PMC8209372_01
Radiological images of the fragility fractures diagnosed before the diagnosis of TIO. Compression fractures and kyphoscoliosis of the spine in CT (A), MRI scan showing fragility fracture of the lateral condyle of the right tibia (B), X-ray of the fragility fracture of left femoral neck (C) and X-ray of pelvis showing arthroplasty of the left hip and osteosynthesis performed after fragility fractures in right femoral shaft and lateral condyle after surgery (D). CT scan of the tumor in the mandible (E), hematoxylin and eosin staining (F) (18.4 x) and vimentin staining (positive) (15.9 x) (G) of the tumor.
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Fractures were found in the vertebrae ( Figure 1A ), right femur, sacrum and lateral condyle of the right tibia, and in the left talus. During the year before the diagnosis, she suffered from a stress fracture of the left femur with significant dislocation ( Figure 1C ), which was treated with total hip arthroplasty, as well as a stress fracture of the right femur that was treated with an intramedullary nail ( Figure 1D ). Within the next months, she also suffered from stress fractures of the right distal femur, tibia ( Figure 1B ) and humerus. CT confirmed a tumor with invasive growth in the right mandible ( Figure 1E ). Cytologic analysis of a fine needle aspiration taken from the tumor demonstrated myoepithelial-like cells. Histopathological examination of formalin-fixed and paraffin-embedded slides demonstrated a 2.6 cm phosphaturic mesenchymal tumor with multinucleated, osteoclast-like cells ( Figure 1F ), with minimum tumor free resection margins of 0.5 mm.
Timeline showing serum phosphate and FGF23 (C-terminus) concentrations at diagnosis and postoperatively. Time of surgery is marked with the black triangle and X-axis presents the time in months relative to surgery. Reference ranges are 0.76-1.41 mmol/l, and 26-110 kRU/l are marked to the y-axes with a bar, respectively.
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Serum FGF23 concentrations decreased immediately after the operation and have remained slightly increased ( Figure 2 ).