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CASE REPORT
Year : 2019  |  Volume : 18  |  Issue : 2  |  Page : 189-191

Jaffe–Campanacci syndrome: Any role for99mTc-methylene diphosphonate bone and99mTc-octreotide scans for evaluation of the disorder?


Department of Nuclear Medicine, Taleghani Educational Hospital, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Web Publication5-Apr-2019

Correspondence Address:
Mohsen Qutbi
Department of Nuclear Medicine, Taleghani Hospital, Yaman St., Velenjak, Tehran 1985711151
Iran
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DOI: 10.4103/wjnm.WJNM_21_18

PMID: 31040754

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   Abstract 


Jaffe–Campanacci syndrome (JCS) is a rare clinical disorder with almost unknown etiology. The main feature of this syndrome is skeletal involvement as nonossifying fibroma which may cause severe morbidity to these patients. X-ray imaging is the widely available modality for evaluation of skeleton, but radionuclide imaging modalities may have a role in workup. Herein, we present a case of JCS evaluated with99mTc-methylene diphosphonate bone and99mTc-octreotide scans for the extent of skeletal involvement. To the best of our knowledge, from over than 30 cases reported in the literature, no evaluation with radionuclide imaging has been done.

Keywords: Bone scan, Jaffe–Campanacci syndrome, octreotide scan


How to cite this article:
Qutbi M, Ghanbari S, Asli IN, Shafiei B. Jaffe–Campanacci syndrome: Any role for99mTc-methylene diphosphonate bone and99mTc-octreotide scans for evaluation of the disorder?. World J Nucl Med 2019;18:189-91

How to cite this URL:
Qutbi M, Ghanbari S, Asli IN, Shafiei B. Jaffe–Campanacci syndrome: Any role for99mTc-methylene diphosphonate bone and99mTc-octreotide scans for evaluation of the disorder?. World J Nucl Med [serial online] 2019 [cited 2019 Aug 18];18:189-91. Available from: http://www.wjnm.org/text.asp?2019/18/2/189/255496




   Introduction Top


Jaffe–Campanacci syndrome (JCS) is a rare condition with various clinical pictures including bony lesions as nonossifying fibroma (NOF), skin pigmentation, and other rarer abnormalities. The exact etiology has not been completely understood.[1],[2] Skeletal involvement is the most prominent and debilitating feature of this syndrome, and pathologic fracture is a common initial presentation.[3] Although X-ray seems to be the modality of choice for diagnosis of bony lesions, radionuclide imaging may also play a role mostly for evaluation of extent of the disorder. We present a case of JCS evaluated with99m Tc-methylene diphosphonate (MDP) bone and99m Tc-octreotide scans.


   Case Report Top


A 27-year-old male presented to the emergency department with a fracture of the right femur following a motor accident. During imaging workup, a fracture with an underlying soft-tissue mass was detected. On histopathological examination, an NOF without any pathologic evidence of malignancy was reported. The patient underwent an orthopedic surgery for the femoral fracture. Three to four months later, following a persistent nontraumatic right arm pain, another lesion with similar pathologic result was discovered during workup. Meanwhile, the patient stated episodes of bone pain and fever as well as malaise which was gradually worsening over the preceding months. A99m Tc-octreotide scan was requested on which multiple zones with varying degrees of uptake throughout the body were noted [Figure 1]. For better localization of the lesions, a bone scan was performed subsequently which showed a similar pattern with very intense uptake in the mentioned regions [Figure 2]. Alongside, faint hyperactivity was discovered in the thorax above the region of the heart. The computed tomography scan of the chest shortly afterward demonstrated a mediastinal mass invading to major vascular structures. On pathology, a low-grade soft-tissue sarcoma was found, and then chemotherapy was commenced immediately. A few months later, the patient expired.
Figure 1: (a) Early phase (30 min postinjection) and (b) delayed phase (2–3 h) of whole-body99mTc-octreotide scan of the patient. There are multiple zones with varying degrees of uptake (faint to intense) throughout the body. A region with faint uptake is evident in the mediastinum above the heart, more readily noticeable on delayed image, which is subsequently confirmed as sarcoma

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Figure 2: A whole-body99mTc-methylene-diphosphonate bone scan is performed for better evaluation and localization of lesions. Lesions revealed similar pattern of uptake but mostly intense. The true extent of skeletal involvement on bone scan, compare to octreotide scan, is much more evident

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   Discussion Top


JCS is a rare genetic disorder whose etiology is not clearly understood. Historically, this syndrome was first reported by Jaffe[4] in 1958 as an entity with some different features from Albright's disease including limited skeletal fibrodysplasia, less striking skin changes (as pigmentation), and absence of sexual precocity. Later, more cases were reported with similar features by Campanacci et al.,[5] and Mirra et al.[6] In 1983, Campanacci et al. published a report of 10 cases with multiple NOFs and other extraskeletal anomalies in that a new syndrome with a possible connection with neurofibromatosis was proposed.[5]

