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CLINICAL IMAGE
Year : 2020  |  Volume : 152  |  Issue : 7  |  Page : 222-223

Phosphaturic mesenchymal tumour: A rare tumour & its diagnostic dilemma


Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai 400 012, Maharashtra, India

Date of Submission20-Nov-2019
Date of Web Publication25-May-2021

Correspondence Address:
Sudhir Kumar Srivastava
Department of Orthopaedics, Seth Gordhandas Sunderdas Medical College & King Edward Memorial Hospital, Mumbai 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_2371_19

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How to cite this article:
Srivastava SK, Raj A. Phosphaturic mesenchymal tumour: A rare tumour & its diagnostic dilemma. Indian J Med Res 2020;152, Suppl S1:222-3

How to cite this URL:
Srivastava SK, Raj A. Phosphaturic mesenchymal tumour: A rare tumour & its diagnostic dilemma. Indian J Med Res [serial online] 2020 [cited 2021 Jul 30];152, Suppl S1:222-3. Available from: https://www.ijmr.org.in/text.asp?2020/152/7/222/316840

Patient consent obtained to publish clinical information and images.


A 32 yr old male presented to the department of Orthopaedics, Seth G.S. Medical College, Mumbai, India, in July 2019, complaining generalized arthralgia, weakness and difficulty in walking [Figure 1] for the past five years and was diagnosed as a case of phosphaturic mesenchymal tumour (PMT) of the proximal fibula with severe osteomalacia and elevated fibroblast growth factor (FGF)-23 [Figure 2] and [Figure 3]. Surgical excision of the right proximal fibula was planned and carried out along with calcium, phosphate and vitamin D supplementation [Figure 4], [Figure 5], [Figure 6]. Post-surgery, the patient's phosphate and FGF-23 levels returned to normal and his symptoms largely resolved at seven months of follow up.
Figure 1: Bilateral malunited subcapital neck femur fractures (arrows) and coxa vara deformity.

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Figure 2: A seemingly normal radiograph of the knee joint and tibia anteroposterior view.

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Figure 3: STIR magnetic resonance imaging coronal image with a hyperintense signal intensity in the right proximal fibula (arrow).

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Figure 4: Intra-operative photograph demonstrating the common peroneal nerve (blue arrow) dissected free off the right proximal fibula (black arrow).

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Figure 5: Intra-operative image demonstrating dissection of expanded right proximal fibula (arrow) and excision of proximal fibula around 6 cm of length with normal tumour-free margin.

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Figure 6: Post-operative radiograph with proximal fibula excision and reattachment of the lateral ligament complex by suture anchor (arrow).

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PMTs are rare tumours which are frequently associated with tumour-induced osteomalacia that manifests as renal phosphate wasting. It should be kept as a differential diagnosis in mind when treating patients with severe osteomalacia and pathological fractures [Figure 1] because isolated calcium and vitamin D supplementation is inadequate to treat this uncommon condition and renal phosphate wasting promptly resolves upon removal of the tumour.

Conflicts of Interest: None.


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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