|Table of Contents|

Misdiagnosis analysis of phosphaturic mesenchymal tumor(7 cases)

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2023 08
Page:
1496-1501
Research Field:
Publishing date:

Info

Title:
Misdiagnosis analysis of phosphaturic mesenchymal tumor(7 cases)
Author(s):
WANG Leiqiong; ZHOU Jie; HUANG Yaohua
Imaging Department,the First Affiliated Hospital of Guangzhou University of Chinese Medicine，Guangdong Guangzhou 510405，China.
Keywords:
phosphaturic mesenchymal tumor; tumor-induced osteomalacia; hypophosphatemia; misdiagnosis; imaging
PACS:
R730.262
DOI:
10.3969/j.issn.1672-4992.2023.08.020
Abstract:
Objective:To analyze the causes of misdiagnosis of phosphaturic mesenchymal tumor（PMT）and clarify imaging pathway.Methods：The clinical,imaging and pathological data of patients with PMT confirmed by pathology in our hospital from July 2017 to March 2022 were analyzed retrospectively.Combined with literature review,summary the causes of misdiagnosis and suggested imaging pathway.Results：There were 7 patients,3 males and 4 females,with an average age of (50.29±15.66)years (range 17~69).The patients showed different degrees of fatigue and bone pain,accompanied by fractures,with an average course of (5.00±3.25)years (range 1~12 years).The blood phosphorus of all patients decreased before operation and increased after operation.The blood phosphorus in 6 patients returned to normal 7~15 days after operation,and 1 case was lost to follow-up.Alkaline phosphatase increased in 6 patients before operation,and 1 case was normal.The maximum diameter of the tumor was (2.01±1.32)cm (range 0.8~2.5 cm),2 cases were located in soft tissue and 5 cases in bone tissue.X-ray examination of 6 cases showed osteomalacia of different degrees in the whole body or local area and concomitant fracture.The lesion could not be displayed in 3 cases.CT examination was performed in 6 cases,5 cases of bone tissue lesions showed high density,1 case was soft tissue density nodule.On plain MRI scans,6 cases showed low and equal signal on T1WI,and occasionally high signal.6 cases showed low and equal signal mixed high signal on T2WI,and low signal areas were seen in some parts of the interior or edges.MRI enhanced lesions in 4 cases showed moderate to obvious enhancement and uneven enhancement.Conclusion：PMT images lack specificity and are easy to be misdiagnosed.Patients with osteomalacia,bone pain,fracture,low blood phosphorus and high alkaline phosphatase should be considered.Suspicious lesions can be found by OCT first,and then anatomic examination (X-ray,CT,MRI) can be performed to further diagnose and locate the suspected pathogenic tumor before operation,evaluate the surgical margin and follow-up treatment.

References:

