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Positron emission tomography in combination with computed tomography with 18F-fluorocholine in the topical diagnosis of parathyroid tumors and secondary changes in bone tissue associated with hyperparathyroid osteodystrophy: two case studies

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Abstract


Primary hyperparathyroidism (PHPT) is caused by parathyroid malignant neoplasm in 1% of cases. The risk of the latter is higher in patients with symptomatic PHPT. The prognosis in this group of patients depends on the extent of the process and primary surgical intervention.

In these cases, the differential diagnosis between secondary foci in the bones associated with parathyroid cancer and hyperparathyroid osteodystrophy is a challenging problem.

This article describes two cases of severe PHPT accompanied by hyperparathyroid osteodystrophy suspected for metastatic parathyroid cancer. Positron emission tomography in combination with computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and/or 18F-fluorocholine was included in the examination algorithm. In both cases, pronounced bone changes similar to parathyroid metastases were observed. Accumulation of 18F-fluorocholine was also observed only in altered parathyroid gland. Histological examination of postoperative material verified benign parathyroid tumors, and characteristic lesions of bone tissue were regarded as areas of osteodystrophy.

Therefore, accumulation of 18F-fluorocholine at the areas of bone destruction does not enable differentiation between hyperparathyroid osteodystrophy and metastatic lesions; further research is required to assess sensitivity and specificity of the method with respect to topical diagnosis of altered parathyroid gland.


Natalia G. Mokrysheva

Endocrinology Research Centre 

Email: nm70@mail.ru
ORCID iD: 0000-0002-9717-9742
SPIN-code: 5624-3875

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD, Professor

Julia A. Krupinova

Endocrinology Research Centre 

Author for correspondence.
Email: krupinovaj@gmail.com
ORCID iD: 0000-0001-7963-5022
SPIN-code: 6279-8247

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, researcher at Parathyroid Glands Pathology Department

Mikhail B. Dolgushin

Blokhin Russian Cancer Research Center

Email: mdolgushin@mail.ru
ORCID iD: 0000-0003-3930-5998

Russian Federation, 24, Kashirskoye sh., Moscow, 115478

MD, PhD, Professor

Akgul A. Odzharova

Blokhin Russian Cancer Research Center

Email: odzharova07@yandex.ru
ORCID iD: 0000-0003-3576-6156
SPIN-code: 1074-3862

Russian Federation, 24, Kashirskoye sh., Moscow, 115478

MD, PhD

Iya A. Voronkova

Endocrinology Research Centre

Email: iya-v@yandex.ru
ORCID iD: 0000-0001-6687-3240
SPIN-code: 9685-1371

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Valeriy V. Voskoboynikov

Endocrinology Research Centre 

Email: vall_nat@rambler.ru
ORCID iD: 0000-0003-3911-6636
SPIN-code: 8438-8887

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD

Nikolaj S. Kuznecov

Endocrinology Research Centre

Email: surgery@endocrincentr.ru
ORCID iD: 0000-0002-9947-9511
SPIN-code: 8412-1098

Russian Federation, 11, Dm. Ulyanova street, Moscow, 117036

MD, PhD, Professor

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Supplementary files

Supplementary Files Action
1. Fig. 1. The results of radiation diagnosis of patient B. View (2MB) Indexing metadata
2. Fig. 2. Results of radiation diagnosis of patient V. (arrows indicate pathological foci in the bones). View (2MB) Indexing metadata
3. Fig. 3. Microscopic structure of OSHG adenoma of patient V. and the results of immunohistochemistry. View (2MB) Indexing metadata
4. Fig. 4. The results of radiation diagnosis of patient A. (arrows indicate dystopic in the upper mediastinum OCH, PET / CT with 18F-PC). View (2MB) Indexing metadata
5. Fig. 5. The results of radiation diagnosis of patient A. (arrows indicate pathological foci in the bones, PET / CT with 18F-PF). View (2MB) Indexing metadata
6. Fig. 6. The microscopic structure of the adenoma of the OShZh.A patient A. and the results of immunohistochemistry. View (2MB) Indexing metadata

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Copyright (c) 2018 Mokrysheva N.G., Krupinova J.A., Dolgushin M.B., Odzharova A.A., Voronkova I.A., Voskoboynikov V.V., Kuznecov N.S.

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