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

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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 18F-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.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea

    Sejin Ha, Sujin Park, Hyunji Kim & Jin-Sook Ryu

  2. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Heounjeong Go

  3. Division of Endocrinology and Metabolism, Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Seung Hun Lee

  4. Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Ji Yoon Choi

  5. Department of Oncology, and Department of Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Jung Yong Hong

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  1. Sejin Ha
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Correspondence to Jin-Sook Ryu.

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Conflict of Interest

Sejin Ha, Sujin Park, Hyunji Kim, Heounjeong Go, Seung Hun Lee, Ji Yoon Choi, Jung Yong Hong, and Jin-Sook Ryu declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the respective institutional research committees and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

The study protocol was approved by the institutional review board of our institute, which waived the requirement for informed consent due to the retrospective nature of the study (IRB no. 2018-1391-0001).

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Ha, S., Park, S., Kim, H. et al. Successful Localization Using 68Ga-DOTATOC PET/CT of a Phosphaturic Mesenchymal Tumor Causing Osteomalacia in a Patient with Concurrent Follicular Lymphoma. Nucl Med Mol Imaging 52, 462–467 (2018). https://doi.org/10.1007/s13139-018-0546-5

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  • DOI: https://doi.org/10.1007/s13139-018-0546-5

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