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68Ga-DOTANOC PET/CT for the detection of a mesenchymal tumor causing oncogenic osteomalacia
Eur J Nucl Med Mol Imaging
68Ga-DOTANOC PET/CT for the detection of a mesenchymal tumor causing oncogenic osteomalacia
Christian von Falck 0 1 2 3
Thomas Rodt 0 1 2 3
Herbert Rosenthal 0 1 2 3
Florian Länger 0 1 2 3
Thomas Goesling 0 1 2 3
Wolfram H. Knapp 0 1 2 3
Michael Galanski 0 1 2 3
0 T. Goesling Department of Trauma Surgery, Hannover Medical School , Hannover , Germany
1 F. Länger Institute of Pathology, Hannover Medical School , Hannover , Germany
2 C. von Falck (
3 W. H. Knapp Department of Nuclear Medicine, Hannover Medical School , Hannover , Germany
-
A 54-year-old female patient had presented with clinical
features of hyperphosphaturia, hypophosphatemia and
osteomalacia. These findings were suggestive of oncogenic
osteomalacia, a rare paraneoplastic disorder that is usually
associated with a phosphaturic mesenchymal tumor [
1
].
Conventional morphologic imaging including whole-body
computed tomography (CT) failed to localise the primary
tumor. The patient underwent additional positron emission
tomography (PET)/CT using 68Ga-DOTANOC, a highly
sensitive and specific tracer for imaging of somatostatin
receptor overexpression, which has recently proven
potential in oncogenic osteomalacia [
2, 3
].
Abnormal focal tracer uptake was seen in the right distal
femur (A). Using image fusion and three-dimensional
volume-rendering techniques, the localisation of the
suspected primary tumor was clearly visualised (B). Notably,
no morphologic correlative was observed in the
corresponding low-dose CT (C). Based on the PET/CT
findings, the patient underwent segmental resection and
compound osteosynthesis of the distal femur. The
hematoxylin and eosin-stained section (D) demonstrated
randomly organised spindle cells with slight cellular and
nuclear atypia and a sparse intercellular matrix.
Immunohistochemistry was negative for myogenic, neural, vascular
and epithelial markers. These histopathologic findings were
consistent with the diagnosis of a benign phosphaturic,
mesenchymal tumor.
1. Edmister KA , Sundaram M. Oncogenic osteomalacia . Semin Musculoskelet Radiol 2002 ; 6 : 191 - 6 .
2. Hesse E , Moessinger E , Rosenthal H , et al. Oncogenic osteomalacia: exact tumor localization by co-registration of positron emission and computed tomography . J Bone Miner Res 2007 ; 22 : 158 - 62 .
3. Hesse E , Rosenthal H , Bastian L . Radiofrequency ablation of a tumor causing oncogenic osteomalacia . N Engl J Med 2007 ; 357 : 422 - 44 . (...truncated)