Serendipitous detection of metastatic breast cancer on Tc99m-sestamibi parathyroid scan

Case contributed by Dr Chris O'Donnell

Presentation

Presentataion with hypercalcemia detected on routine bloods. Scan for ? parathyroid adenoma

Patient Data

Age: 80
Gender: Female

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

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

Modality: CT

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 hypercalcaemia.

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 hypercalcaemia.

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Case Information

rID: 32858
Case created: 18th Dec 2014
Last edited: 21st Nov 2015
System: Breast
Inclusion in quiz mode: Included

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