Cic edizioni internazionali
Clinical Cases in mineral and bone metabolism

Multi-organ extraosseous 99mTc-HMDP uptake in a case of metastatic melanoma

Case report, 123 - 127
doi: 10.11138/ccmbm/2018.15.1.123
Tag this article
Abstract
Full text PDF
99mTc-diphosphonates are a class of radiopharmaceuticals, used for bone scintigraphy, able to highlight all lesions characterised by altered osteogenesis. We report the case of a 47-year-old male with an end-stage melanoma, presenting a multi-organ extraosseous activity.
Patient underwent whole body scintigraphy using a dual head γ-camera, equipped with LEHR collimators. Images were obtained at 3 hours from i.v. injection of 700 MBq of 99mTc-HMDP. Radiochemical purity was 98.2%.
The scan showed a decreased skeletal and urinary activity, as well as an intense extraosseous activity in the lungs (especially in the right one), in the stomach, in the liver and a bit lesser in the spleen. Unknown skeletal metastases were also identified. At the time of bone scan, the patient had hypercalcemia and an oliguric acute kidney injury caused by sepsis. Moreover, ultrasound and chest radiography showed the presence of hepatic metastases and radiographic signs of pneumonia in the right lung, respectively.
Soft tissues calcifications can be classified in two groups: metastatic calcifications, where calcium sediments in normal tissues, and dystrophic calcifications, where this deposit occurs only in previously injured organs.
Metastatic calcifications mainly occur in patients in hemodialytic treatment, since the hyperparathyroism and the acidosis, due to the interdialytic interval, induce an hypercalcemia. Moreover, the reduced glomerular filtration causes hyperphosphatemia and, consequently, increased calcium-phosphate products. On the other hand, dystrophic calcifications occur in injured tissues, even without increased serum calcium levels. Our patient had high levels of calcemia, but not a secondary hyperparathyroidism, so other causes must be researched.
It’s common knowledge that a high level of calcemia can be found in 10 to 20% of cases with advanced cancer. Indeed, the patient had bone metastases and malignant hypercalcemia. The 99mTc-HMDP uptake was different in the two lungs, with a greater intensity in the right one. This pattern is probably due to two causes: hypercalcemia (linked to the end-stage cancer), that explains the bilateral lungs uptake, and an injured tissue, for example in presence of an infection, that generates a greater uptake in the right lung. The increased uptake of 99mTc-HMDP in other patient’s organs was probably due to some of mechanisms already involved in pulmonary calcifications. Moreover hepatic image showed a patchy activity, with some areas of more evident calcifications, probably due to the presence of malignant metastases.
Malignant hypercalcemia depends on several causes, like the osteoclastic bone resorption and the secretion of parathyroid hormone related protein (PTHrP), and may be associated with extra-skeletal images at bone scintigraphy. A previous oxidant injury can contribute to more intense calcifications in the involved tissues.

Vol. XV (No. 3) 2018 September - December

  1. From the Editor-in-Chief
    Brandi M.L.
  2. Effect on Trabecular Bone Score (TBS) of Tissue-Selective Estrogen Complex (TSEC) in early post-menopausal women: case report
    Lello S., Capozzi A., Scambia G.
  3. Sport and physical activity in patients with hereditary multiple exostoses
    D'Ambrosi R., Caldarini C., Massari G., Facchini R.M., Ragone V.
  4. Underdiagnosis of osteoporosis in different ethnic groups when bone mineral density is measured in a single area
    Mastaglia S.R., Bagur A., Mautalen C.A.
  5. Approach in aromatase inhibitors - induced osteoporosis: results from an Italian multicenter observational study
    Migliaccio S., de Sire A., Marocci C., Fornari R., Paoletta M., Greco E.A., Amar I.D., Moretti A., Ronzoni S., Gimigliano F., Vinicola V., Chiacchiararelli F., Guadalascara F., Pastore R., Falaschi P., Minisola G., Falla O., Castellitto D., Lenzi A., Villa P., Iolascon G.
  6. The clinical safety and possibility of immediate implant placement in aggressive periodontitis patients in maxillary esthetic zone: an empty systematic review
    Yussif N.M., Rahman A.R.A., Darhous M.
  7. Bilateral atypical femoral fractures in macroprolactinoma with hypopituitarism: a case report
    Charoensri S., Pongchaiyakul C.
  8. Spinal deformities in neurofibromatosis type 1
    Lykissas M.G., Mavrogenis A.F., Megaloikonomos P.D., Gelalis I.D., Lykomitros V.
  9. Treatment of osteoarthritis: focus on glucosamine
    Rovati L.C.
  10. Refractory hypercalcemia after idiopathic rhabdomyolysis
    Rodríguez-Quintero J.H., Ramos-Pineda A., Salas-Villela R., Gotés-Palazuelos J.
  11. Severe scoliosis in a Colombian patient with childhood hypophosphatasia
    Zarante Bahamón A.M.
  12. Teriparatide in cervical fracture consolidation
    Cordeiro Albino C., Porcelli Savarani C., Aguiar Moreira C.
  13. Incidental finding of osteopetrosis complicated with osteomyelitis
    Ibrahim A.K., Sansare K., Karjodkar F.R:
  14. Hungry bone syndrome presenting as pathological fracture in a young boy
    Chandra A., Hussain Z., Prasad Assat R., Chandra Meena R.
  15. Rare multifocal eosinophilic granuloma involving maxilla and mandible. A case report
    Shawky Shaker I., Salah Mohamed N.
  16. Teriparatide treatment for an atypical femoral fracture in a patient with calcinosis cutis associated with juvenile dermatomyositis: a case report
    Yoshitani J., Kabata T., Yamamoto N., Shimizu M., Kajino Y, Takagi T., Ohmori T., Ueno T., Tsuchiya H.
  17. Surgical approach to rare case of recurrent pheochromocytoma and bones metastatic paraganglioma
    Cosseddu F., Sacchetti F., Shytaj S., Grossi S., Citarelli C., De Gori M., D'Arienzo A., Capanna R.
  18. Mazabraud’s syndrome: a case report
    Ramírez Stieben R. S., Lifton S.
  19. A case of hypercalcemic parathyroid crisis in a patient with normocalcemic hyperparathyroidism
    Lithgow K., Pasieka J., Kline G.
  20. A Platelet Rich Plasma (PRP) and bovine xenograft combination placed in a jaw bone defect after surgical removal of a compound odontoma associated with an impacted lower canine using piezoelectric surgery: a case report
    Ayoub Al-Delayme R.M.
  21. Pharmacological therapy of sarcopenia: past, present and future
    Iolascon G., Moretti A., de Sire A., Liguori S., Toro G., Gimigliano F.
  22. Revision surgery for acetabular nonunion: role and challenges to preservation of hip joint
    Rollò G., Meccariello L., Bisaccia M., Pichierri P., Filipponi M., Giaracuni M., Di Giacomo L.M., Zinghì G.
  23. Reliability and value of external modular fixation (Hoffmann II®) in the management of humeral shaft fracture
    Bisaccia M., Meccariello L., Rinonapoli G., Ibáñez-Vicente C., Ribes-Iborra J., Gomez-Garrido D., Rollo G., Falzarano G., Shahid Khan M., Grubor P., Caraffa A.
Last Viewed articles: la lista degli ultimi x visitati.
  1. Multi-organ extraosseous 99mTc-HMDP uptake in a case of metastatic melanoma
    Calandri E., Aretano I., Pultrone M., Liberatore M.
    doi: 10.11138/ccmbm/2018.15.1.123
credits