Bone scintigraphic patterns in patients of tumor induced osteomalacia
A 32-year-old female patient presented to our hospital with a history of progressive, generalized weakness and bony pain of 1½ year duration, after having unsuccessful treatment at different hospitals. Her biochemical report revealed low serum phosphate level with elevated fibroblast growth factor 23 (FGF23) (452.6 RU/ml) and alkaline phosphatase level while other investigations were within the normal limits. She was subjected to bone scan to rule out metabolic bone disorders and assess the secondary bony changes. Bone scan was performed after 4 h of intravenous injection of 20 mCi of technetium 99m methylene diphosphonate. The bone scan demonstrated increased radiotracer uptake over the mandible, ribs, vertebrae and sternum suggestive of metabolic bone disease. There were features of prominent costochondral beadings and increased tracer uptake over multiple growth plates []. The TIO has been established on subsequent imaging followed by excision of tumor that came out to ameloblastic fibroma.