Cases reported "Osteomalacia"

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1/8. Oncogenic osteomalacia presenting as bilateral stress fractures of the tibia.

    We report on a patient with bilateral stress fractures of the tibia who subsequently showed classic biochemical features of oncogenic osteomalacia. Conventional radiographs were normal. MR imaging revealed symmetric, bilateral, band-like low-signal lesions perpendicular to the medial cortex of the tibiae and corresponding to the only lesions subsequently seen on the bone scan. A maxillary sinus lesion was subsequently detected and surgically removed resulting in prompt alleviation of symptoms and normalization of hypophosphatemia and low 1,25-(OH)2 vitamin D3. The lesion was pathologically diagnosed as a hemangiopericytoma-like tumor. patients with oncogenic osteomalacia may present with stress fractures limited to the tibia, as seen in athletes. The clue to the real diagnosis lies in paying close attention to the serum phosphate levels, especially in patients suffering generalized symptoms of weakness and not given to unusual physical activity.
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keywords = tibia
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2/8. Phosphaturic mesenchymal tumor-induced rickets.

    We describe two prepubertal girls with oncogenic rickets. The first patient, 9 years of age, presented with recent-onset lower-extremity pain. The second girl, presented at 4 years of age following a 9-month period of muscle weakness, bone pain, and poor linear growth. Laboratory analyses in both patients revealed hypophosphatemia and hyperphosphaturia; elevated circulating alkaline phosphatase activity was present in one of them. Radiographic evidence of a generalized rachitic process was evident in both cases. Computerized tomography of the paranasal sinuses and facial bones in patient 1 revealed a small lesion eroding through the inner table of the left mandibular ramus. Microscopic examination of this mass revealed a spindle cell neoplasm with chondroid material, dystrophic calcification, and both osteoclast-like and fibroblast-like cells. Prominent vascularity and marked atypia were present. These features are consistent with a phosphaturic mesenchymal tumor of the mixed connective tissue variant. In the second patient, computerized tomography revealed a lytic lesion located in the right proximal tibia, with histologic features consistent with a phosphaturic mesenchymal tumor of the nonossifying fibroma-like variant. Resection of each tumor resulted in rapid correction of the phosphaturia and healing of the rachitic abnormalities. A careful search for small or occult tumors should be carried out in cases of acquired phosphaturic rickets.
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ranking = 0.14285714285714
keywords = tibia
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3/8. osteoblastoma as a cause of osteomalacia assessed by bone scan.

    A 27-year-old female patient was admitted to our hospital with a history of leg pain and mass. She had a benign osteoblastoma in right tibia. Resection of the tumor without treatment by vitamin d antagonist resulted in rapid cure of the osteomalacia. Bone scintigraphy with Tc-99m MDP revealed multiple hot uptakes in initial scan, and follow up scan showed a clear resolution of the lesions.
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ranking = 0.14285714285714
keywords = tibia
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4/8. Osteomesopycnosis. A new case.

    A 10-year old, mentally and physically normally developed girl complained of back pain following an accident. Radiological findings revealed an inhomogeneous, coarse osteosclerosis along the endplates and posterior parts of the ovoid shaped vertebral bodies, in the proximal and distal femora-, proximal humeri and tibia epiphyses, and along the lateral aspects of the femoral necks. The pelvis presented a mottled appearance of the trabecular pattern at the symphysis pubis and the lateral parts of ischii and sclerosis in the acetabular region. The only laboratory abnormality was a high serum parathormone level. The family history revealed an autosomal dominant inheritance. The name proposed by Maroteaux for this skeletal disorder is osteomesopycnosis, as the lesions were localized to the spine, pelvis and sometimes proximal femur. The skull, ribs, long bones, hands and feet were not involved in the reported 12 cases. Radiographs of this patient showed in addition changes in the hand. This disease must be distinguished from atypical axial osteomalacia.
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ranking = 0.14285714285714
keywords = tibia
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5/8. fanconi syndrome associated with a non-ossifying fibroma of bone.

    A 20-year-old man presenting with osteomalacia was found to have the fanconi syndrome, as evidenced by hypophosphatemia with hyperphosphaturia, glycosuria in the presence of normoglycemia, and generalized aminoaciduria. After removal of a non-ossifying fibroma of the left tibia, the renal tubular abnormalities promptly resolved with subsequent healing of the osteomalacia. A humoral factor released from the tumor may have caused the disorder in proximal renal tubular cell transport.
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ranking = 0.14285714285714
keywords = tibia
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6/8. Normal hepatic vitamin-D metabolism in icteric primary biliary cirrhosis associated with pronounced vitamin-D deficiency symptoms.

    The intestinal absorption and hepatic metabolism of vitamin d were studied in a woman with icteric primary biliary cirrhosis (PBC) complicated by pronounced bone pain and muscle weakness due to vitamin-D deficiency. The patient had a markedly reduced intestinal absorption of vitamin d, while the 25-hydroxylation of this vitamin was found to be normal despite the presence of longstanding icterus. The malabsorption of fat-soluble compounds secondary to the cholestasis was probably further impaired by several years of cholestyramine treatment. Administration of 1.25-(OH)2D3 increased intestinal calcium absorption, normalized serum calcium and increased bone mineral content of the proximal tibia. Furthermore, drastic improvement of muscle weakness and relief of bone pain were observed. It is recommended that repeated measurements of serum 25-(OH)D should be carried out in patients with PBC, and especially in those treated with cholestyramine. In certain vitamin d deficient patients, studies using radio-labelled vitamin d may provide clinically valuable information as to the exact site of the underlying disturbances.
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ranking = 0.14285714285714
keywords = tibia
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7/8. Hypophosphataemic osteomalacia associated with a malignant tumour of the tibia: report of a case.

    A case of vitamin d resistant hypophosphataemic osteomalacia with glycosuria and aminoaciduria is reported. The course of the disease was dramatically altered by the removal of a bone sarcoma which probably had been growing slowly since the onset of the patient's symptoms five years previously. The histology and electron microscopy of the tumour are described. Three years after the operation the patient remains free of symptoms.
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ranking = 0.57142857142857
keywords = tibia
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8/8. Flare response seen in therapy for osteomalacia.

    We report an interesting case of osteomalacia in which flare response was seen during therapy. The first 99mTc-methylene diphosphonate bone scan showed increased bilateral and symmetric uptake in the ribs, clavicles and iliac bones. Thoracic CT showed symmetric radiolucent seams (Looser's zones) in both ribs, which were pathognomonic of osteomalacia. After initiation of therapy with vitamin d, the patient's subjective symptoms gradually were relieved. On a second bone scan 4 mo. after initiation of therapy, the hot spots in the ribs remained unchanged. Uptake in the bilateral clavicles had become more intense, and new hot spots were recognized in the right lower ribs and left tibia. A third bone scan after 10 mo. demonstrated an obvious decrease in the number and intensity of the hot spots. Increased uptakes in the second scan were thought to be a flare response caused by therapy.
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ranking = 0.14285714285714
keywords = tibia
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