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


CONCLUSIONS
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.
Hodgson
Stephen F
SF
Division of Endocrinology, Diabetes, Nutrition & Metabolism, Mayo Clinic Rochester, Rochester, Minnesota 55905, USA.
Clarke
Bart L
BL
Tebben
Peter J
PJ
Mullan
Brian P
BP
Cooney
William P
WP
Shives
Thomas C
TC
D000368:Aged; D001859:Bone Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008648:Mesoderm / Q000473:pathology; D008875:Middle Aged; D018205:Neoplasms, Adipose Tissue / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D009372:Neoplasms, Connective Tissue / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010018:Osteomalacia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D011877:Radionuclide Imaging; D018570:Risk Assessment; D012494:Sampling Studies; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D017256:Technetium Tc 99m Sestamibi
D017256:Technetium Tc 99m Sestamibi