Salih Sinan Gültekin

The false-positive radioiodine I-131 uptake in the foreign body granuloma located in gluteal adipose tissue

The false-positive radioiodine I-131 uptake in the foreign body granuloma located in gluteal adipose tissue Background. The purpose of using a whole-body scanning after the radioactive I-131 treatment is to screen functional residual or metastatic thyroid tissues. In whole-body scanning of some patients, false positive radioiodine I-131 uptakes may be seen in physiological uptake regions or atypical localizations. Case report. A 54 year-old woman underwent total thyroidectomy for papillary thyroid carcinoma. A positive appearance seen in the upper postero-lateral part of the right gluteal region was determined by a post-therapy I-131 whole body scan. The colour Doppler ultrasonography, magnetic resonance imaging features and histopathological characteristics of the excised lesion were presented. The lesion was demonstrated to be a foreign body granuloma. Conclusions. Unexpected positive findings in the post-therapy I-131 whole body scan should be confirmed with other imaging modalities in order to avoid unnecessary treatments. In uncertain situations, the diagnosis should be established histopathologically.

The efficacy of apparent diffusion coefficient value calculation in differentiation between malignant and benign thyroid nodules

PURPOSE To evaluate the efficacy of apparent diffusion coefficient (ADC) calculation in differentiation between malignant and benign thyroid nodules. METHODS AND MATERIALS A prospective study was conducted in 52 patients. Diffusion-weighted echoplanar imaging was performed and b factors were taken as 0 and 400 s/mm(2). RESULTS The mean ADC value for malignant thyroid nodules was 0.829±0.179×10(-3) mm(2)/s and that for benign thyroid nodules was 1.984±0.482×10(-3) mm(2)/s. The mean ADC value for malignant nodules was significantly lower than that for benign nodules (P=.0001). CONCLUSION ADC value calculation is an effective method in differentiation of malignant thyroid nodules from benign ones.

A Rare Variation of the Heterotaxy Syndrome

Heterotaxy syndrome is a rare, complex, and confusing type of the situs anomalies. It is not possible to estimate the degree of lateralization, isomerism, and rotational variation in these types of cases. Heart and abdominal organ anatomy is specific to the individual, and it should be defined specifically on the basis of each case due to possible cardiac and extracardiac surgical interventions in patients with heterotaxy syndrome. Here, we present our findings obtained from a 58-year-old female patient with heterotaxy syndrome. The main components of this rare variation consist of right-hand-sided aorta, aortic arc, cardiac apex, gall bladder and left-hand-sided inferior vena cava, stomach, and spleen (polysplenia, 3 foci) according to the midline. Besides, the components include left-dominant liver, right-hand-sided large intestines, and left-hand-sided small intestines.

Fracture Risk Analysis in Postmenopausal Women with the Current Methods

Aim: This study was conducted to assess the risk of fracture in postmenopausal women using dual x-ray absorptiometry bone mineral density (DEXA-BMD) as a reference method and FRAX as a new clinical risk assessment tool. Material and Method: 168 postmenopausal women (> 50 years) evaluating with DEXA-BMD and FRAX methods were included in the study. Femoral BMD (F-BMD), femoral T-score (F-Ts), lumbar spine BMD (L-BMD) and lumbar spine T-score (L-Ts) values of the patients were calculated. Fracture risk assessments were carried out using T-score values and FRAX 10-year hip fracture (HF) and major osteoporotic fracture (MOF) risk ratios. Data were analyzed statistically. Results: According to the results of F-Ts and L-Ts, 44/168 (26.2%) and 65/168 (38.7%) of patients had osteoporosis as compatible with high fracture risk. In osteoporotic patients, mean values for F-Ts L-Ts, F-BMD and L-BMD were -2.8 ± 0.4, -3.2 ± 0.5, 0.530 ± 0.049 and 0.682 ± 0.066, respectively. There were found to be high MOF risk in 16/168 (9.5%) and high HF risk in 51/168 (30.4%) of patients according to FRAX. Positive correlations were determined between F-Ts and L-Ts (moderate; rho = 0.424, p <0.05) and between HF and MOF (strong; rho = 0.958, p <0001). There were strong negative correlations among HF and MOF with F-Ts (respectively, rho = -0.897 and rho = -0.844, p <0.001) and moderate negative correlations among HF and MOF with L-Ts (respectively, rho = -0.535 and rho = - 0.567, p <0.05). Discussion: In postmenopausal women with osteoporosis, risk assessment by the FRAX besides the DXABMD measurements can be useful for not to be missed of patients with high risk of fracture.

