A clinical case of phosphopenic osteomalacia due to paraneoplastic secretion of metastatic prostate cance
https://doi.org/10.14341/osteo12948
Abstract
Phosphaturic mesenchymal tumor can cause osteomalacia due to excessive secretion of fibroblast growth factor 23 (FGF23), which disrupts the metabolism of phosphate and vitamin D. These tumors are predominantly benign, but less than 5% of them are malignant forms. This article presents the first clinical case in the Russian Federation of a 69-year-old patient with severe hypophosphatemia due to metastatic prostate cancer. Increased secretion of FGF23 are described in the androgen-resistent prostate cancer, which led to pronounced disorders of mineral metabolism, accompanied by a clinical symptom of weakness, pain in the bones, immobilization of the patient. The condition was regarded as worsening against the background of the progression of the disease. However, symptomatic therapy aimed at increasing the level of phosphate significantly improved the patient’s general condition. The medical community should be aware of the possibility of developing hypophosphatemia in patients with weakness and bone pain, which are not always associated with the progression of metastatic prostate cancer.
About the Authors
S. A. GronskayaRussian Federation
Sofya A. Gronskaya, MD
eLibrary SPIN: 7624-0391
11 Dm. Ulyanova street, 117036 Moscow
O. O. Golounina
Russian Federation
Olga O. Golounina, Student, Medical faculty
eLibrary SPIN: 7793-2123
Moscow
Yu. V. Buklemishev
Russian Federation
Yuri V. Buklemishev, MD
eLibrary SPIN: 4329-4720
Moscow
A. V. Khairieva
Russian Federation
Angelina V. Khairieva, MD
eLibrary SPIN: 4516-8297
Moscow
M. V. Degtyarev
Russian Federation
Mikhail V. Degtyarev, MD
eLibrary SPIN-код: 7725-7831
Moscow
L. Ya. Rozhinskaya
Russian Federation
eLibrary SPIN: 5691-7775
Moscow
Zh. E. Belaya
Russian Federation
Zhanna E. Belaya, MD, PhD, Professor
eLibrary SPIN: 4746-7173
Moscow
References
1. Grebennikova TA, Umiarova DSh, Slashchuk KY, et al. Tumor-induced osteomalacia: a clinical case report. Osteoporosis and Bone Diseases. 2019;21(4):24-28. (In Russ.). doi: https://doi.org/10.14341/osteo10264.
2. Rodionova SS, Snetkov AI, Akinshina AD, et al. Hypophosphatemic osteomalacia induced by FGF23-secreting tumor of the left femur. Rheumatol Sci Pract. 2019;57(6):708-712. (In Russ.). doi: https://doi.org/10.14412/1995-4484-2019-708-712
3. Bulycheva IV, Rodionova SS, Karpenko VY, et al. Oncogenic osteomalacia/phosphaturic mesenchymal tumor: clinical case and literature review. Bone soft tissue sarcomas, tumors Ski. 2022;14(1):48-54. (In Russ.). doi: https://doi.org/10.17650/2782-3687-2022-14-1-48-54
4. Mak MP, da Costa e Silva VT, Martin RM, et al. Advanced prostate cancer as a cause of oncogenic osteomalacia: an underdiagnosed condition. Support Care Cancer. 2012;20(9):2195-2197. doi: https://doi.org/10.1007/s00520-012-1474-z
5. Layman AAK, Joshi S, Shah S. Metastatic prostate cancer presenting as tumour-induced osteomalacia. BMJ Case Rep. 2019;12(7):e229434. doi: https://doi.org/10.1136/bcr-2019-229434
6. Abramson M, Glezerman IG, Srinivasan M, et al. Hypophosphatemia and FGF23 tumor-induced osteomalacia in two cases of metastatic breast cancer. Clin Nephrol. 2021;95(2):104-111. doi: https://doi.org/10.5414/CN110242
7. Abate EG, Bernet V, Cortese C, Garner HW. Tumor induced osteomalacia secondary to anaplastic thyroid carcinoma: A case report and review of the literature. Bone Reports. 2016;5(2):81-85. doi: https://doi.org/10.1016/j.bonr.2015.11.004
8. Leaf DE, Pereira RC, Bazari H, Jüppner H. Oncogenic osteomalacia due to FGF23-expressing colon adenocarcinoma. J Clin Endocrinol Metab. 2013;98(3):887-891. doi: https://doi.org/10.1210/jc.2012-3473
