problendoПроблемы ЭндокринологииProblems of Endocrinology0375-96602308-1430Endocrinology Research Centre10.14341/probl9548problendo-9548Research ArticleКлинические случаиCase ReportsПозитронная эмиссионная томография совмещенная с компьютерной томографией с 18F-фторхолином в топической диагностике опухолей околощитовидных желез и вторичных изменений костной ткани при гиперпаратиреоидной остеодистрофии: два клинических наблюденияPositron emission tomography in combination with computed tomography with 18F-fluorocholine in the topical diagnosis of parathyroid tumors and secondary changes in bone tissue associated with hyperparathyroid osteodystrophy: two case studieshttps://orcid.org/0000-0002-9717-9742МокрышеваНаталья ГеоргиевнаMokryshevaNatalia G.

д.м.н., профессор

MD, PhD, Professor

nm70@mail.ruhttps://orcid.org/0000-0001-7963-5022КрупиноваЮлия АлександровнаKrupinovaJulia A.

научный сотрудник отделения патологии околощитовидных желез 

MD, researcher at Parathyroid Glands Pathology Department

krupinovaj@gmail.comhttps://orcid.org/0000-0003-3930-5998ДолгушинМихаил БорисовичDolgushinMikhail B.

д.м.н. профессор

MD, PhD, Professor

mdolgushin@mail.ruhttps://orcid.org/0000-0003-3576-6156ОджароваАкгуль АтаевнаOdzharovaAkgul A.

к.м.н.

MD, PhD

odzharova07@yandex.ruhttps://orcid.org/0000-0001-6687-3240ВоронковаИя АлександровнаVoronkovaIya A.

к.м.н.

MD, PhD

iya-v@yandex.ruhttps://orcid.org/0000-0003-3911-6636ВоскобойниковВалерий ВитальевичVoskoboynikovValeriy V.

к.м.н.

MD, PhD

vall_nat@rambler.ruhttps://orcid.org/0000-0002-9947-9511КузнецовНиколай СергеевичKuznecovNikolaj S.

д.м.н., профессор

MD, PhD, Professor

surgery@endocrincentr.ru<p>ФГБУ &laquo;Национальный медицинский исследовательский центр эндокринологии&raquo; Минздрава России</p>Россия<p>Endocrinology Research Centre&nbsp;</p>Russian Federation<p>ФГБУ &laquo;НМИЦ эндокринологии&raquo;&nbsp;Минздрава России</p>Россия<p>Endocrinology Research Centre&nbsp;</p>Russian Federation<p>ФГБУ &laquo;Национальный медицинский исследовательский центр онкологи и им. Н.Н. Блохина&raquo; Минздрава России</p>Россия<p>Blokhin Russian Cancer Research Center</p>Russian Federation<p>ФГБУ &laquo;Национальный медицинский исследовательский центр эндокринологии&raquo; Минздрава России</p>Россия<p>Endocrinology Research Centre</p>Russian Federation201829122018645299305Copyright &#x00A9; Мокрышева Н.Г., Крупинова Ю.А., Долгушин М.Б., Оджарова А.А., Воронкова И.А., Воскобойников В.В., Кузнецов Н.С., 20182018Мокрышева Н.Г., Крупинова Ю.А., Долгушин М.Б., Оджарова А.А., Воронкова И.А., Воскобойников В.В., Кузнецов Н.С.Mokrysheva N.G., Krupinova J.A., Dolgushin M.B., Odzharova A.A., Voronkova I.A., Voskoboynikov V.V., Kuznecov N.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.probl-endojournals.ru/jour/article/view/9548

Первичный гиперпаратиреоз (ПГПТ) в 1% случаев обусловлен злокачественным новообразованием околощитовидной железы (ОЩЖ), риск наличия которого выше у пациентов с манифестной формой заболевания. Прогноз пациентов данной группы зависит от распространенности процесса и объема первичного хирургического вмешательства.

Большую трудность в таких случаях представляет дифференциальная диагностика между вторичными очагами в костях при раке ОЩЖ и гиперпаратиреоидной остеодистрофией.

В данной статье описаны два случая тяжелого ПГПТ, сопровождавшегося гиперпаратиреоидной остеодистрофией, подозрительной на метастазы рака ОЩЖ. В алгоритм обследования была включена позитронная эмиссионная томография, совмещенная с компьютерной томографией (ПЭТ/КТ) с 18F-фтордезоксиглюкозой (18F-ФДГ) и/или 18F-фторхолином и выявлены выраженные костные изменения, схожие с метастазами ОЩЖ. Накопление 18F-фторхолина наблюдалось также только в измененных ОЩЖ. При гистологическом исследовании послеоперационного материала верифицированы доброкачественные опухоли ОЩЖ, а характерные поражения костной ткани расценены как участки остеодистрофии.

Таким образом, накопление 18F-фторхолина в участках костной деструкции не позволяет дифференцировать гиперпаратиреоидную остеодистрофию от метастатического поражения, а чувствительность и специфичность метода в отношении топической диагностики измененных ОЩЖ требуют дальнейшего исследования.

Primary hyperparathyroidism (PHPT) is caused by parathyroid malignant neoplasm in 1% of cases. The risk of the latter is higher in patients with symptomatic PHPT. The prognosis in this group of patients depends on the extent of the process and primary surgical intervention.

In these cases, the differential diagnosis between secondary foci in the bones associated with parathyroid cancer and hyperparathyroid osteodystrophy is a challenging problem.

This article describes two cases of severe PHPT accompanied by hyperparathyroid osteodystrophy suspected for metastatic parathyroid cancer. Positron emission tomography in combination with computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and/or 18F-fluorocholine was included in the examination algorithm. In both cases, pronounced bone changes similar to parathyroid metastases were observed. Accumulation of 18F-fluorocholine was also observed only in altered parathyroid gland. Histological examination of postoperative material verified benign parathyroid tumors, and characteristic lesions of bone tissue were regarded as areas of osteodystrophy.

Therefore, accumulation of 18F-fluorocholine at the areas of bone destruction does not enable differentiation between hyperparathyroid osteodystrophy and metastatic lesions; further research is required to assess sensitivity and specificity of the method with respect to topical diagnosis of altered parathyroid gland.

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The authors declare that there are no conflicts of interest present.