Differential diagnosis between secondary and tertiary hyperparathyroidism in a case of a giant-cell and brown tumor containing mass. Findings by (99m)Tc-MDP, (18)F-FDG PET/CT and (99m)Tc-MIBI scans.
Brown tumor is one of the skeletal manifestations of hyperparathyroidism. It is a benign but locally aggressive bone lesion and its differential diagnosis with giant cell containing skeletal tumors or metastases may be complicated. We present a male patient with chronic renal failure who was initially misdiagnosed as having a giant-cell rich neoplasm of bone in his right thumb. Diffusely increased fluorine-18 fluorodeoxyglucose ((18)F-FDG) uptake in the axial and appendicular skeleton and multiple (18)F-FDG avid lytic lesions suggesting multiple metastases were observed on the (18)F-FDG positron emission tomography/computed tomography (PET/CT) scan. On the usual technetium-99m methylene diphosphonate ((99m)Tc-MDP) bone scan we noticed diffusely increased uptake in the skeleton and two focuses with very much increased uptake, which suggested a metabolic bone disease rather than a multiple metastatic giant cell tumor or bone metastases. Additional investigation documentated increased levels of parathyroid hormone. Parathyroid hyperplasia was finally diagnosed with (99m)Tc-methoxyisobutylisonitrile (MIBI) parathyroid scintigraphy. Fluorine-18-FDG avid lytic lesions were attributed to hyerparathyroidism associated brown tumors instead of multiple metastases. In conclusion, we present a patient with chronic renal insufficiency, who suffered from secondary and later from tertiary HPT with polyostotic brown tumors, which were best shown by the (18)F-FDG PET/CT than by the (99m)Tc-MDP or the (99m)Tc-MIBI scans.
Selcuk University, Faculty of Medicine, Department of Nuclear Medicine,Selcuklu, Konya, Turkey. goncakara@yahoo.com.
Gonca Kara
GK
Gedik
Ozlem
O
Ata
Pinar
P
Karabagli
Oktay
O
Sari
D018286:Carcinoma, Giant Cell / Q000150:complications / Q000000981:diagnostic imaging*; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D006961:Hyperparathyroidism / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D010282:Parathyroid Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013669:Technetium Tc 99m Medronate; D017256:Technetium Tc 99m Sestamibi; D014057:Tomography, X-Ray Computed / Q000379:methods
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D017256:Technetium Tc 99m Sestamibi; D013669:Technetium Tc 99m Medronate