A. Biyi

Pulmonary Sarcoidosis following Etanercept Treatment for Ankylosing Spondylitis: A Case Report and Review of the Literature

Antitumor necrosis factor therapies have revolutionized the treatment of some inflammatory diseases. However, the use of these agents is associated with the development of many paradoxical autoimmune diseases. Less well-recognized is the association with sarcoidosis. We report a 55-year-old female with long-standing ankylosing spondylitis who developed persistent dry cough and dyspnea while receiving etanercept therapy. High-resolution computed tomography scanning showed mediastinal lymphadenopathy and multiple nodules in both lung fields developed two months after the administration of etanercept. Lymph node biopsy was not practicable. Histopathological examination of minor salivary gland biopsy revealed noncaseating granulomata, and the serum angiotensin-converting enzyme was very elevated. All infectious studies were negative. Etanercept was discontinued plus a course of corticosteroids with a clinical improvement, and a follow-up high-resolution computed tomography scanning 4 months later showed evident regression of mediastinal lymph nodes and pulmonary nodules. Potential pathogenic mechanisms of this paradoxical effect of tumor necrosis factor-alpha blocking agents are discussed.

Diagnostics différentiels d’images d’hypofixations sur une scintigraphie du squelette: à propos d’un cas de leucémie aigue lymphoblastique

If increased uptake during bone scan usually bring to light many bone pathologies, reduced uptakes are a rare occurrence and they require careful analysis to avoid erroneous interpretations. We report the case of a 17-year old admitted with diffuse bone pain, hypercalcemia and thrombopenia. Bone scan showed areas of low uptakes. Bone marrow tests allowed the diagnosis of acute lymphoblastic leukemia. This case report aims to discuss the main differential diagnoses based on such bone scan abnormalities.

Soft tissue uptake of 99mTc-MDP in a case of myxoid liposarcoma with breast metastasis

Breast metastasis arising from non mammary malignancy is very rare and occurs in malignant melanomas, sarcomas, lung cancers, ovarian tumors, renal and thyroid carcinomas. Few cases of breast metastasis from myxoid liposarcoma have been reported in the worldwide literature. We report herein a case of a 51-year-old woman with 2-year history of a slowly growing, painless mass of the right proximal thigh. Imaging investigations showed an intermuscular mass with low-attenuation areas on the CT scan (A) and high signal intensity on T2-weighted MR images (B). Material obtained by biopsy revealed a myxoid liposarcoma. A bone scan performed as part of the initial staging process showed multiple hot spots suggestive of skeletal metastasis in addition to increased soft tissue tracer uptake projected over the right proximal thigh and the left mammary gland corresponding respectively to the primitive tumour and a breast metastasis (C). Chest CT scan showed a left breast mass with similar attenuation feature to the primitive tumour (D). The patient was treated by six chemotherapy cycles (Doxorubicine, Ifosfamide) with good control of his disease at tree years follow up (E). Myxoid Liposarcoma is a rare soft-tissue tumour with a possible aggressive evolution leading to intensive chemotherapy protocols. Soft tissue uptake on bone scan is exceptional, but can occur in a large spectrum of disease. In this case, necrosis and high-water content of myxoid tissue, reflected as marked high signal intensity on T2-weighted MR images, may contribute to the soft tissue uptake mechanism of the bone seeking radiopharmaceutical.

Muscular visualisation on a bone scan in paraneoplastic dermatomyositis associated with breast cancer

Bone scintigraphy is widely used for initial staging and subsequent follow-up of oncologic patients. 99mTc-labelled diphosphonates also have the ability to detect nonosseous disorders. Muscular uptake on bone scintigraphy has been reported in various conditions including rhabdomyolysis, inflammatory muscle disease, traumatic myositis, polymyositis and dermatomyositis. The proposed mechanism of radiotracer uptake is binding to mitochondrial calcium which is increased in the damaged muscle cells. Here, we report a case of a 62 years old woman with a past history of mastectomy for a galactophoric breast carcinoma, without additional adjuvant treatment, who complained of generalized muscle pain and weakness, erythematous rash on the face, the neck and upper arms. Creatine kinase level was elevated (462 IU/L; normal <200 IU/L). Antinuclear antibodies were negative. These findings with the electromyographic examination (myopathic changes) supported the diagnosis of dermatomyositis. A bone scan performed as a part of the staging process showed diffuse and intense muscular uptake of 99mTc-MDP in the shoulder girdles, both proximal upper and lower limbs corresponding to the sites of symptomatic muscles. No evidence of skeletal involvement was detected (A). PET-CT images showed hypermetabolic foci in multiple thoracic lymph nodes (C) and the left iliac bone (D). A punch biopsy confirmed the diagnosis of metastatic lymph node from a breast carcinoma. Immunosuppressive therapy based on oral prednisone and endoxan followed by molecular targeted therapy (Herceptin and taxotere) improved the myositis and cutaneous eruption. Tree months later, creatine kinase level and muscular uptake of 99mTc-MDP dramatically decreased (B).

Functioning Metastases from Thyroid Papillary Carcinoma in Bone.

Functioning thyroid metastases are a rare cause of hyperthyroidism. Most are follicular carcinoma. Here, we report a case in which a 62-y-old man with a history of right subtotal thyroidectomy for a benign adenoma complained of symptoms of hyperthyroidism associated with left arm pain. Biopsy of a humeral lesion was consistent with papillary carcinoma metastatic from the thyroid. Postoperatively, the patient received a cumulative dose of 14.8 GBq of 131I with good control of the hyperthyroidism but without eradication of the bone metastasis.