Mammary analogue secretory carcinoma in minor salivary gland

ABSTRACT Mammary analogue secretory carcinoma is a rare neoplasm usually confused with other neoplasms in the salivary glands region. It has great similarity with the breast carcinoma. We report a case of a patient who presented with gingival submucosal bleeding and lesion, with the initial histopathological examination revealing salivary gland neoplasm of low crane. Computed tomography revealed the lesion near the tooth 27, with extension to the floor of the left maxillary sinus and to the palate mucosa. Resection of the infra-structure was performed, with a diagnosis of breast cancer secretory carcinoma in the minor salivary gland.

Presentaciones infrecuentes y atípicas del carcinoma hepatocelular en tomografía computarizada y resonancia magnética / Rare and atypical presentations of hepatocellular carcinoma on CT and MRI

Resumen La apariencia en imágenes típicas del carcinoma hepatocelular (HCC) es ampliamente reconocida y consiste en hiperrealce en fase arterial con lavado en las fases venosa portal y tardía, tanto en tomografía computada como en resonancia magnética. Este patrón se observa en el 60% de los casos y se ha incorporado en las directrices diagnósticas de las diferentes organizaciones que participan en el estudio de las enfermedades hepáticas y su presencia evita la necesidad de una biopsia. Además, son signos auxiliares útiles en el diagnóstico del HCC la hiperintensidad en secuencias ponderadas en T2, la presencia de grasa, la trombosis tumoral venosa y el crecimiento entre intervalos en los estudios de seguimiento. Sin embargo, no todos los pacientes con HCC presentan estas características y en el 40% de los casos las presentaciones atípicas plantean un reto diagnóstico y de manejo de los pacientes.

Abstract The typical imaging appearance of hepatocellular carcinoma (HCC) is widely recognized and consists in hyper enhancement in the arterial phase with lavage in the portal and late venous phases, as on computed tomography (CT) as on magnetic resonance imaging (MRI). This pattern is observed in 60% of cases and has been incorporated into the diagnostics directives of the different organizations which participates in the hepatic diseases studies and its presence avoid the necessity of a biopsy. Besides, are auxiliar signs useful on the HCC diagnostic, T2 hyperintensity, presence of grease, venous tumor thrombosis and the growth between intervals in follow up studies. However, not all HCC patients harbor these characteristics and in 40% of cases the atypical introduction proposes a diagnostic and handling challenge of patients.

Microcalcificaciones en ausencia de nódulo tiroideo identificable por ecografía y su asociación a cáncer de tiroides: a propósito de un caso / Microcalcifications in the absence of identifiable thyroid nodule on sonography and its association with thyroid carcinoma: a case report

La ecografía tiroidea es la principal herramienta diagnóstica en el manejo de los nódulos tiroideos, siendo la presencia de microcalcificaciones un signo de malignidad. Sin embargo, existen escasas publicaciones acerca de la presencia de microcalcificaciones en ausencia de nódulo identificable y su asociación con cáncer de tiroides. Presentamos un caso de una mujer de 26 años, que, tras hallazgo incidental de bocio, se describe en ecografía un tiroides con alteración difusa de su ecogenicidad e imágenes compatibles con microcalcificaciones sin claro nódulo definido en su polo inferior. Tras realización de punción aspiración con aguja fina de la lesión con resultado Bethesda categoría 5, se decide realizar tiroidectomía total, presentando estudio histológico con diagnóstico de carcinoma papilar de tiroides variante clásica con metástasis ganglionares p(T1bN1a). Tras una revisión sistemática, los estudios hasta hoy publicados sugieren que la presencia de microcalcificaciones aisladas sin nódulo identificable debe considerarse un importante factor de riesgo de cáncer de tiroides, especialmente en gente joven, y en aquellas asentadas sobre una tiroiditis de Hashimoto. Por ende, resulta imperativo mantener una alta sospecha ante el hallazgo de este tipo de lesiones, recomendando una valoración exhaustiva de las mismas con la realización de una punción aspiración con aguja fina a todas las lesiones con dichas características.

