Metin Kir

Clinical experience with Tc-99m MIBI imaging in patients with malignant tumors. Preliminary results and comparison with Tl-201.

Tc-99m MIBI imaging was performed in 34 patients with histopathologically proven malignant tumors. The study was performed in two steps. In the first step, only Tc-99m MIBI imaging was performed (Group 1). In the second step, both Tc-99m MIBI and TI-201 imaging were performed for comparison (Group 2). Seventeen patients were studied in each step. The size of the smallest primary tumor (breast cancer) was 15 × 10 mm, and that of the largest (lung cancer) was 145 × 130 mm. Of the 34 patients, 26 showed Tc-99m MIBI uptake at the tumor site. In Group 1, 12 patients showed Tc-99m MIBI tumor uptake, but no uptake was detected in five patients (squamous cell carcinoma of the esophagus, teratoma of the testis, nonHodgkins lymphoma, and squamous cell carcinoma of the lung). In Group 2, 13 patients showed both Tc-99m MIBI and TI-201 uptake at the tumor site, but one patient with breast cancer showed only Tc-99m MIBI uptake, and three patients showed no Tc-99m MIBI and TI-201 uptake (embryonal cell carcinoma of the testis, hepatocellular carcinoma). The overall sensitivity of Tc-99m MIBI imaging was 76.4%. In Group 2, the sensitivity was 82.3% for Tc-99m MIBI and 76.4% for TI-201. Our preliminary clinical experience suggests that Tc-99m MIBI can be helpful in localizing malignant tumors and that its sensitivity is slightly higher than TI-201.

Unexpected uptake of technetium 99m hexakis-2-methoxy-isobutylisonitrile in giant lymph node hyperplasia of the mediastinum (Castleman's disease)

The case of a patient with giant lymph node hyperplasia of the mediastinum who unexpectedly showed focal uptake of technetium 99m hexakis-2-methoxyisobutylisonitrile (99mTc-MIBI) is presented in this article. The patient was included in our research programme of tumour imaging with 99mTc-MIBI because the appearance of the mass on the chest radiogram and CT scan resembled a mediastinal tumour. Final diagnosis of giant lymph node hyperplasia was achieved through histopathological examination of the surgically removed lymph node.

Synchronous occurrence of papillary carcinoma in the thyroid gland and thyroglossal duct in an adolescent with congenital hypothyroidism.

Thyroid carcinoma (TC) combined with congenital hypothyroidism is rare. The synchronous occurrence of these two conditions is even rarer. We describe a patient with congenital hypothyroidism in whom hyperthyroglobulinemia and nodules developed despite adequate replacement therapy. Papillary TC was detected at age 19 years. Postoperative diagnostic scintigraphy showed increased uptake in the thyroglossal duct region. Repetitive imaging of the thyroid gland can be useful in the early detection of TC in patients with congenital hypothyroidism. Moreover, this rare situation can be complicated by a synchronous thyroglossal duct carcinoma. Thyroglossal duct carcinoma can be detected if diagnostic scintigraphy is performed after total thyroidectomy. Conflict of interest:None declared.

The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders.

Abstract Autoimmune thyroiditis has been suggested as a precancerous condition in some adult studies, but there is still controversy. The importance of autoimmune thyroiditis in childhood thyroid cancer is not yet completely clear. We aimed to evaluate in this study the characteristics of childhood thyroid cancer in patients particularly in terms of coexisting factors including autoimmune thyroid disorders (ATD). Twenty patients diagnosed with primary thyroid cancer were evaluated retrospectively in a Pediatric Endocrinology clinic for 10 years. Patients were followed up for 57.22±11 months. Concomitant conditions (thyroidal and/or extra thyroidal) were determined. Most of the patients (80%) had a coexisting factor. ATDs are the most frequently encountered among them (40%). The ages at the time of diagnosis were older; and the tumor sizes were smaller in patients with concomitant ATDs than without autoimmune thyroid disorders. The follow-up characteristics were similar in both groups. In conclusion, ATDs are frequently encountered in association with thyroid cancer during childhood and adolescence. A thyroid autoimmunity may facilitate the development of a malignant thyroid tumor; on the other hand, increased attention to the thyroid gland may facilitate frequent diagnosis of thyroid cancer. A close follow-up of ATD patients should also include the evaluation of the development of thyroid malignancy.

18F-NaF Positive Bone Metastases of Non 18F-FDG Avid Mucinous Gastric Cancer

Detection of gastric cancer bone metastasis is crucial since its presence is an independent prognostic factor. In this case report, we would like to present 18F-NaF positive bone metastases of non 18F-FDG avid gastric mucinous cancer.

Sentinel lymph node detection and accuracy in vulvar cancer: Experience of a tertiary center in Turkey.

OBJECTIVE To explore the accuracy of sentinel lymph node (SLN) dissection in predicting regional lymph node status by using either only Technetium-99m-labelled (Tc-99m) or in combination with a blue dye in patients with squamous cell cancer of vulva. MATERIAL AND METHODS Twenty-one patients who had T1 (≤2 cm) or T2 (>2cm) tumors that did not encroach into the urethra, vagina or anus were included in the study. For the first twelve patients, Tc-99m was used for SLN identification, and the combined technique was used in subsequent patients. Preoperatively, Tc-99m and a blue dye was injected intradermally around the tumor. Following SLN dissection, complete inguinofemoral lymphadenectomy was performed. RESULTS We could detect SLN in all 21 patients (100%) by either Tc-99m or the combined method. SLN was found to be histopathologically negative in 13 groins via Tc-99m and 10 groins via the combined method. Twenty-one of these 23 (91.3%) groin non-SLN were also negative, but in two groins, we detected metastatic non-SLN. CONCLUSION Although SLN dissection appears promising in vulvar cancer, false negative cases are reported in the literature. Sentinel lymph node dissection without complete lymphadenectomy does not seem appropriate for routine clinical use, since it is known that groin metastasis is fatal.

Uptake of Tc-99m human immunoglobulin in malignant abdominal lymphoma.

Hodgkins and non-Hodgkins lymphomas are malignant lymphoreticular tumors. The usual imaging procedures used for diagnosis and prognosis include radiography, CT, and Ga-67 citrate scintigraphy. Tc-99m human immunoglobulin is an inflammatory imaging agent that has been reported to show uptake in some malignant tumors and was used for imaging non-Hodgkins lymphoma before and after therapy.