Tc-99m MDP uptake in hepatoblastoma

Fractures in children with newly diagnosed hepatoblastoma

BACKGROUND

Hepatoblastoma is the most common primary hepatic malignancy in children. We have recently noticed an increased incidence of unsuspected fractures in children with newly diagnosed hepatoblastoma. This association has been suggested in the past, but the incidence and pathophysiology remain uncertain.

OBJECTIVE

To define the incidence and imaging features of fractures in children with newly diagnosed hepatoblastoma.

MATERIALS AND METHODS

We searched the oncology database and the radiology picture archiving and communication system of our large tertiary care children's hospital between January 2000 and August 2013 for all patients who presented to our institution with newly diagnosed hepatoblastoma. We reviewed all available imaging exams (radiographs, CT scans, MRIs, and nuclear medicine studies) to identify children who had radiologically apparent fractures on exams during the 50 days prior to diagnosis or up to 2 weeks after the date of hepatoblastoma diagnosis.

RESULTS

Forty-five children were included in this retrospective study. Eight children (17.8%) had fractures within 50 days prior to diagnosis or up to 2 weeks after the date of diagnosis, with a mean number of 4.9 fractures per patient (range 1-13). Only 21 of the 39 fractures (54%) were diagnosed during the initial image interpretation. Fractures most commonly occurred in the ribs (n=21) and vertebral bodies (n=10). The presence of a fracture was not associated with an identified demographic, tumor or laboratory finding.

CONCLUSION

Unsuspected fractures are relatively common in children with newly diagnosed hepatoblastoma.

Technetium-99m Diphosphonate Imaging of Psammocarcinoma of Probable Ovarian Origin

Technetium-99m methylene diphosphonate (Tc-99m MDP) bone scans have long been used by clinicians to diagnose osseous metastases in patients with cancer. However, in several benign and malignant diseases, notably those characterized by extensive soft tissue calcification, Tc-99m MDP may be taken up by the tumor itself. We present a case of a stage IIIC psammoma-rich low-grade serous carcinoma of the ovary, whose identity and extent of disease were first suggested by Tc-99m MDP scintigraphy. The literature concerning this form of cancer, and the use of Tc-99m MDP bone scans to image soft tissue lesions, are reviewed.

Soft tissue uptake on 99mTc methylene diphosphonate bone scan imaging: pictorial review

99mTechnetium methylene diphosphonate (MDP) bone isotope may accumulate in many extra-osseous sites due to a variety of both benign and malignant conditions. This finding on a bone scan can be crucial to the diagnosis and may not be apparent in other imaging or the clinical evaluation of the patient. We present a pictorial review sampling some of the many causes of extra-osseous 99mTc MDP accumulation.