Tumour induced osteopenia due to phosphaturic mesenchymal sinonasal tumour presenting with delayed onset insufficiency fractures

Abstract

We present a case of a 48-year-old female who presented with epistaxis. Magnetic resonance imaging (MRI) revealed a mass within the left nasal cavity which was revealed to be a phosphaturic mesenchymal sinonasal tumour. The patient defaulted treatment at this stage and later re-presented with pelvic and groin pain for which plain radiographs and computed tomography (CT) scan demonstrated diffuse osteopenia and multiple pelvic fractures of varying ages. MRI of the pelvis and both thighs revealed abnormal marrow signal of the bones and confirmed the presence of pelvic fractures. Multiple pseudo-fractures were seen at both femurs and scapula. The radiological findings along with abnormal biochemical markers were attributed to the paraneoplastic entity of tumour induced osteomalacia, in the context of unresected phosphaturic mesenchymal tumour. The tumour was resected, and patient showed complete reversal of the associated biochemical abnormalities. This case exemplifies that with early identification and complete resection of the causative tumour, the prognosis is excellent.