Using 18 F-FDG PET/CT to Detect an Occult Mesenchymal Tumor Causing Oncogenic Osteomalacia
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CASE REPORT
Using 18F-FDG PET/CT to Detect an Occult Mesenchymal Tumor Causing Oncogenic Osteomalacia Hyo Jung Seo & Yun Jung Choi & Hyun Jeong Kim & Yong Hyu Jeong & Arthur Cho & Jae Hoon Lee & Mijin Yun & Jong Doo Lee & Won Jun Kang
Received: 25 March 2011 / Accepted: 29 June 2011 / Published online: 14 July 2011 # Korean Society of Nuclear Medicine 2011
Abstract Oncogenic osteomalacia is a rare paraneoplastic syndrome characterized by renal phosphate excretion, hypophosphatemia, and osteomalacia. This syndrome is often caused by tumors of mesenchymal origin. Patients with oncogenic osteomalacia have abnormal bone mineralization, resulting in a high frequency of fractures. Tumor resection is the treatment of choice, as it will often correct the metabolic imbalance. Although oncogenic osteomalacia is a potentially curable disease, diagnosis is difficult and often delayed because of the small size and sporadic location of the tumor. Bone scintigraphy and radiography best characterize osteomalacia; magnetic resonance imaging findings are nonspecific. Here, we report a case of oncogenic osteomalacia secondary to a phosphaturic mesenchymal tumor that was successfully detected by 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). This case illustrates the advantages of 18F-FDG PET/CT in detecting the occult mesenchymal tumor that causes oncogenic osteomalacia. Keywords Oncogenic osteomalacia . 18 F-fluorodeoxyglucose . Positron emission tomography
H. J. Seo : Y. J. Choi : H. J. Kim : Y. H. Jeong : A. Cho : J. H. Lee : M. Yun : J. D. Lee : W. J. Kang (*) Division of Nuclear Medicine, Department of Radiology, Yonsei University College of Medicine, Seongsanno 250, Seodaemun-gu, Seoul 120-752, Korea e-mail: [email protected]
Introduction Oncogenic osteomalacia is a rare paraneoplastic syndrome associated with benign mesenchymal tumors, with clinical features mimicking those of X-linked or autosomaldominant hereditary hypophosphatemic rickets. Oncogenic osteomalacia is characterized by severe hypophosphatemia and hyperphosphaturia. The tumors that are frequently related to oncogenic osteomalacia are a rare class of phosphaturic mesenchymal tumors of mixed connective tissue origin [1]. It is well known that surgical removal of the mesenchymal tumors relieves the symptoms and signs of osteomalacia in oncogenic osteomalacia, and phosphate levels return to normal levels within 2–3 days after surgery [2]. Because oncogenic osteomalacia is potentially curable after tumor resection, it is of great importance to detect occult mesenchymal tumors in patients with unexplained osteomalacia. To date, there are no standard methods for detecting occult tumors causing oncogenic osteomalacia. Computed tomography (CT) and magnetic resonance imaging (MRI) are often non-contributory in detecting mesenchymal tumors [3–5]. Bone scintigraphy or radiography only reveals the osteomalacia and rarely detects the mesenchymal tumor causing the syndrome [6, 7]. Somatostatin receptor expression is elevated in mesench
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