Incidental metastatic breast cancer (Tc99m-sestamibi parathyroid scan)

Case contributed by Dr. Chris O'Donnell

Presentation

Presentation with hypercalcemia detected on routine blood. Scan for ? parathyroid adenoma.

Patient Data

Age: 80 years
Gender: Female

Abnormal accumulation of isotope in the left anterior chest wall (patchy) and also within the right lung (rouned).

On the basis of the Tc99m-sestamibi findings, CT was undertaken

Large lobulated mass in the left breast consistent with advanced cancer. Rounded lung metastases and large lytic bone metastasis in the left ilium no doubt responsible for the hypercalcemia.

Case Discussion

Tc99m-sestamibi is a radiopharmaceutical that is taken up by cells with a high concentration of mitochondria, i.e. highly cellular/metabolically active tissues such as the heart but also abnormal tissues such as oxyphil cell parathyroid adenomas, myeloma and breast cancer (the basis of so-called scintimammography). This latter technique has a high specificity for cancer but uses significant radiation dose. In this case, a scan for hyperparathyroidism has shown up a breast cancer with metastases (also accumulating sestamibi) explaining the hypercalcemia.

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