A case of neuroendocrine oncogenic osteomalacia associated with a PHEX and fibroblast growth factor-23 expressing sinusidal malignant schwannoma

Bone. 2001 Oct;29(4):393-402. doi: 10.1016/s8756-3282(01)00586-5.

Abstract

Oncogenic osteomalacia is a rare paraneoplastic syndrome that is characterized biochemically by hypophosphatemia and low plasma 1,25-dihydroxyvitamin D3, and clinically by osteomalacia, pseudofractures, bone pain, fatigue, and muscle weakness. We present a patient with a malignant schwannoma as the underlying cause of this disorder. A permanent cell line (HMS-97) derived from this tumor showed evidence of neuroendocrine differentiation by immunohistochemistry and of neurosecretory activity by electron microscopy. The cell line did express PHEX (phosphate-regulating gene with homologies to endopeptidases located on the X-chromosome) and FGF-23 (fibroblast growth factor-23) transcripts on northern hybridization; however, none of the known mutations from the related mendelian disorders of X-linked hypophosphatemic rickets or autosomal-dominant hypophosphatemic rickets could be detected. Tumor cell (HMS-97)-derived conditioned medium did not inhibit phosphate transport in a standard opossum kidney cell assay and in animal experiments. The medium also showed no PTH1- or PTH2-receptor-stimulating bioactivity. HMS-97 cells might be useful for further studies that aim to determine the genetic mechanism that leads to the observed PHEX and FGF-23 expression, both of which might have a direct role in the pathogenesis of oncogenic osteomalacia. In addition, these cells might be a useful tool for the investigation of neuroendocrine Schwann cell function and autoimmune peripheral nerve disease.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Female
  • Fibroblast Growth Factor-23
  • Fibroblast Growth Factors / genetics*
  • Gene Expression Regulation, Neoplastic
  • Humans
  • Magnetic Resonance Imaging
  • Middle Aged
  • Neurilemmoma / complications*
  • Neurilemmoma / diagnostic imaging
  • Neurilemmoma / pathology
  • Neuroendocrine Tumors / complications*
  • Neuroendocrine Tumors / diagnostic imaging
  • Neuroendocrine Tumors / pathology
  • Osteomalacia / diagnostic imaging
  • Osteomalacia / etiology*
  • PHEX Phosphate Regulating Neutral Endopeptidase
  • Proteins / genetics*
  • RNA, Messenger / analysis
  • Radionuclide Imaging
  • Tumor Cells, Cultured

Substances

  • FGF23 protein, human
  • Proteins
  • RNA, Messenger
  • Fibroblast Growth Factors
  • Fibroblast Growth Factor-23
  • PHEX Phosphate Regulating Neutral Endopeptidase
  • PHEX protein, human