Thyroid ultrasound is the main diagnostic tool in the management of thyroid nodules, with the presence of microcalcifications being a sign of malignancy. However, there are few publications about the presence of microcalcifications in the absence of an identifiable nodule and its association with thyroid cancer. We present a case of a 26-year-old woman who, after an incidental finding of goiter, a thyroid with diffuse echogenicity alteration and images compatible with microcalcifications without a clear nodule defined in the lower pole of the lobe is described on the ultrasound. After performing a fine needle aspiration of the lesion resulting in a Bethesda category 5, a total thyroidectomy was performed, presenting in the histological study a diagnosis of a classic variant of a papillary thyroid carcinoma with lymph node metastases p (T1bN1a). After a systematic review, the studies previously published suggest that the presence of isolated microcalcifications without an identifiable nodule should be considered an important risk factor for thyroid cancer, especially in young people, and in those with a concomitant Hashimoto's thyroiditis. Therefore, it is imperative to maintain a high suspicion of the discovery of this type of lesion, recommending an exhaustive assessment of them with the performance of a fine needle aspiration to all lesions with these features.

Reporte de caso: metástasis gástrica de carcinoma endometrial, una localización inusual / Case report: gastric metastasis of endometrial carcinoma, an unusual localization

INTRODUCCIÓN: el carcinoma endometrial es la sexta entidad maligna más común a nivel mundial. En la mayoría de casos se diagnóstica de forma temprana. Recurre principalmente a cúpula vaginal y a nivel linfático, sin embargo, se han descrito metástasis a vagina, peritoneo y pulmones, entre otros. PRESENTACIÓN DEL CASO: paciente femenina adulta mayor con antecedente de carcinoma endometrial hace 7 años, tratado quirúrgicamente con estudio histopatológico que evidenciaba un miometrio infiltrado en un 95% sin invasión a otros órganos y linfadenectomía libre de lesión (estadio FIGO IB), quien consulta por dolor abdominal localizado en mesogastrio y deposiciones melénicas, evidenciándose una lesión gástrica, con resultado de biopsia que reporta carcinoma pobremente diferenciado con positividad focal para vimentina compatible con metástasis gástrica secundaria a carcinoma endometrial. Se indica manejo sistémico con quimioterapia, se documenta respuesta total de la lesión. DISCUSIÓN: las lesiones tumorales a nivel de estómago son primarios en su gran mayoría, una metástasis a este nivel es inusual. En el momento del diagnóstico de una metástasis gástrica, la mitad de las pacientes presentan concomitante compromiso de otros órganos. El carcinoma endometrial no está descrito dentro de los primarios que generan este compromiso. CONCLUSIÓN: el caso expuesto es un reto clínico, que representa un vacío en la evidencia actual; se comparte la experiencia de un manejo exitoso. Son necesarios más estudios para evaluar el pronóstico, opciones de tratamiento y definir la pertinencia de métodos de tamización para la detección temprana de estos casos.

INTRODUCTION: the endometrial carcinoma is the sixth cancer worldwide. Usually it is diagnosed in early stages. The sites of recurrence includes vaginal cuff and lymph nodes, however some metastasis have been described to vagina, peritoneum and lungs, among others. CASE REPORT: Elder female with history of an endometrial carcinoma 7 years ago, surgically treated. With histopathology that reported myometrial infiltration in a 95% without invasion to other organs and lymphadenectomy free of neoplasm (FIGO IB), who consult at the emergency room due to abdominal pain and black stool, with further studies that make evident a gastric lesion with biopsy reported as a poorly differentiated carcinoma, vimentin positive, compatible with gastric metastasis secondary to an endometrial carcinoma. Chemoterapy was indicated, documenting total posterior response of the lesion. DISCUSSION: Secondary lessions in stomach are rare. If they are present at the moment of diagnosis half of the patients concomitantly have metastasis in other organs. The endometrial carcinoma hasn't been described as a common localization that result in this compromise. CONCLUSION: the case exposed is a clinical challenge, a therapeutic success is shared. Limited evidence is available. Further studies are necessary to evaluate the prognosis, therapeutic options and to define the relevance of screening tests for early detection.

Metastatic non-muscle invasive bladder cancer with cervical lymph node metastasis

ABSTRACT Bladder cancer is a common cancer that may present as superficial, invasive, or metastatic disease. Non-muscle-invasive bladder cancer (NMIBC) represents the majority of bladder cancer diagnoses, but represents a spectrum of disease with a variable clinical course, notably for significant risk of recurrence and potential for progression. NMIBC metastasis to distant organs without local invasion or regional metastasis is a very rare occurrence, so there are limited case reports about early metastasis in the literature.