Transformation of nonfunctioning pancreatic tumor into malignant insulinoma after 3 years: an uncommon clinical course of insulinoma.

A 62-year-old man admitted to our outpatient clinic with two months of recurrent life threatening hypoglycemia episodes. He was diagnosed as malignant insulinoma with multiple metastases of liver and peripancreatic lymph nodes. Liver biopsy specimen was demonstrated grade 2 neuroendocrine tumor compatible with clinical and radiological results. He was followed under the treatment of continuous intravenous glucose infusion during the diagnostic procedures. He had a pancreatic lesion history measured 20 x 12 mm in diameter via the abdominal tomography examination approximately two years before the diagnosis. Unusual course of this case suggests the transformation of nonfunctioning pancreatic neuroendocrine tumor into functional insulin secreting tumor with metastases. The patient was found inoperable and started on chemotherapy.

Initial Fludeoxyglucose (18F) Positron Emission Tomography-Computed Tomography (FDG-PET/CT) Imaging of Breast Cancer – Correlations with the Primary Tumour and Locoregional Metastases

Summary Backround We aimed to evaluate initial PET/CT features of primary tumour and locoregional metastatic lymph nodes (LNs) in breast cancer and to look for potential relationships between several parameters from PET/CT. Material/Methods Twenty-three women (mean age; 48.66±12.23 years) with a diagnosis of primary invasive ductal carcinoma were included. They underwent PET/CT imaging for the initial tumour staging and had no evidence of distant metastates. Patients were divided into two groups. The LABC (locally advanced breast cancer) group included 17 patients with ipsilateral axillary lymph node (LN) metastases. The Non-LABC group consisted of six patients without LN metastases. PET/CT parameters including tumour size, axillary LN size, SUVmax of ipsilateral axillary LNs (SUVmax-LN), SUVmax of primary tumour (SUVmax-T) and NT ratios (SUVmax-LN/SUVmax-T) were compared between the groups. Correlations between the above-mentioned PET/CT parameters in the LABC group as well as the correlation between tumour size and SUVmax-T within each group were evaluated statistically. Results The mean values of the initial PET/CT parameters in the LABC group were significantly higher than those of the non-LABC group (p<0.05). The correlation between tumour size and SUVmax-T value within both LABC and non-LABC groups was statistically significant (p<0.05). In the LABC group, the correlations between the size and SUVmax-LN values of metastatic axillary LNs, between tumour size and metastatic axillary LN size, between SUVmax-T values and metastatic axillary LN size, between SUVmax-T and SUVmax-LN values, and between tumour size and SUVmax-LN values were all significant (p<0.05). Conclusions We found significant correlations between PET/CT parameters of the primary tumour and those of metastatic axillary LNs. Patients with LN metastases had relatively larger primary tumours and higher SUVmax values.

