Intracranial Phosphaturic Mesenchymal Tumor Detected by 68 Ga-DOTATATE PET/CT

ABSTRACT

A 68 Ga-DOTATATE PET/CT scan was conducted to locate the causative tumor responsible for suspected tumor-induced osteomalacia in a 56-year-old woman. The PET/CT images showed a focus in the right occipital region. Subsequent MRI showed an extra-axial nodule in the right occipital region, mimicking a meningioma. Although rare, an intracranial phosphaturic mesenchymal tumor was still suspected because of the typical clinical settings. Finally, phosphaturic mesenchymal tumor was confirmed by the postoperative pathology.

Multimodality Imaging of Intimal Sarcoma Causing Both Severe Mitral Stenosis and Mitral Regurgitation

Intimal sarcomas (IS) are rare, malignant, rapidly progressive mesenchymal tumors that typically occur in the tunica intima of larger vessels, and they rarely involve the heart. IS are frequently misdiagnosed during the initial clinical presentation. This case report describes an uncommonly located IS, highlighting specific findings obtained through multimodality imaging.

Clinical Characteristics of Malignant Phosphaturic Mesenchymal Tumor Causing Tumor-Induced Osteomalacia

CONTEXT

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome usually caused by oversecretion of fibroblast growth factor 23 (FGF23) from a phosphaturic mesenchymal tumor (PMT). PMTs are usually benign neoplasms but some of them show malignant characteristics.

OBJECTIVE

The aim of this study was to compare the clinical characteristics of benign and malignant PMTs inducing TIO.

METHODS

On March 31, 2023, we performed a systematic review of individual patient data analysis in Medline, Google Scholar, Google book, and Cochrane Library using the terms "tumor induced osteomalacia," "oncogenic osteomalacia," "hypophosphatemia," with no language restrictions and according to Preferred Reporting Items for Systematic reviews and Meta-Analyses criteria.

RESULTS

Overall, we collected data from 837 patients with TIO in which the diagnosis of benign and malignant PMT was specified. Of them, 89 were affected by malignant PMT and 748 by benign PMT. Patients with malignant PMTs were younger and presented bone pain, functional impairment, and bone deformities more frequently. Malignant PMTs showed higher values of intact FGF23 and a higher mortality rate.

CONCLUSION

The study results identify the clinical characteristics of patients with malignant TIO, permitting the early identification of patients with PMT at increased risk of malignancy. This may significantly improve the diagnostic approach to disease. Further experimental studies are mandatory to clarify the role of FGF23 in the pathogenesis of malignancy in PMTs.

Tumour-induced osteomalacia due to a durally-based intracranial phosphaturic mesenchymal tumour

A man in his 40s was referred with persistent hypophosphataemia and bony pain. A serum fibroblast growth factor 23 level was markedly elevated and a diagnosis of tumour-induced osteomalacia was considered. Whole body imaging revealed multiple insufficiency fractures but no osseus tumours. There was, however, a durally-based intracranial lesion whose imaging characteristics were consistent with a meningioma. The tumour was removed, leading to rapid normalisation of the patient's symptoms and serum markers. Histology confirmed a phosphaturic mesenchymal tumour. We review the literature regarding this rare clinical situation.

Paediatric thoracic wall lipoblastoma in a 7-year old: a rare tumour of childhood

Lipoblastoma is a rare benign mesenchymal tumour derived from embryonic white fat tissue. Lipoblastoma generally occurs in children less than 3 years of age, and fewer than 200 cases have been reported in the English literature. There are hardly a dozen reports describing intrathoracic and thoracic involvement. We report a case of a 7-year-old boy who presented with a slowly growing right thoracic wall mass for a duration of 1 year. Radiological investigations (ultrasonography and contrast-enhanced CT of the chest showed the presence of a fat-containing, low density extrapulmonary soft tissue mass) could not confirm the diagnosis, and repeat biopsies also were not conclusive. The mass was excised and histopathology confirmed it as lipoblastoma. A review of literature pertaining to the clinical presentation, radiological features and histopathology of this rare condition has been discussed.

[Borderline and malignant mesenchymal tumors of the abdomen]

BACKGROUND

Soft tissue sarcomas are most common mesenchymal malignancies in the abdomen. Their radiologic features are often unspecific and establishing a differential diagnosis to other pathologies can be difficult.

OBJECTIVES

This review presents a selection of the most common mesenchymal abdominal tumors and their imaging characteristics, as well as the associated differential diagnoses. Knowledge of fundamental pathologic, anatomic and radiologic features of these malignancies is crucial for the differential diagnosis and key in clinical decision making and subsequent selection of an appropriate therapeutic regimen.

