S P E C I A L I m a g e
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F E A T U R E
E n d o c r i n o l o g y
Oncogenic Osteomalacia Caused by Renal Cell Carcinoma Yi Xie and Han-zhong Li Departments of Urology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
ncogenic osteomalacia (OO), also known as tumorinduced osteomalacia, is a rare paraneoplastic syndrome (1, 2). A 17-year-old male was admitted with a history of progressively worsened bilateral limb weakness, muscle atrophy, and pains of ankle and knee joints for 4 years (Figure 1). The patient gradually became unable to walk. Physical examination showed thoracic deformation, tenderness of left ribs, and decreased myodynamia of lower limbs. His x-rays showed decreasedbonedensityofpelvisandwedgecompressionoflumbar spine (Figure 2, left). Computed tomography confirmed the presence of soft tissue occupation in the left kidney (Figure 2, right). Biochemical investigations confirmed osteomalacia that was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphatemic osteomalacia. These evidences indicated thecauseasOO,whichwasconfirmedonoctreotidescan.Aleft radical nephrectomy was performed, and a tumor (15.1 ⫻
O
14.5 ⫻ 13.2 cm) covered by twisted veins was removed. The histologicaldiagnosiswasrenalclearcellcarcinoma.Sevendays after the operation, the serum phosphate level returned to normal (1.25 mmol/L), compared with that before surgery (0.55 mmol/L), and the myodynamia of lower limbs was improved obviously. The patient received no radiation or chemotherapy. There was no evidence of recurrence for 4 years after surgery. The case presented is the first case of OO caused by renal clear cell carcinoma. In conclusion, if a patient presents a tumor together with osteomalacia, the diagnosis of OO should be considered. Early detection and removal of the tumor are crucial for successful treatment of OO (3, 4).
Acknowledgments Address all correspondence and requests for reprints to: Hanzhong Li, Departments of Urology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing 100730, China. E-mail: [email protected]. Disclosure Summary: The authors have nothing to disclose.
References
Figure 1. Severe muscle atrophy of bilateral lower limb. ISSN Print 0021-972X ISSN Online 1945-7197 Printed in U.S.A. Copyright © 2013 by The Endocrine Society Received September 1, 2013. Accepted October 7, 2013. First Published Online November 11, 2013
doi: 10.1210/jc.2013-3335
1. Chong WH, Molinolo AA, Chen CC, Collins MT. Tumor-induced osteomalacia. Endocr Relat Cancer. 2011;18:R53–R77. 2. Jiang Y, Xia WB, Xing XP, et al. Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: report of 39 cases and review of the literature. J Bone Miner Res. 2012;27:1967–1975. 3. Folpe AL, Fanburg-Smith JC, Billings SD, et al. Most osteomalaciaassociated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol. 2004;28:1–30. 4. Chiam P, Tan HC, Bee YM, Chandran M. Oncogenic osteomalacia— hypophosphataemic spectrum from “benignancy” to “malignancy.” Bone. 2013;53:182–187. Abbreviation: OO, oncogenic osteomalacia.
J Clin Endocrinol Metab, December 2013, 98(12):4597– 4598
jcem.endojournals.org
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 05 November 2015. at 19:40 For personal use only. No other uses without permission. . All rights reserved.
4597
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Xie and Li
OO Caused by RCC
J Clin Endocrinol Metab, December 2013, 98(12):4597– 4598
Figure 2. Left, X-ray showed decreased pelvic bone density, fuzzy gap of hip joint and sacroiliac joint; right, computed tomography scan showed a huge and moderate enhanced soft tissue mass covered by twisted veins at the lower pole of left kidney.