Although currently, some advocate the notion of JCS as a distinct clinical entity, close pathophysiologic relationships are present with other clinical syndromes such as neurofibromatosis type 1, McCune-Albright syndrome, and Jaffe-Lichtenstein syndrome. These syndromes share common clinical and pathologic features including skeletal dysplasia and cutaneous pigmentation with JCS. However, no global consensus has been developed yet.[1],[2],[7],[8] Since a pathogenic germline NF1 mutation has been found in a recent study in such patients, it is suggested that many JCS patients actually have neurofibromatosis.[9] Recently, a role for melatonin has also been proposed for the above spectrum of syndromes.[8] Due to this overlap, misdiagnosis, especially at presentation, is not uncommon or surprising.

JCS is clinically characterized by multiple skeletal lesions of NOF, café-au-lait spots on the skin, cardiovascular malformations, etc. Radiologically, findings compatible with NOF, although require distinguishing from polyostotic fibrous dysplasia, are evident involving the skeleton in various regions. Therefore, X-ray bone imaging seems to be the primary modality for evaluation of skeletal lesions.[1],[2],[3],[10] Radionuclide imaging modalities including99m Tc-MDP bone and99m Tc-octreotide scans can be considered as adjunct tools mainly for evaluation of the true extent of the disease and possibly for biological activity of lesions. In addition, based on the degree of uptake on99m Tc-octreotide scan, a role for radionuclide peptide therapy can be considered for locally aggressive somatostatin receptor-positive lesions to prevent pathologic fracture in weight-bearing bones. The bone scan can localize the lesion with much better clarity as in our patient. To the best of our best knowledge, no radionuclide study has been performed in the more than thirty patients with JCS reported in the literature. The multiple NOF lesions caused a debilitating morbidity to the patient, but it seems that the leading cause of death was the sarcoma in the thorax. As many reports in the literature, a pathologic fracture is a common clinical picture at presentation. To date, to the best of our knowledge, no death or concomitant malignancy is reported shortly following the diagnosis which requires a particular attention.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Hau MA, Fox EJ, Cates JM, Brigman BE, Mankin HJ. Jaffe-campanacci syndrome. A case report and review of the literature. J Bone Joint Surg Am 2002;84-A:634-8.  Back to cited text no. 1
    
2.
Mankin HJ, Trahan CA, Fondren G, Mankin CJ. Non-ossifying fibroma, fibrous cortical defect and Jaffe-Campanacci syndrome: A biologic and clinical review. Chir Organi Mov 2009;93:1-7.  Back to cited text no. 2
    
3.
Cherix S, Bildé Y, Becce F, Letovanec I, Rüdiger HA. Multiple non-ossifying fibromas as a cause of pathological femoral fracture in Jaffe-Campanacci syndrome. BMC Musculoskelet Disord 2014;15:218.  Back to cited text no. 3
    
4.
Jaffe HL. Tumors and Tumorous Conditions of the Bones and Joints. London: Henry Kimpton; 1958. p. 83-91.  Back to cited text no. 4
    
5.
Campanacci M, Laus M, Boriani S. Multiple non-ossifying fibromata with extraskeletal anomalies: A new syndrome? J Bone Joint Surg Br 1983;65:627-32.  Back to cited text no. 5
    
6.
Mirra JM, Gold RH, Rand F. Disseminated nonossifying fibromas in association with café-au-lait spots (Jaffe-Campanacci syndrome). Clin Orthop Relat Res 1982;168:192-205.  Back to cited text no. 6
    
7.
Colby RS, Saul RA. Is Jaffe-Campanacci syndrome just a manifestation of neurofibromatosis type 1? Am J Med Genet A 2003;123A: 60-3.  Back to cited text no. 7
    
8.
Abdel-Wanis ME, Kawahara N. Skeletal disorders associated with skin pigmentation: A role of melatonin? Med Hypotheses 2003;61:640-2.  Back to cited text no. 8
    
9.
Stewart DR, Brems H, Gomes AG, Ruppert SL, Callens T, Williams J, et al. Jaffe-Campanacci syndrome, revisited: Detailed clinical and molecular analyses determine whether patients have neurofibromatosis type 1, coincidental manifestations, or a distinct disorder. Genet Med 2014;16:448-59.  Back to cited text no. 9
    
10.
Sevencan A, İnan U, Köse N. A new syndrome mimicking Jaffe-Campanacci syndrome: A case report. Eklem Hastalik Cerrahisi 2013;24:46-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2]



 

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