［1］ ANGELES-ANGELES A,REZA-ALBARR NA,CHABLE-MONTERO F,et al.Phosphaturic mesenchymal tumors:Survey of 8 cases from a single Mexican medical institution［J］.Annals of Diagnostic Pathology,2015,19(6):375-380.
［2］ FOLPE AL.Phosphaturic mesenchymal tumors:A review and update［J］.Semin Diagn Pathol,2019,36(4):260-268.
［3］ 钟媛,黄媛媛,唐黎之,等.肿瘤相关性成人低血磷骨软化症1例报道［J］.中国骨质疏松杂志,2020,26(08):1175-1179. ZHONG Y,HUANG YY,TANG LZ,et al.Case report of adult-onset tumor-induced osteomalacia ［J］.Chinese Journal of Osteoporosis,2020,26(08):1175-1179.
［4］ WEIDNER N,SANTA CRUZ D.Phosphaturic mesenchymal tumors.A polymorphous group causing osteomalacia or rickets［J］.Cancer,1987,59(8):1442-1454.
［5］ FLETCHER CDM,BRIDGE JA,HOGENDOORN PCW,et al.WHO classification of tumours of soft tissue and bone［M］.4th ed.Lyon:IARC Press,2013:211-212.
［6］ RENDINA D,ABATE V,CACACE G,et al.Tumor induced osteomalacia:a systematic review and individual patient's data analysis ［J/OL］.J Clin Endocrinol Metab,2022,dgac253［2022-6-15］.http://doi.org/10.1210/clinem/dgac253.
［7］ KAWTHALKAR AS,JANU AK,DESHPANDE MS,et al.Phosphaturic mesenchymal tumors from head to toe:imaging findings and role of the radiologist in diagnosing tumor-induced osteomalacia［J］.Indian J Orthop,2020,54(2):215-223.
［8］FENG J,JIANG Y,WANG O,et al.The diagnostic dilemma of tumor induced osteomalacia:a retrospective analysis of 144 cases［J］.Endocr J,2017,64(7):675-683.
［9］ 李冬梅,吴焕文,李敬东,等.磷酸盐尿性间叶肿瘤的临床及免疫组织化学特点分析［J］.中华病理学志,2018,47(06):427-431. LI DM,WU HW,LI JD,et al.Clinical and immunohistopathologic study of phosphaturic mesenchymal tumor［J］.Chinese Journal of Pathology,2018,47(06):427-431.
［10］ 李璐,宋爱平,孙宏亮,等.磷酸盐尿性间叶组织肿瘤临床与影像学特点及文献复习［J］.中日友好医院学报,2020,34(3):140-143,148. LI L,SONG AP,SUN HL,et al.Analysis of clinical and imaging features of phosphaturic mesenchymal tumor and review of literatures［J］.Journal of China-Japan Friendship Hospital,2020,34(3):140-143,148.
［11］FENG J,JIANG Y,WANG O,et al.The diagnostic dilemma of tumor induced osteomalacia:a retrospective analysis of 144 cases［J］.Endocr J,2017,64(7):675-683.
［12］CHATTERJEE D,BARDIA A,PAL R,et al.Clinical,morphological and immunohistochemical analysis of 13 cases of phosphaturic mesenchymal tumor-A holistic diagnostic approach［J］.Ann Diagn Pathol,2021,54:151783.
［13］伍冬林,冷西,邱士军.骨磷酸盐尿性间叶肿瘤的影像表现及文献复习［J］.临床放射学杂志,2020,39(06):1162-1165. WU DL,LENG X,QIU SJ.Imaging features of osseous phosphaturic mesenchymal tumor and literature review［J］.Journal of Clinical Radiology,2020,39(06):1162-1165.
［14］ KOBAYASHI H,MAKISE N,USHIKU T,et al.Infiltrative nature of tumor-induced osteomalacia lesions in bone:Correlation between radiological and histopathological features［J］.J Orthop Sci,2019,24(5):900-905.
［15］BROSKI SM,FOLPE AL,WENGER DE.Imaging features of phosphaturic mesenchymal tumors［J］.Skeletal Radiol,2019,48(1):119-127.
［16］颜方方,陈梦宇,陈喆祎,等.磷酸盐尿性间叶肿瘤的影像表现及诊断［J］.中华放射学杂志,2018,52(11):858-863. YAN FF,CHEN MY,CHEN ZY,et al.Imaging manifestations and clinical diagnosis of phosphaturic mesenchymal tumor［J］.Chinese Journal of Radiology,2018,52(11):858-863.
［17］FLORENZANO P,HARTLEY IR,JIMENEZ M,et al.Tumor-induced osteomalacia［J］.Calcif Tissue Int,2021,108(1):128-142.
［18］JIANG Y,HOU G,CHENG W.Performance of 68Ga-DOTA-SST PET/CT,octreoscan SPECT/CT and 18F-FDG PET/CT in the detection of culprit tumors causing osteomalacia［J］.Nucl Med Commun,2020,41(4):370- 376.
［19］ ZHANG J,ZHU Z,ZHONG D,et al.68GA DOTATATE PET/CT is an accurate imaging modality in the detection of culprit tumors causing osteomalacia［J］.Clin Nucl Med,2015,40(8):642-646.
［20］PAQUET M,GAUTH M,ZHANG YJ,et al.Diagnostic performance and impact on patient management of 68Ga-DOTA-TOC PET/CT for detecting osteomalacia-associated tumours［J］.Eur J Nucl Med Mol Imaging,2018,45(10):1710-1720.
［21］RAYAMAJHI SJ,YEH R,WONG T,et al.Tumor-induced osteomalacia-current imaging modalities and a systematic approach for tumor localization［J］.Clin Imaging,2019,56:114-123.
［22］ BRANDI ML,CLUNIE GPR,HOUILLIER P,et al.Challenges in the management of tumor-induced osteomalacia (TIO)［J］.Bone,2021,152:116064.
［23］HUSSEIN MAM,CAFARELLI FP,PAPARELLA MT,et al.Phosphaturic mesenchymal tumors:radiological aspects and suggested imaging pathway［J］.Radiol Med,2021,126(12):1609-1618.
［24］单凤玲,孙贞魁,沈晨天,等.磷酸盐尿性间叶肿瘤的临床特点及其综合影像学表现［J］.国际放射医学核医学杂志,2021,45(08):479-485. SHAN FL,SUN ZK,SHEN CT,et al.Clinical features and comprehensive imaging findings of phosphaturic mesenchymal tumor ［J］.International Journal of Radiation Medicine and Nuclear Medicine,2021,45(08):479-485.
［25］SHI Z,DENG Y,LI X,et al.CT and MR imaging features in phosphaturic mesenchymal tumor-mixed connective tissue:A case report［J］.Oncol Lett,2018,15(4):4970-4978.

Memo

Memo:
-
Last Update: 1900-01-01