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. Author manuscript; available in PMC: 2019 Oct 10.
Published in final edited form as: Clin Nucl Med. 2012 Feb;37(2):198–199. doi: 10.1097/RLU.0b013e31823e9f95

Incidental Detection of Gastrointestinal Stromal Tumor by Technetium 99m MDP Bone Scan

Timothy M Shepherd 1, Ibrahim A Idakoji 2, Miguel H Pampaloni 1
PMCID: PMC6786789  NIHMSID: NIHMS489961  PMID: 22228353

Abstract

This case demonstrates extraosseous 99m-technetium methylene diphosphonate (99m-Tc-MDP) accumulation from a gastrointestinal stromal tumor (GIST). A 75-year-old woman underwent a temporal bone CT for conductive hearing loss that showed sclerosis in the right occipital condyle. Follow-up 99m-Tc-MDP bone scan for osseous metastases instead showed a mass-like extraosseous accumulation of 99m-Tc MDP in the anterior left upper quadrant. Differential included gastric cancer, lymphoma, metastatic melanoma, systemic hypercalcemia or heterotopic mesenteric ossification. Contrast CT showed a well-circumscribed mass arising from the stomach and subsequent pathology confirmed GIST. These tumors rarely can contain osteoclast-like giant cells and should be considered for extra-osseous 99m-Tc-MDP accumulation.

Keywords: GIST, extraosseous, MDP

Figure 1 –

Figure 1 –

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Temporal bone CT in a 75-year-old patient for mixed sensorineural and conductive hearing loss demonstrated a nonspecific sclerotic focus in the right occipital condyle. Anterior and posterior planar images from a subsequent whole body 99m-Tc-MDP bone scan were negative for suspicious osseous accumulation of radiotracer, but instead demonstrated a large discrete mass-like accumulation of extra-osseous 99m-Tc-MDP in the anterior left upper quadrant. Differential for this finding in an elderly patient included gastric lymphoma or cancer (1,2), metastatic melanoma (3,4) and heterotopic mesenteric ossification, such as from prior gastric bypass surgery (5,6). Gastric 99m-Tc-MDP uptake also has been observed in sarcoidosis (7) and diseases that cause hypercalcemia (8), including multiple myeloma (9), hyperparathyroidism (10) and vitamin D intoxication (11). Isolated splenic infarction and solitary metastasis from a mucinous ovarian or colon cancer seemed unlikely (1). A contrast-enhanced CT was obtained for further characterization.

Figure 2 –

Figure 2 –

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Axial, sagittal and coronal contrast CT images of the abdomen and pelvis showed a large, well-circumscribed, heterogeneous necrotic mass arising from the greater curvature of the stomach most consistent with a gastrointestinal stromal tumor (GIST) (12). Endoscopic ultrasound-guided biopsy demonstrated spindle cells with strong CD117 and DOG-1 immunoperoxidase staining confirming the diagnosis. Previous literature has described unusual presentations of GIST on PET/CT (13), but this case represents the first example of a GIST initially detected by 99m-Tc-MDP bone scan. Malignant stromal tumors, such as GIST, can rarely contain osteoclast-like giant cells (14) that may explain the observed 99m-Tc-MDP accumulation in this case. This patient is currently undergoing imatinib mesylate therapy prior to surgical resection.

Acknowledgments

Support: TMS supported by NIH/NIBIB T32 EB001631-05

Footnotes

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