Seval Erhamamci

A Case of a Man With Isolated Breast Metastasis From Lung Adenocarcinoma Incidentally Detected by FDG PET/CT.

Breast metastases from an extramammary primary tumor are very rare, particularly in men. In this study, we present a case of a 74-year-old man with isolated breast metastasis from lung adenocarcinoma as an incidental finding on PET/CT and diagnosed concomitantly with the primary tumor. Detection of isolated incidental metastatic lesions in the breast on PET/CT imaging has a significant clinical impact on patients with known malignant disease due to change of disease stage, management, and also treatment method.

A case of brain and leptomeningeal metastases from urothelial carcinoma of the bladder

Brain metastases are unusual from urethelial carcinoma of bladder and particularly the occurrence of leptomeningeal metastases is extremely rare, with few cases described in the literature. We present a case of a 45-year-old man with a rare brain metastases as the first metastatic manifestation secondary to urethelial carcinoma of bladder followed by leptomeningeal metastases without any other organ involvement. Eleven months after the diagnosis of high-grade urethelial carcinoma of bladder (T2N0M0), the patient was detected having brain metastases by MRI. FDG PET/CT images for the metastatic evaluation showed no abnormal FDG uptake elsewhere in the body except the brain. Histopathology examination from brain lesion demonstrated the cerebral lesion to be a metastatic urothelial carcinoma. Two months later, the patient was diagnosed to have leptomeningeal metastases by MRI. Our patients condition gradually worsened, and he died 3 months after the diagnosis of leptomeningeal metastases.

The clinical value and histopathological correlation of lacrimal scintigraphy in patients with primary Sjögren's syndrome.

PurposeTo evaluate the lacrimal gland function in patients with primary Sjögren’s syndrome (SS) using lacrimal scintigraphy (LS) and to determine the relationship between clinicopathological stage of primary SS and LS findings. MethodsSeventy eyes from 35 patients with primary SS and 20 eyes from 10 healthy age-matched and sex-matched individuals who served as the control group were included in this study. The patients with primary SS were divided into two groups – early stage and advanced stage – according to the labial biopsy scores (23 patients in early stage and 12 in advanced stage). LS, the Schirmer-1 test, determination of break-up time (BUT), Rose bengal ocular surface vital staining and assessment of functional parameters including ocular surface disease index (OSDI) scores were performed for all cases. LS was used to evaluate tear clearance. Lacrimal scintigrams were evaluated for the presence and severity of delayed tear clearance. Delay in clearance was also subclassified according to the severity of delay (mild, moderate, severe and very severe). LS findings and ophthalmological test results of patients in early stage of disease were compared with the results of those in advanced stage and with those of normal individuals. ResultThe Schirmer-1 test and BUT values of patients in advanced stage of primary SS decreased significantly, whereas the Rose bengal and OSDI values increased significantly when compared with the values of patients in early stage of primary SS and with those of normal individuals (P<0.05 and P<0.001, respectively). Tear clearance of patients in advanced-stage disease was delayed significantly, compared with the tear delay in patients in early stage of disease and that of normal individuals (P<0.001). An inverse correlation existed between tear clearance and both the Schirmer-1 test and BUT value in all patients (P<0.001). However, there was a positive correlation between both the Rose bengal ocular surface staining values and OSDI scores and tear clearance in all cases (P<0.001). LS findings and ophthalmologic test results were significantly different between early-stage and advanced-stage primary SS. ConclusionThe results indicate that LS, which is correlated closely with ophthalmological test results, may be a useful method for the assessment of the lacrimal gland function in patients with primary SS. LS findings and ophthalmological tests may be used for determining disease severity in primary SS.

Incidental diagnosis of tumor thrombosis on FDG PET/CT imaging

OBJECTIVE Clinical data are presented on patients with tumor thrombosis (TT) incidentally detected on FDG PET/CT imaging, as well as determining its prevalence and metabolic characteristics. MATERIALS AND METHODS Out of 12,500 consecutive PET/CT examinations of patients with malignancy, the PET/CT images of 15 patients with TT as an incidental finding were retrospectively investigated. A visual and semiquantitative analyses was performed on the PET/CT scans. An evaluation was made of the pattern of FDG uptake in the involved vessel as linear or focal via visual analyses. For the semiquantitative analyses, the metabolic activity was measured using SUVmax by drawing the region of interest at the site of the thrombosis and tumor (if any). RESULTS The prevalence of occult TT was 0.12%. A total of 15 patients had various malignancies including renal (1 patient), liver (4), pancreas (2), stomach (1), colon (1), non-Hodgkin lymphoma (1), leiomyosarcoma (1), endometrial (1), ovarian (1), malign melanoma (1) and parotid (1). Nineteen vessels with TT were identified in 15 patients; three patients had more than one vessel. Various vessels were affected; the most common was the inferior vena cava (n=7) followed by the portal (n=5), renal (n=3), splenic (n=1), jugular (n=1), common iliac (n=1) and ovarian vein (n=1). The FDG uptake pattern was linear in 12 and focal in 3 patients. The mean SUVmax values in the TT and primary tumors were 8.40±4.56 and 13.77±6.80, respectively. CONCLUSION Occult TT from various malignancies and locations was found incidentally in 0.12% of patients. Interesting cases with malign melanoma and parotid carcinoma and with TT in ovarian vein were first described by FDG PET/CT. Based on the linear FDG uptake pattern and high SUVmax value, PET/CT may accurately detect occult TT, help with the assessment of treatment response, contribute to correct tumor staging, and provide additional information on the survival rates of oncology patients.

