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Extended Whole-body Ga-68 DOTATATE PET-CT in evaluating Tumour-Induced Osteomalacia: Case report and review of literature

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Abstract

Tumour-induced osteomalacia is a rare paraneoplastic syndrome that manifests as chronic hypophosphataemia, non-specific bone pain and muscle weakness. It is generally caused by phosphaturic mesenchymal tumour (PMT), which is uncommonly associated with synchronous tumours. However, diagnosis is often delayed for several years due to the rarity, indolent growing nature and non-specific symptoms of the disease, often resulting in an overlook by clinicians during assessments. The patient initially presented with hypophosphataemia and generalised skeletal pain with multiple atraumatic fractures. Blood tests revealed serum calcium levels at the upper limit and extremely low inorganic phosphate levels. Herein, we report a case where two synchronous PMTs from two different sites were detected by ‘extended’ whole-body Ga-68 DOTATATE PET-CT, leading to remission of the disease after complete surgical removal. Early detection and diagnosis of PMT neoplasm is crucial, as complete surgical resection of this tumour is the only definitive treatment currently known. Upon excision, this curable disease will result in complete resolution of symptoms and blood parameters, leading to remission of the disease which significantly improves the patient’s quality of life. PMT often over-expresses somatostatin receptors (SSTR), predominantly subtype 2A, and Ga-68 DOTATATE PET-CT is a selective SSTR imaging that targets this characteristic over-expression in these tumours. The high diagnostic accuracy of Ga-68 DOTATATE PET-CT should be the primary imaging modality for full evaluation of this disease.

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Acknowledgements

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Funding

This study was supported by funding from both Sunway Medical Centre and Sunway University (Funding No.: GRTEX-OTR-CBP-SMC-002–2019).

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Authors and Affiliations

  1. Centre for Applied Physics and Radiation Technologies, School of Engineering and Technology, Sunway University, No. 5 Jalan Universiti, Bandar Sunway, 47500, Petaling Jaya, Selangor Darul Ehsan, Malaysia

    Teik Hin Tan, Ew-Jun Chen & Ming Tsuey Chew

  2. Nuclear Medicine Centre, Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway, 47500, Petaling Jaya, Selangor Darul Ehsan, Malaysia

    Teik Hin Tan & Ew-Jun Chen

  3. Orthopaedic Oncology, Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway, 47500, Petaling Jaya, Selangor Darul Ehsan, Malaysia

    Ping Ching Chye

  4. Internal Medicine & Endocrinology, Internal Medicine, Sunway Medical Centre, No. 5 Jalan Lagoon Selatan, Bandar Sunway, 47500, Petaling Jaya, Selangor Darul Ehsan, Malaysia

    Ming Wong

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  1. Teik Hin Tan
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  2. Ew-Jun Chen
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Contributions

Teik Hin Tan: Conceptualization and design; funding acquisition; analysis and interpretation of data; writing – review and revision; final approval of version for publication.

Ew-Jun Chen: Investigation; data acquisition and analysis; data curation; writing – original draft, review and editing.

Ming Tsuey Chew: Funding acquisition; investigation; writing – article draft, review and editing; final approval of version for publication.

Ping Ching Chye: Acquisition and interpretation of data; review of writing.

Ming Wong: Acquisition, interpretation and analysis of data; review of writing; final approval.

Corresponding author

Correspondence to Ming Tsuey Chew.

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Conflict of Interest

Teik Hin Tan, Ew-Jun Chen, Ming Tsuey Chew, Ping Ching Chye and Ming Wong declare that they have no conflict of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional research committee and with the Helsinki declaration as revised in 2013 and its later amendments or comparable ethical standards.

Informed Consent

The institutional review board of our institute approved this retrospective study, and the requirement to obtain informed consent was waived.

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Tan, T.H., Chen, EJ., Chew, M.T. et al. Extended Whole-body Ga-68 DOTATATE PET-CT in evaluating Tumour-Induced Osteomalacia: Case report and review of literature. Nucl Med Mol Imaging 55, 130–135 (2021). https://doi.org/10.1007/s13139-021-00695-6

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  • DOI: https://doi.org/10.1007/s13139-021-00695-6

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