Sachin Jain

Prostate cancer with lytic bone metastases: 18F-fluorodeoxyglucose positron emission tomography-computed tomography for diagnosis and monitoring response to medical castration therapy

Lytic bone metastases are rare in prostate cancer. We here present 18 fluorine fluorodeoxyglucose (18F-FDG) positron emission tomography computed tomography (PET-CT) images of a 67-year-old male patient with lytic metastases from prostate cancer. Repeat 18F-FDG PET-CT done 6 months later showed response to medical castration therapy. While the role of 18F-FDG PET-CT for sclerotic bone metastases in prostate cancer remains controversial, it appears to be useful for detection and response assessment of lytic prostate cancer metastases.

Incremental value of single photon emission tomography/computed tomography in 3-phase bone scintigraphy of an accessory navicular bone

Accessory navicular bone is one of the supernumerary ossicles in the foot. Radiography is non diagnostic in symptomatic cases. Accessory navicular has been reported as a cause of foot pain and is usually associated with flat foot. Increased radio tracer uptake on bone scan is found to be more sensitive. We report a case highlighting the significance of single photon emission tomography/computed tomography in methylene diphosphonate bone scan in the evaluation of symptomatic accessory navicular bone where three phase bone scan is equivocal.

Lymphoma as a second malignancy in a patient with neuroendocrine tumor: mimicking dedifferentiation on dual-tracer PET/CT with 68Ga-DOTANOC and 18F-FDG.

Neuroendocrine tumors (NETs) are rare tumors which express somatostatin receptors (SSTRs). We here present a case of a 50-year-old female patient with metastatic bronchial carcinoid. She underwent 68Ga-DOTANOC PET/CT and 18F-FDG PET/CT which suggested a diagnosis of poorly differentiated NET. Biopsy of the lesion, however, revealed a second malignancy in the form of diffuse large B-cell lymphoma. Thus, very rarely, other primary tumors can mimic NETs on dual-tracer PET/CT, and biopsy is advised in doubtful cases.

Iris metastasis in a patient with small cell lung cancer: incidental detection with 18F-FDG PET/CT.

Iris metastasis is one of the rare forms of ocular metastasis. Lung and breast cancers represent more than two thirds of the primary tumor sites in such patients. We here present the F-FDG PET/CT findings in a 60-year-old male patient with small cell lung cancer where metastasis to iris was incidentally discovered on PET/CT.

Horseshoe kidney mimicking cross-fused ectopia on 99m Tc-EC renal dynamic scintigraphy

The ‘horseshoe kidney’ is the most common renal fusion anomaly. In this disorder, two developed kidneys are connected to each other at the lower part and grow together. We report a case of horseshoe kidney mimicking cross-fused ectopia in 99mTc-EC renal dynamic scintigraphy.

Asymptomatic cauda equina metastasis in a patient with nasopharyngeal carcinoma: Detection by (18)F-FDG PET/CT.

The central nervous system metastasis from nasopharyngeal carcinoma (NPC) is an extremely rare occurrence, although direct intracranial invasion is not infrequent in patients with NPC. Herein we report a case of a 62-year-old male with NPC, in whom the asymptomatic cauda equina metastasis was detected on staging 18F-Fluordeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT). By demonstrating distant metastasis to cauda equina, 18F-FDG PET/CT detection helped in change of management in this patient.

A case of dual ectopy thyroid along the thyroglossal tract demonstrated on 99mTc-Pertechnatate hybrid single photon emission computed tomography/computed tomography

Ectopic thyroid tissue (ETT) refers to the presence of thyroid tissue in locations other than the normal anterior neck region between the second and fourth tracheal cartilages. Multiple ectopia of the thyroid is extremely rare. Here we report a case of 10-year-old girl with anterior midline neck swelling and hypothyroidism with dual ectopia of thyroid gland without orthotopic thyroid gland. Planar 99 m-technetium pertechnatate scan identified ETT corresponding to the palpable neck swelling. Single photon emission computed tomography/computed tomography (SPECT/CT) demonstrated ETT in two locations, one corresponding to the palpable mass and another in the in the sublingual location. This case thus demonstrates the important role of hybrid SPECT/CT in the identification of dual ectopia along the thyroglossal tract.

Pulmonary amyloidosis in a patient with Langerhans cell histiocytosis: diagnostic dilemma on 18F-FDG PET/CT.

Amyloidosis associated with Langerhans cell histiocytosis (LCH) is extremely rare. We here present the 18F-FDG PET/CT images of a 48-year-old male patient with multifocal skeletal involvement of LCH. In addition, he had a left lung upper lobe 18F-FDG avid mass that was misinterpreted as pulmonary involvement of LCH on PET/CT. Biopsy from the mass showed amyloidosis. Therefore, amyloidosis should be kept as a differential for 18F-FDG pulmonary avid nodule.

Ovarian carcinoma producing parathyroid hormone-related protein causing hypercalcemia and metastatic calcification detected on (18)F-FDG PET-CT.

Hypercalcemia is associated with gynecologic malignant diseases, and cases involving various organs such as the uterus, ovaries, vulva, and vagina. This may be due to elevated levels of parathyroid hormone-related peptide (PTHrP). We describe here two cases of ovarian carcinoma simultaneously producing PTHrP that caused hypercalcemia and metastatic calcification detected on 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT).

68Ga-DOTA-D Phe1-Tyr3-octreotide (DOTATOC)-PET/CT in a suspected case of recurrent meningioma

We present a case of 45-year-old female who presented with headache for last 1 month. She was a follow-up case of left frontal meningioma that was operated 4 years back. CEMRI of the brain suggested post-surgical changes with no obvious enhancing residual/recurrent lesion. The patient was then referred for 68 Ga DOTANOC PET/CT to rule out recurrent disease. PET/CT revealed a focus of somatostatin receptor expressing lesion in the left frontal region at the post-operative site suggesting recurrent disease.