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©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the femur: A case report
Dong Tang, Xiao-Man Wang, Yong-Sheng Zhang, Xiao-Xiao Mi
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
Yong-Sheng Zhang, 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
Author contributions: All authors contributed significantly to this case report; Mi XX and Tang D conceived and designed the case report with great input from Wang XM and Zhang YS; Tang D and Wang XM provided the radiological imaging and pathological analyses; Zhang YS was involved in the biomedical analysis; Mi XX wrote the manuscript with input from Wang XM, Zhang YS, and Tang D.
Informed consent statement: Informed written consent was obtained from the patient for publication of this case report and accompanying images.
Conflict-of-interest statement: The authors declare that they have no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Xiao-Xiao Mi, PhD, Chief Technician, Institute of Translational Medicine, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou 310015, Zhejiang Province, China. mixiaoxiao1987@163.com
Telephone: +86-571-88303635
Supported by Research Fund of Hangzhou Normal University Affiliated Hospital.
Received: February 2, 2019
Peer-review started: February 11, 2019
First decision: May 31, 2019
Revised: June 4, 2019
Accepted: June 20, 2019
Article in press: June 21, 2019
Published online: August 6, 2019
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.
Core tip: Oncogenic osteomalacia caused by phosphaturic mesenchymal tumors is not easily identifiable or detectable due to its rarity and nonspecific presentations. Herein, we provide a successful example of diagnosis of phopshaturic mesenchymal tumor-induced oncogenic osteomalacia in a female patient who presented progressive bone pain. Our case emphasizes that histologically benign phosphaturic mesenchymal tumors that are responsible for oncogenic osteomalacia can also cause bone destruction.
