Tc-99m-MDP Uptake in Extraosseous Metastases from Ovarian Papillary Serous Adenocarcinoma

The uptake of Tc-99m-uptake of Tc-99m-methylene diphosphonate (MDP) on bone scintigraphy can be seen at sites other than bone in a varying number of benign and malignant conditions. Extraosseous metastatic calcifications can occur in ovarian papillary serous adenocarcinoma (PSAC). These extraosseous calcifications show Tc-99m-MDP uptake. We report a case of a female in her sixties who had a previous history of PSAC of the ovary. The patient had undergone neoadjuvant chemotherapy (NACT) followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy. She also received adjuvant chemotherapy. Tc-99m-MDP bone scan was performed post chemotherapy because the patient complained of lower backache. The scan showed increased uptake in the lower thoracic and lumbar vertebral regions. However, single-photon emission computed tomography/computed tomography (CT) localizes the uptake to metastatic calcified peritoneal deposits. Further ¹⁸F-fluorodeoxyglucose positron emission tomography/CT confirmed widespread peritoneal and omental metastatic disease with increased uptake.