Venous thrombosis of sarcoidosis as an unusual incidental finding on 18F-fluorodeoxyglucose positron emission tomography/computed tomography.

Sarcoidosis is defined as a multisystem granulomatous disorder of unknown cause. Venous thrombosis (VT) in the sarcoidosis is rare. The routine use of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) has resulted in clinicians detecting many incidental findings, which have proven to be clinically significant such as thrombosis. Here, we present a case with VT of sarcoidosis in the inferior vena cava and portal vein as an unusual incidental finding on 18F-FDG PET/CT.

Assessment of the effect of interferon-beta1a therapy on thyroid and salivary gland functions in patients with multiple sclerosis using quantitative salivary gland scintigraphy.

Objective: Interferon-beta (IFN-β) is widely used in patients with multiple sclerosis (MS), a demyelinating disease of the central nervous system. High incidence of thyroid dysfunction has been reported after administration of IFN-β in MS patients. The aim of this study was to assess the effect of IFN-β1a therapy on simultaneous thyroid and salivary gland function in patients with MS using quantitative salivary gland scintigraphy (QSGS). Methods: Fifteen relapsing-remitting (RR) MS patients treated with IFN-β1a and two control groups consisting of 15 untreated RRMS patients and 20 healthy age and sex-matched individuals were included in the study. The functional status of the salivary and thyroid glands was analysed with the QSGS and laboratory tests, including thyroid function and thyroid antibody. After intravenous administration of 150 MBq Tc-99m pertechnetate, dynamic study was performed for 25 minutes. Salivary gland secretion was stimulated with oral lemon juice at 15 minutes. At the end of dynamic study, a static image in the same projection was taken. Uptake ratios at 12-14 min (UR%) and stimulated excretion fraction (EF%) of each parotid and submandibular gland were calculated automatically from SGS. Thyroid uptake ratio (TUR) of thyroid gland was calculated from the static image. Results: All MS patients treated and untreated with IFN-β1a, and healthy individuals were euthyroid. Anti-thyroid peroxidase antibody (anti-TPO) was detected in 4 out of 15 MS patients (26.6%) treated with IFN-β1a. There was no significant differences in the UR, EF and TUR values among MS patients treated and untreated with IFN-β1a, and healthy controls (p>0.05). Although the TUR values in MS patients treated with IFN-β1a were less than those of the both control group, the difference was not statistically significant (p>0.05). Conclusion: IFN-β1a therapy was demonstrated to have no effect on thyroid and salivary gland functions using QSGS in patients with MS. Thyroid and salivary gland functions were also found to remain unchanged in untreated MS patients.

Fluorodeoxyglucose-positron emission tomography/computed tomography imaging of squamous cell carcinoma arising in a meningomyelocele.

The patient was a 26-years-old female with a history of lumbosacral meningomyelocele with paraplegia. She was admitted to the hospital due to the lumbosacral wound having become infecting and producing a discharge for 6-months. The patient underwent excisional biopsy of the lumbosacral region. The pathological diagnosis was consistent with metastatic moderately-differentiated squamous cell carcinoma (SCC) (Fig. 1). Fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) imaging was performed for the detection and localisation of the primary tumor and metastatic evaluation (Fig. 2). Figure 1. Atypical squamous cells have keratinization that infiltrating desmoblastic stroma (H&E, ×100). Figure 2. (A) Maximum intensity projection, (B) sagittal fusion positron emission tomography/computed tomography (PET/CT), and (C) CT images show heterogeneously increased high fluorodeoxyglucose (FDG) uptake (maximum standardized uptake value [SUVmax], 12.7) including ... The development of carcinoma associated with meningomyelocele is rare and only limited sporadic cases have been reported in the literature. Reported cases were usually of SCC, as in our case. It has been proposed that malignancy arises at these sites as a result of chronic mechanical irritation and chronic infection, again as in our case. The term Marjolin’s ulcer is often used to describe the formation of neoplastic changes in the scar tissue of chronic ulcers. The most common cell type is SCC, and those SCCs resulting from Marjolin’s ulcers have a much greater tendency to metastasize than those SCCs arising from other causes, which makes early diagnosis imperative. Imaging studies are useful for the characterization of the tumor, the evaluation of its extent, and are essential for treatment planning. FDG-PET/CT whole-body imaging is a widely used technique for the evaluation of many types of malignancies including SCC and is particularly useful for the detection of the primary tumor of unknown origin. FDG-PET/CT can also identify additional sites of metastases that can alter the patient’s management. In a recent study, PET/CT was shown to be useful in differentiating Marjolin ulcer from benign inflammatory conditions of chronic nonhealing ulcer in burn scars and in the evaluation of the depth of invasion in Marjolin’s ulcer cases.