9. Sauder A, Wiernek S, Dai X, et al. FGF23-Associated tumor-induced osteomalacia in a patient with small cell carcinoma. Int J Surg Pathol. 2016;24(2):116-120. doi: https://doi.org/10.1177/1066896915617828
10. Auethavekiat P, Roberts JR, Biega TJ, et al. Difficult diagnostic cases: CASE 3. oncogenic osteomalacia associated with hemangiopericytoma localized by octreotide scan. J Clin Oncol. 2005;23(15):3626-3628. doi: https://doi.org/10.1200/JCO.2005.05.043
11. Kinoshita Y, Takashi Y, Ito N, et al. Ectopic expression of Klotho in fibroblast growth factor 23 (FGF23)-producing tumors that cause tumor-induced rickets/osteomalacia (TIO). Bone Reports. 2019;10(15):100192. doi: https://doi.org/10.1016/j.bonr.2018.100192
12. Weidner N, Cruz DS. Phosphaturic mesenchymal tumors. A polymorphous group causing osteomalacia or rickets. Cancer. 1987;59(8):1442-1454. doi: https://doi.org/10.1002/1097-0142(19870415)59:8<1442::AID-CNCR2820590810>3.0.CO;2-Q
13. Oyama N, Kojima-Ishii K, Toda N, et al. Malignant transformation of phosphaturic mesenchymal tumor: a case report and literature review. Clin Pediatr Endocrinol. 2020;29(2):69-75. doi: https://doi.org/10.1297/cpe.29.69
14. Hosking DJ, Chamberlain MJ, Shortland-Webb WR. Osteomalacia and carcinoma of prostate with major redistribution of skeletal calcium. Br J Radiol. 1975;48(570):451-456. doi: https://doi.org/10.1259/0007-1285-48-570-451
15. Folpe AL. Phosphaturic mesenchymal tumors: A review and update. Semin Diagn Pathol. 2019;36(4):260-268. doi: https://doi.org/10.1053/j.semdp.2019.07.002
16. Sundaram M, McCarthy EF. Oncogenic osteomalacia. Skeletal Radiol. 2000;29(3):117-124. doi: https://doi.org/10.1007/s002560050581
17. Fizazi K, Carducci M, Smith M, et al. Denosumab versus zoledronic acid for treatment of bone metastases in men with castration-resistant prostate cancer: a randomised, double-blind study. Lancet. 2011;377(9768):813-822. doi: https://doi.org/10.1016/S0140-6736(10)62344-6
18. Saad F, Gleason DM, Murray R, et al. Long-Term efficacy of zoledronic acid for the prevention of skeletal complications in patients with metastatic hormone-refractory prostate cancer. J Natl Cancer Inst. 2004;96(11):879-882. doi: https://doi.org/10.1093/jnci/djh141
19. Lesnyak O, Gladkova E, Aleksandrov N, et al. Treatment of high fracture risk patients in routine clinical practice. Arch Osteoporos. 2020;15(1):184. doi: https://doi.org/10.1007/s11657-020-00851-z
20. Golounina OO, Belaya ZE. Bisphosphonates: 50 years in clinical practice. Consilium Medicum. 2020;22(4):66-73. (In Russ.). doi: https://doi.org/10.26442/20751753.2020.4.200102.
21. Rozhinskaya LYa, Gronskaia SA, Mamedova EO, et al. The comparative efficiency of denosumab treatment in patients with postmenopausal osteoporosis, primary hyperparathyroidism and glucocorticoid-induced osteoporosis in real clinical practice. Osteoporosis and Bone Diseases. 2021;23(1):4-13. (In Russ.). doi: https://doi.org/10.14341/osteo12415
22. Golounina OO, Runova GE, Fadeyev VV. Osteomalacia in practice of endocrinologist: etiology, pathogenesis, differential diagnosis with osteoporosis. Osteoporosis and Bone Diseases. 2020;22(2):23-31. (In Russ.). doi: https://doi.org/10.14341/osteo12117
23. Chong WH, Molinolo AA, Chen CC, Collins MT. Tumor-induced osteomalacia. Endocr Relat Cancer. 2011;18(3):R53-R77. doi: https://doi.org/10.1530/ERC-11-0006
24. Feng J, Jiang Y, Wang O, et al. The diagnostic dilemma of tumor induced osteomalacia: a retrospective analysis of 144 cases. Endocr J. 2017;64(7):675-683. doi: https://doi.org/10.1507/endocrj.EJ16-0587
25. Eremkina AK, Mirnaya SS, Gorbacheva AM, et al. The case of oncogenic hypophosphatemic osteomalacia. Obesity and metabolism. 2020;17(2):220-227. (In Russ.). doi: https://doi.org/10.14341/omet12472.
