Bone scintigraphic patterns in patients of tumor induced osteomalacia
A 26-year-old female patient presented with a history of proximal muscle weakness, low backache and pain both lower limbs of 1 year duration, more so for last 3 months. The provisional diagnosis of hypophosphatemic rickets secondary to TIO was made on the basis of biochemical and imaging findings. The FGF23 (918.2 RU/ml) and alkaline phosphatase were markedly elevated and low phosphorus level. The bone scan revealed bilateral multiple ribs, bilateral shoulders, acetabulum and femoral heads and mild increased focal uptake in right mid foot focally. In addition, the delayed bone scan revealed increased focal uptake in left proximal fibula (also noticed on flow and pool phases) however that was not related to metabolic pattern []. Finally, patient turned out to be a case of TIO. The tumor was excised and histopathology revealed it to be suspicious of mesenchymal tumor.