FDG PET/CT imaging in prostate adenocarcinoma presenting as isolated brain metastases of unknown origin.

A 75-year-old man was admitted to the hospital due to forgetfulness, gait instability and right hand apraxia during 2-weeks. A CT of the brain revealed a solitary mass lesion in the right parietooccipital region (Fig. 1). The patient underwent craniectomy and excisional biopsy. The pathological diagnosis of the lesion was consistent with metastatic adenocarcinoma. FDG PET/CT images were performed for the detection of the primary tumor localization and metastatic evaluation. FDG PET/CT images showed abnormal intense FDG uptake in the left lobe of the prostate and no other abnormal FDG uptake was observed elsewhere in the body except physiologic uptake in the muscle in the bilateral femoral region (Fig. 2). PET/CT images of brain demonstrated craniectomy defect and a hypometabolic area in the right parieto-occipital region due to excisional biopsy (Fig. 2). The serum PSA was found to be 13.42 ng/mL (normal < 4 ng/mL). Transrectal ultrasound-guided biopsy confirmed the diagnosis of prostate adenocarcinoma (Gleason score: 4 + 5 = 9). The patient was treated with a whole brain radiotherapy for a total dose of 30 Gy in 10 fractions and hormonal treatment with subcutaneous luteinizing hormone releasing hormone agonist goserelin. At 12 months follow-up, his PSA down to 0.46 ng/mL. Prostate cancer metastasizes most commonly to the pelvic lymph nodes and to the axial skeleton. Brain metastases from prostate adenocarcinoma are rare presentation with an incidence of <1%.1 However, isolated brain matastases as the first clinic manifestation of prostate adenocarcinoma without other systemic involvement is exceedingly rare, with fewer cases reported in the literature.1 FDG PET/CT has a low sensitivity in prostatic adenocarcinoma due to the low metabolic activity of this type of cancer and to the urinary excretion of FDG with tracer activity in the ureters and bladder, making it difficult to distinguish local cancer lesions and lymph node metastases.2 Although the sensitivity of FDG

A Case of Primary Colon Carcinoma Demonstrated by FDG PET/CT Imaging After Detection of a Solitary Brain Metastasis

The detection of brain metastases as the initial manifestation of colorectal carcinoma without liver or lung involvement is extremely rare. Herein we present a case of a 52-year-old male patient with an unusual presentation of colon cancer, with primary lesions demonstrated by fluorine-18-labeled fluorodeoxyglucose (FDG) Positron-emission tomography/computed tomography (PET/CT) after detection of a solitary brain metastasis. Brain CT images revealed a brain tumor. Histopathologic evaluation indicated metastatic poorly differentiated adenocarcinoma, while his physical examination was normal. The PET/ CT revealed abnormal intense FDG uptake in the right parietal region and in descending colon, with no other abnormal FDG uptake elsewhere in the body. The histopathologic diagnosis of the descending colon lesion revealed moderately differentiated adenocarcinoma. This case indicates that FDG PET/CT imaging may have a positive impact on the evaluation of patients with brain metastasis from an unknown primary.

Diffuse Metastasis of Malignant Melanoma

Kirk uc yasinda erkek hasta 1 aydir devam eden bel agrisi ve karinda sislik sikayetiyle basvurdu. Inguinal bolgeden yapilan eksizyonel lenf nodu biyopsisi ile malign melanom tanisi alan olgudan evreleme amaciyla 18F Florodeoksiglukoz (FDG) Pozitron Emission Tomografi (PET)/BT istendi. Olgunun PET/BT goruntusunde; beyinde, her iki akciger ve plevrada, karaciger, dalak, her iki surrenal bezde; iskelet sisteminde kranyumda, her iki klavikula ve skapulada, sternumda, kostalarda, tum kollumna vertebraliste, pelvis kemiklerinde ve her iki ust ve alt ekstremite kemiklerinde; bas-boyun, mediasten, batin ve inguinal bolgedeki lenf nodlarinda; omentum ve peritonda (peritonitis karsinomatoza); her iki alt ekstremite ve sol gluteal bolge kas yapilarinda; alt ekstremitede birkac duzeyde cilt-ciltaltinda artmis FDG tutulumu gosteren cok sayida hipermetabolik lezyonlar izlenmistir (Resim 1).