Cytologic diagnosis of gastrointestinal stromal tumors of the stomach by endoscopic ultrasound-guided fine-needle aspiration biopsy: cytomorphologic and immunohistochemical study of 12 cases

Gastrointestinal stromal tumor (GIST) is an uncommon tumor, which was usually diagnosed by endoscopic biopsy or surgical resection. This study evaluated the efficacy and accuracy of endoscopic ultrasound (EUS) -guided fine-needle aspiration (FNA) biopsy in the diagnosis of GIST and reported its cytomorphologic features. Twelve patients with gastric GIST were diagnosed through EUS-guided FNA. Immediate on-site evaluation and cytologic diagnoses were given in nine cases (75.0%) with an average of three passes. Cell blocks provided diagnostic material in three cases (25.0%). Spindle cells were present in the cytologic material in all cases. Two patients had subsequent surgical resections. Immunohistochemical (IHC) studies performed in cell blocks and two surgical specimens all supported the original diagnoses. In the two cases with surgical resections, IHC results in cell blocks were similar to that in the resected specimens. This study demonstrated that when combining smears and cell blocks, EUS-guided FNA is accurate and efficient in the diagnosis of GIST. IHC reactivity in cell blocks correlated with that of the main tumors.

Botryoid sarcoma of the vagina

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Malignant mesenchymoma arising in an incisional scar of the abdominal wall

A case of malignant mesenchymoma of the anterior abdominal wall, composed of leiomyosarcoma, chondrosarcoma and osteosarcoma is described. The tumour, arising in the old scar of a previous operation, was completely removed surgically. Eleven months after the operation the patient is well with no evidence of recurrence. There have been no previous reports of malignant mesenchymoma developing in operation scars. We believe that this traumatic factor played a significant role in the aetiology of this rare soft-tissue neoplasm.

THE HISTOLOGICAL CLASSIFICATION OF LOWER RESPIRATORY TRACT TUMOURS

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TUMOURS OF THE CENTRAL NERVOUS SYSTEM IN CHILDREN

One hundred and fifty-five tumours of the central nervous system which occurred in children in the north west of England during a period of nine years are analysed from a pathological point of view. It is probable that these represent over 90% of all such tumours occurring in the region at that time and that the relative incidence of various tumour types is, therefore, a true one: just over a fifth (35) were medulloblastomas; just under a fifth (29) were juvenile astrocytomas; a similar group (33) were of the adult astrocytic type; there were 24 ependymomas and 34 in miscellaneous minor groups.

Malignant liver tumors of children

Malignant liver tumors in children are uncommon but have a high mortality. Survival rates have improved with advances in chemotherapy, imaging, tumor biology, and supportive care. However, complete surgical resection is the cornerstone of successful management. Important determinants of outcome are stage, histology, and resectability. A multidisciplinary team approach to the care of pediatric patients with liver tumors using the latest guidelines from clinical trials provides the best opportunity for care.

Mediastinal tumours and cysts. A review of 91 cases

The experience with 91 primary tumours of the mediastinum during a period of 20 years is presented. A total of 24 separate cell types were identified. The most frequent lesions were thyroid tumours, neurogenic tumours, cysts and tumours of lymphatic origin. About 50% of the tumours were discovered by chance in asymptomatic patients undergoing routine chest examination. Twenty per cent of the patients with malignant lesions were free of symptoms. The pre-operative diagnosis was uncertain in most instances, and early surgical exploration is therefore recommended. Seventy-four patients underwent surgery and the operative mortality rate was 2.7%. The long-term survival was closely related to the histological nature of the neoplasm.

Suppression of precocial copulation by progesterone implants in the male chick forebrain

Precocial copulation in 2-wk.-old male chicks, described behaviorally as free mount, tread, posterior contact, waggle, peek, and seize, was developed through hand-training experience and androgen treatment. Crystalline progesterone was then implanted in various forebrain or midbrain regions. Results indicated that progesterone inhibited copulatory behavior when placed in the periventricular areas of the preoptic-hypothalamic continuum. Progesterone implants in the preoptic lateral forebrain bundle regions also suppressed precocial copulation. Forebrain implants of cholesterol did not result in copulatory inhibition. The suppression of copulatory behavior was not accompanied by loss of weight or deficits in general activity or comb growth. These data indicate that brain regions responsible for progesterone-induced copulatory inhibition are similar in neuroanatomical distribution to those involved in testosterone-induced copulatory activation.