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68Ga-DOTANOC PET/CT for the detection of a mesenchymal tumor causing oncogenic osteomalacia

  • Christian von Falck
  • Thomas Rodt
  • Herbert Rosenthal
  • Florian Länger
  • Thomas Goesling
  • Wolfram H. Knapp
  • Michael Galanski
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Keywords

Distal Femur Osteomalacia Mesenchymal Tumor Hypophosphatemia Intercellular Matrix 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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.

References

  1. 1.
    Edmister KA, Sundaram M. Oncogenic osteomalacia. Semin Musculoskelet Radiol 2002;6:191-6.CrossRefPubMedGoogle Scholar
  2. 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.PubMedGoogle Scholar
  3. 3.
    Hesse E, Rosenthal H, Bastian L. Radiofrequency ablation of a tumor causing oncogenic osteomalacia. N Engl J Med 2007;357:422-44.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Christian von Falck
    • 1
  • Thomas Rodt
    • 1
  • Herbert Rosenthal
    • 1
  • Florian Länger
    • 2
  • Thomas Goesling
    • 3
  • Wolfram H. Knapp
    • 4
  • Michael Galanski
    • 1
  1. 1.Department of Diagnostic RadiologyHannover Medical SchoolHannoverGermany
  2. 2.Institute of PathologyHannover Medical SchoolHannoverGermany
  3. 3.Department of Trauma SurgeryHannover Medical SchoolHannoverGermany
  4. 4.Department of Nuclear MedicineHannover Medical SchoolHannoverGermany

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