Two meningiomas detected incidentally by Tc-99m HDP bone scintigraphy during a work-up for breast cancer

A 64-year-old woman was diagnosed with infiltrating ductal carcinoma of the left breast by needle biopsy. Results of a Tc-99m HDP bone scan were normal, except for two areas of increased uptake in the head - one in the left posterior frontal bone and the other in the left sphenoid wing. These findings were investigated further. A plain film study showed a blastic abnormality in the left posterior frontal area. An MRI confirmed two contrast-enhancing lesions adjacent to bone, corresponding to the abnormalities on the bone scans. The findings are consistent with benign meningiomas. The patient subsequently underwent a left modified radical mastectomy. If the lesions on bone scan had not been further evaluated, the patient's cancer would have been categorized stage IV instead of stage I (T1N0M0), which carries a much better prognosis. The patient continues to remain free of neurologic symptoms, so surgery is not being considered at this time.