Partha Sarathi Chakraborty

Metastatic poorly differentiated prostatic carcinoma with neuroendocrine differentiation: negative on 68Ga-PSMA PET/CT.

Glu-NH-CO-NH-Lys-(Ahx)-[Ga-68(HBED-CC)], abbreviated as Ga-PSMA, is a novel radiotracer undergoing evaluation for PET/CT imaging of prostate carcinoma. Its major advantage is the sensitive detection of lesions even at low prostate-specific antigen level and high target-to-background ratios obtained in metastatic lesions, which is better than that obtained with F-fluoromethylcholine. We present the case of a 28-year-old man with poorly differentiated prostate carcinoma with neuroendocrine differentiation, whose lesions did not show significant Ga-PSMA localization. As literature on utility of Ga-PSMA PET/CT for imaging prostate carcinoma grows, it is important to be aware of potential false negatives that could influence study results.

Detection of brain metastasis with 68Ga-labeled PSMA ligand PET/CT: a novel radiotracer for imaging of prostate carcinoma.

Brain metastasis in prostate cancer is rare and not expected at initial presentation especially when the patient is asymptomatic for the same. A 45-year-old male patient undergoing initial evaluation for newly diagnosed prostatic adenocarcinoma was referred to our department for 99mTc-MDP bone scintigraphy. As part of the study protocol, he also underwent Glu-NH-CO-NH-Lys-(Ahx)-[Ga-68(HBED-CC)] (68Ga-PSMA) PET/CT, which revealed tracer accumulation in brain lesions, apart from localization in the primary, lymph node, and bone metastases. A subsequent MR evaluation confirmed brain metastases.

Malignant melanoma with cavitary pulmonary metastasis: Diagnostic dilemma resolved by FDG PET/CT guided biopsy

196 Indian Journal of Nuclear Medicine | Vol. 29: Issue 3 | July-September, 2014 2. Valenta LJ, Treadwell T, Berry R, Elias AN. Idiopathic thrombocytopenic purpura and Graves disease. Am J Hematol 1982;12:69-72. 3. Kurata Y, Nishioeda Y, Tsubakio T, Kitani T. Thrombocytopenia in Graves’ disease: Effect of T3 on platelet kinetics. Acta Haematol 1980;63:185-90. 4. Cordiano I, Betterle C, Spadaccino CA, Soini B, Girolami A, Fabris F. Autoimmune thrombocytopenia (AITP) and thyroid autoimmune disease (TAD): Overlapping syndromes? Clin Exp Immunol 1998;113:373-8. 5. Cheung E, Liebman HA. Thyroid disease in patients with immune thrombocytopenia. Hematol Oncol Clin North Am 2009;23:1251-60. 6. Gill H, Hwang YY, Tse E. Primary immune thrombocytopenia responding to antithyroid treatment in a patient with Graves’ disease. Ann Hematol 2011;90:223-4. 7. Hofbauer LC, Spitzweg C, Schmauss S, Heufelder AE. Graves disease associated with autoimmune thrombocytopenic purpura. Arch Intern Med 1997;157:1033-6. 8. Bartalena L, Bogazzi F, Martino E. Adverse effects of thyroid hormone preparations and antithyroid drugs. Drug Saf 1996;15:53-63.

Synchronous thoracic and abdominal enteric duplication cysts: Accurate detection with 99m Tc-pertechnetate scintigraphy

Enteric duplication cysts (EDCs) are uncommon congenital anomalies, which can occur anywhere along the gastrointestinal tract and vary greatly in presentation, size, location and symptoms. Ectopic gastric mucosa is reported to be found in 20-30% of these duplications. 99mTc-pertechnetate scintigraphy is a useful modality for preoperative localization of the ectopic functioning gastric mucosa in the EDCs. We report a case where 99mTc-pertechnetate scintigraphy was useful in detecting synchronous thoracic and abdominal duplication cysts with functioning gastric mucosa thus having an impact on the patient management.

Ciliary body metastasis in a patient with non-small cell lung carcinoma — incidental detection with 18F-FDG PET/CT

Ciliary body metastasis in a case of lung cancer is very rare. Intraocular metastasis by any cancer most commonly involves choroid followed by iris and ciliary body. We present a case of a 71-year-old male with non-small cell lung cancer who was found to have an 18F-FDG avid right lung mass. Incidentally a focus of abnormal increased 18F-FDG uptake was noted in the region of ciliary body in the right eyeball. The findings were confirmed to be a metastatic lesion in ciliary body on Ultrasonography and MRI. Our case depicts this extremely rare occurrence corroborated by various modalities.

