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Rheumatological differential diagnosis has been established in cases such as dry mouth, pain or swelling in the locomotor system, muscle weakness, fever, weight loss, Raynaud's phenomenon, lymphadenopathy, splenomegaly, skin stiffness and rash, which cannot be explained with an explicit reason. The idea that existing symptoms in a person with a clean oncological history may have been caused by disorganization of an occult cancer in the immune system is confusing for many clinicians. Rheumatologic complaints in a person with a history of cancer may be the primary tumor recurrence in the locomotor system, metastasis or a complication of previous treatment. Rapid increase in the size of the articular or periarticular structure in the follow-up, irregular boundary invasion of the surrounding structures, aggressive periosteal reaction and the presence of skin ulceration are the characteristics evoking malignancy. Radiotherapy, various chemotherapeutic agents and the rheumatic effects of hematological stem cell transplantation are worth mentioning. In patients whose medical histories do not indicate any malignancy, a newly developed local cancer, metastasis or paraneoplastic syndrome in the musculoskeletal system may present as a rheumatic disease. Rheumatic paraneoplastic syndrome is mainly characterized by carcinomatous polyarthritis, connective tissue diseases, Jaccoud's arthropathy, secondary Raynaud's phenomenon, vasculitis, palmar fasciitis and polyarthritis, hypertrophic osteoarthropathy, remitting seronegative symmetric synovitis and pitting edema, tumor-associated osteomalacia, reflex sympathetic dystrophy and eosinophilic fasciitis. One of the important issues to remember is that the current symptoms may have been due to a rheumatic disease associated with malignancy which is already present and has been unnoticed. Knowing that malignancy may be the underlying reason for rheumatic complaints through current knowledge and skepticism, the clinician may be able to make effective treatment of occult tumor with earlier diagnose. Therefore; if atypical symptoms occur rapidly and severely in patients over 50 years of age, the presence of malignancy should be ruled out before the primary rheumatologic diagnosis is established. [ABSTRACT FROM AUTHOR]

Oncogenic osteomalacia is a rarely seen paraneoplastic syndrome characterized by hypophosphatemic osteomalacia. Even though serum 1,25 (OH)2 vitamin D level is almost very low to be detected, 25 (OH) vitamin D level is normal. Alkaline phosphatase level is frequently high, however calcium and parathyroid hormon levels are normal. Majority of the tumours leading to the paraneoplastic syndrome with oncogenic osteomalacia patients are mesenchymally originated. Age of diagnosis is usually in the fourth decade however there are also reported cases under the age of 18 in the literature. Pain, gait abnormalities and loss of muscle strength seen in the patients can be as severe as to be misdiagnosed for muscle diseases. When the cases reported in the literature are evaluated it is seen that detection of the turnouts come about on average after 4 years of osteomalacia diagnosis. The most important aspect of the disease is unresponsiveness to osteomalacia treatment and recovery by only tumor resection. We propose that it is important for osteomalacia patients whom we come across frequently in the population, to be evaluated from the point of tumoral constitution during the follow up period especially for the ones who are resistant hypophosphatemic and to treatment. [ABSTRACT FROM AUTHOR]