Francisca Redondo

The role of PET-CT in patients with incidental gallbladder cancer

INTRODUCTION After a cholecystectomy, incidental gallbladder cancer (IGC) requires accurate imaging studies to determine the actual extent of the disease to properly tailor subsequent treatment. The aim of this study was to evaluate the utility of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography ((18)FDG PET-CT) to provide optimal pre-treatment staging in patients with IGC. MATERIAL AND METHODS Between January 2006 and August 2008, all patients with IGC and at least muscular layer invasion were studied with (18)FDG PET-CT. The examination was considered positive when the standardized uptake values (SUV) were >/=2.5. In all instances patients were offered to undergo definitive exploration and possible radical resection. RESULTS The series included 32 patients, 26 women and 6 men, with a median age of 57 years (range 30-81 years). The examination was performed at a median time of 6 weeks after cholecystectomy (range 2-52 weeks). (18)FDG PET-CT was negative in 13 patients and positive in 19 patients: 9 with localized potentially resectable disease (PRD) and in 10 with disseminated disease. Of the 13 patients with negative PET-CT, 9 refused surgery and 4 underwent formal exploration: 3 patients were resected with no disease identified in the final pathology report (FPR) and 1 was not resected as a result of peritoneal carcinomatosis. Of the 9 with PRD, 4 patients refused reoperation and 5 underwent exploration: 3 were resected with residual disease noted in the FPR and 2 did not undergo resection because of dissemination. Two patients with disseminated disease were reoperated and in both instances disseminated disease was confirmed. The median survival for the entire group was 20.3 months (range 1.6-32.9 months). The median survival for those patients with negative PET-CT was 13.5 months (range 5.6-32.9 months), 6.2 months (range 1.6-18.7 months) for localized potentially resectable disease and 4.9 months (range 2-14.1 months) for disseminated disease (P < 0.003). CONCLUSIONS For patients presenting with stage T1b or greater IGC, the use of (18)FDG PET-CT will help reduce the number of patients undergoing non-therapeutic re-exploration and may help to determine the likely prognosis. (18)FDG PET-CT might be a useful tool for the selection of patients for potentially curative treatment.

Anal and rectal syphilis on F-18 FDG PET/CT.

A 59-year-old man was referred for F-18 fluorodeoxyglucose (FDG) PT/CT to characterize pulmonary nodules. Although the lung lesions were negative, an unsuspected increased FDG uptake was detected in the distal rectum, anus, and regional lymphadenopathy. On physical examination a nonpurulent maculopapular exanthema, mainly on the chest, was identified. Anorectal examination and colonoscopy were negative; however the patient recognized a risky sexual behavior. Lymphadenopathy was not palpable. HIV antibody test was negative. Rapid plasma reagin and chromatographic immunoassay (SmarTest) were positive for syphilis. The patient was treated with benzylpenicillin with complete remission of the skin lesions. A new RPR test after therapy was negative.

Thyroid metastases from gallbladder cancer.

BackgroundGallbladder cancer is an aggressive malignancy and radical resection is the only curative therapy available. Metastatic disease in the thyroid is rarely seen; however, different studies have confirmed that the most common primary tumor source is the kidney.Case ReportThyroid metastases from tumors originating in the gastrointestinal tract have been reported. We report a patient with gallbladder cancer (T2N1M0) treated with radical resection and postoperative chemoradiation who developed thyroid metastases.

Carcinoma hepatocelular variedad fibrolamelar metastásico en menores de 20 años. Reporte de 2 casos tratados con intención curativa y revisión de la literatura

Fibrolamellar hepatocellular carcinoma (FLC) is a rare histologicvariant of hepatocellular carcinoma that appears most commonly in teenagers and young adults.The diagnosis is often made incidentally and surgical resection is the only curative treatment.Here we report two cases of incidental FLC involving a 19 year-old male, initially diagnosed withscreening abdominal ultrasound, and a 14 year-old female that presented with abdominal pain.Diagnostic workup consisted of abdominal PET/CT and MRI Imaging studies and tissue diagnosiswas confirmed with percutaneous liver biopsy. Both patients were treated with radical liverresection/tumor excision. However, tumor recurrence was observed in both during short-termfollow-up. The male patient was treated successfully with surgical treatment however the femalepatient succumbed to pregression of disease (Rev Med Chile 2009; 137: 394-400).(

Una nueva modalidad diagnóstica para la detección de tumores neuroendocrinos con 68Ga-DOTATATE PET/CT: Caso clínico

We report a 74-year-old male with liver metastases from a neuroendocrine tumor (NET) of unknown origin. Conventional imaging studies with ultrasound, computed tomography colonoscopy and Positron emission tomography-computed tomography (PET/CT) with 18Fluor odeoxyglucose did not identify the site of origin of the primary tumor. The patient was submitted for a PET/CT scan with a new radiopharmaceuticai, the somatostatin analogue 68Ga-DOTATATE. This new technique demonstrated increased focal uptake at the ileocecal valve. This lesion and other two liver metastases were surgically removed. The histopathology and immunohistochemistry analysis confirmed the diagnosis of NET (carcinoid). This case illustrates the advantages of the PET/CT scan with 68Ga-DOTATATE.