Oncogenic osteomalacia: localization of underlying peripheral mesenchymal tumors with use of Tc 99m sestamibi scintigraphy

Endocr Pract. Jan-Feb 2006;12(1):35-42. doi: 10.4158/EP.12.1.35.

Abstract

Objective: To highlight a strategy for potential detection of mesenchymal tumors in oncogenic malacia, as illustrated by 3 cases.

Methods: Three case reports are presented in which successful localization of the offending neoplasm was accomplished by using whole-body Tc 99m sestamibi scanning. Alternative localization techniques are also reviewed.

Results: Oncogenic osteomalacia occurs infrequently and is caused by neoplasms that secrete phosphatonins, substances that interfere with proximal tubular resorption of phosphorus and can result in phosphaturia, hypophosphatemia, reduced 1,25-dihydroxyvitamin D concentration, and osteomalacia. Removal of the underlying neoplasm results in complete resolution of all biochemical, pathologic, and physical manifestations of this disorder, as shown in our 3 patients. Because the neoplasms are small and can occur in any tissue compartment, they are difficult to localize, a feature that often results in therapeutic failure.

Conclusion: We conclude that use of whole-body Tc 99m sestamibi scanning may be an appropriate and cost-effective initial strategy for the localization of peripheral phosphatonin-secreting tumors.

MeSH terms

  • Aged
  • Bone Neoplasms / complications
  • Bone Neoplasms / diagnostic imaging*
  • Bone Neoplasms / pathology
  • Bone Neoplasms / surgery
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Mesoderm / pathology
  • Middle Aged
  • Neoplasms, Adipose Tissue / complications
  • Neoplasms, Adipose Tissue / diagnostic imaging*
  • Neoplasms, Adipose Tissue / pathology
  • Neoplasms, Adipose Tissue / surgery
  • Neoplasms, Connective Tissue / complications
  • Neoplasms, Connective Tissue / diagnostic imaging*
  • Neoplasms, Connective Tissue / pathology
  • Neoplasms, Connective Tissue / surgery
  • Osteomalacia / diagnostic imaging*
  • Osteomalacia / etiology
  • Osteomalacia / pathology
  • Radionuclide Imaging
  • Risk Assessment
  • Sampling Studies
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Technetium Tc 99m Sestamibi*

Substances

  • Technetium Tc 99m Sestamibi