatemia and hypocalcemia had been noted by a local physician, but her symptoms persisted despite receiving calcium and vitamin D supplements. A recent onset of epistaxis and nasal blockage led to referral to the head and neck services. Nasal endoscopy revealed a left nasal cavity mass. Further evaluation with imaging studies revealed a mass in the nasal cavity with intracranial extension. Biopsy of the lesion suggested a neurogenic tumor. A putative diagnosis of anterior skull base neurogenic tumor with paraneoplastic hypophosphatemia was made. After the biochemical parameters were corrected, the patient underwent craniofacial resection. The final histopathologic study suggested the lesion as a "giant cell tumor." During the postoperative period the patient's biochemical and clinical symptoms improved dramatically, allowing her to regain normal mobility. CONCLUSIONS Clinicians and pathologists must be aware of the clinical symptoms, laboratory abnormalities, and pathologic features of oncogenic osteomalacia, which may be caused by tumors in the head and neck and thus make an exhaustive effort to diagnose the same.
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Affiliation(s)
- Azhar Jan Battoo
- Head and Neck Surgery, Amrita Institute of Medical Sciences, Cochin, Kerala, India
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23
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Mavrogenis AF, Sakellariou VI, Soultanis K, Mahera H, Korres DS, Papagelopoulos PJ. A nonphosphaturic mesenchymal tumor mixed connective tissue variant of the sacrum. Orthopedics 2010; 33:851. [PMID: 21053876 DOI: 10.3928/01477447-20100924-27] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tumor-induced or oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by overproduction of fibroblast growth factor-23 as a phosphaturic agent and renal phosphate wasting. A range of predominantly mesenchymal neoplasms have been associated with tumor-induced osteomalacia and classified as phosphaturic mesenchymal tumor mixed connective tissues. However, phosphaturic mesenchymal tumor mixed connective tissues could be nonphosphaturic in the first stage of the disease, either because the tumors are resected early in the clinical course or because the patient's osteomalacia was attributed to another cause. This article presents a case of a 42-year-old woman with a 2-year history of low back and right leg pain. Laboratory examinations including serum and urine calcium and phosphorous were within normal values. Imaging of the lumbar spine and pelvis showed an osteolytic lesion occupying the right sacral wing. Histology was unclear. Reverse-transcription polymerase chain reaction analysis for fibroblast growth factor-23 was positive and confirmed the diagnosis of phosphaturic mesenchymal tumor mixed connective tissues. Preoperative selective arterial embolization and complete intralesional excision, bone grafting, and instrumented fusion from L4 to L5 to the iliac wings bilaterally was performed. Postoperative recovery was uneventful. Neurological deficits were not observed. A lumbopelvic corset was applied for 3 months. At 12 months, the patient was asymptomatic. Serum and urine values of calcium and phosphorous were normal throughout the follow-up evaluation.
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Affiliation(s)
- Andreas F Mavrogenis
- First Department of Orthopedics, Athens University Medical School, Athens, Greece
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24
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Oncogenic osteomalacia in a patient with an ethmoid sinus tumour. The Journal of Laryngology & Otology 2009; 124:799-803. [PMID: 20003602 DOI: 10.1017/s0022215109992313] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To highlight the clinical presentation and management of a rare case of oncogenic osteomalacia due to an ethmoid sinus tumour. MATERIALS AND METHODS We examined the case records of a 55-year-old man who presented with progressive fatigue, weakness and bone pain, and noted the clinical presentation, laboratory investigations, computed tomography findings, operative notes and follow-up details. CONCLUSION Oncogenic osteomalacia secondary to a paranasal sinus neoplasm is a rare entity. The causative tumour is often occult and may be missed by routine clinical examination. This case report illustrates the appropriate pattern of evaluation and management to ensure a successful outcome.
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25
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Woo VL, Landesberg R, Imel EA, Singer SR, Folpe AL, Econs MJ, Kim T, Harik LR, Jacobs TP. Phosphaturic mesenchymal tumor, mixed connective tissue variant, of the mandible: report of a case and review of the literature. ACTA ACUST UNITED AC 2009; 108:925-32. [PMID: 19828339 DOI: 10.1016/j.tripleo.2009.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 06/26/2009] [Accepted: 07/02/2009] [Indexed: 12/11/2022]
Abstract
Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome that results in renal phosphate wasting with hypophosphatemia. In most cases, the underlying cause of TIO is a small mesenchymal neoplasm that is often difficult to detect, resulting in delayed diagnosis. One such neoplasm is the phosphaturic mesenchymal tumor, mixed connective tissue variant (PMTMCT), an unusual entity with unique morphologic and biochemical features. Most of these tumors are found at appendicular sites with only rare cases reported in the jaws. We describe a PMTMCT involving the mandible in a patient with a protracted history of osteomalacia. A review of the current literature is provided with emphasis on the clinical and histologic features, etiopathogenesis, and management of PMTMCT in the setting of TIO.
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Affiliation(s)
- Victoria L Woo
- Department of Biomedical Sciences, School of Dental Medicine, University of Nevada, Las Vegas, NV 89106, USA.
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26
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A phosphaturic mesenchymal tumor of the floor of the mouth with oncogenic osteomalacia: report of a case. J Oral Maxillofac Surg 2009; 67:402-5. [PMID: 19138617 DOI: 10.1016/j.joms.2008.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 11/05/2007] [Accepted: 01/03/2008] [Indexed: 11/20/2022]
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27
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Beech TJ, Rokade A, Gittoes N, Johnson AP. A haemangiopericytoma of the ethmoid sinus causing oncogenic osteomalacia: a case report and review of the literature. Int J Oral Maxillofac Surg 2007; 36:956-8. [PMID: 17498926 DOI: 10.1016/j.ijom.2007.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2006] [Revised: 03/04/2007] [Accepted: 03/16/2007] [Indexed: 10/23/2022]
Abstract
Oncogenic osteomalacia is a rare cause of osteomalacia. It is caused by a tumour which is generally benign. These tumours, when identified, are often found in the head and neck region. The case is reported here of a haemangiopericytoma isolated in the ethmoid sinus, and the literature regarding tumours at this site is reviewed. Including the present case there are five reported in the world literature of an ethmoid sinus tumour causing oncogenic osteomalacia. The treatment for this disease is excision of the mass, which is where the head and neck specialist's expertise is required.
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Affiliation(s)
- T J Beech
- Queen Elizabeth Hospital, Birmingham, UK.
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28
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Sahnoune I, Tazi-Mezalek Z, Essaadouni L, Harmouche H, Ismael F, Adnaoui M, Aouni M, Kettani F, Maaouni A. Oncogenic osteomalacia in a patient with hemangioma: a clinical diagnosis. Joint Bone Spine 2005; 73:115-8. [PMID: 16213774 DOI: 10.1016/j.jbspin.2005.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2004] [Accepted: 06/28/2005] [Indexed: 01/12/2023]
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