Incidental Finding of Parathyroid Adenoma in a Patient with Breast Carcinoma Detected by PET/CT 18F -FDG Examination and Confirmed by 99 mTc -Terofosmin SPECT/CT
DOI:
https://doi.org/10.3889/oamjms.2024.11918Keywords:
Positron emission tomography–computed tomography;, 18F-Fluorodesoxyglucosae, Single-photon emission computed tomography/computed tomography, Parathyroid adenoma, TetrofosminAbstract
BACKGROUND: Primary hyperparathyroidism (PHPT) is due to the overproduction of PTH by one or more abnormally altered parathyroid glands and leads to the development of hypercalcemia.
CASE PRESENTATION: We present a case of a 69-year-old female patient who was diagnosed with carcinoma of the right mammary gland in 2010. She underwent surgical treatment (right sided mammectomy) and follow-up hormone therapy with Letrozole until cancer remission in 2020. The patient was sent for a positron emission tomography-computed tomography (PET/CT) scan for restaging in May 2022. The patient underwent a whole- body PET/CT 18F-Fluorodesoxyglucosae (18F-FDG) examination on a “SIEMENS” hybrid PET/CT device, model “Biograph mCT64.” During the processing of the hybrid PET/CT images, a rounded lesion suspicious for a parathyroid adenoma of the lower right parathyroid gland was visualized with a slightly increased metabolic activity of SUVmax-2.91. The neck ultrasound revealed a solid, hypoechoic, rounded formation with peripheral blood supply suspicious for a lower right parathyroid adenoma. Blood tests revealed primary hyperparathyroidism osteoporosis of the proximal femur. To diagnostic clarification of the area caudal to the right lobe of the thyroid gland, after 1 month, a single isotope two-phase scintigraphy with 99 mTc-tetrofosmin combined with an early single-photon emission CT (SPECT/CT) technique was performed on a SPECT/ CT gamma camera “Siemens,” model “Symbia Intevo 6.” In the early phase (20 min.) and on the early SPECT/CT images, a hyperfixing zone accumulating the radiomarker, suspicious for a parathyroid adenoma, was visualized under the right lobe of the thyroid gland. The patient underwent surgery, during which a parathyroid adenoma was histologically proven.
CONCLUSION: This case shows that PET/CT 18F-FDG examination can be useful in discovering parathyroid adenomas.
Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Neumann DR, Esselstyn CB, Maclntyre WJ, Go RT, Obuchowski NA, Chen EQ, et al. Comparison of FDG-PET and sestamibi-SPECT in primary hyperparathyroidism. J Nucl Med. 1996;37(11):1809-15. PMid:8917180
Melon P, Luxen A, Hamoir E, Meurisse M. Fluorine-18- fluorodeoxyglucose positron emission tomography for preoperative parathyroid imaging in primary hyperparathyroidism. Eur J Nucl Med. 1995;22(6):556-8. https://doi.org/10.1007/BF00817282 DOI: https://doi.org/10.1007/BF00817282
Vallejos V, Martin-Comin J, Gonzalez MT, Rafecas R, MunozA, FernandezA, et al. The usefulness of Tc-99m tetrofosmin scintigraphy in the diagnosis and localization of hyperfunctioning parathyroid glands. Clin Nucl Med. 1999;24(12):959-64. https://doi.org/10.1097/00003072-199912000-00011 PMid:10595477 DOI: https://doi.org/10.1097/00003072-199912000-00011
Gallowitsch HJ, Mikosch P, Kresnik E, Gomez I, Lind P. Technetium 99m tetrofosmin parathyroid imaging. Results with double-phase study and SPECT in primary and secondary hyperparathyroidism. Invest Radiol. 1997;32(8):459-65. https://doi.org/10.1097/00004424-199708000-00005 PMid:9258734 DOI: https://doi.org/10.1097/00004424-199708000-00005
Gallowitsch HJ, Mikosch P, Kresnik E, Unterweger O, Lind P. Comparison between 99mTc-tetrofosmin/pertechnetate subtraction scintigraphy and 99mTc-tetrofosmin SPECT for preoperative localization of parathyroid adenoma in an endemic goiter area. Invest Radiol. 2000;35(8):453-96. https://doi.org/10.1097/00004424-200008000-00001 PMid:10946972 DOI: https://doi.org/10.1097/00004424-200008000-00001
Prior JO. New scintigraphic methods for parathyroid imaging. Ann Endocrinol (Paris). 2015;76(2):145-7. https://doi.org/10.1016/j.ando.2015.03.026 PMid:25913525 DOI: https://doi.org/10.1016/j.ando.2015.03.026
Kluijfhout WP, Pasternak JD, Drake FT, Beninato T, Gosnell JE, Shen WT, et al. Use of PET tracers for parathyroid localization: A systematic review and meta-analysis. Langenbecks Arch Surg. 2016;401(7):925-35. https://doi.org/10.1007/s00423-016-1425-0 PMid:27086309 DOI: https://doi.org/10.1007/s00423-016-1425-0
Vallabhajosula S. 18f-labeled positron emission tomographic radiopharmaceuticals in oncology: An overview of radiochemistry and mechanisms of tumor localization. Semin Nucl Med. 2007;37(6):400-19. https://doi.org/10.1053/j.semnuclmed.2007.08.004 PMid:17920348 DOI: https://doi.org/10.1053/j.semnuclmed.2007.08.004
Ishizuka T, Kajita K, Kamikubo K, Komaki T, Miura K, Nagao S, et al. Phospholipid/Ca2+-dependent protein kinase activity in human parathyroid adenoma. Endocrinol Jpn. 1987;34(6):965-8. https://doi.org/10.1507/endocrj1954.34.965 PMid:3450512 DOI: https://doi.org/10.1507/endocrj1954.34.965
Treglia G, Piccardo A, Imperiale A, Strobel K, Kaufmann PA, Prior JO, et al. Diagnostic performance of choline PET for detection of hyperfunctioning parathyroid glands in hyperparathyroidism: A systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2019;46(3):751-65. https://doi.org/10.1007/s00259-018-4123-z PMid:30094461 DOI: https://doi.org/10.1007/s00259-018-4123-z
Downloads
Additional Files
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2024 Albena Botushanova, Aleksandar Botushanov, Nikolay Botushanov, Veselin Popov (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
http://creativecommons.org/licenses/by-nc/4.0