26. Payne RB. Renal tubular reabsorption of phosphate (TmP/GFR): indications and interpretation. Ann Clin Biochem. 1998;35(Pt2):201-206. doi: https://doi.org/10.1177/000456329803500203
27. Folpe AL, Fanburg-Smith JC, Billings SD, et al. Most Osteomalacia-associated Mesenchymal Tumors Are a Single Histopathologic Entity. Am J Surg Pathol. 2004;28(1):1-30. doi: https://doi.org/10.1097/00000478-200401000-00001
28. Gibril F. Somatostatin Receptor Scintigraphy: Its Sensitivity Compared with That of Other Imaging Methods in Detecting Primary and Metastatic Gastrinomas: A Prospective Study. Ann Intern Med. 1996;125(1):26. doi: https://doi.org/10.7326/0003-4819-125-1-199607010-00005
29. Yavropoulou MP, Gerothanasi N, Frydas A, et al. Tumor-induced osteomalacia due to a recurrent mesenchymal tumor overexpressing several growth factor receptors. Endocrinol Diabetes Metab Case Rep. 2015;2015:150025. doi: https://doi.org/10.1530/EDM-15-0025
30. Pushkareva AS, Bibik EE, Eremkina AK, et al. Phosphopenic form of osteomalacia in a patient with FGF23 producing tumor. Rheumatol Sci Pract. 2022;60(2):249-255. (In Russ.). doi: https://doi.org/10.47360/1995-4484-2022-249-255
31. Rodionova SS. Metabolicheskie osteopatii: sistemnyi osteoporoz i osteomaliatsiia u vzroslykh [dissertation]. Moscow; 1992. (In Russ.).
32. Florenzano P, Hartley IR, Jimenez M, et al. Tumor-induced osteomalacia. Calcif Tissue Int. 2021;108(1):128-142. doi: https://doi.org/10.1007/s00223-020-00691-6
33. Li X, Jiang Y, Huo L, et al. Nonremission and Recurrent Tumor‐Induced Osteomalacia: A Retrospective Study. J Bone Miner Res. 2020;35(3):469-477. doi: https://doi.org/10.1002/jbmr.3903
34. Yamada Y, Kinoshita I, Kenichi K, et al. Histopathological and genetic review of phosphaturic mesenchymal tumours, mixed connective tissue variant. Histopathology. 2018;72(3):460-471. doi: https://doi.org/10.1111/his.13377
35. Uchihashi K, Nishijima-Matsunobu A, Matsuyama A, et al. Phosphaturic mesenchymal tumor, nonphosphaturic variant, causing fatal pulmonary metastasis. Hum Pathol. 2013;44(11):2614-2618. doi: https://doi.org/10.1016/j.humpath.2013.04.027
36. Morimoto T, Takenaka S, Hashimoto N, et al. Malignant phosphaturic mesenchymal tumor of the pelvis: A report of two cases. Oncol Lett. 2014;8(1):67-71. doi: https://doi.org/10.3892/ol.2014.2081
37. Seijas R, Ares O, Sierra J, Pérez-Dominguez M. Oncogenic osteomalacia: two case reports with surprisingly different outcomes. Arch Orthop Trauma Surg. 2009;129(4):533-539. doi: https://doi.org/10.1007/s00402-008-0808-2
38. Sidell D, Lai C, Bhuta S, et al. Malignant phosphaturic mesenchymal tumor of the larynx. Laryngoscope. 2011;129(4):1860–1863. doi: https://doi.org/10.1002/lary.21916
39. Jan de Beur SM, Miller PD, Weber TJ, et al. Burosumab for the treatment of tumor‐induced osteomalacia. J Bone Miner Res. 2021;36(4):627-635. doi: https://doi.org/10.1002/jbmr.4233
40. Ho BB, Bergwitz C. FGF23 signalling and physiology. J Mol Endocrinol. 2021;66(2):R23-R32. doi: https://doi.org/10.1530/JME-20-0178
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For citations:
Gronskaya S.A., Golounina O.O., Buklemishev Yu.V., Khairieva A.V., Degtyarev M.V., Rozhinskaya L.Ya., Belaya Zh.E. A clinical case of phosphopenic osteomalacia due to paraneoplastic secretion of metastatic prostate cance. Osteoporosis and Bone Diseases. 2022;25(4):43-51. (In Russ.) https://doi.org/10.14341/osteo12948

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