Mark Your Calendar for Clinical Endocrinology Update September 4-6, 2014, San Francisco, California www.endocrine.org/CEU The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 05 November 2015. at 19:40 For personal use only. No other uses without permission. . All rights reserved.
i n
F E A T U R E
E n d o c r i n o l o g y
Oncogenic Osteomalacia Caused by Renal Cell Carcinoma Yi Xie and Han-zhong Li Departments of Urology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing 100730, China
ncogenic osteomalacia (OO), also known as tumorinduced osteomalacia, is a rare paraneoplastic syndrome (1, 2). A 17-year-old male was admitted with a history of progressively worsened bilateral limb weakness, muscle atrophy, and pains of ankle and knee joints for 4 years (Figure 1). The patient gradually became unable to walk. Physical examination showed thoracic deformation, tenderness of left ribs, and decreased myodynamia of lower limbs. His x-rays showed decreasedbonedensityofpelvisandwedgecompressionoflumbar spine (Figure 2, left). Computed tomography confirmed the presence of soft tissue occupation in the left kidney (Figure 2, right). Biochemical investigations confirmed osteomalacia that was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphatemic osteomalacia. These evidences indicated thecauseasOO,whichwasconfirmedonoctreotidescan.Aleft radical nephrectomy was performed, and a tumor (15.1 ⫻
O
14.5 ⫻ 13.2 cm) covered by twisted veins was removed. The histologicaldiagnosiswasrenalclearcellcarcinoma.Sevendays after the operation, the serum phosphate level returned to normal (1.25 mmol/L), compared with that before surgery (0.55 mmol/L), and the myodynamia of lower limbs was improved obviously. The patient received no radiation or chemotherapy. There was no evidence of recurrence for 4 years after surgery. The case presented is the first case of OO caused by renal clear cell carcinoma. In conclusion, if a patient presents a tumor together with osteomalacia, the diagnosis of OO should be considered. Early detection and removal of the tumor are crucial for successful treatment of OO (3, 4).
Acknowledgments Address all correspondence and requests for reprints to: Hanzhong Li, Departments of Urology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, 1 Shuai-Fu-Yuan, Wang-Fu-Jing, Beijing 100730, China. E-mail: [email protected]. Disclosure Summary: The authors have nothing to disclose.
References
Figure 1. Severe muscle atrophy of bilateral lower limb. ISSN Print 0021-972X ISSN Online 1945-7197 Printed in U.S.A. Copyright © 2013 by The Endocrine Society Received September 1, 2013. Accepted October 7, 2013. First Published Online November 11, 2013
doi: 10.1210/jc.2013-3335
1. Chong WH, Molinolo AA, Chen CC, Collins MT. Tumor-induced osteomalacia. Endocr Relat Cancer. 2011;18:R53–R77. 2. Jiang Y, Xia WB, Xing XP, et al. Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: report of 39 cases and review of the literature. J Bone Miner Res. 2012;27:1967–1975. 3. Folpe AL, Fanburg-Smith JC, Billings SD, et al. Most osteomalaciaassociated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol. 2004;28:1–30. 4. Chiam P, Tan HC, Bee YM, Chandran M. Oncogenic osteomalacia— hypophosphataemic spectrum from “benignancy” to “malignancy.” Bone. 2013;53:182–187. Abbreviation: OO, oncogenic osteomalacia.
J Clin Endocrinol Metab, December 2013, 98(12):4597– 4598
jcem.endojournals.org
The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 05 November 2015. at 19:40 For personal use only. No other uses without permission. . All rights reserved.
4597
4598
Xie and Li
OO Caused by RCC
J Clin Endocrinol Metab, December 2013, 98(12):4597– 4598
Figure 2. Left, X-ray showed decreased pelvic bone density, fuzzy gap of hip joint and sacroiliac joint; right, computed tomography scan showed a huge and moderate enhanced soft tissue mass covered by twisted veins at the lower pole of left kidney.
Mark Your Calendar for Clinical Endocrinology Update September 4-6, 2014, San Francisco, California www.endocrine.org/CEU The Endocrine Society. Downloaded from press.endocrine.org by [${individualUser.displayName}] on 05 November 2015. at 19:40 For personal use only. No other uses without permission. . All rights reserved.
