Occult Maxillary Sinus Phosphaturic Mesenchymal Tumor Localized by 68 Ga-DOTATATE PET/CT After Repeated Negative Parathyroid Imaging.
Yuyue Hou, Jinyu Wang, Yu Dai et al.
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Case in brief
A 34-year-old woman had persistent hypophosphatemia and elevated parathyroid hormone levels, prompting repeated evaluation for primary hyperparathyroidism despite negative parathyroid imaging. 68 Ga-DOTATATE PET/CT instead showed a somatostatin receptor-avid lesion in the left maxillary sinus. Histopathology and single-cell RNA sequencing identified a phosphaturic mesenchymal tumor with an FGF23- and PHEX-expressing tumor cell population, confirming the imaging diagnosis. After surgical resection, her biochemical abnormalities and clinical symptoms rapidly improved.
What made this case unusual
The tumor arose in the left maxillary sinus, an exceptionally rare location, and was detected on 68 Ga-DOTATATE PET/CT after repeated negative parathyroid imaging.
Diagnostic / clinical pearl
Persistent hypophosphatemia with elevated parathyroid hormone and negative parathyroid imaging may warrant consideration of an ectopic phosphaturic mesenchymal tumor; 68 Ga-DOTATATE PET/CT localized the lesion in this case.