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BackgroundPrimary hyperparathyroidism revealed by a pathological fracture is very uncommon; in the majority of cases the discovery of lytic bone lesions on imaging examinations evokes in the clinician first a neoplastic etiology and a metabolic origin is often omitted. This case report adds to the existing literature as it describes an unusual presentation of primary hyperparathyroidism.Case presentationWe report a case of a 50-year-old Moroccan man, without any known tumor, who presented a fracture of his left clavicle with multiple osteolytic lesions on computed tomography suggesting bone metastases. However, bone scintigraphy oriented the diagnosis to a metabolic pathology by showing a metabolic bone “super scan” with increased tracer uptake in the left clavicle; parathyroid scintigraphy was able to localize pathological right parathyroid tissue.ConclusionsWhenever multiple osteolytic lesions are found in a patient without any known tumor, metabolic bone diseases including hyperparathyroidism should be highly considered.

A 77 years-old man with lung and bone involvement of proven IgG4-related disease complained of tree month's memory deficits. Brain MRI was normal. 18F-FDG whole body PET/CT showed in addition to the bone lesions, a marked symmetrical striatal hypermetabolism in contrast with cortical hypometabolism. Despite steroid treatment, the patient's clinical status declined rapidly and he died two months later. Striatal hypermetabolism has been reported in autoimmune limbic encephalitis, but to the best of our knowledge, this is the first description in a case of IgG4-related disease.

BackgroundParapharyngeal space (PPS) tumors are rare, accounting for 0.5% of all neoplasms of head and neck. PPS tumors may be primary, metastatic or a direct extension of tumors from the adjacent spaces. The frequency of benign and malignant tumors is about 80% and 20%, respectively. Most of them originate from the salivary gland (40-50%), followed by a neurogenic etiology and the remainder are a broad spectrum of miscellaneous tumors [1][2][3][4][5][6][7].The PPS is a lateral pharyngeal region. It is divided by muscular aponeurotic partition into an anterior (prestyloid) muscular compartment and a posterior (poststyloid) neurovascular compartment [1,[3][4][5][6][7]. Imaging is crucial for the assessment of PPS tumors. Surgery is performed based on information provided by these diagnostic modalities.This article will present a case of left parapharyngeal squamos cell carcinoma with unusual spinal metastases, and the potential role of FDG PET/CT will be illustrated. Case PresentationA 36-year-old male patient who showed up in April 2016 with 3 months' history of left side facial paralysis, left trismus, difficulty in swallowing and otological symptoms: otorrhea and otorrhagia. For the last month, he had developed a pharyngeal cavity mass. CT scan head and neck showed well defined heterogeneously enhancing left parapharyngeal solid mass (32×50×62 mm) with multiple area of necrosis, bulging into nasopharynx with extension to pharyngeal mucosal surface.The mass overwhelms the tympanic cavity and spreads to the ipsilateral external auditory meatus and pterygoid muscle. It causes the AbstractBackground: Tumors of the parapharyngeal space (PPS) are rare and account for only 0.5% of head and neck neoplasms. Approximately 80% of these tumors are benign lesions, yet they represent a formidable diagnostic and treatment challenge. They are difficult to diagnose because they have few symptoms, therefore, CT and MRI are essential to delineate the tumor extent, intracranial involvement and relationship to the adjacent vital structures.

We report the case of a 67 years old male patient, followed for epidermoïd carcinoma of the right lung, and hyper-eosinophilia on peripheral blood exploration. 18F-FDG positron emission tomography-computed tomography (18F-FDG PET-CT) performed for initial extension assessment showed, in addition to the intense hypermetabolism in the right upper pulmonary lobe related to the primary tumor and the mediastinal lymph node involvement (Fig. 1A), an unusually intense muscular hypermatbolism