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LETTER TO THE EDITOR tubulopathy, with elevated FGF-23 levels supported diagnosis in our case.Treatment of the tumor is crucial for the resolution of osteomalacia, symptoms, and laboratory abnormalities. 1,2 A rapid decrease of FGF-23 level occurs after successful removal of the tumor. 12 Persistent or increasing FGF levels warn that an incomplete resection or a relapse exists. TIO is an uncommon paraneoplastic syndrome for pediatric oncologists. Diagnosis can be delayed due to nonspecific symptoms and difficulty in identifying the tumor. Although it is usually associated to slow-growing and nonmetastatic mesenchymal tumors, this case demonstrates that aggressive and malignant tumors can also be responsible. CONFLICT OF INTERESTThe authors declare that there is no conflict of interest. ORCID Raquel Olivas-Mazón