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Extraosseous uptake of metastatic lymph nodes of ureteral cancer on 99Tcm hydroxymethylene diphosphonate bone scintigraphy.

Extraosseous uptake of metastatic lymph nodes of ureteral cancer on 99 Tc m hydroxymethylene diphosphonate bone scintigraphy 1 We describe a case of extraosseous uptake of 99 Tc m diphosphonate in metastatic lymph nodes in a patient with a carcinoma of the ureter. A 70-year-old man with transitional cell carcinoma of the ureter had a total nephroureterectomy and a partial resection of the bladder. CT showed lymph node enlargement in both the left cervical and right common iliac artery regions and outside the iliopsoas muscle, with calcification (Figure 1). A biopsy confirmed transitional cell carcinoma, and metastases regressed following MVAC chemotherapy (Methotrexate, Vinblastine, Adriamycin and Cisplatin). When the metas-tases increased in size again, chemotherapy was given for a second time. Bone scintigraphy was performed to look for bone metastases. Extraosseous uptake in the lymph node metastases was noted in both the left cervical and right common iliac artery regions and outside the right iliopsoas muscle (Figure 2). The extraosseous uptake of 99 Tc m diphosphonate compounds has been reported [1, 2], but the mechanism by which it occurs has not yet been explained. It has been suggested that there may be ionic exchange at the crystalline surface of an area of calcification [2, 3]. As there are some cases in which extraosseous uptake is noted without calcification, other mechanisms have been suggested, such as acceleration of calcium metabolism in tissues and tumours [2], vascularity and capillary permeability [2–5], and an increase in the calcium level in ischaemic cellular tissues [2, 3, 6]. It has also been suggested that 99 Tc m diphosphonate compounds may deposit on the surface of the hydroxyapatite of intracellular mitochondria [2, 5, 7] and may combine with Figure 1. Enhanced CT of abdominal region showing lymph node metastases, including calcification outside the right iliopsoas muscle. Figure 2. Bone scintigraphy, performed to look for bone metastases, showing an extraosseous uptake in the lymph metastases in both the left cervical and right common iliac artery regions and outside the right iliopsoas muscle.