We describe a case of oncogenic osteomalacia in an adult male who presented with low back pain and bilateral hip pain. Extensive investigations had failed to find a cause. A plain pelvic radiograph showed Looser's zones in both femoral necks. MRI confirmed the presence of insufficiency fractures bilaterally in the femoral head and neck. Biochemical investigations confirmed osteomalacia which was unresponsive to treatment with vitamin D and calcium. A persistently low serum phosphate level suggested a diagnosis of hypophosphataemic osteomalacia. The level of fibroblast growth factor-23 was highly raised, indicating the cause as oncogenic osteomalacia. This was confirmed on positron-emission tomography, MRI and excision of a benign fibrous histiocytoma following a rapid recovery. The diagnosis of oncogenic osteomalacia may be delayed due to the non-specific presenting symptoms. Subchondral insufficiency fractures of the femoral head may be missed unless specifically looked for.
Capillary hemangiomas are benign tumors and tumor like conditions commonly involving skin and mucus membrane of head and neck region. They are extremely rare in the spinal cord. We report a 35-year-old male presenting with gradual progressive paraparesis over a period of 4 months. Magnetic resonance imaging showed a hypo- to isointense intradural mass at the level of D12 vertebral body on T1-weighted images and homogenous enhancement on gadolinium contrast. Complete surgical resection revealed intradural extramedullary tumor, which on histopathologic examination showed characteristics of capillary hemangioma. At 1.5 years followup patient was asymptomatic.
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