Steven D. Richman

67Ga accumulation in pulmonary lesions associated with bleomycin toxicity

The radionuclide, gallium‐67, accumulates in a wide variety of neoplastic and inflammatory lesions. Diffuse bilateral lung localization of67Ga occurred in two cases of interstitial pneumonitis associated with bleomycin therapy. Clinical symptoms and laboratory evaluation of pulmonary status correlated with scintigraphic studies in these two patients, while discrepancies between scinti‐graphic and roentgenographic findings were observed.Cancer 36:1966–1972,1975.

Abnormal Pulmonary Gallium Accumulation in P. Carinii Pneumonia

The potentially fatal interstitial pneumonia of Pneumocystis carinii is a frequent opportunistic invader of patients treated for malignancy with immunosuppressive and cytotoxic agents. Generalized Ga-67 pulmonary localization which is markedly disproportionate to the clinical and radiographic findings has led to earlier diagnoses by open lung biopsy in this setting. The potential usefulness of gallium scintigraphy in patients with suspected P. Carini pneumonia is presented.

Renal localization of gallium-67 citrate.

Renal localization of 67Ga citrate has been observed in 1.7% of 2,000 whole-body gallium scans in three major diseases: lymphoreticular neoplasms, leukemia, and malignant melanoma. Correlation of this finding with autopsy data in 13 cases revealed 9 with tumor and 2 with an inflammatory process. Findings in two cases were normal. In the remaining patients, correlation with abnormal urograms and laboratory data was poor. Nevertheless, gallium localization in the kidneys may be the first indicator of renal involvement with either tumor or inflammation.

67Ga radionuclide imaging in Burkitt's lymphoma.

Whole-body gallium imaging was evaluated as a diagnostic tool for 14 patients with Burkitts lymphoma, and a dramatic gallium affinity for the tumor was demonstrated. The gallium image is recommended as a staging procedure and as an effective test for determining the therapeutic response.

Radionuclide studies in Hodgkin's disease and lymphomas

A rational, multidisciplinary approach to Hodgkins disease and the non-Hodgkins lymphomas has been responsible for major advances in therapy. Invasive diagnostic procedures and exploratory laparotomy, with their associated complications, make nontraumatic radionuclide imaging most appealing in both the clinical staging of disease and in evaluating therapy. Gallium-67-citrate, the tumor scanning agent of the early 1970s, has demonstrated a marked affinity for Hodgkins disease and the other lymphomas. False positives are few, with sensitivity greater than 70% throughout the spectrum of Hodgkins disease and the histiocytic lymphomas. In addition to confirming sites of suspected neoplasm, this agent has proved useful in the detection of occult involvement. Moreover, resolution of abnormal gallium-67 concentrations on follow-up studies functions as a visual ancillary index of therapeutic response. The value of wholebody gallium-67 scintigraphy is further enhanced when used in conjunction with routine technetium brain, bone, liver, and spleen scans. While the diagnostic accuracy of gallium-67 studies has been limited in the abdomen due to bowel activity, our attempts to improve these results with the tumor-seeking radiopharmaceutical indium-111-Bleomycin were unrewarding and subsequently were discontinued. Finally, radionuclide lymphography has also been explored. Its diagnostic usefulness in detecting pelvic and abdominal lymph node involvement warrants further investigation.

Acute pulmonary edema associated with Librium abuse. A case report.

Abstract A case of acute pulmonary edema associated with the intravenous injection of the dissolved contents of Librium (chlordiazepoxide) capsules is presented. Findings on admission included diffuse poorly defined infiltrates of both lung fields, shortness of breath, and frothy pink sputum. In this case, symptoms were short-lived with nearly complete return to normal by the eighth hospital day.

Mediastinoscopy: a diagnostic aid in metastatic carcinoma of the breast.

Six patients with metastatic carcinoma of the breast underwent mediastinoscopy to obtain tissue for estrogen receptor analysis and pathologic confirmation of metastatic tumor. The indication for mediastinoscopy was an abnormal mediastinal accumulation of gallium in five patients, only two of whom had an abnormality noted on tomography. All six patients had tumor recovered by mediastinoscopy as demonstrated by pathologic examination and/or estrogen receptor assay, Therefore, the diagnosis of mediastinal metastases in breast cancer may be suggested by either chest roentgenograms, mediastinal tomography, or gallium scintigraphy. Mediastinoscopy is a safe, effective procedure capable of establishing the diagnosis of metastatic carcinoma of the breast and of procuring sufficient tissue for estrogen receptor analysis in patients without more readily accessible sites of metastases.

Gastrointestinal and Pelvic Tumors

Various malignancies of the abdomen and retroperitoneal areas have been observed to accumulate the radionuclide 67-Ga (18, 19, 20, 24, 29, 36, 54, 55, 56). Both primary and metastatic disease have been visualized and the agent has been useful in delineating both carcinomas and lymphomas. The 67-Ga scintiscan has been helpful in detecting unsuspected sites of neoplastic involvement and in delineating the extent of neoplastic spread within a given area. In patients with malignant lymphoma, the agent has been useful in defining the degree of lymph node involvement since it tends to be concentrated within disease-laden lymphatic tissue (51). Thus, it has become a valuable adjunct in ‘staging’ the degree of neoplastic spread in this type of malignancy (50).