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Oncogenic osteomalacia due to phosphaturic mesenchymal tumour in the upper thoracic spine
  1. Bhavuk Garg1,
  2. Nishank Mehta1,
  3. Archit Goyal1 and
  4. Rajesh Khadgawat2
  1. 1Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
  2. 2Endocrinology, All India Institute of Medical Sciences, New Delhi, India
  1. Correspondence to Dr Nishank Mehta; mehta.nishank{at}gmail.com

Abstract

Oncogenic osteomalacia (OO) is an uncommon paraneoplastic syndrome occurring due to the presence of a tumour that oversecretes fibroblast growth factor-23, which impairs renal phosphate handling. In most cases, the tumour is a morphologically distinct entity called ‘phosphaturic mesenchymal tumour’ (PMT). Spinal tumours causing OO are exceedingly rare. A 55-year-old man presented with multiple bone pain and proximal muscle weakness in the lower limbs. The constellation of biochemical findings (hypophosphataemia, normocalcaemia, increased alkaline phosphatase, low–normal serum vitamin D and hyperphosphaturia) with radiographical rarefaction of the skeleton and pseudofractures led us to consider OO as a possibility. Functional imaging (68Ga DOTA-NOC positron emission tomography/CT scan) localised the tumour to the D2 vertebra. Complete surgical resection led to resolution of symptoms, improved ambulatory status, normalisation of biochemical parameters and healing of pseudofractures. PMT should be considered in the differential diagnosis of hypophosphataemic osteomalacia with hyperphosphaturia. Tumour localisation with functional imaging and complete surgical resection produces satisfactory outcome.

  • calcium and bone
  • orthopaedics
  • pathology

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Footnotes

  • Twitter @Archit18Goyal

  • Contributors BG, NM, AG and RK contributed to the conception and design of this case report, interpretation of data, critical revision and final approval of the manuscript. All authors agreed to be accountable for the article and to ensure that all questions regarding the accuracy or integrity of the article are investigated and resolved.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.