Case Author(s): Thomas H. Vreeland,MD/J. Wallis , 8/2/94 . Rating: #D2, #Q4

Diagnosis: Paget's Disease

Brief history:

65 year old man with newly diagnosed prostate cancer. Evaluate for metastatic disease.

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Full history/Diagnosis is available below

Diagnosis: Paget's Disease

Full history:

The patient is a 65 year old man with known Paget's Disease, who was recently diagnosed with prostate cancer. He is being evaluated for metastatic disease.

Findings:

Bone Scintigraphy:

(1) Markedly increased activity is noted throughout an expanded, deformed left lower extremity. In addition, markedly increased activity is noted in the third lumbar vertebrae and in the manubrium.

(2) Moderately increased activity is noted in the right knee, and shoulders bilaterally in a pattern characteristic of degenerative changes.

Discussion:

This case is a dramatic example of Paget's disease involving the manubrium, third lumbar vertebrate, and the entire left lower extremity. The third lumbar vertebrae has the appearance of "Mickey Mouse" , because of the expansion and marked uptake in the entire vertebral body. Paget's disease can undergo sarcomatous degeneration on rare occasions; and, other known cancers, such as prostate cancer can metastasize to bone involved with Paget's disease. Comparison radiographs demonstrate Paget's Disease.

Followup:

The patient's PSA levels are stable, and the patient is presently taking flutamide to treat his prostate cancer.

Major teaching point(s):

1. Paget's disease is a relatively common finding on bone scintigraphy, and should not be confused with more serious diseases. When very intense uptake is seen involving large portions of bones in an older patient, Paget's disease should be considered.

2. A small percentage of bones involved with Paget's disease may undergo malignant degeneration; comparison radiographs may be useful in this setting.

3. The markedly increased activity in the areas of Paget's disease can pose filming problems. Filming at different intensities may be useful.

Differential Diagnosis List

(1) Paget's Disease Polyostotic

(2) Fibrous Dysplasia

ACR Codes and Keywords:

References and General Discussion of Bone Scintigraphy (Anatomic field:Skeletal System, Category:Misc)

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Case number: bs002

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