PMC4729017_01
Tc99m methylene diphosphonate bone scan (a) showing multiple foci of increased uptake in the skull bones, mandible, axial and appendicular skeleton with focally increased uptake in the upper and lower ends of both femurs, both tibia, both shoulder joints and forearm bones. 99mTc-MIBI WBS (b) showing increased uptake in the mandible, upper and lower ends of the right femur, both tibial bones, and around the shoulder joints, similar to that of the bone scan and SPECT/CT (c) of the lower limb that showed MIBI avid lytic-cystic lesions in the lower end of the right femur and midshaft of both tibial bones
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F1
Subsequently, bone scan was done for metastatic workup of the GCT. (a) 99mTc-methoxyisobutylisonitrile (MIBI) bone scan Figure 1a showed multiple foci of increased uptake in the skull bones, mandible, and axial and appendicular skeleton with focally increased uptake in the upper and lower ends of both femurs, both tibia, both shoulder joints and forearm bones. The patient was subjected to 99mTc-MIBI dual-phase (DP) parathyroid scan and whole body scan (WBS). (b) 99mTc-MIBI WBS Figure 1b showed increased uptake in the mandible, upper and lower ends of the right femur, both tibial bones and around the shoulder joints, similar to the bone scan and single photon emission computed tomography/computed tomography (SPECT/CT) of lower limb Figure 1c showed MIBI avid lytic-cystic lesions in the lower end of the right femur and mid shaft of both tibial bones.
DP 99mTc-MIBI parathyroid scan of the neck (a) showing focally increased tracer uptake in relation to the inferior pole of the right lobe of thyroid gland, which on SPECT/CT of the neck (b) localized to an isodense lesion inferior to lower pole of the right lobe of thyroid gland, suggestive of right inferior parathyroid adenoma that was confirmed on histopathology (c)
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F2
DP 99mTc-MIBI parathyroid scan of the neck Figure 2a showed focally increased tracer uptake in relation to the inferior pole of the right lobe of thyroid gland, which on SPECT/CT Figure 2b of the neck was localized to an isodense lesion of 1.3 x 1.2 cm size inferior to lower pole of the right lobe of thyroid gland suggestive of right inferior parathyroid adenoma, which later on was confirmed on histopathology [Figure 2c].
99mTc-MIBI WBS scan acquired 2 months after surgical removal of parathyroid adenoma (a and b) shows complete resolution of MIBI avid lesions as compared to presurgical scan and DP parathyroid scan (c) showing no abnormal MIBI avid lesion in the neck
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F3
The patient underwent surgery and histopathology that showed chief cells, clear cells and tumor cell with thick capsule (hematoxylin and eosin stain, 400x magnification) confirming diagnosis of parathyroid adenoma. 99mTc-MIBI WBS [Figure 3a and b] acquired 2 months after surgical removal of parathyroid adenoma (Figure 3a and b) showed complete resolution of MIBI avid lesions as compared to presurgical scan and DP parathyroid scan Figure 3c showed no abnormal MIBI avid lesion in the neck.