Metastatic superscan on 99m Tc-MDP bone scintigraphy in a case of carcinoma colon: Common finding but rare etiology

Bone scintigraphy in which there is excessive skeletal radioisotope uptake in relation to soft tissues along with absent or faint activity in the genitourinary tract is known as a ‘superscan’. Prostate cancer is the most common malignancy associated with superscan along with others such as lung cancer, breast cancer and haematological malignancies. Here we present the case of a 41 year old woman with carcinoma colon with metastatic superscan on 99mTc-MDP bone scintigraphy, a very rare cause for metastatic superscan.

Dystrophic calcification in muscles of legs in calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia syndrome: Accurate evaluation of the extent with (99m)Tc-methylene diphosphonate single photon emission computed tomography/computed tomography.

We present the case of a 35-year-old man with calcinosis, Raynauds phenomenon, esophageal dysmotility, sclerodactyly and telangiectasia variant scleroderma who presented with dysphagia, Raynauds phenomenon and calf pain. 99mTc-methylene diphosphonate bone scintigraphy was performed to identify the extent of the calcification. It revealed extensive dystrophic calcification in the left thigh and bilateral legs which was involving the muscles and was well-delineated on single photon emission computed tomography/computed tomography. Calcinosis in scleroderma usually involves the skin but can be found in deeper periarticular tissues. Myopathy is associated with a poor prognosis.

An uncommon case showing three different pathologies on (99m)technetium-methylene diphosphonate bone scintigraphy.

99mTechnetium-methylene diphosphonate bone scintigraphy (BS) has an important role in evaluating skeletal pathology, especially its extent. Incidental extra-osseous uptake may sometimes be seen in soft-tissue pathologies. We present a 64-year-old female with skull base osteomyelitis referred for BS which revealed involvement of the skull base on the left side, uptake was also noted in bilateral lungs secondary to hypercalcemia of renal failure and in the D12-L1 vertebrae as the patient had a history of Potts spine. This is perhaps a unique case showing three findings each of a different etiology in the same scan.

Radiation-Induced Esophagitis Masquerading as Disease Progression in Case of Esophageal Carcinoma: A Diagnostic Dilemma Solved on Follow-up FDG PET/CT.

Radiation esophagitis is one of the commonest complications of the radiotherapy involving esophagus. It is characterized by diffuse radiotracer uptake in the esophagus on ¹⁸F-FDG PET/CT. Thus, it can be often confused with the esophageal malignancy. We present the sequential ¹⁸F-FDG PET/CT images of a 45-year-old woman with locally advanced squamous cell carcinoma of the esophagus who developed radiation esophagitis after chemoradiotherapy. It was confused with the progression of the disease, and the dilemma was resolved by the follow-up PET/CT.

Rare case of gall bladder neuroendocrine tumor: 18F-FDG and 68Ga-DOTANOC PET/CT findings

We present the case of a 33-year-old female patient who resented 1 year back with anorexia, bloating after meals and achexia for duration of 4 months. She underwent a contrast nhanced computed tomography (CECT) of the abdomen which evealed an irregular large, lobulated, space occupying lesion nvolving gall bladder (GB) and adjacent segment 5 of liver. Gross scites, periportal and peripancreatic lymphadenopathy were lso noted. CT guided biopsy from GB mass was suggestive of igh grade neuroendocrine tumor (NET). Ki-67 index was >20. er serum Chromogranin A (CgA) levels were 632.64 U/ml. As part of metastatic work up, the patient was referred to our department for 68Ga-labeled [1,4,7,10-tetraazacyclododecane1,4,7,10-tetraacetic acid]-1-NaI3-Octreotide (68Ga-DOTANOC) positron emission tomography-computed tomography (PET/CT) to look for disease status. 68Ga-DOTANOC PET/CT revealed ill-defined large gall bladder mass (measuring 55 mm × 43 mm) with loss of fat plane and infiltration into adjacent liver parenchyma (segment 5) showing central necrosis and increased DOTANOC uptake (SUVmax-20.5) at the margins (A–C, arrow). No other abnormal radiotracer uptake was noted elsewhere. In view of high grade NET, the patient underwent 18F-fluorodeoxyglucose (18F-FDG) PET/CT for further evaluation of disease status. 18F-FDG PET/CT revealed a