Ovarian cancer-related hypophosphatemic osteomalacia--a case report

Hung-An Lin, Shyang-Rong Shih, Yu-Ting Tseng, Chi-Hau Chen, Wei-Yih Chiu, Chih-Yao Hsu, Keh-Sung Tsai, Hung-An Lin, Shyang-Rong Shih, Yu-Ting Tseng, Chi-Hau Chen, Wei-Yih Chiu, Chih-Yao Hsu, Keh-Sung Tsai

Abstract

Context: Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused primarily by benign mesenchymal tumors. It has been associated with malignancies in rare cases. High serum levels of fibroblast growth factor (FGF) 23 reported in a group of patients with ovarian cancer had normal serum phosphate levels. There had been no ovarian cancer-related hypophosphatemic osteomalacia in a search of the literature.

Objective: We investigated a 57-year-old woman with progressive low back pain.

Design and intervention: Clinical, biochemical, and radiological assessments were performed. The patient's serum phosphate and FGF23 levels were evaluated at baseline and after treatment for ovarian cancer.

Results: The patient presented with progressive low back pain and weight loss during the previous 6 months. Imaging studies revealed low bone mineral density and multiple suspicious spinal metastatic lesions. Laboratory examination showed hypophosphatemia, hyperphosphaturia, normocalcemia, an elevated serum alkaline phosphatase level, and an elevated serum FGF23 level. Because TIO was suspected, a tumor survey was performed, and ovarian carcinoma with multiple metastasis was detected. After surgery and chemotherapy treatments for ovarian cancer, the serum phosphate and FGF23 levels returned to normal, and the low back pain improved.

Conclusions: To our knowledge, this is the first case of ovarian cancer-related hypophosphatemic osteomalacia reported in the literature. TIO should be considered in patients with ovarian cancer presenting with weakness, bone pain, and fractures. Investigation of TIO is appropriate when these patients present hypophosphatemia.

Trial registration: ClinicalTrials.gov NCT01660308.

Figures

Figure 1.
Figure 1.
CT scan showing multilobulated cystic lesions over the left adnexa.
Figure 2.
Figure 2.
Pathological specimen of the hepatic tumor showing an undifferentiated carcinoma with high cellularity and an infiltrative pattern (magnification, ×400; hematoxylin and eosin stain).
Figure 3.
Figure 3.
The treatment course and laboratory data. P, Serum phosphate level; CA-125, cancer antigen 125.
Figure 4.
Figure 4.
Comparison of serum FGF23 and phosphorus (P) levels between the present case and 19 TIO cases reported in three case series (1, 9, 10). (The arrow points to the present case.) FGF23 levels > 2000 pg/mL are presented at the level of 2000, with the exact data shown above.

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Source: PubMed

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