Localization of Metastatic Parathyroid Carcinoma by 18F FDG PET Scanning

摘要

A47-yr-oldman,diagnosedwithparathyroidcarcinomain1989(1),wasnotedonroutinefollow-up18yrlaterto have raised adjusted calcium (2.82 mmol/liter) and PTH(29.9pmol/liter;normalrange,1.3–6.8pmol/liter)afterpre-viouslynormalvalues.Serumcalciumcontinuedtoincreasedespite treatment with a calcimimetic (Cinacalcet) at a doseof60mgtwicedailyfor1month,andthepatientrequiredivpamidronate to reduce his calcium level. The patient wasotherwise well, with normal clinical examination and neckultrasound. Thoracic computed tomography (CT) demon-strated a 1 ? 1.5-cm nodule in the right lung of unknownsignificance,notamenabletopercutaneousbiopsy.Techne-tium 99m-sestamibi examination and indium-labeled oct-reotide whole body and single photon emission CT of themediastinum were normal (Fig. 1). Subsequently, an18 F-fluorodeoxyglucose positron emission tomography ( 18 F-FDG PET) CT was performed, which showed increased18 F-FDG activity with a maximum standardized uptakevalue (SUV max) of 3.2 in the lung nodule. The nodule wasremoved by open thoracotomy with immediate and sus-tained normalization of the serum calcium (postoperativePTH,6.1pmol/liter;adjustedcalcium,2.04mmol/liter).Cal-cium remains normal 12 months after surgery. Histologydemonstrated metastatic parathyroid carcinoma.