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LETTER TO THE EDITOR
Year : 2012  |  Volume : 8  |  Issue : 4  |  Page : 655-656

Extensive 99m Tc-MDP uptake in metastasis to contralateral pleura from osteosarcoma of femur: An indirect measure of extent of disease involvement at diagnosis


1 Radiation Medicine Centre, Bhabha Atomic Research Centre, Mumbai, Maharashtra, India
2 Department of Radiology, Tata Memorial Hospital, Mumbai, Maharashtra, India

Date of Web Publication29-Jan-2013

Correspondence Address:
Sandip Basu
Radiation Medicine Centre (BARC), Tata Memorial Hospital, Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.106594

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How to cite this article:
Basu S, Mahajan A. Extensive 99m Tc-MDP uptake in metastasis to contralateral pleura from osteosarcoma of femur: An indirect measure of extent of disease involvement at diagnosis. J Can Res Ther 2012;8:655-6

How to cite this URL:
Basu S, Mahajan A. Extensive 99m Tc-MDP uptake in metastasis to contralateral pleura from osteosarcoma of femur: An indirect measure of extent of disease involvement at diagnosis. J Can Res Ther [serial online] 2012 [cited 2019 Dec 7];8:655-6. Available from: http://www.cancerjournal.net/text.asp?2012/8/4/655/106594

Sir,

An 18 year old male presented with progressive swelling of lower end of right femur of 1 month duration and a large left sided pleural effusion. Before this, he initially presented with pleural effusion and diagnosed to have tuberculosis and treated with anti-Koch's therapy for 6 months without benefit. MRI of right knee with femur demonstrated altered marrow signal with associated moderate surrounding soft tissue with areas of new bone formation involving lower metadiaphyseal region suggestive of neoplastic lesion with a likely diagnosis of osteogenic sarcoma. The biopsy proved this to be osteosarcoma. 99mTc-MDP whole body skeletal survey [Figure 1] showed intense tracer uptake in the lower end of femur corresponding to the site of primary in addition to foci of MDP uptake in the left parietal bone, left acetabulum, right chest, left humerus suggestive of metastatic lesion at those sites. There was also extensive tracer uptake along the left pleura almost at its entirety. CT thorax with contrast [Figure 2]a and b showed gross left pleural effusion with underlying complete passive collapse of left lung with evidence of mediastinal shift toward right side. Diffuse curvilinear calcification along visceral and parietal pleura was noted which was suggestive of metastatic calcification.
Figure 1: 99mTc-MDP whole body skeletal scintigraphy (anterior and b posterior view) demonstrating intense tracer uptake in the lower end of femur corresponding to the site of primary in addition to foci of MDP uptake in the left parietal bone, left acetabulum, right chest, left humerus suggestive of metastatic lesion at those sites. There is also evidence of extensive tracer uptake along the left pleura almost at its entirety

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Figure 2: Post contrast axial (a) and coronal (b) images of the chest, mediastinal window (left panel) and chest window (Right panel), show gross pleural effusion (asterisk) with collapse of the underlying left lung parenchyma (arrowhead). Discontinuous pleural calcifi cation is seen along the left pleural cavity (arrow)

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Calcification is a hallmark of osteogenic sarcoma not only for the skeletal lesions but also at the extraskeletal sites. [1],[2],[3],[4] Serendipitous observation of 99mTc-MDP uptake has been reported to aid in detecting unusual metastatic sites in the soft tissue. Apart from revealing unsuspected metastatic sites, this characteristic of osteosarcoma can also be useful as an indirect measure of extent of disease involvement in these patients and can help in individual cases on a case-to-case basis. The present case demonstrates one such example of extensive metastatic involvement in the contralateral pleura where the findings in the skeletal scintigraphy suggested global involvement of the pleura. The case underscores the fact that incidental finding in routine bone scan can frequently demonstrate uptake at the extraskeletal metastatic locations and this can serve as an indirect complementary approach to assess the true extent of the soft tissue involvement.

 
 > References Top

1.Pace WM, Ross McDougall I. Tc-99m MDP uptake in soft tissue extraskeletal metastasis from osteogenic sarcoma. Clin Nucl Med 2000;25:333-4.  Back to cited text no. 1
    
2.Basu S, Moghe SH, Shet T. Metastasis of humeral osteosarcoma to the contralateral breast detected by 99mTc-MDP skeletal scintigraphy. Jpn J Radiol 2009;27:455-7.  Back to cited text no. 2
    
3.Wolf R, Wolf RF, Hoekstra HJ. Recurrent, multiple, calcified soft tissue metastases from osteogenic sarcoma without pulmonary involvement. Skeletal Radiol 1999;28:710-3.  Back to cited text no. 3
    
4.Velchik MG, Wegener W. Osteogenic sarcoma with pulmonary metastasis visualized by bone imaging. Clin Nucl Med 1989;14:662-5.  Back to cited text no. 4
    


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