Carsten-Oliver Sahlmann

Early diagnosis and follow-up of aortitis with [18F]FDG PET and MRI

The aim of this prospective study was to compare fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) with magnetic resonance imaging (MRI) in patients with early aortitis, at the time of initial diagnosis and during immunosuppressive therapy. The study population consisted of 15 patients (nine females and six males; median age 62 years, range 26–76 years) who presented with fever of unknown origin or an elevated erythrocyte sedimentation rate or elevated C-reactive protein and who showed pathological aortic [18F]FDG uptake. Fourteen of these patients had features of early giant cell arteritis (GCA), while one had features of early Takayasu arteritis. During follow-up, seven PET scans were performed in six patients with GCA 4–30 months (median 19 months) after starting immunosuppressive medication. The results of [18F]FDG imaging were compared with the results of MRI at initial evaluation and during follow-up and with the clinical findings. At baseline, abnormal [18F]FDG uptake was present in 59/104 (56%) of the vascular regions studied in 15 patients. Seven follow-up PET studies were performed in six patients. Of 30 regions with initial pathological uptake in these patients, 24 (80%) showed normalisation of uptake during follow-up. Normalisation of [18F]FDG uptake correlated with clinical improvement and with normalisation of the laboratory findings. All except one of the patients with positive aortic [18F]FDG uptake were investigated with MRI and MRA. Thirteen of these 14 patients showed inflammation in at least one vascular region. Of 76 vascular regions studied, 41 (53%) showed vasculitis on MRI. Of 76 vascular regions studied with both PET and MRI, 47 were concordantly positive or negative on both modalities, 11 were positive on MRI only and 18 were positive on PET only. MRI was performed during follow-up in six patients: of 17 regions with inflammatory changes, 15 regions remained unchanged and two showed improvement. Whole-body [18F]FDG PET is valuable in the primary diagnosis of early aortitis. The results of [18F]FDG PET and MRI in the diagnosis of aortitis in this study were comparable, but FDG imaging identified more vascular regions involved in the inflammatory process than did MRI. In a limited number of patients [18F]FDG PET was more reliable than MRI in monitoring disease activity during immunosuppressive therapy.

Pelvic lymph node dissection for nodal oligometastatic prostate cancer detected by 68Ga-PSMA-positron emission tomography/computerized tomography.

The first evaluation of pelvic extended lymph node dissection (pLND) in oligometastatic prostate cancer (PCa) detected by 68Ga‐PSMA PET/CT.

Intraoperative Detektion von Sentinel‐Lymphknoten beim malignen Melanom der Haut‐Vitalfärbung allein versus Vitalfärbung plus Gammasonde

Hintergrund: Im Vergleich zur alleinigen Vitalfärbung der Lymphabflusswege bei der Sentinel‐Lymphknotendissektion hat die intraoperative Anwendung einer Gamma‐Detektionssonde die Identifikationsraten verbessert. In der vorliegenden retrospektiven Studie wird der Einfluss der Gamma‐Detektion hinsichtlich weiterer Aspekte ausführlich analysiert.

[Intraoperative detection of sentinel lymph nodes in cutaneous malignant melanoma -- blue dye alone versus blue dye plus gamma detection].

Hintergrund: Im Vergleich zur alleinigen Vitalfärbung der Lymphabflusswege bei der Sentinel‐Lymphknotendissektion hat die intraoperative Anwendung einer Gamma‐Detektionssonde die Identifikationsraten verbessert. In der vorliegenden retrospektiven Studie wird der Einfluss der Gamma‐Detektion hinsichtlich weiterer Aspekte ausführlich analysiert.

Blastomatoid pulmonary carcinosarcoma: report of a case with a review of the literature

BackgroundPulmonary carcinosarcoma is a biphasic tumour with an unfavourable prognosis. The differential diagnosis includes pulmonary blastoma and is often challenging.Case presentationWe here describe a case of blastomatoid pulmonary carcinosarcoma in a 58-year-old patient, who underwent surgical resection. Histopathological examination revealed immature glandular epithelium resembling high-grade fetal adenocarcinoma expressing epithelial markers and membranous beta-catenin, and blastomatoid spindle cells with partial rhabdomyosarcoma-like differentiation. Both elements expressed p53, MDM2, and cyclin-dependent kinase 4 (CDK4), but not thyroid-transcription factor 1 (TTF-1). Mutation analysis of KRAS, EGFR, and beta-catenin revealed no mutations. Comparative genomic hybridization detected +1q, +6p, +6q24qter, +8q, +11q12q14, +11q23qter, +12q12q21, +12q24qter, +17q, +20q, -5q14q23, -9p13pter, -13q21q21, and amplifications at 12q14q21, 15q24qter, 20q11q12.ConclusionThe observed molecular and cytogenetic findings may provide additional tools for the differential diagnosis of biphasic pulmonary neoplasms. Furthermore, TP53, MDM2, CDK4, and PTPN1 may be involved in tumourigenesis.

