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Sánchez Muñoz R, Sanmillan JL, Vidal Sarró N, Martín Quintero G, Martí Duce D, Gabarrós Canals A. Intracranial Phosphaturic Mesenchymal Tumors: A Systematic Literature Review of a Rare Entity. World Neurosurg 2024; 187:70-81. [PMID: 38561034 DOI: 10.1016/j.wneu.2024.03.138] [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: 12/23/2023] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Phosphaturic Mesenchymal Tumors (PMTs) are rare mesenchymal neoplasms known for producing Tumor-induced Osteomalacia (TIO). TIO is an uncommon paraneoplastic syndrome characterized by radiographic evidence of inadequate bone mineralization and analytical abnormalites. METHODS We sought to present a case of TIO caused by skull base PMT with intracranial extension, manifesting with pain, progressive weakness, and multiple bone fractures. Furthermore, a systematic review was performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. A search was conducted in PubMed database with title/abstract keywords "Phosphaturic mesenchymal tumor" and "Osteomalacia." Search results were reviewed looking for intracranial or skull base tumors. RESULTS Our systematic review included 29 reported cases of intracranial PMT. In the reviewed cases there was a significative female predominance with 22 cases (75,86%). Osteomalacia was presented in 25 cases (86,20%). Bone fractures were present in 10 cases (34,48%). The most common site of involvement was the anterior cranial fossa in 14 cases (48,27%). Surgery was performed in 27 cases (93,10%) with previous tumor embolization in 4 cases (13,79%). Total recovery of the presenting symptoms in the first year was achieved in 21 cases (72,41%). Recurrence of the disease was described in 6 cases (25%). CONCLUSIONS Skull base PMTs with intracranial extension are extremely rare tumors. Most patients are middle-aged adults with a PMT predominantly located in anterior cranial fossa. Surgery is the current treatment of choice with optimal outcome at 1-year follow-up, although recurrence could be present in almost 25% of the cases.
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Affiliation(s)
- Raúl Sánchez Muñoz
- Department of Neurosurgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
| | - Jose L Sanmillan
- Department of Neurosurgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Noemi Vidal Sarró
- Department of Pathology, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Guillermo Martín Quintero
- Department of Neurosurgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Daniel Martí Duce
- Department of Neurosurgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
| | - Andreu Gabarrós Canals
- Department of Neurosurgery, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain
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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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Wang H, Zhong D, Liu Y, Jiang Y, Qiu G, Weng X, Xing X, Li M, Meng X, Li F, Zhu Z, Yu W, Xia W, Jin J. Surgical Treatments of Tumor-Induced Osteomalacia Lesions in Long Bones: Seventeen Cases with More Than One Year of Follow-up. J Bone Joint Surg Am 2015; 97:1084-94. [PMID: 26135075 DOI: 10.2106/jbjs.n.01299] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tumor-induced osteomalacia is a rare and fascinating paraneoplastic syndrome usually caused by a small, benign phosphaturic mesenchymal tumor. Most tumors are treated surgically, but we are unaware of any reports that compare the results of curettage and segmental resection for lesions in long bones. METHODS Seventeen patients (ten male and seven female) with tumor-induced osteomalacia lesions in long bones, who underwent surgical treatment from December 2004 to August 2013 in our hospital, were included in this retrospective study. The mean follow-up (and standard deviation) was 35 ± 27 months (range, twelve to 116 months). The characteristics of the tumor and the effects of different surgical treatments (curettage compared with segmental resection) were evaluated. RESULTS All patients showed typical clinical characteristics of tumor-induced osteomalacia, including elevated serum fibroblast growth factor-23 (FGF-23); 82% of tumors were in the epiphysis, and 82% grew eccentrically. The mean maximum diameter of the tumors was 2.4 ± 2.0 cm. The complete resection rates were similar for curettage (67%) and segmental resection (80%). However, the recurrence rate after curettage (50%) was higher than that after segmental resection (0%). The complete resection rate for secondary segmental resection (75%) was not different from that for primary segmental resection (83%). All of our cases of tumor-induced osteomalacia were caused by phosphaturic mesenchymal tumors. After successful removal of tumors, serum FGF-23 returned to normal within twenty-four hours and serum phosphorus levels returned to normal at a mean of 6.5 ± 3.5 days. CONCLUSIONS Most lesions in long bones are located in the epiphysis, so curettage is first suggested to maintain joint function. If curettage is incomplete or there is a recurrence, secondary segmental resection should be considered curative. Changes of serum FGF-23 and phosphorus levels before and after the operation may be of prognostic help.
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Affiliation(s)
- Hai Wang
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Dingrong Zhong
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Yong Liu
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Yan Jiang
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Guixing Qiu
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Xisheng Weng
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Xiaoping Xing
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Mei Li
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Xunwu Meng
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Fang Li
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Zhaohui Zhu
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Wei Yu
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Weibo Xia
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
| | - Jin Jin
- Departments of Orthopaedic Surgery (H.W., Y.L., G.Q., X.W., and J.J.), Endocrinology (Y.J., X.X., M.L., X.M., and W.X.), Pathology (D.Z.), Nuclear Medicine (F.L. and Z.Z.), and Radiology (W.Y.), Peking Union Medical College Hospital (PUMCH), Number 1 Shuaifuyuan hutong, Beijing 100730, People's Republic of China. E-mail address for H. Wang: . E-mail address for D. Zhong: . E-mail address for Y. Liu: . E-mail address for Y. Jiang: E-mail address for G. Qiu: . E-mail address for X. Weng: . E-mail address for X. Xing: . E-mail address for M. Li: . E-mail address for X. Meng: . E-mail address for F. Li: . E-mail address for Z. Zhu: . E-mail address for W. Yu: . E-mail address for W. Xia: . E-mail address for J. Jin:
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