Effect of Arrabidaea chica extract against chemically induced breast cancer in animal model

Abstract Purpose: To examine the effects of Arrabidaa chica (Bignoniacea) extract, a native plant of the Amazon known as crajiru, on a 7,12-dimethyl-1,2-benzanthracene (DMBA)-induced breast cancer model in Wistar rats. Methods: We compared the response of breast cancer to the oral administration of A. chica extract (ACE) for 16 weeks, associated or not with vincristine. Groups: normal control; DMBA (50mg/kg v.o,) without treatment; DMBA+ACE (300 mg/kg); DMBA+vincristine. 500μg/kg injected i.p; DMBA+ACE+Vincristine 250μg/kg i.p. Imaging by microPET and fluorescence, biochemistry, oxidative stress, hematology and histopathology were used to validate the treatments. Results: All animals survived. A gradual weight gain in all groups was observed, with no significant difference (p>0.05). The oral administration of ACE and ACE+vincristine 50% significantly reduced breast tumors incidence examined with PET-18FDG and fluorescence (p<0.001). Significant reduction of serum transaminases, oxidative stress and hematological toxicity were observed in these groups. Antioxidant enzyme levels in breast tissue were significantly higher compared to the DMBA and DMBA+vincristine groups. Conclusion: These results demonstrate for the first time that ACE positively influences the treatment of DMBA-induced breast cancer in animal model, inducing a reduction in oxidative stress and chemotherapy toxicity, meaning that ACE may have clinical implication in further studies.

The role of intraoperative narrow-band imaging in transoral laser microsurgery for early and moderately advanced glottic cancer / O papel da imagem de banda estreita intraoperatória na microcirurgia transoral a laser para câncer glótico inicial e moderadamente avançado

Abstract Introduction: Trans-oral laser microsurgery is an established technique for the treatment of early and moderately advanced laryngeal cancer. Objective: The authors intend to test the usefulness of narrow-band imaging in the intraoperative assessment of the larynx mucosa in terms of specifying surgical margins. Methods: Forty-four consecutive T1-T2 glottic cancers treated with trans-oral laser microsurgery Type I-VI cordectomy were presented. Suspected areas (90 samples/44 patients) were biopsied under the guidance of narrow-band imaging and white light and sent for frozen section. Results: Our study revealed that 75 of 90 (83.3%) white light and narrow-band imaging-guided samples were histopathologically positive: 30 (40%) were confirmed as carcinoma in situ or invasive carcinoma and 45 (60%) as moderate to severe dysplasia. In 6 patients mucosa was suspected only in narrow-band imaging, with no suspicion under white light. Thus, in these 6 patients 18/90 (20%) samples were taken. In 5/6 patients 16/18 (88.8%) samples were positive in frozen section: in 6/18 (33.3%) carcinoma (2 patients), 10/18 (66.6%) severe dysplasia was confirmed (3 patients). In 1 patient 2/18 (11.1%) samples were negative in frozen section. Presented analysis showed, that sensitivity, specificity and accuracy of white light was 79.5%, 20% and 71.1% respectively, while narrow-band imaging was 100%, 0.0% and 85.7%, respectively. Conclusion: The intraoperative use of narrow-band imaging proved to be valuable in the visualization of suspect areas of the mucosa. Narrow-band imaging confirms the suspicions undertaken in white light and importantly, it showed microlesions beyond the scope of white light.

