Tumor-induced Osteomalacia in a 3-Year-Old With Unresectable Central Giant Cell Lesions.
Tumor-induced osteomalacia (TIO) is a rare cause of hypophosphatemia involving overproduction of fibroblast growth factor 23. TIO has been described largely in adults with small mesenchymal tumors. We report a case of TIO in a child who presented with knee pain and radiographic findings concerning for rickets, and was found to have maxillomandibular giant cell lesions. The patient was treated with oral phosphorus and calcitriol, surgical debulking, and intralesional corticosteroids, which resulted in tumor regression and normalization of serum fibroblast growth factor 23 and phosphorus. This case illustrates the occurrence of this rare paraneoplastic syndrome in children and adds to our knowledge about clinical manifestations and pathologic findings associated with pediatric TIO.
Divisions of *Pediatric Endocrinology and Diabetes §Medical Genetics ¶Pediatric Hematology and Oncology Departments of †Pathology ‡Radiology ∥Otolaryngology, Stanford University School of Medicine, Stanford, CA.
Stephanie S
SS
Crossen
Eduardo
E
Zambrano
Beverley
B
Newman
Jonathan A
JA
Bernstein
Anna H
AH
Messner
Laura K
LK
Bachrach
Clare J
CJ
Twist
D000505:Alopecia / Q000209:etiology; D002117:Calcitriol / Q000627:therapeutic use; D002675:Child, Preschool; D003131:Combined Modality Therapy; D065426:Cytoreduction Surgical Procedures; D003937:Diagnosis, Differential; D000089703:Fibroblast Growth Factor-23; D005346:Fibroblast Growth Factors / Q000096:biosynthesis; D056304:Genu Valgum / Q000209:etiology; D005870:Giant Cell Tumors / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D006801:Humans; D017674:Hypophosphatemia / Q000209:etiology; D015552:Injections, Intralesional; D008297:Male; D008339:Mandibular Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D008441:Maxillary Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000378:metabolism / Q000601:surgery; D009363:Neoplasm Proteins / Q000096:biosynthesis; D019226:Oral Ulcer / Q000209:etiology; D010018:Osteomalacia / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010257:Paraneoplastic Syndromes / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D010758:Phosphorus / Q000627:therapeutic use; D012279:Rickets / Q000175:diagnosis; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use
D009363:Neoplasm Proteins; D014221:Triamcinolone; D010758:Phosphorus; D005346:Fibroblast Growth Factors; D000089703:Fibroblast Growth Factor-23; D002117:Calcitriol