Visualisation of a paraganglioma by technetium-99m-sestamibi scintigraphy

Abstract

A 68-yr-old woman presented to our observation with multinodular goiter and a contiguous right laterocervical mass. In spite of ultrasound, technetium and iodine scan, CT and fine-needle biopsy, the precise origin of the mass remained uncertain. On additional multi-phase sestamibi scan, the neck region showed an early high uptake rapidly decreasing over time in the laterocervical mass, and a persistent inhomogeneous distribution in the thyroid gland. This behavior suggested that the laterocervical mass could derive from an anatomical structure other than the thyroid. Surgical exploration established the extrathyroid nature of the laterocervical mass and the histological examination confirmed that it was a typical paraganglioma. This finding is in keeping with a recent report of positive sestamibi uptake in a cervical paraganglioma, although our case showed a more rapid kinetic. This tumor should be therefore taken into consideration in the differential interpretation of focal sestamibi uptake.

Intraoperative near-infrared fluorescence imaging of a paraganglioma using methylene blue: A case report

“…The mechanism behind this accumulation is based on physicochemical similarities between MB and sestamibi, a nuclear tracer used for MIBI-scans. Reports which describe the identification of paragangliomas using MIBI-scan are rare [16,17] , but strengthens the hypothesis that MB and sestamibi have a comparable biodistribution. A better understanding of the exact mechanism would be of obvious clinical importance, since this technique could potentially enhance patient cure rates.…”

Cervical Paraganglioma Mimicking a Parathyroid Adenoma on Tc-99m Sestamibi Scintigraphy

“…This case also suggests that a hormone (PTH)-secreting neuroendocrine tumor should be considered in the differential diagnosis of focal cervical MIBI uptake. 13,14 …”

Paraganglioma in the Neck Masquerading as Primary Hyperparathyroidism

“…However, uptake in paraganglioma has been reported. 10 The simulation was so perfect that the preoperative diagnosis of primary hyperparathyroidism resulting from adenoma in the left inferior parathyroid gland was the consensus opinion. Only after the histologic picture of paraganglioma was established and positive immunostaining for PTH in the tumor tissue confirmed was the correct diagnosis revealed.…”