Resumo Introdução: A microcirurgia transoral a laser é uma técnica bem estabelecida para o tratamento de câncer de laringe inicial e moderadamente avançado. Objetivo: Verificar a utilidade da imagem de banda estreita na avaliação intraoperatória da mucosa laríngea na especificação das margens cirúrgicas. Método: Foram avaliados 44 cânceres glóticos T1-T2 consecutivos, tratados com cordectomia Tipo I-VI, por microcirurgia transoral a laser. As áreas suspeitas (90 amostras/44 pacientes) foram submetidas a biopsia e avaliadas através de imagens de banda estreita e luz branca e enviadas para cortes por congelação. Resultados: Nosso estudo revelou que 75 (83,3%) das 90 amostras apresentaram histopatologia positiva na análise com luz branca e imagens de banda estreita: 30 (40%) foram confirmadas como carcinoma in situ ou carcinoma invasivo e 45 (60%) como displasia moderada a grave. Em seis pacientes, a mucosa apresentou-se suspeita apenas na imagem de banda estreita, sem suspeita sob luz branca. Assim, nesses seis pacientes 18/90 (20%) amostras foram colhidas. Em 5/6 pacientes, 16/18 (88,8%) amostras mostraram resultado positivo na análise de congelação: em 6/18 (33,3%) amostras foi confirmado carcinoma (dois pacientes) e em 10/18 (66,6%) foi confirmada displasia grave (três pacientes). Em um paciente, 2/18 (11,1%) as amostras mostraram resultado negativo na congelação. A análise apresentada mostrou que a sensibilidade, a especificidade e a acurácia da luz branca foram de 79,5%, 20% e 71,1%, respectivamente, enquanto a imagem de banda estreita apresentou como resultados 100%, 0,0% e 85,7%, respectivamente. Conclusão: O uso intraoperatório de imagem de banda estreita provou ser valioso na identificação de áreas suspeitas da mucosa, confirmou as suspeitas verificadas na análise com luz branca e, o que é mais importante, identificou microlesões além do alcance da luz branca.

PET/CT com 18F-FDG como ferramenta de avaliação do desenvolvimento de carcinoma hepatocelular secundário a doença hepática gordurosa não alcoólica em modelo experimental / 18f-fdg pet/ct as an assessment tool of hepatocellular carcinoma secondary to non-alcoholic fatty liver disease development in experimental model

ABSTRACT BACKGROUND: Hepatocellular carcinoma (HCC) can be the last step of non-alcoholic fatty liver disease (NAFLD) evolution. Experimental models are crucial to elucidate the pathogenesis of HCC secondary to NAFLD. The 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) plays an important role in evaluating HCC development and progression. OBJECTIVE: To standardize the imaging method of PET/CT with 18F-FDG as an evaluation tool of the experimental model of HCC secondary to NAFLD. METHODS: Ten male Sprague-Dawley rats were fed with choline-deficient high-fat diet and diethylnitrosamine (DEN) in the drinking water for 16 weeks and then received 1 mL of saline solution (0.9%) daily by gavage for three weeks. At the 16th and 19th weeks, abdominal ultrasonography (USG) was performed. 18F-FDG PET/CT images were obtained before the beginning of experiment (week 0) and at the end (week 19). Histological and immunohistochemically analysis were also performed. RESULTS: The USG results showed a homogeneous group at the 16th week with an average of 4.6±2.74 nodules per animal. At the 19th week, PET/CT findings demonstrated an average of 8.5±3.7 nodules per animal. The mean values of SUVmed and SUVmax were 2.186±0.1698 and 3.8±1.74, respectively. The average number of nodules per animal in the histological analysis was 5.5±1.5. From all nodules, 4.6% were classified as well-differentiated HCC and 81.8% were classified as poorly-differentiated HCC. CONCLUSION: 18F-FDG PET/CT was able to evaluate the development of HCC in an experimental model of NAFLD non-invasively. From the standardization of PET/CT in this model, it is possible to use this tool in future studies to monitor, in vivo and non-invasively, the progression of HCC.

RESUMO BACKGROUND: O carcinoma hepatocelular (CHC) pode ser a última fase da doença hepática gordurosa não alcoólica (DHGNA). Modelos experimentais são cruciais para elucidação da patogênese do CHC secundário a DHGNA. A tomografia por emissão de pósitrons/tomografia computadorizada (PET/TC) com 2-desoxi-2-(18F)fluoro-D-glicose (18F-FDG) desempenha um importante papel na avaliação do desenvolvimento e progressão do CHC. OBJETIVO: Padronizar a metodologia de imagem por PET/TC com 18F-FDG como uma ferramenta de avaliação do modelo experimental de CHC secundário a DHGNA. MÉTODOS: Dez ratos Sprague-Dawley machos foram alimentados com dieta hiperlipídica deficiente em colina associada a dietilnitrosamina (DEN) na água de beber por 16 semanas e depois receberam 1 mL de solução salina (0,9%) por gavagem diariamente por três semanas. Nas 16ª e 19ª semanas, foi realizada a ultrassonografia abdominal. As imagens do PET/TC com 18F-FDG foram obtidas antes do início do experimento (semana 0) e no final (semana 19). Análises histológica e imunohistoquímica também foram realizadas. RESULTADOS: Os resultados da ultrassonografia demonstraram um grupo homogêneo na 16ª semana com uma média de 4,6±2,74 nódulos por animal. Na 19ª semana, os achados do PET/CT demonstraram uma média de 8,5±3,7 nódulos por animal. Os valores médios de SUVmed e SUVmáx foram 2,186±0,1698 e 3,8±1,74, respectivamente. A média do número de nódulos na análise histológica foi de 5,5±1,5. De todos os nódulos, 4,6% foram classificados como bem diferenciados e 81,8% foram classificados como CHC pouco diferenciado. CONCLUSÃO: O PET/TC com 18F-FDG foi capaz de avaliar o desenvolvimento do CHC secundário a DHGNA de forma não invasiva. A partir da padronização do PET/CT neste modelo, faz-se possível a utilização desta ferramenta em futuros estudos para monitorar, in vivo e de forma não invasiva, a progressão do CHC.

