Accumulation of technetium-99m MDP in pseudomyxoma peritonei

Extraosseous distribution of 99mTc-diphosphonates during bone scintigraphy: review of the literature with case series presentation

PURPOSE

Technetium-99m (99mTc)-diphosphonates represent the most common radiopharmaceutical used for bone scintigraphy. Even if the uptake in bone tissue has been widely explored, atypical uptake could be seen in soft tissue malignancies during bone scintigraphy. Increased vascularization and endothelium permeability represent front-row players in the biodistribution of the tracer, albeit other causes have been identified such as trauma, necrosis, the presence of calcification in metastasis, the pH of the tissue and consequently the type of ion concentration.

CONCLUSION

The aim of this paper is to summarize the state of art of atypical soft tissue uptake seen in cancer tissues. The research was conducted on PubMed. The analysis of the literature suggests that calcium metabolism and ionic saturation have a pivotal role in the biodistribution of bone tracers. This phenomenon ranks in a complex scenario that includes carcinogenesis and cancer environment aspects. We also report two cases in our Institution in which atypical uptake in cancer tissues was observed.

MDP uptake in peritoneal carcinomatosis and Krukenberg tumors from mucinous adenocarcinoma

Altered biodistribution of Tc-99m methylene diphosphonate is a common occurrence on bone scintigraphy and mucin-producing neoplasms of the gastrointestinal tract are associated with dystrophic uptake. In addition to the uptake in the primary tumor, activity has been reported in metastasis within lymph nodes and liver. We present a case of Tc-99m methylene diphosphonate uptake in peritoneal carcinomatosis and metastatic Krukenberg tumors from a primary mucinous adenocarcinoma of the descending colon. Each of these findings is uncommon and their combination in this case is particularly unique.