Nucl Med Mol Imaging.  2018 Dec;52(6):462-467. 10.1007/s13139-018-0546-5.

Successful Localization Using ⁶⁸Ga-DOTATOC PET/CT of a Phosphaturic Mesenchymal Tumor Causing Osteomalacia in a Patient with Concurrent Follicular Lymphoma

Affiliations
  • 1Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, South Korea. jsryu2@amc.seoul.kr
  • 2Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  • 3Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  • 4Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  • 5Department of Oncology, and Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

Abstract

Diagnosing tumor-induced osteomalacia is often challenging because conventional imaging modalities may fail to locate the responsible tumor. This report describes the ability of ⁶⁸Ga-DOTATOC PET/CT to successfully distinguish between the responsible phosphaturic mesenchymal tumor and concurrent lymphoma lesions. A 52-year-old man with bone pain for several years was diagnosed with a vitamin D-resistant hypophosphatemic osteomalacia. Whole body ¹â¸F-FDG PET/CT revealed multiple enlarged hypermetabolic lymph nodes in his bilateral cervical, axillary, mediastinal, abdominal, pelvic, and inguinal regions. Core needle biopsy of the right cervical lymph node confirmed the diagnosis of follicular lymphoma. However, lymphoma was not considered the cause of osteomalacia. ⁶⁸Ga-DOTATOC PET/CT before chemotherapy showed a small nodule with intensely increased uptake in the right inguinal region, which was distinguished from the other enlarged lymph nodes. The nodule was surgically removed and histopathologically consistent with phosphaturic mesenchymal tumor. After surgery, the patient's serum phosphorus and alkaline phosphatase levels normalized without nutritional supplement.

Keyword

PET/CT; ⁶⁸Ga-DOTATOC; Hypophosphatemia; Oncogenic osteomalacia; Phosphaturic mesenchymal tumor

MeSH Terms

Alkaline Phosphatase
Biopsy, Large-Core Needle
Diagnosis
Drug Therapy
Humans
Hypophosphatemia
Lymph Nodes
Lymphoma
Lymphoma, Follicular*
Middle Aged
Osteomalacia*
Phosphorus
Positron-Emission Tomography and Computed Tomography*
Vitamins
Alkaline Phosphatase
Phosphorus
Vitamins
Full Text Links
  • NMMI
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2022 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr