RESUMEN
BACKGROUND: Tumor-induced osteomalacia (TIO) is a rare clinical entity in which secondary osteomalacia is induced by tumor-related products. Fibroblast growth factor 23 (FGF-23) mRNA is overexpressed in the tumor tissue, leading to impaired reabsorption of phosphorus in the renal tubules and hypophosphatemia. Curative treatment is considered to be total resection of the tumor. METHODS AND RESULTS: A 53-year-old woman had experienced systemic bone pain and muscle weakness for several years. She had refractory hypophosphatemia and marked elevation of serum FGF-23 level. Whole body imaging eventually revealed a hypervascular mass in the right temporal bone, leading to a diagnosis of TIO. She underwent skull-base surgery after embolization of the tumor. After the en bloc resection, FGF-23 became undetectable, phosphate reabsorption normalized, and all symptoms resolved. CONCLUSIONS: We discuss the clinical features and treatment options for this rare disease.
Asunto(s)
Factores de Crecimiento de Fibroblastos/sangre , Neoplasias de Tejido Conjuntivo/complicaciones , Osteomalacia/etiología , Neoplasias Craneales/complicaciones , Hueso Temporal , Embolización Terapéutica , Femenino , Factor-23 de Crecimiento de Fibroblastos , Humanos , Hipofosfatemia/metabolismo , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias de Tejido Conjuntivo/sangre , Neoplasias de Tejido Conjuntivo/patología , Neoplasias de Tejido Conjuntivo/cirugía , Osteomalacia/sangre , Neoplasias Craneales/sangre , Neoplasias Craneales/patología , Neoplasias Craneales/cirugíaRESUMEN
In a 53-year-old male who received a right liver graft from his son, computed tomography 1 week before living donor liver transplantation (LDLT) revealed three hepatocellular carcinoma (HCC) tumors in the liver that met the Milan criteria. Resected specimen revealed four tumors and microscopically, one of four HCC tumors in the resected whole liver comprised a glandular structure with spindle-like cells indicative of a sarcomatous change in HCC. Two hundred and sixty days after LDLT, the patient complained of left meralgia, which was diagnosed as iliac bone metastasis from HCC. Over a period of 3 months, the iliac bone metastasis rapidly enlarged. The tumor aggressively extended into the patient's bone marrow, causing severe pancytopenia. The patient died 371 days after LDLT. This tumor was detected preoperatively by computed tomography but lack of enhancement. These findings indicate that pathologic evaluation of each tumor is a key to predicting an accurate prognosis.