{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T04:27:21Z","timestamp":1765254441824,"version":"3.41.2"},"reference-count":38,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T00:00:00Z","timestamp":1734566400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by hypophosphatemia caused by excessive secretion of fibroblast growth factor-23 (FGF-23) by tumors. This leads to impaired bone mineralization and, ultimately, osteomalacia. The most common underlying cause is a phosphaturic mesenchymal tumor (PMT). Due to its rarity, nonspecific clinical presentation, and limited clinician awareness, TIO is frequently underdiagnosed or misdiagnosed. A 42-year-old man presented with persistent pain in the chest, lower back, knees, and ankles for more than six months, which had worsened in the preceding week. Laboratory tests revealed hypophosphatemia and abnormalities in markers of bone metabolism. Symptomatic treatment provided minimal improvement. The whole-body PET\/CT scan subsequently identified a cystic and solid mass in the popliteal fossa of the right knee, with high somatostatin receptor expression. The tumor was surgically removed, and histopathological examination confirmed PMT. The patient\u2019s blood phosphorus concentration returned to normal one week after surgery, and levels of other laboratory indicators gradually returned to normal. Although symptoms persisted during the first postoperative week, significant relief was noted by the second week. This case report highlighted the necessity of improving clinical recognition and management of TIO to ensure timely diagnosis and treatment.<\/jats:p>","DOI":"10.3389\/fonc.2024.1501499","type":"journal-article","created":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T06:24:18Z","timestamp":1734589458000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Phosphaturic mesenchymal tumor of the popliteal fossa: a case report and literature review"],"prefix":"10.3389","volume":"14","author":[{"given":"Yingjie","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shiwei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caixia","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjing","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yimin","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2024,12,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19870415)59:8<1442::AID-CNCR2820590810>3.0.CO;2-Q","article-title":"Phosphaturic mesenchymal tumors. A polymorphous group causing osteomalacia or rickets","volume":"59","author":"Weidner","year":"1987","journal-title":"Cancer"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/00000478-200401000-00001","article-title":"Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: an analysis of 32 cases and a comprehensive review of the literature","volume":"28","author":"Folpe","year":"2004","journal-title":"Am J Surg Pathol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgac253","article-title":"Tumor-induced osteomalacia: A systematic review and individual patient\u2019s data analysis","volume":"107","author":"Rendina","year":"2022","journal-title":"J Clin Endocrinol Metab"},{"key":"B4","doi-asserted-by":"publisher","first-page":"101772","DOI":"10.1016\/j.bonr.2024.101772","article-title":"Tumor-induced osteomalacia: A systematic literature review","volume":"21","author":"Alvarez-Rivas","year":"2024","journal-title":"Bone Rep"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.EJ16-0587","article-title":"The diagnostic dilemma of tumor induced osteomalacia: a retrospective analysis of 144 cases","volume":"64","author":"Feng","year":"2017","journal-title":"Endocr J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad297","article-title":"Tumor-induced osteomalacia in patients with Malignancy: A meta-analysis and systematic review of case reports","volume":"108","author":"Bouraima","year":"2023","journal-title":"J Clin Endocrinol Metab"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgad690","article-title":"Clinical characteristics of Malignant phosphaturic mesenchymal tumor causing tumor-induced osteomalacia","volume":"109","author":"Abate","year":"2024","journal-title":"J Clin Endocrinol Metab"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1111\/joim.v293.3","article-title":"Global guidance for the recognition, diagnosis, and management of tumor-induced osteomalacia","volume":"293","author":"Jan de Beur","year":"2023","journal-title":"J Intern Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"17044","DOI":"10.1038\/nrdp.2017.44","article-title":"Tumour-induced osteomalacia","volume":"3","author":"Minisola","year":"2017","journal-title":"Nat Rev Dis Primers"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s00256-011-1159-6","article-title":"Phosphaturic mesenchymal tumor with chondromyxoid fibroma-like feature: an unusual morphological appearance","volume":"40","author":"Suryawanshi","year":"2011","journal-title":"Skeletal Radiol"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1967\/s002449910337","article-title":"Missed causative tumors in diagnosing tumor-induced osteomalacia with (18)F-FDG PET\/CT: a potential pitfall of standard-field imaging","volume":"19","author":"Kaneuchi","year":"2016","journal-title":"Hell J Nucl Med"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06432-9","article-title":"A literature review to understand the burden of disease in people living with tumour-induced osteomalacia","volume":"33","author":"Minisola","year":"2022","journal-title":"Osteoporos Int"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.1642","article-title":"Tumor-induced osteomalacia: an important cause of adult-onset hypophosphatemic osteomalacia in China: Report of 39 cases and review of the literature","volume":"27","author":"Jiang","year":"2012","journal-title":"J Bone Miner Res"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1002\/smll.202207951","article-title":"Journey of mineral precursors in bone mineralization: evolution and inspiration for biomimetic design","volume":"20","author":"Zhang","year":"2024","journal-title":"Small"},{"key":"B15","doi-asserted-by":"publisher","first-page":"e2001271","DOI":"10.1002\/adhm.202001271","article-title":"Multiple pathways for pathological calcification in the human body","volume":"10","author":"Vidavsky","year":"2021","journal-title":"Adv Healthc