1
|
Çelik DŞ, Ayar K, Ermurat S, Üstündağ Y. Fibroblast growth factor 23 (Fgf23) levels and their relationship with disease activity, bone mineral density, and radiological damage score in patients with rheumatoid arthritis: a single center case–control study. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There is limited and conflicting information on Fgf23 levels and their relationship with bone loss and disease activity in rheumatoid arthritis (RA). The aim of this study was to compare Fgf23 levels in RA patients with a healthy population and to evaluate the relationship between Fgf23 levels in RA with disease activity, bone mineral density (BMD), and radiological damage score.
Results
The median Fgf23 levels in patients with RA and in hospital staff were 20.06 (11.2–51.0) and 26.40 (12.6–49.5) pg/ml (P < 0.001), respectively. RA patients were divided into active (DAS28 > 3.2) and inactive (DAS28 ≤ 3.2) subgroups. The median Fgf23 levels in active and inactive RA patients were 22.12 (13.90–51.02) and 17.71 (11.20–31.19) pg/ml, respectively (P = 0.001). BMD of RA patients was evaluated with dual-energy X-ray absorptiometry and radiological damage scores were evaluated independently by two investigators using the modified Sharp score (MSS). In RA patients, Fgf23 values correlated with DAS28 and with erosion score of observer-2 (r = 0.297, P = 0.036), but not with erosion score of observer-1 (r = 0.252, P = 0.077). No correlation was found between DAS28 and femur and lumbar vertebra BMD.
Conclusion
In RA, Fgf23 is not associated with BMD but may be associated with local bone loss and disease activity.
Collapse
|
2
|
Warman M, Syn-Hershko A, Cohen O, Tzipin Y, Lahav Y, Tessler I. Sino-nasal hemangiopericytoma: a case series and systematic literature review. Eur Arch Otorhinolaryngol 2022; 279:3989-3996. [PMID: 35103868 DOI: 10.1007/s00405-021-07239-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 12/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hemangiopericytoma is a rare tumor of the sino-nasal tract. Its clinical behavior is controversial. Whereas some describe an indolent course, others consider it to be an aggressive lesion with a tendency toward rapid local recurrence. Here, we describe our experience in the management of sino-nasal hemangiopericytoma (SN-HPC), comparing our experience with the current literature, and evaluating signs and tools to improve diagnosis and treatment. METHODS All cases of SN-HPC between 2010 and 2020 were extracted and reviewed from our institutional electronic medical records. SN-HPC cases from PubMed and EMBASE between 2010 and 2020 were analyzed in a systematic literature review using the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines. Data regarding demographics, presentation, diagnosis, treatment, and outcome were collected. RESULTS We identified four cases of SN-HPC in the nasal cavity in our institution and an additional 53 cases in previous reports. The mean age at the time of diagnosis was 59 years, with a 1.2:1 male to female ratio. SN-HPC mostly appears unilaterally, arising in the ethmoid sinus (42.1%). The most common presenting symptoms were epistaxis (47.3) and nasal obstruction (47.3%). Both computed tomography (CT) and magnetic resonance imaging (MRI) were required for diagnosis and for tailoring the treatment plan. Endoscopic surgical excision was used in 85.9% of the patients, and in 15.7%, an additional preoperative embolization was performed, which was associated with septal necrosis in one patient (2.6%). The recurrence rate was 7%. CONCLUSION Although previous reports attribute an aggressive tumoral behavior to SN-HPC, our experience and the literature review support a more indolent course with low recurrence rates following complete endoscopic resection. Preoperative embolization can be useful in certain cases, but due to potential complications, it should not be routinely indicated.
Collapse
Affiliation(s)
- Meir Warman
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel. .,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Adi Syn-Hershko
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oded Cohen
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yevgeny Tzipin
- Department of Radiology, Invasive Radiology Unit, Kaplan Medical Center, Rehovot, Israel
| | - Yonatan Lahav
- Department of Otolaryngology, Head and Neck Surgery, Kaplan Medical Center, POB 1, 76100, Rehovot, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Idit Tessler
- Department of Otolaryngology, Head and Neck Surgery, Sheba Medical Center, Ramat Gan, Israel
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Tonello L, Gatti AP, Neto JD, Teixeira UF, Bertozzi Goldoni M, Fontes PRO, Sampaio JA, Lima LMP, Waechter FL. A case of oncogenic osteomalacia owing to inguinal tumor. Oxf Med Case Reports 2018; 2017:omx045. [PMID: 29744113 PMCID: PMC5934660 DOI: 10.1093/omcr/omx045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 06/05/2017] [Indexed: 11/25/2022] Open
Abstract
The oncogenic hypophosphatemic osteomalacia is a very incapacitating disease and the mortality rate, mainly due to metabolic disorder, depends on the early diagnosis, since the surgery is curative. The major difficulty is to consider this kind of disease in patients with complex clinical presentation. Moreover, medical centers have to provide a good diagnostic infrastructure because these tumors, in most cases, are small and do not have an obvious site. This case report is about a man with a rapid loss of strength and muscle mass, which had his diagnosis in a late, culminating in significant deformities and organic dysfunctions with clinical repercussions. However, the fast diagnosis with appropriate tests determined the stop point of the evolution of disease and marked the beginning of metabolic recovery. This case reinforces the global problem health care infrastructure and the access to diagnostic equipment, demonstrating the impact on the patient’s health of our service.
