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Indian J Nucl Med
Indian J Nucl Med
IJNM
Indian J Nucl Med
Indian Journal of Nuclear Medicine : IJNM : The Official Journal of the Society of Nuclear Medicine, India
0972-3919
0974-0244
Wolters Kluwer - Medknow India

IJNM-39-234
10.4103/ijnm.ijnm_38_24
Interesting Image
Unexpected Extrarenal Accumulation of Tc-99m Ethylene Dicysteine in a Case of Liposarcoma
Jamshidi Zahra 1
Hekmat Sepideh 2
Hassanzadeh Leila 13
1 Department of Nuclear Medicine, School of Medicine, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Department of Nuclear Medicine, School of Medicine, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran
3 Department of Molecular Imaging, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
Address for correspondence: Dr. Leila Hassanzadeh, Department of Nuclear Medicine, School of Medicine, Rajaie Cardiovascular, Medical and Research Center, Iran University of Medical Sciences, Shahid Hemmat Highway, Tehran 14496-14535, Iran. E-mail: hassanzadeh.l@iums.ac.ir
May-Jun 2024
17 8 2024
39 3 234235
22 3 2024
13 4 2024
13 4 2024
Copyright: © 2024 Indian Journal of Nuclear Medicine
2024
https://creativecommons.org/licenses/by-nc-sa/4.0/ This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
The technetium-99m ethylene dicysteine (Tc-99m EC) is a radiopharmaceutical used for renal scintigraphy, a noninvasive imaging technique that assesses kidney function as well as urinary tract obstruction. We describe the extrarenal Tc-99m EC uptake in a 70-year-old man with recurrent well-differentiated abdominal liposarcoma. In the present case, both liposarcoma lesions which were diagnosed by abdominal CT scan showed heterogeneous accumulation of the Tc-99m EC.

Ethylene dicysteine
liposarcoma
technetium-99m ethylene dicysteine
well-differentiated
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pmcFigure 1 A 70-year-old male patient, with uncontrolled hypertension despite antihypertensive medications, underwent technetium-99m ethylene dicysteine (Tc-99m EC) scintigraphy before and after captopril administration to evaluate potential renovascular hypertension.[1] However, the assessment ruled out the suspected diagnosis. Interestingly, pre- and postcaptopril Tc-99m EC scanning disclosed accumulation of the radiotracer in the left perirenal space (c: black arrow and b: black arrowhead). A photopenic area, corresponding to heterogeneous uptake on posterior views (c: null arrow), was seen on the left side of the bladder on dynamic images. For more accurate evaluation, anterior (a) and lateral (d) planar static images were obtained for a duration of 5 min which showed accumulation in the same area (white arrows). The patient’s medical history revealed recurrent well-differentiated abdominal liposarcomas with a previous resection of a small bowel liposarcoma mass around 3 years ago, which included surgical margins and omental involvement. It is worth noting that several studies have reported unusual accumulation of renal radiotracers such as Tc-99m DTPA[2] and Tc-99m (V) DMSA[34] in extrarenal sites of various soft-tissue sarcoma types during renal scintigraphic examinations.[56] The uptake of these radiotracers has been linked to the histological subtype and tumor differentiation degree. Specifically, dedifferentiated liposarcoma has been found to exhibit a higher uptake of radiotracers compared to well-differentiated liposarcoma.[789] In the present case, nonuniform accumulation of Tc-99m EC in tumor sites, which has been confirmed by subsequent CT scan [Figure 2], may be related to the transformation of tumor tissue from well-differentiated to dedifferentiated type

Figure 2 Following the unexpected findings of extrarenal radiotracer accumulation and concurrent ipsilateral nonobstructive hydroureteronephrosis [Figure 1], it was suggested that a noncontrast-enhanced CT scan is performed to pinpoint the exact anatomical location of these findings. One month after the Tc-99m EC study, a noncontrast-enhanced abdominal CT scan was performed. This procedure revealed the presence of two distinct masses. The first was a significant fat-containing mass located in the left section of the abdominal cavity, specifically in the pararenal space. This mass extended downward to the left iliac fossa, moving the descending colon leftward and infiltrating the left abdominal wall (a). The second soft-tissue mass was found in the left side of the pelvic cavity. It was exerting a compression effect on the urinary bladder causing it to deviate to the right (b)

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Conflicts of interest

There are no conflicts of interest.
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