Paradoxic Technetium-99 Methylene Diphosphonate Localization in Malignant Mesothelioma

Abstract

The literature is replete with cases of Tc-99m bone imaging agent uptake in pleural effusions. Far rarer is the report of photopenia in a pleural effusion. In this case of malignant mesothelioma, we describe a unique case of unilateral hemithoracic photopenia from a pleural effusion with concomitant uptake in the contralateral lung resulting from calcified pleural plaques. Although initially perplexing clinically, this case can be readily explained with an understanding of basic physiological principles.

Platinum–bisphosphonate complexes have proven to be inactive chemotherapeutics targeted for malignant mesothelioma because of inappropriate hydrolysis

“…Compound 3b was prepared, similarly to 3a, starting from the sodium salt of the bisphosphonate, Na 4 The signals at 3.16 (broad singlet with broad Pt-satellites) and 1.93 ppm were assigned to the methinic and methylenic protons of coordinated cis-1,4-DACH, respectively.…”

“…The uptake of the bone scan agent 99m Tc-medronate ( 99m Tc-MDP, medronate stands for methylene diphosphonate) in malignant pleural mesothelioma (MPM) effusions [2][3][4] was found serendipitously and this tropism is now well-established. Although the exact mechanism is still unclear, there are unambiguous indications of preferential accumulation of BPs in MPM with respect to other tumor cell lines implanted in mice [5].…”