Mater"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1210\/er.2017-00220","article-title":"X-linked hypophosphatemia and FGF23-related hypophosphatemic diseases: prospect for new treatment","volume":"39","author":"Kinoshita","year":"2018","journal-title":"Endocr Rev"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1038\/nature25451","article-title":"alpha-Klotho is a non-enzymatic molecular scaffold for FGF23 hormone signalling","volume":"553","author":"Chen","year":"2018","journal-title":"Nature"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1152\/ajprenal.00250.2021","article-title":"Fibroblast growth factor 23 leads to endolysosomal routing of the renal phosphate cotransporters NaPi-IIa and NaPi-IIc in vivo","volume":"321","author":"Kung","year":"2021","journal-title":"Am J Physiol Renal Physiol"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2009050559","article-title":"Intestinal npt2b plays a major role in phosphate absorption and homeostasis","volume":"20","author":"Sabbagh","year":"2009","journal-title":"J Am Soc Nephrol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1096\/fj.201600473R","article-title":"Hypophosphatemia promotes lower rates of muscle ATP synthesis","volume":"30","author":"Pesta","year":"2016","journal-title":"FASEB J"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1977.tb10002.x","article-title":"Red cell 2,3-diphosphoglycerate and oxygen affinity","volume":"32","author":"MacDonald","year":"1977","journal-title":"Anaesthesia"},{"key":"B22","article-title":"A clinical approach to common electrolyte problems: 4. Hypomagnesemia","volume":"132","author":"Berkelhammer","year":"1985","journal-title":"Can Med Assoc J"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1210\/endrev\/bnac026","article-title":"Tumor-induced osteomalacia: A comprehensive review","volume":"44","author":"Minisola","year":"2023","journal-title":"Endocr Rev"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1007\/s40618-018-0849-5","article-title":"Phosphaturic mesenchymal tumors: what an endocrinologist should know","volume":"41","author":"Boland","year":"2018","journal-title":"J Endocrinol Invest"},{"key":"B25","doi-asserted-by":"publisher","first-page":"252","DOI":"10.3390\/jcm12010252","article-title":"Phosphaturic mesenchymal tumors: rethinking the clinical diagnosis and surgical treatment","volume":"12","author":"Liu","year":"2022","journal-title":"J Clin Med"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4620","article-title":"Clinical challenges in diagnosis, tumor localization and treatment of tumor-induced osteomalacia: outcome of a retrospective surveillance","volume":"37","author":"Hidaka","year":"2022","journal-title":"J Bone Miner Res"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000000854","article-title":"68Ga DOTATATE PET\/CT is an accurate imaging modality in the detection of culprit tumors causing osteomalacia","volume":"40","author":"Zhang","year":"2015","journal-title":"Clin Nucl Med"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgab258","article-title":"Utility of 18F-alF-NOTA-octreotide PET\/CT in the localization of tumor-induced osteomalacia","volume":"106","author":"Long","year":"2021","journal-title":"J Clin Endocrinol Metab"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2024.1400751","article-title":"(18)F-AlF-NOTA-octreotide PET\/CT in the localization of tumor-induced osteomalacia: case series and literature review","volume":"15","author":"Li","year":"2024","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-022-03039-2","article-title":"Persistence and recurrence in tumor-induced osteomalacia: A systematic review of the literature and results from a national survey\/case series","volume":"76","author":"Cianferotti","year":"2022","journal-title":"Endocrine"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.1007\/s00223-022-01005-8","article-title":"Tumor-induced osteomalacia: A systematic clinical review of 895 cases","volume":"111","author":"Bosman","year":"2022","journal-title":"Calcif Tissue Int"},{"key":"B32","doi-asserted-by":"publisher","first-page":"100276","DOI":"10.1016\/j.bonr.2020.100276","article-title":"Lessons learnt from delayed diagnosis of FGF-23-producing tumour-induced osteomalacia and post-operative hungry bone syndrome","volume":"12","author":"Kumar","year":"2020","journal-title":"Bone Rep"},{"key":"B33","doi-asserted-by":"publisher","first-page":"101142","DOI":"10.1016\/j.bonr.2021.101142","article-title":"High bone turnover and hyperparathyroidism after surgery for tumor-induced osteomalacia: A case series","volume":"15","author":"Kilbane","year":"2021","journal-title":"Bone Rep"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1097\/CM9.0000000000001448","article-title":"Consensus on clinical management of tumor-induced osteomalacia","volume":"134","author":"Jiang","year":"2021","journal-title":"Chin Med J (Engl)"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2020399","article-title":"Targeted FGFR blockade for the treatment of tumor-induced osteomalacia","volume":"383","author":"Hartley","year":"2020","journal-title":"N Engl J Med"},{"key":"B36","doi-asserted-by":"publisher","first-page":"116077","DOI":"10.1016\/j.bone.2021.116077","article-title":"Tumor induced osteomalacia: A single center experience on 17 patients","volume":"152","author":"Crotti","year":"2021","journal-title":"Bone"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.070304","article-title":"Cinacalcet in the management of tumor-induced osteomalacia","volume":"22","author":"Geller","year":"2007","journal-title":"J Bone Miner Res"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1038\/nrc.2017.8","article-title":"Advances and challenges in targeting FGFR signalling in cancer","volume":"17","author":"Babina","year":"2017","journal-title":"Nat Rev Cancer"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1501499\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,19]],"date-time":"2024-12-19T06:24:22Z","timestamp":1734589462000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2024.1501499\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,12,19]]},"references-count":38,"alternative-id":["10.3389\/fonc.2024.1501499"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2024.1501499","relation":{},"ISSN":["2234-943X"],"issn-type":[{"type":"electronic","value":"2234-943X"}],"subject":[],"published":{"date-parts":[[2024,12,19]]},"article-number":"1501499"}}