technetium-tc-99m-medronate and Paraneoplastic-Syndromes

Bone scintigraphy is very sensitive in detecting metastases in an early stage, when changes in osteoblast function precede morphologic changes. In many oncologic situations, however, osteoarticular abnormal changes seen on the bone scan are not caused by tumor infiltration. They may be due to tumor associated conditions, such as carcinoma polyarthritis and hypertrophic pulmonary osteoarthropathy. They also may be due to therapy-associated conditions, such as the flare effect on metastases due to hormonal treatment, chemotherapy or radiotherapy, and osteonecrosis as a complication of radiotherapy or the use of corticosteroids. The introduction of Colony Stimulating Factors (CSF) to reduce myelotoxicity have allowed higher doses of chemotherapeutic agents to be administered. Currently, there is research being performed on the clinical effects of CSF in phase-II studies. In addition to the flare response of metastases, increased uptake in the axial skeleton and/or juxta-articular areas on bone scintigraphy in five patients receiving CSF has been observed. This new phenomenon could be explained by a reaction to a very cellular marrow caused by the use of CSF. The clinical relevance of this finding remains to be established. The authors present an overview of these old and new phenomena seen on the bone scan with clinical and roentgenologic correlation.

Topics: Adult; Aged; Bone and Bones; Breast Neoplasms; Female; Granulocyte Colony-Stimulating Factor; Humans; Iatrogenic Disease; Male; Middle Aged; Neoplasms; Paraneoplastic Syndromes; Radionuclide Imaging; Rhabdomyosarcoma; Technetium Tc 99m Medronate; Teratoma; Testicular Neoplasms

Topics: Aged; Bone and Bones; Breast Neoplasms; Female; Humans; Hypercalcemia; Neoplasm Metastasis; Paraneoplastic Syndromes; Parathyroid Hormone-Related Protein; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon

A 39-year-old man with bone pain underwent Tc-MDP bone scan to assess skeletal lesions, which demonstrated multiple fractures and a focus of subtle extraosseous activity in the left thigh. A Tc-hynic-octreotide imaging was performed due to the suspected diagnosis of tumor-induced osteomalacia, which revealed a hypermetabolic subcutaneous nodule in the left thigh, which exactly corresponded to the same site of MDP activity. Biopsy confirmed the subcutaneous nodule as the culprit tumor of tumor-induced osteomalacia. Bone scan, as a conventional imaging, provided useful information for detecting culprit tumor as shown in our case.

Topics: Adult; Bone and Bones; Bone Neoplasms; Humans; Male; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Radionuclide Imaging; Technetium Tc 99m Medronate; Tomography, X-Ray Computed

Topics: Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Neoplasms, Connective Tissue; Osteomalacia; Paraneoplastic Syndromes; Positron-Emission Tomography; Radiopharmaceuticals; Technetium Tc 99m Medronate; Tomography, Emission-Computed, Single-Photon; Whole Body Imaging

A 23-year-old man, with no relevant medical history, presented with inflammatory peripheral and axial polyarthritis, wrist pain, and persistent low-grade fever for the past 4 months. A bone scintigraphy showed intense periosteal early and delayed uptake in long bones, with normal uptake in the spine, pelvis, and rib cage, and no clear focus of hypermetabolism. CT scan revealed a mediastinal mass. A biopsy of the mass demonstrated Hodgkin lymphoma with bulky disease. This paraneoplastic syndrome as the first sign of intrathoracic Hodgkin's disease is rare.

Topics: Bone Neoplasms; Hodgkin Disease; Humans; Male; Paraneoplastic Syndromes; Radiopharmaceuticals; Technetium Tc 99m Medronate; Young Adult

Topics: Calcinosis; Humans; Hypercalcemia; Male; Middle Aged; Paget Disease, Extramammary; Paraneoplastic Syndromes; Predictive Value of Tests; Radiopharmaceuticals; Technetium Tc 99m Medronate; Whole Body Imaging

Topics: Aged; Biopsy; Carcinoma, Squamous Cell; Humans; Male; Muscle, Skeletal; Paraneoplastic Syndromes; Polymyositis; Radionuclide Imaging; Technetium Tc 99m Medronate; Tongue Neoplasms

To assess the prognostic significance of hypertropic osteoarthropathy (HOA) discovered on routine staging bone scintigraphy in patients with lung cancer.. Between 1989 and 1992 all 99mTc-MDP bone scintigrams performed for the staging of bronchogenic carcinoma were reviewed. HOA was diagnosed by the observation of cortical/periosteal increased uptake in the extremities of the long bones. Follow-up and confirmation of the diagnosis was obtained by hospital computer, histology records, operative records, patient notes and radiological data where available.. 164 staging scintigrams for lung cancer were identified. Twenty-eight patients (17%) were observed to have HOA. Patients with and without HOA were well matched for age and sex. There was little difference in the distribution of cell type but the HOA groups has a greater incidence of peripheral tumours. There was no significance in survival between the two groups. Two of three long-term survivors had clinically overt HOA and one presented with arthralgia.. HOA is often seen on skeletal scintigraphy for staging of lung cancer and has no prognostic significance. The data also support current teaching that a high index of suspicion for HOA, as a cause of arthralgia may lead to early diagnosis of a potentially resectable lung carcinoma.

Topics: Aged; Aged, 80 and over; Carcinoma, Bronchogenic; Female; Follow-Up Studies; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Osteoarthropathy, Secondary Hypertrophic; Paraneoplastic Syndromes; Prognosis; Radionuclide Imaging; Survival Rate; Technetium Tc 99m Medronate

Topics: Carcinoma, Squamous Cell; Humans; Lung Neoplasms; Male; Middle Aged; Muscles; Paraneoplastic Syndromes; Radionuclide Imaging; Technetium Tc 99m Medronate