⁶⁸Ga-DOTATATE positron emission tomography/computed tomography to detect the recurrence of phosphaturic mesenhcymal tumor-induced osteomalacia

Abstract

⁶⁸Ga-DOTATATE positron emission tomography/computed tomography (PET/CT) has shown superiority over¹¹¹Indium-octreotide scanning for the detection of phosphaturic mesenchymal tumors (PMTs). We report a case of tumor-induced osteomalacia resulting from PMT which, although initially clinically suspected, was not localized on octreotide scintigraphy performed several years prior. Subsequent surgical excision of a presumed benign osseous lesion a few years later revealed the diagnosis on pathology. Imaging assessment using ⁶⁸Ga-DOTATATE PET/CT following recent clinical suspicion for recurrence revealed an intense tracer-avid lesion at the primary tumor site. DOTATATE imaging plays an important role in localizing tumors with high somatostatin receptor expression, such as neuroendocrine tumors (pheochromocytoma, paraganglioma, and neuroblastoma), meningioma, and mesenchymal tumors, causing oncogenic osteomalacia.

Keywords

⁶⁸Ga-DOTATATE - phosphaturic mesenchymal tumor - positron emission tomography - somatostatin receptors - tumor-induced osteomalacia

• References

• 1 Folpe AL, Fanburg-Smith JC, Billings SD, Bisceglia M, Bertoni F, Cho JY, et al. Most osteomalacia-associated mesenchymal tumors are a single histopathologic entity: An analysis of 32 cases and a comprehensive review of the literature. Am J Surg Pathol 2004;28:1-30.
• 2 Jonsson KB, Zahradnik R, Larsson T, White KE, Sugimoto T, Imanishi Y, et al. Fibroblast growth factor 23 in oncogenic osteomalacia and X-linked hypophosphatemia. N Engl J Med 2003;348:1656-63.
• 3 Jan de Beur SM. Tumor-induced osteomalacia. JAMA 2005;294:1260-7.
• 4 Garcia CA, Spencer RP. Bone and in-111 octreotide imaging in oncogenic osteomalacia: A case report. Clin Nucl Med 2002;27:582-3.
• 5 Wild D, Mäcke HR, Waser B, Reubi JC, Ginj M, Rasch H, et al. 68Ga-DOTANOC: A first compound for PET imaging with high affinity for somatostatin receptor subtypes 2 and 5. Eur J Nucl Med Mol Imaging 2005;32:724.
• 6 El-Maouche D, Sadowski SM, Papadakis GZ, Guthrie L, Cottle-Delisle C, Merkel R, et al. 68Ga-DOTATATE for tumor localization in tumor-induced osteomalacia. J Clin Endocrinol Metab 2016;101:3575-81.
• 7 Breer S, Brunkhorst T, Beil FT, Peldschus K, Heiland M, Klutmann S, et al. 68Ga DOTA-TATE PET/CT allows tumor localization in patients with tumor-induced osteomalacia but negative 111In-octreotide SPECT/CT. Bone 2014;64:222-7.
• 8 Dalm SU, Nonnekens J, Doeswijk GN, de Blois E, van Gent DC, Konijnenberg MW, et al. Comparison of the therapeutic response to treatment with a 177Lu-labeled somatostatin receptor agonist and antagonist in preclinical models. J Nucl Med 2016;57:260-5.
• 9 Hofman MS, Lau WF, Hicks RJ. Somatostatin receptor imaging with 68Ga DOTATATE PET/CT: Clinical utility, normal patterns, pearls, and pitfalls in interpretation. Radiographics 2015;35:500-16.
• 10 Jadhav S, Kasaliwal R, Lele V, Rangarajan V, Chandra P, Shah H, et al. Functional imaging in primary tumour-induced osteomalacia: Relative performance of FDG PET/CT vs somatostatin receptor-based functional scans: A series of nine patients. Clin Endocrinol (Oxf) 2014;81:31-7.