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Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism.

Sager S, Aliyev A, Halac M, Oztürk T - Indian J Endocrinol Metab (2012)

Bottom Line: Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images.Pathological results confirmed the diagnosis of parathyroid adenoma.Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

ABSTRACT
Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

No MeSH data available.


Related in: MedlinePlus

Maximum intensity projection of PET (a), axial PET (b), axial CT (c), and axial fusion (d) images showed multiple enhanced FDG uptake of bone lesions in skeletal system
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Figure 1: Maximum intensity projection of PET (a), axial PET (b), axial CT (c), and axial fusion (d) images showed multiple enhanced FDG uptake of bone lesions in skeletal system

Mentions: A 49-year-old male patient was admitted to our hospital with a history of right shoulder and right hip pain. X-ray graphy and CT images were performed and multiple lytic and destructive bone lesions were found. These bone lesions mimicked multiple skeletal metastatic lesions. PET/CT imaging was requested for the evaluation of FDG uptake of these lesions and to search the possible unknown primary tumor site. F-18 FDG PET/CT whole body imaging was performed after intravenously injection of 420 MBq (11.3 mCi) 18F FDG. After 1 hour of waiting period in a silent room patient was imaged using an integrated PET/CT camera, which is consists of a 6-slice CT gantry, integrated with a LSO-based fullring PET scanner (Siemens Biograph 6, IL, Chicago, USA). PET/CT images showed multiple enhanced FDG uptake of bone lesions in skeletal system [Figure 1]. These lesions are prominent in right humerus, bilateral ribs and right iliac bone with a maximum standardized uptake value of 18.5. Firstly, these lesions were thought metastates because of their FDG uptake. However, a nodular structure inferior to the left lobe of the thyroid gland which has no increased FDG-uptake was discovered. He has no family history of hyperparathyroidism. Laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone and low serum phosphate. Parathormone level was 461 pg/ ml (normal 15-65 pg/ml). DEXA was performed for right hip and showed osteopenia. The biopsy results revealed no signs of malignancy. After these findings, parathyroid adenoma and brown tumors were thought and for confirmation parathyroid scintigraphy was performed.


Positron emission tomography/computed tomography imaging of brown tumors mimicking multiple skeletal metastases in patient with primary hyperparathyroidism.

Sager S, Aliyev A, Halac M, Oztürk T - Indian J Endocrinol Metab (2012)

Maximum intensity projection of PET (a), axial PET (b), axial CT (c), and axial fusion (d) images showed multiple enhanced FDG uptake of bone lesions in skeletal system
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3475922&req=5

Figure 1: Maximum intensity projection of PET (a), axial PET (b), axial CT (c), and axial fusion (d) images showed multiple enhanced FDG uptake of bone lesions in skeletal system
Mentions: A 49-year-old male patient was admitted to our hospital with a history of right shoulder and right hip pain. X-ray graphy and CT images were performed and multiple lytic and destructive bone lesions were found. These bone lesions mimicked multiple skeletal metastatic lesions. PET/CT imaging was requested for the evaluation of FDG uptake of these lesions and to search the possible unknown primary tumor site. F-18 FDG PET/CT whole body imaging was performed after intravenously injection of 420 MBq (11.3 mCi) 18F FDG. After 1 hour of waiting period in a silent room patient was imaged using an integrated PET/CT camera, which is consists of a 6-slice CT gantry, integrated with a LSO-based fullring PET scanner (Siemens Biograph 6, IL, Chicago, USA). PET/CT images showed multiple enhanced FDG uptake of bone lesions in skeletal system [Figure 1]. These lesions are prominent in right humerus, bilateral ribs and right iliac bone with a maximum standardized uptake value of 18.5. Firstly, these lesions were thought metastates because of their FDG uptake. However, a nodular structure inferior to the left lobe of the thyroid gland which has no increased FDG-uptake was discovered. He has no family history of hyperparathyroidism. Laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone and low serum phosphate. Parathormone level was 461 pg/ ml (normal 15-65 pg/ml). DEXA was performed for right hip and showed osteopenia. The biopsy results revealed no signs of malignancy. After these findings, parathyroid adenoma and brown tumors were thought and for confirmation parathyroid scintigraphy was performed.

Bottom Line: Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images.Pathological results confirmed the diagnosis of parathyroid adenoma.Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

View Article: PubMed Central - PubMed

Affiliation: Department of Nuclear Medicine, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.

ABSTRACT
Brown tumors of bone are highly vascular, lytic bone lesions representing a reparative cellular process rather than a neoplastic process usually seen in patients with hyperparathyroidism. These tumors can behave aggressively and be destructive. We report a 49-year-old male patient who was admitted to our hospital with a long-term history of right shoulder and right hip pain. Multiple lytic and destructive bone lesions were found in X-ray graphy and CT images. These bone lesions mimicked multiple skeletal metastatic lesions and seemed to be those of the terminal stage of malignancy. PET scan was requested for the evaluation of FDG uptake of these lesions and to search the unknown primary tumor site. Positron emission tomography/computed tomography (PET/CT) images showed multiple hypermetabolic malignant or metastatic FDG avid bone lesions in skeletal system. However the biopsy results revealed no signs of malignancy and laboratory data showed elevated serum calcium, alkaline phosphatase, parathyroid hormone, low serum phosphate and parathyroid scintigraphy was performed. Adenoma in the left parathyroid gland was seen with Tc-99m MIBI parathyroid scintigraphy. Pathological results confirmed the diagnosis of parathyroid adenoma. Brown tumor is the potential cause of false-positive result in evaluation of a patient for unknown primary tumor or skeletal metastases with PET/CT imaging.

No MeSH data available.


Related in: MedlinePlus