Spinal Decompression and Radionuclide Therapy for an Unresectable FGF23 Transmitted Tumor Causing Cervical Myelopathy: A Case Report and Literature Review

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Abstract
Background: Tumor-induced osteomalacia (TIO) is a rare disorder characterized by hypophosphatemic osteomalacia that is mainly caused by benign tumors with excessive secretion of fibroblast growth factor 23 (FGF23) and somatostatin receptor expression. Although complete excision is recommended, reports of treatment strategies for anatomically challenging surgical cases are lacking. We report an unresectable case of FGF23 transmitted tumor at the cervical vertebrae causing myelopathy that was treated with surgical decompression combined with radionuclide therapy. Case presentation: A 52-year-old woman presented to another hospital with knee pain. After confirmation of abnormal tracer uptake at the C7 vertebrae using somatostatin receptor scintigraphy and an elevated serum FGF23 level (> 800 pg/mL), TIO was diagnosed 7 years after the initial presentation. Gait disturbance occurred 10 years after the initial presentation; therefore, the patient was referred to our department. Magnetic resonance imaging revealed a tumor with spinal cord compression and vertebral artery encasement; as such, complete resection was impossible. Gait disturbance improved after spinal decompression with partial resection. Peptide receptor radionuclide therapy targeting the somatostatin receptors was initiated 2 years after surgery. Serum phosphate levels normalized and the tumor size remained stable after the initiation of PRRT. Ambulation was maintained without joint pain recurrence 3 years after surgery. Conclusions: The current literature regarding FGF23 transmitted tumors at the cervical spine includes six cases that were treated with definitive local therapy. This case suggests an alternative option for unresectable FGF23 transmitted tumor at the vertebrae causing spinal myelopathy.
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Authors Iwata, Akira
Journal Frontiers in surgery
Year Year not found
DOI
10.3389/fonc.2026.1754565
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