See the unseen: Mesorectal lymph node metastases in prostate cancer

Our study is the first evaluation of nodal metastatic prostate cancer (PCa) to mesorectal lymph nodes (MLN) detected by 68Ga‐PSMA‐PET/CT.

Intraoperative Detektion von Sentinel-Lymphknoten beim malignen Melanom der Haut-Vitalfarbung allein versus Vitalfarbung plus Gammasonde. Intraoperative detection of sentinel lymph nodes in cutaneous malignant melanoma - blue dye alone versus blue dye plus gamma-detection

Hintergrund: Im Vergleich zur alleinigen Vitalfärbung der Lymphabflusswege bei der Sentinel‐Lymphknotendissektion hat die intraoperative Anwendung einer Gamma‐Detektionssonde die Identifikationsraten verbessert. In der vorliegenden retrospektiven Studie wird der Einfluss der Gamma‐Detektion hinsichtlich weiterer Aspekte ausführlich analysiert.

Individualized Surgery: Gamma-Probe-Guided Lymphadenectomy in Patients with Clinically Enlarged Lymph Node Metastases from Melanomas

BackgroundThe value of a preoperative lymphoscintigraphy in melanoma patients with clinically evident regional lymph node metastases has not been studied. Therapeutic lymph node dissection (TLND) is regarded as the clinical standard, but the appropriate extent of TLND is controversial in all lymphatic basins.Patients and MethodsOf the 115 consecutive patients with surgery on palpable lymph node metastases, 34 received a pre-operative lymphoscintigraphy. Lymphatic drainage to a second nodal basin outside the clinically involved basin was found in 15 cases. In 13 patients, the ectopic tumor-draining lymph nodes were excised as in a sentinel node biopsy. The lymph nodes from the TLND specimens were postoperatively separated and classified as either radioactive or non-radioactive.ResultsA total of 493 lymph nodes were examined pathologically. The largest macrometastasis maintained the ability to take up radiotracer in 77% of cases. Radioactively labeled lymph nodes carried a higher risk of being involved with metastasis. The proportions of tumor involvement for radioactive and non-radioactive lymph nodes were 44.5 and 16.9%, respectively (P=0.00002). Of the 13 ectopic nodal basins surgically explored, six harbored clinically occult metastases.ConclusionIn patients undergoing TLND for palpable metastases, tumor-draining lymph nodes in a second, ectopic nodal basin should be excised, because they could be affected by occult metastasis. With respect to radioactive lymph nodes situated within the nodal basin of the macrometastasis but beyond the borders of a less-radical lymphadenectomy, further studies are needed.

Partial Response to First-Line Crizotinib in an Elderly Male Patient with ROS1 Translocation-Positive Lung Cancer.

We report on a 90-year-old male patient with a ROS1-translocated adenocarcinoma of the lung who was treated with crizotinib as first-line therapy. After 11 months of treatment, we noticed complete metabolic response as measured by 18F-FDG-PET/CT scan and a partial response according to RECIST criteria. This patient indicates that ROS1 translocations are not restricted to young age, female gender and low stage. Furthermore, this case illustrates exemplarily that crizotinib therapy is effective and manageable even as first-line treatment in elderly patients with comorbidities. Based on our findings, we recommend to include elderly patients with advanced pulmonary adenocarcinomas in molecular screening approaches for ROS1 translocations.

22-jährige Frau mit Fieber, Nachtschweiß, Gewichtsverlust und Hepatomegalie

A 22 year old female patient presented with fever, night sweats, weight loss and hepatomegaly associated with elevated inflammatory parameters and liver enzymes. Computer tomography revealed a mass located between the inferior vena cava and the psoas muscle as well as enlarged celiac, retroperitoneal and retrocaval lymph nodes. Biopsies of the retrocaval mass led to the diagnosis of retroperitoneal fibrosis. Within a few days of treatment with corticosteroids clinical presentation improved and imaging studies detected complete regression of the retrocaval mass after 6 months.