Tushar Mohapatra

Spontaneous biliary perforation in an infant: an unusual chronic presentation.

Spontaneous perforation of the biliary ducts is a rare disorder in infants. Early diagnosis of this entity is important because it can be treated surgically. We report on a 4-month-old child presenting with jaundice and progressive abdominal distention present since birth. Hepatobiliary scintigraphy, which was done to rule out any obstructive pathology, showed a biliary leak from the porta hepatis region leading to biliary ascites and bilateral hydroceles. Surgical exploration and intraoperative cholangiogram confirmed cystic duct perforation. Cholecystectomy and inguinal herniorrhaphy were performed. Follow-up hepatobiliary scintigraphy demonstrated complete resolution of the bile leak and hydroceles.

18 F-FDG PET/CT for initial assessment and response monitoring in a case of high grade primary lymphoma of the thyroid gland: A case report and review of literature

Thyroid lymphoma is a rare disease entity of elderly females. Chronic lymphocytic thyroiditis is said to be the precursor of thyroid lymphoma, suggesting a role of chronic antigen stimulation in the development of the disease. We present a case of male with lymphocytic thyroiditis who presented with painless progressive neck enlargement and pathology revealed features of high grade lymphoma. Staging and posttreatment 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was performed. This report reemphasizes the role of 18F-FDG PET/CT in the diagnosis, staging, and assessment of therapy response in patients with extranodal lymphoma, including the primary thyroid lymphoma.

Coexisting iodine avid and iodine nonconcentrating lesions with multiple distant soft tissue metastasis in papillary thyroid cancer

Distant soft tissue metastasis and the simultaneous presence of iodine concentrating and nonconcentrating lesions in papillary thyroid cancer are extremely rare. The concerned patient, a histopathologically proven case of papillary thyroid cancer with nodal metastases treated with total thyroidectomy, bilateral cervical nodal dissection, and radioablation, subsequently developed lung, muscle, and liver metastasis. Triggered by increased thyroglobulin, the iodine-131 whole body scan and 200 mci iodine-131 post-therapy scan showed a left gluteus maximus lesion and a liver lesion. Fludeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) scan intended to find additional lesions revealed iodine and FDG nonconcentrating bilateral pulmonary nodules and a single FDG avid hepatic and two muscle metastases. Although FDG concentration in metastatic pulmonary nodules is generally low, the CT characteristics were classical for metastatic lesion. A follow-up FDG PET-CT study six months after 200 mci iodine-131 radioablation showed treatment response in muscle and liver lesions but not lungs.

Malignant phyllodes tumor of the left atrium.

Metastatic tumors to the heart usually involve right sided chambers. We report a rare case of malignant phyllodes tumor of breast with metastatic involvement of left atrium occurring through direct invasion from mediastinal micro-metastasis and presenting as a left atrial mass causing arrhythmia.

Suppurative salmonellosis in a case of mature anterior mediastinal teratoma – a case report

Germ Cell Tumors (GCT) can be classified into benign GCT which include mature teratomas; and malignant GCT such as seminomas, malignant teratomas, embryonal carcinomas, choriocarcinomas and endodermal sinus tumors [1]. Mediastinal teratomas are uncommon, making up only about 5 % to 10 % of all mediastinal tumors [1]. Almost all the benign teratomas occur in the anterior compartment of the mediastinum [1]. Rarely, less than 3 % to 5 % are located in the posterior compartment [1]. These tumors arise from primordial germ cells that fail to migrate to the gonads during embryonic development [1]. The first example of a mediastinal teratoma was described by J. A. Gordon in 1823. They are most commonly seen between the 2nd and 4th decades of life, with an equal distribution with regard to sex. Teratomas are slow-growing tumors and are mostly discovered incidentally on chest radiographs performed for some other reasons [1].Mediastinal teratomas become symptomatic due to mass effect, endocrine function e.g., hormone production e.g., β Human Chorionic Gonadotropin (HCG), insulin or rarely, rupture. Secondary infection in mediastinal teratomas are rarely described [2–5]. We are presenting a case of benign anterior mediastinal teratoma, coming to clinical attention with fever, acute onset respiratory discomfort due to secondary S.typhi infection within the mass.

A rare case of mature teratoma. Has FDG PET/CT a role to play?

Authors describe a very rare case of mature teratoma with malignant transformation, preoperatively suggested by FDG PET/CT study. So the role of CT component in elucidating three embryonal components and hypermetabolism evident on PET part suggesting possible malignant transformation makes PET/CT a valuable modality in evaluation of these rare tumors

Increased renal corticomedullary FDG activity in a patient of NHL-malignant or benign?

Authors describe diagnostic dilemma of differentiating pyelonephritis with lymphomatous involvement of kidney in a known case of lymphoma. FDG uptake pattern was non-discriminatory and pyelonephritis diagnosed retrospectively on follow up study. Authors emphasize the importance of recognition of features and subtle clues of infection evident on CT component of PET-CT.