A rare case of ectopic ACTH syndrome originating from malignant renal paraganglioma

Ectopic adrenocorticotropic hormone (ACTH) syndrome is characterized by hypercortisolism due to the hypersecretion of a non-pituitary ACTH-secreting tumor leading to Cushings syndrome. Only a few cases have been reported previously as causing ectopic ACTH related to paraganglioma. Herein, we present a case of Cushings syndrome, in who was proved to be attributable to an ACTH-secreting renal malignant paraganglioma. A 40-year-old woman presented with a five-month history of newly diagnosed hypertension and diabetes, weakness, hyperpigmentation, oligomenorrhea, hirsutism, and acneiform lesions. She showed cushingoid features, including moon face, facial hirsutism, facial and truncal acne, hyperpigmentation, and severe muscle weakness of the limbs. She did not have other findings such as striae, supraclavicular fat accumulation, and buffalo hump. Laboratory examination showed the presence of hypopotasemia, hyperglycemia, hyperthyroidism, and leukocytosis. The serum levels of ACTH, cortisol, and urine-free cortisol were markedly elevated. Results of an overnight 2-mg dexamethasone suppression test included a basal serum cortisol of 61.1 mcg/dL (normal range: 4.6-22.8 mcg/dL) and a cortisol value of 46.1 mcg/dL after dexamethasone administration. There was no suppression found after 2-day 8-mg dexamethasone administration. Magnetic resonance imaging (MRI) of the pituitary gland indicated two microadenomas. An abdominal MRI scan revealed horseshoe kidney, bilateral adrenal hyperplasia, and masses with dimensions of 35 x 31 mm in the left kidney. Inferior petrosal sinus sampling showed no evidence of a central-to-peripheral gradient of ACTH. A positron emission tomography/computed tomography scan showed intense increased activity in the lower pole of the left kidney. Left adrenalectomy and left partial nephrectomy were performed. The resected tumor was diagnosed as the ACTH-secreting paraganglioma in the pathological examination, which was confirmed by immunohistochemical studies with chromogranin A, synaptophysin, and ACTH. Only a few cases of paragangliomas as a cause of ectopic ACTH syndrome have been reported. To our knowledge, this is the first case of renal paraganglioma resulting in Cushings syndrome due to ectopic ACTH hypersecretion.

The Role of Radiologic and Scintigraphic Imaging in Differentiating Thoracic Pyogenic Spondylodiscitis from Metastasis

Background: Physical examination, basic laboratory tests and plain radiographs can give important data in diagnosis of the patients presenting with complaints of back pain. However, advanced imaging tools may be necessary for further evaluation of complicated processes in geriatric patients. Case presentation: We presented plain radiography, magnetic resonance imaging (MRI) and bone scintigraphy (BS) findings of thoracic pyogenic spondylodiscitis in a 72-year-old male patient which resembles metastatic disease. Conclusion: Multimodal imaging, particularly MRI and BS can provide useful data in the initial diagnosis and follow-up of geriatric patients with a complicated vertebral pathology. Spondylodiscitis can mimic metastatic disease.

Sentinel Lymph Node Detection by 3D Freehand Single-Photon Emission Computed Tomography in Early Stage Breast Cancer.

We herein present our first experience obtained by 3D freehand single-photon emission computed tomography (SPECT) (F-SPECT) guidance for sentinel lymph node detection (SLND) in two patients with early stage breast cancer. F-SPECT guidance was carried out using one-day protocol in one case and by the two-day protocol in the other one. SLND was performed successfully in both patients. Histopathologic evaluation showed that the excised nodes were tumor negative. Thus, patients underwent breast-conserving surgery alone.

The contributions of gamma probe to lesion detectability and surgical safety in recurrent thyroid cancer at risk.

In patients, who underwent thyroid surgery or treated with I-131 radioiodine previously for differentiated thyroid cancer, a second surgical intervention carries higher risks due to distortion of the natural anatomy and development of fibrotic/cicatricial tissue. In addition, accurate assessment of current status about extent of the disease is important in terms of success of the surgery. In this case report, we present the positive contribution of intraoperative gamma probe used for lesion detectability and for surgical safety in a patient operated for several times and administered high cumulative dose of radioiodine therapy for diffentiated thyroid carcinoma previously. Conflict of interest:None declared.