PMC10115527_01
Case 1: left scapula 68Ga-DOTATATE-PET/CT images. Coronal (a), sagittal (b), and two axial (c and d) 68Ga-DOTATATE-PET/CT images with multiple foci of mild uptake noted with bilateral ribs, costovertebral junctions, and left glenoid concerning for microfractures; and area of hyperintesnse uptake within the left scapula (circle) consistent with primary PMT secreting FGF-23.
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TIO, which was supported by an elevated FGF23 (403 RU/mL, normal <180 RU/mL). Total-body 68Ga-DOTATATE-PET/CT scan identified a lesion in the left scapula (Figure 1), confirmed by CT scan (Figure 2).
Case 1: left scapula CT and reconstruction images. Axial (a and b) and 3D reconstruction (c) CT images demonstrating the primary bone PMT arising from the left scapular body (arrow) in the patient from Case 1, corresponding to the findings from the DOTATATE-PET/CT in Figure 1.
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TIO, which was supported by an elevated FGF23 (403 RU/mL, normal <180 RU/mL). Total-body 68Ga-DOTATATE-PET/CT scan identified a lesion in the left scapula (Figure 1), confirmed by CT scan (Figure 2).
Photomicrograph of the specimen from Case 1. The tumor shows mitotically inactive, cytologically bland spindled to epithelioid cells arranged in a vaguely trabecular pattern (solid arrow) interspersed among hemangiopericytoma-like vessels (double arrow) and microcysts (dashed arrow) (Hematoxylin and eosin, 10x).
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PMC10115527_02
Bilateral feet 68Ga-DOTATATE-PET/CT images for Case 2. Axial 68Ga-DOTATATE-PET/CT slice through the bilateral feet demonstrating increased uptake in the right foot plantar soft tissue corresponding to the FGF-23 secreting PMT.
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March 2020, where a 68Ga-DOTATATE-PET/CT revealed a partially calcified, somatostatin receptor type 2 intensely positive soft tissue lesion in the right plantar foot (Figure 4). MRI showed an enhancing mass in the plantar right midfoot measuring approximately 2.6 cm x 1.4 cm x 1.0 cm (Figure 5).
Right foot MRI with contrast for Case 2. Contrast-enhanced axial (a) and sagittal (b) images from an MRI of the foot from patient 2, showing an avidly enhancing soft tissue mass in the plantar aspect of the right midfoot, corresponding to the findings from the DOTATATE-PET/CT in Figure 4.
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March 2020, where a 68Ga-DOTATATE-PET/CT revealed a partially calcified, somatostatin receptor type 2 intensely positive soft tissue lesion in the right plantar foot (Figure 4). MRI showed an enhancing mass in the plantar right midfoot measuring approximately 2.6 cm x 1.4 cm x 1.0 cm (Figure 5).
Photomicrograph of the specimen from Case 2. The tumor is composed of spindled to epithelioid cells admixed with few giant cells, with regions of grungy calcification (solid arrow) and hyalinized matrix (double arrow), surrounded by a rim of bone (dashed arrow). The presence of regions with increased cellularity (double dashed arrow) and nuclear atypia are features that have been associated with a more aggressive tumor biology (Hematoxylin and eosin, 4x).
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Case 2 timeline. Timeline of the patient's development of TIO symptoms, diagnosis, and treatment for the patient in Case 2.
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The timeline of this patient's symptoms, workup, and treatment is summarized in Figure 7.