Detection of Synchronous Parathyroid Adenoma and Breast Cancer with ¹⁸F-Fluorocholine PET-CT

Excerpt

A 71-year-old woman was referred to our tertiary care center for evaluation of asymptomatic recurrence of primary hyperparathyroidism. As per our protocol, the patient underwent neck/mediastinum ¹⁸F-fluorocholine (FCH) positron emission tomography-computed tomography (PET-CT) for localization. In our institution, FCH PET-CT is performed in patients with hyperparathyroidism and negative conventional imaging [1]. FCH PET-CT is a promising new imaging modality for detection of hyperfunctioning parathyroid glands [2, 3]. Thirty minutes after injection of 139 MBq (3.8 mCi), the PET-CT images showed a focal uptake (SUVmax = 1.8) at the lower anterior neck, level VI, anterior to the right common carotid artery (Fig. 1a-f), suspicious for parathyroid adenoma. Additionally, it showed a second focal uptake (SUVmax = 2.5) in a nodal structure measuring 1.2 cm, within the outer lower quadrant of the right breast (Fig. 2a-f). No other pathological uptake was seen. On the subsequent ultrasound (US) of the breast, there was an area of microcalcifications seen with no definite abnormal lesion. US of the axilla was negative for any suspicious lesions. Mammography showed a blurry 1.3-cm mass without clear boarders and microcalcifications within relatively dense fibro-glandular tissue (BI-RADS IV). US-guided core biopsy showed papillary carcinoma. Pathological examination after breast-conserving surgery revealed papillary breast cancer of 1.0 cm, staged pT1N0. The location of the cancer corresponded with that indicated by FCH PET-CT. Due to the finding of breast cancer, surgery for primary hyperparathyroidism was postponed.

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