Journal Article

Orthopedic surgical treatment of osteomalacia induced by culprit soft tissue tumor in the hip region: a single-center retrospective study

Liu, Shuzhong, Zhou, Xi, Liu, Yong, Xia, Weibo, Xing, Jinyi, Liang, Annan

2025

Overview

Background Due to its occult position, complex anatomical structure, and spatial relationships, the causative tumor of Tumor-Induced Osteomalacia (TIO) in the hip region is quite difficult to detect and qualitatively diagnose in clinical practice. In this regard, clinicians often lack sufficient knowledge about such tumors, leading to frequent missed diagnoses, misdiagnoses, and unreasonable treatment. Objective This study aimed to investigate the clinical characteristics of TIO patients with culprit soft tissue tumors in the hip region and evaluate the effect of surgical treatment on these individuals to improve clinicians’ understanding of the rare phenomenon. Methods The clinical data of all patients, from January 2013 to January 2023, who underwent surgical treatment for hip located culprit soft tissue tumors by the subspecialty group on bone and soft tissue tumors at our institution, were retrospectively analysed. Specifically, the clinical characteristics and therapeutic effects were examined and the patients’ clinical experience was summarized. Results Twenty-two patients, who met the inclusion criteria, were included. All patients experienced varying degrees of bone pain, commonly accompanied by weakness (16/22) and limited mobility (21/22), and 10 patients (45.5%) experienced a significant reduction in body height during the course of the disease. All patients underwent orthopedic surgery in the hip region, as hypophosphatemia occurred in all of them. Pathological diagnosis was confirmed to be consistent with causative tumors of TIO. All patients experienced a gradual increase in serum phosphorus postoperatively during short-term follow-up. The follow-up period was between 1 and 10 years, and the postoperative serum phosphorus levels were monitored at our hospital or other facilities close to the patients. Conclusions Oncogenic soft tissue tumors for TIO in the hip region are occult, making clinical misdiagnoses or missed diagnoses highly likely. Therefore, enhancing the clinician’s understanding of this rare condition is imperative. Notably, for TIO patient whose culprit tumor can be located, complete surgical resection of the causative tumor is the best treatment option. Furthermore, close postoperative monitoring of serum phosphorus is necessary, and patients should be subjected to long-term follow-up for prompt detection of recurrent conditions. Highlights Tumor-induced osteomalacia caused by causative soft tissue tumor in the hip region is a rare entity, resulting in great challenges to orthopedists. Qualitative and localized diagnosis led by multi-disciplinary team is a prerequisite for subsequent surgical intervention. For the inguinally located culprit tumors, it may be quite effective after remove the culprit tumor directly and surgical resection may bring huge benefit. Exploring the site of onset of the causative tumor is beneficial for improving the treatment strategy of orthopedic surgery and understanding the prognostic characteristics of TIO patients.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adolescent / Adult / Aged / Body height / Bone density / Bone surgery / Bone tumors / Care and treatment / Causes of / Complications and side effects / Diagnosis / Endocrinology / Epidemiology / Female / Health aspects / Hip / Hip - surgery / Hip region / Humans / Hypophosphatemia / Internal Medicine / Laboratories / Localization / Male / Medicine / Medicine & Public Health / Methods / Middle Aged / Neoplasms, Connective Tissue - surgery / Orthopedic Procedures - methods / Orthopedic surgery / Orthopedics / Osteomalacia / Osteomalacia - etiology / Osteomalacia - surgery / Pain / Paraneoplastic Syndromes - etiology / Paraneoplastic Syndromes - surgery / Pathology / Patients / Phosphaturic mesenchymal tumor / Phosphorus / Rehabilitation / Retrospective Studies / Rheumatology / Sarcoma / Soft Tissue Neoplasms - complications / Soft Tissue Neoplasms - surgery / Software / Sports Medicine / Surgical treatment / Treatment Outcome / Tumor-Induced osteomalacia / Tumors / Ultrasonic imaging / Urine / Young Adult