Collapse
Affiliation(s)
- Luiza Tonello
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Arthur Paredes Gatti
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - João Diedrich Neto
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Uirá Fernandes Teixeira
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Marcos Bertozzi Goldoni
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Paulo Roberto Ott Fontes
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - José Artur Sampaio
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Luiz Maraninchi Pereira Lima
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| | - Fábio Luiz Waechter
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre/RS 90050-170, Brazil
| |
Collapse
|
5
|
Gresham MS, Shen S, Zhang YJ, Gallagher K. Anterior Skull Base Glomangioma-Induced Osteomalacia. J Neurol Surg Rep 2017; 78:e9-e11. [PMID: 28180054 PMCID: PMC5283168 DOI: 10.1055/s-0036-1597599] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Oncogenic osteomalacia (OO) is an uncommon but treatable cause of osteomalacia related to tumor production of FGF23, usually caused by benign mesenchymal neoplasms. Paranasal sinus glomangiomas are a rare cause of OO, with only one previously reported case. Here we describe a second case (first reported in English) of paranasal sinus glomangioma-induced osteomalacia in a 42-year-old man. He presented with weakness and multiple spontaneous fractures, and was found to have an ethmoid sinus glomangioma with intracranial extension. The tumor was removed via endoscopic endonasal approach to the anterior skull base, which resulted in complete resolution of symptoms and no further evidence of disease 1 year postoperatively.
Collapse
Affiliation(s)
- Malia S Gresham
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| | - Steven Shen
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas, United States
| | - Yi J Zhang
- Division of Neurological Surgery, Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, United States
| | - Kelly Gallagher
- Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, United States
| |
Collapse
|
6
|
Verma A, Tewari S, Kannaujia A. Perioperative management of patients with severe hypophosphataemia secondary to oncogenic osteomalacia: Our experience and review of literature. Indian J Anaesth 2017; 61:590-593. [PMID: 28794533 PMCID: PMC5530746 DOI: 10.4103/ija.ija_57_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Oncogenic osteomalacia (OOM) is a rare paraneoplastic syndrome associated with mesenchymal tumours. It is characterised by phosphaturia, hypophosphataemia, decreased serum Vitamin D3 levels and severe osteomalacia. OOM-inducing tumours are usually benign, arising either from bone or soft tissue, with extremities and craniofacial region being the most common sites. Surgical resection of the tumour remains the mainstay of treatment. Challenges to an anaesthesiologist arise when such patients are planned for surgical resection of the underlying tumour. All the perioperative dilemmas are directly related to the severe hypophosphataemia. We describe three such cases of OOM and their perioperative management.
Collapse
Affiliation(s)
- Alka Verma
- Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Saipriya Tewari
- Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ashish Kannaujia
- Department of Anaesthesia, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|
7
|
Gatti AP, Tonello L, Neto JAD, Teixeira UF, Goldoni MB, Fontes PRO, Sampaio JA, Lima LMP, Waechter FL. Oncogenic hypophosphatemic osteomalacia: From the first signal of disease to the first signal of healthy. Int J Surg Case Rep 2016; 30:130-133. [PMID: 28012328 PMCID: PMC5192016 DOI: 10.1016/j.ijscr.2016.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/20/2016] [Indexed: 12/16/2022] Open
Abstract
Oncogenic hypophosphatemic osteomalacia is an uncommon paraneoplastic syndrome. Neoplasia with high morbimortality if not detected early. A free margin excision is necessary to stop deformity evolution.
Introduction The physical incapacitation of the oncogenic hypophosphatemic osteomalacia (OHO) can be catastrophic and can lead to deformities, metabolic and organic instability and death. The only positive outcome is through early diagnosis by the clinical suspicion. At this moment, medical center infrastructure is also a keypoint. Presentation of case This case report is about a 60-year old woman with multiple fractures, gradual loss of strength and muscle mass and limiting deformities in two years of evolution until the diagnostic. Discussion The lack of knowledge of this disease causes a delay in diagnosis that can bring deformities to the patient, as well as death. Is crucial that is hypothesized to carry out the necessary tests, since they are expensive and not always available. Conclusion This case reinforces the importance to understand the OHO and tumoral search, once this lesion is, in most cases, imperceptible to physical examination or several imaging studies.
Collapse
Affiliation(s)
- Arthur Paredes Gatti
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil.
| | - Luiza Tonello
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - João Alfredo Diedrich Neto
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Uirá Fernandes Teixeira
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Marcos Bertozzi Goldoni
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Paulo Roberto Ott Fontes
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - José Artur Sampaio
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Luiz Maraninchi Pereira Lima
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| | - Fábio Luiz Waechter
- General Surgery Unit, Universidade Federal De Ciências Da Saúde De Porto Alegre, Complexo Hospitalar Santa Casa de Porto Alegre, Porto Alegre, RS 90050-170, Brazil
| |
Collapse
|