Clinical presentation of non-HIV Kaposi sarcoma

Kaposi Sarcoma [KS] is a rare entity. In the north west of Pakistan and Aghanistan, we mostly come across non-HIV related Kaposi sarcoma as Human Immunedeficiency Virus [HIV]. Infections are rare in this part of the world. Here, we present a case of a non-auto Immunedeficiency Disease [AIDS] related KS. A 45-year-old male, Afghan patient presented to our oncology outpatient's unit with multiple subcutaneous nodules. The sites of involvement were the periorbital region, retro-auricular region, forearms, legs, chest and back. Oral mucosa was spared at the nodules. The patient had no visceromegaly at the time of presentation. A biopsy specimen from the retro-auricular region revealed a KS with dermal lymphatic involvement. His serum was negative for the common types of viral infections including Human Immunodeficiency Virus [HIV] on routine serology. His total B-lymphocytes [CD 19+], total T-lymphocyte [CD3+], total CD4+ lymphocyte [CD3+, CD4+] and total CD8+ [CD3+, CD8+] counts were all normal or borderline high. The patient was under treatment with 3 weekly chemotherapeutic regimens of Adriamycin, Bleomycin, Vincristine [ABV] keeping in view socioeconomical constrains, logistical difficulties in getting proper medical care and side effects of other options like radiotherapy for extended surface areas

Role of locally formulated 131I-MIBG in imaging of neuroendocrine tumors

To evaluate the clinical utility of locally formulated kits of Radioactive Iodine-131 labeled Meta-iodo-benzyl-guanidine [131I-MIBG] in the imaging of neuro-endocrine [NE] tumors. Design: It was an observational and experimental study. Place and Duration of Study: The study was conducted at Nuclear Medicine Department, Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar from May, 1997 to April, 1998. Subjects and A total of 25 patients, 20 males and 5 females, were included. Majority of the patients had histologically proven diagnosis of NE tumors and were referred to IRNUM for further management of residual mass or metastasis. Some of the cases were evaluated for suspected NE pathology and followed prospectively. Out of 10 neuroblastoma [NB] cases, 7 showed true positive uptake, 2 showed true negative uptake and one was found to be false negative. All the 3 cases of medullary carcinoma thyroid [MCT] showed positive uptake. None of the 3 paragangliomas and one of the 2 carcinoid tumor cases showed no 131I-MIBG uptake, however, both of pheochromocytoma were correctly localized and diagnosed. None of the 5 cases of non-specific and equivocal histopathology showed any evidence of 131I-MIBG accumulation adding to the diagnostic dilemma. 131I-MIBG scintigraphy is valuable tool in the imaging of NE tumor especially NB, MCT and pheochromocytoma and the locally formulated kits proved useful and of adequate quality clinically

Causes of superscan picture on bone scintigraphy

To identify causes of the superscan picture on 99mTc-MDP bone scintigraphy in our clinical environment. Design: A descriptive study. Place and Duration of Study: The study was conducted over a period of two years [January 1997 to December 1998] at the Nuclear Medicine Department [NMD], Institute of Radiotherapy and Nuclear Medicine [IRNUM], Peshawar. Subjects and A total of 27 cases [23 females and 4 males] having super-scan pictures of metabolic bone disease were prospectively evaluated. After three-observer confirmation of bone scan, serum calcium and parathyroid hormone [PTH] estimation was done. The patients having serum PTH greater than 250 pg /ml underwent two-phase parathyroid MIBI scintigraphy [2PP MIBI scan] for the detection of parathyroid adenoma. The patients having positive scans for parathyroid adenoma were subjected to surgery and histopathological confirmation was obtained. Selected cases [N=19] underwent a trial of depot-preparation of vitamin D3 and calcium supplementation. The final diagnosis of 16 patients was osteomalacia [59%], six were histopathologically confirmed cases of parathyroid adenoma [22.2%], One case had toxic adenoma thyroid [3.7%] and one had chronic renal failure [3.7%]. In three cases, final diagnosis could not be made [11.1%]. Osteomalacia and parathyroid adenoma are the two most common causes for the superscan picture on bone scintigraphy

Visualisation of medullary carcinoma thyroid with locally formulated 99mTC [V] DMS and comparison with 131I-MIBG scintigraphy

Technetium-99m [pentavalent] dimercaptosuccinic acid [99mTc [V] Dms] scintigraphy was performed in one patient with histopathologically confirmed medullary carcinoma thyroid [MCT] using a locally formulated kit. Marked uptake of the tracer by the primary and locally metastatic sites was noted. The same patient was also subjected to Iodine-131-metaiodobenzoilguanidine [131I-Mibg] scintigraphy and the results were found comparable. Better resolution, easy in-house formulation, labelling with 99mTc [V] Dms makes it a better imaging agent as compared to 131I-Mibg for the imaging of the primary and metastatic medullary carcinoma thyroid in our setup. Furthermore, the formulation of 99mTc [V] Dms is simple and convenient procedure. A 52 years old male patient of medullary carcinoma thyroid was diagnosed seventeen years back and successfuly operated for a solitary nodule in the neck at that time. On a routine follow-up visit he was found to have two discrete, firm, palpable nodules in front of his neck. To determine if the nodules were locally metastatic medullary carcinoma thyroid, the patient was prepared for imaging with 99mTc [V] DMS [locally formulated] and 131I-MIBG. The preparation included giving Lugol's iodine in sufficient quantity [10 drops of the solution three times a day for ten days dissolved in water or milk] to block the free pertechnetate uptake in case of 99mTc [V] DMS and 131 I uptake in 131I-MIBG scintigraphy by the thyroid gland. The patient was first subjected to 99mTc [V] DMS and later on to 131I-MIBG scintigraphy. A kit of renal dimercaptosuccinic acid [DMS] supplied by Nuclear Chemistry Division [NCD] Radioisotope Production Group [RIPG], Pakistan Institute of Nuclear Science and Technology [PINSTECH], Islamabad, Pakistan, was taken and 0.2 ml of sterile solution of 7.0% NahCO3 was added and adequately mixed. After that 15 mCi of 99mTc-pertechnetate fresh elute was added into it [upto 150 mCi can be added]. The radio-pharmaceutical [RP] was incubated for fifteen minutes. Quality Control [QC] tests were carried out and labelling efficiency was found to be > 90%. The RP was then injected into the median cubital vein of the forearm of the patient. For 99mTc [V] DMS imaging Toshiba scintillation camera with low-energy-all-purpose [LEAP] collimator was used. A 15% window centred at 140keV g rays energy was set for imaging. After two hours imaging was done for cervico-thoracic region and abdomen. After one week of the 99mTc [V] DMS the patient underwent 131I-MIBG scintigraphy. The 131I-MIBG was formulated at NCD, RIPG, PINSTECH Pakistan with labelling yield of > 90%, the 131I-MIBG was also injected into the median cubital vein by a slow i.v. infusion and having a close look at the vital signs like pulse, blood pressure and respiratory rates. Imaging was done on 1, 2 and 3 postinjection days. Siemens' scintillation gamma camera with large field of view coupled to high-energy-all-purpose [HEAP] parallel hole collimator was employed for imaging. The gamma camera was linked to on-line computer system MicroDelta and Micro Dot imager. The acquisition parameters were as follows: Symmetric energy window was set as 15% centred at the 364 keV Peak energy of 131I. All the images were interpreted by three experienced nuclear physicians in view of the clinical presentation of the patient. Marked uptake of 99mTc [V] DMS was seen in three foci of the neck, corresponding to the palpable nodules in the neck