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Figure 2: (A) 40/M with pain in bilateral hips for 2 years and difficulty in walking with insufficiency fracture in the neck of right femur with nonunion. Preoperative biochemical parameters: Serum calcium - 9.4 mg/dL, serum phosphorus - 1.6 mg/dL, serum Vitamin D3 - 10 ng/mL, serum parathyroid hormone - 43 pg/mL, serum fibroblast growth factor-23 - 3360 RU/mL, serum creatinine - 0.8 mg/dL. 99mTechnetium-methylene diphosphonate bone scintigraphy suggestive of the metabolic bone disease. (B) 18F-fluorodeoxyglucose positron emission contrast-enhanced computed tomography images (a) maximum intensity projection image showing focal fluorodeoxyglucose uptake in region of left lingual tonsil (maximum standardized uptake value 4.4) and in region of greater trochanter of right femur (maximum standardized uptake value 5.4) (b) Transaxial fused contrast enhanced positron emission tomography-computed tomography images showing dual time point imaging which shows increase in maximum standardized uptake value from 4.4 to 5.7 in left lingual tonsil, with no corresponding computed tomography abnormality. (c) Coronal and transaxial contrast-enhanced computed tomography and corresponding fused positron emission contrast-enhanced computed tomography images of a right hand showing focus of fluorodeoxyglucose uptake in soft tissue in the distal forearm between radius and ulna. Histopathological examination of tonsillectomy specimen - reactive lymphoid follicles. (C) 68Gallium-DOTANOC contrast enhanced positron emission tomography-computed tomography images showing a). physiological tracer distribution and focus of abnormal increase in tracer in region of greater trochanter of right femur, (b) Fused contrast enhanced positron emission tomography-computed tomography and (c) corresponding contrast-enhanced computed tomography axial, sagittal and coronal images showing focal increase in tracer uptake in greater trochanter of right femur adjacent to bone chips. The patient underwent bilateral total hip replacement. (d and e) Histopathological examination showed atypical spindle cell lesion. Postoperative serum calcium - 10 mg/dL, serum phosphorus - 2 mg/dL $Figure 2: (A) 40/M with pain in bilateral hips for 2 years and difficulty in walking with insufficiency fracture in the neck of right femur with nonunion. Preoperative biochemical parameters: Serum calcium - 9.4 mg/dL, serum phosphorus - 1.6 mg/dL, serum Vitamin D3 - 10 ng/mL, serum parathyroid hormone - 43 pg/mL, serum fibroblast growth factor-23 - 3360 RU/mL, serum creatinine - 0.8 mg/dL. 99mTechnetium-methylene diphosphonate bone scintigraphy suggestive of the metabolic bone disease. (B) 18F-fluorodeoxyglucose positron emission contrast-enhanced computed tomography images (a) maximum intensity projection image showing focal fluorodeoxyglucose uptake in region of left lingual tonsil (maximum standardized uptake value 4.4) and in region of greater trochanter of right femur (maximum standardized uptake value 5.4) (b) Transaxial fused contrast enhanced positron emission tomography-computed tomography images showing dual time point imaging which shows increase in maximum standardized uptake value from 4.4 to 5.7 in left lingual tonsil, with no corresponding computed tomography abnormality. (c) Coronal and transaxial contrast-enhanced computed tomography and corresponding fused positron emission contrast-enhanced computed tomography images of a right hand showing focus of fluorodeoxyglucose uptake in soft tissue in the distal forearm between radius and ulna. Histopathological examination of tonsillectomy specimen - reactive lymphoid follicles. (C) 68Gallium-DOTANOC contrast enhanced positron emission tomography-computed tomography images showing a). physiological tracer distribution and focus of abnormal increase in tracer in region of greater trochanter of right femur, (b) Fused contrast enhanced positron emission tomography-computed tomography and (c) corresponding contrast-enhanced computed tomography axial, sagittal and coronal images showing focal increase in tracer uptake in greater trochanter of right femur adjacent to bone chips. The patient underwent bilateral total hip replacement. (d and e) Histopathological examination showed atypical spindle cell lesion. Postoperative serum calcium - 10 mg/dL, serum phosphorus - 2 mg/dL$