Age / Sex : 34 / F

Chief complaint : low back and pelvic pain

PMHx : osteoporosis (+)


What is your diagnosis?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy: 최자영 (Ja-Young Choi), 서울대병원 (Seoul National University Hospital)

Phosphaturic mesenchymal tumor - cause of the oncogenic osteomalacia due to production of fibroblast growth factor-23

Discussion

Disease definition

     Phosphaturic mesenchymal tumor

     - cause of the oncogenic osteomalacia due to production of fibroblast growth factor-23

1.Diffuse demineralization on X-ray

2.Vertebral compression fractures & insufficiency fractures on X-ray, CT, MRI, and bone scan

3.Hypermetabolic soft tissue lesion in the left hip subcutaneous layer on Gallium-68 DOTATATE and DOTANDOC PET

4.Insufficiency fracture of the left medial femoral neck on MRI

5.T2 hyperintense, T1 isointense subcutaneous soft tissue mass with intense enhancement on MRI

6.Hypoechoic nodule on USG

1.Kawthalkar AS, Janu AK, Deshpande MS, Gala KB, Gulia A, Puri A. Phosphaturic Mesenchymal Tumors from Head to Toe: Imaging Findings and Role of the Radiologist in Diagnosing Tumor-Induced Osteomalacia. Indian J Orthop. 2020 Jan 13;54(2):215-223.

2.Rayamajhi SJ, Yeh R, Wong T, Dumeer S, Mittal BR, Remotti F, Chikeka I, Reddy AK. Tumor-induced osteomalacia - Current imaging modalities and a systematic approach for tumor localization. Clin Imaging. 2019 Jul-Aug;56:114-123.

3.Broski SM, Folpe AL, Wenger DE. Imaging features of phosphaturic mesenchymal tumors. Skeletal Radiol. 2019 Jan;48(1):119-127.