Although bisphosphonates play an important role in preventing pathologic fractures in patients with cancer, these subtrochanteric stress fractures associated with prolonged use of alendronate should not be ignored.

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Positron emission tomography using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is increasingly used in breast cancer. The new generation cameras integrate PET and CT within the same camera, allowing the simultaneous assessment of the structural and metabolic aspects of disease. There is presently a controversy on the clinical significance of osteoblastic bone metastases in breast cancer which are not detected on FDG-PET. It has been suggested that these radiologically dense lesions represent the result of successful treatment of initially osteolytic lesions. We report a case of a 65-year-old woman with a suspicion of recurrent breast cancer based on an increasing serum tumor marker. Serial PET/CT showed progressive blastic bone metastases on the CT without FDG uptake. These lesions were confirmed by bone single photon emission computed tomography. This case report shows: first, that progressive osteoblastic lesions can lack FDG-avidity, leading to a false-negative PET; and secondly, that bone scintigraphy should not be replaced by FDG-PET/CT for the detection of bone metastases in breast cancer.

Camurati-Engelmann disease is an uncommon condition, radiologically characterized by symmetric diaphyseal sclerosis involving the tubular bones. Clinical features include limb pain, muscle weakness, waddling gait and sometimes deafness. The evaluation is made by conjunction of radiographic and scintigraphic data. Corticosteroids and analgesics improve the quality of life, decrease the pain but do not alter the course of the disease. The evolution is unpredictable. The history of a 23 year old male with such a disorder is presented hereafter. His clinical course shows a very good response to the administration of corticosteroids, whereas no improvement is observed as far as the radiographic and isotopic features are concerned.

Patient: Female, 56Final Diagnosis: Erdheim-Chester diseaseSymptoms: Slurred speech • unsteady gait • walking difficultiesMedication: —Clinical Procedure: —Specialty: OncologyObjective:Rare diseaseBackground:The diagnosis of Erdheim-Chester disease, a rare illness, is difficult and requires increased awareness.Case Report:We report the case of a 56-year-old woman who initially presented with a mesenteric panniculitis and 8 years later developed neurological manifestations and bone lesions that led to a diagnosis of Erdheim-Chester disease.Conclusions:The rather characteristic aspect of the bone lesions as well as the presence of foamy cells in involved tissue biopsies should suggest the diagnosis. No therapy is available at present but recent biological data might suggest new approaches for the understanding and therapy of this condition.

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Radiation-induced sarcoma is a rare complication of radiation therapy. We describe the incidental detection of a radiation-induced undifferentiated soft-tissue sarcoma with increased uptake on 68Ga-labeled prostate-specific membrane antigen (PSMA) PET/CT in a prostate cancer patient previously treated with surgery and external-beam radiotherapy. Results were confirmed by histological analysis. 68Ga-PSMA is known to bind not only to PSMA-expressing prostate cancer cells but also to the neovasculature of various other solid tumors. A careful 68Ga-PSMA PET/CT review of previously irradiated areas is warranted so as not to miss radiation-induced sarcoma in prostate cancer patients.