A predictive model to distinguish malignant and benign thyroid nodules based on age, gender and ultrasonographic features / Modelo preditivo para diferenciação entre nódulos malignos e benignos da tireoide com base na idade, sexo e características ultrassonográficas

Abstract Introduction: A discussion in literature about a standardized decision support tool for the management of thyroid nodules remains. Objective: The purpose of this study was to create a statistical prediction model for thyroid nodules management. Methods: Two hundred and four benign and 57 malignant thyroid nodules were selected for a retrospective study. The variables age, gender and ultrasonographic features were examined using univariate and multivariate models. A statistical formula was used to calculate the risk of cancer of each case. Results: In multivariate analysis, irregular shape, absence of halo, lower mean age, homogeneous echotexture, microcalcifications and solid content were associated with cancer. After applying the formula, 20 cases (7.6%) with a calculated risk for malignancy ≤3.0% were found, all of them benign. Setting the calculated risk in ≥80%, 21 (8.0%) cases were selected, and in 85.7% of them cancer was confirmed in histopathology. Internal accuracy of the prediction formula was 92.5%. Conclusions: The prediction formula reached high accuracy and may be an alternative to other decision support tools for thyroid nodule management.

Resumo Introdução: Persiste na literatura uma discussão sobre uma ferramenta padronizada de apoio à decisão para o manejo de nódulos tireoidianos. Objetivo: Criar um modelo de previsão estatística para o manejo de nódulos tireoidianos. Método: Foram selecionados 204 casos de nódulos tireoidianos benignos e 57 malignos para o estudo retrospectivo. As variáveis idade, sexo e características ultrassonográficas foram analisadas com modelos univariados e multivariados. Uma fórmula estatística foi usada para calcular o risco de câncer de cada caso. Resultados: Na análise multivariada, a forma irregular, a ausência de halo, menor idadesubp média, ecotextura homogênea, microcalcificações e conteúdo sólido foram associadas ao câncer. Após a aplicação da fórmula, foram encontrados 20 casos (7,6%) com risco calculado de malignidade ≤ 3,0%, todos benignos. Definiu-se o risco calculado em ≥ 80%, 21 casos (8,0%) foram selecionados e em 85,7% deles o câncer foi confirmado pela histopatologia. A precisão interna da fórmula de previsão foi de 92,5%. Conclusões: A fórmula de previsão alcançou alta precisão e pode ser uma opção para outras ferramentas de apoio à decisão para o manejo de nódulos da tireoide.

3T magnetic resonance spectroscopy as a powerful diagnostic modality for assessment of thyroid nodules

ABSTRACT Objective: Magnetic resonance spectroscopy (MRS) is a powerful tool for structural studies of chemical compounds and biomolecules and also documented promising findings as a potential imaging technology in thyroid oncology. This prospective study was to ascertain the clinical significance of 3 Tesla MRS in the evaluation of patients with thyroid nodules (TNs) as an ancillary diagnostic technique for thyroid carcinoma. Materials and methods: Magnetic resonance spectroscopy at 3T at echo- times (TEs) 136 and 270 ms was carried out on 15 patients with total number of 32 TNs larger than 1 cm3, which all were surgically resected. Choline (Chol) to creatine (Cr) ratio was assessed at 136 and 270 TEs on each nodule and a receiver operating characteristic (ROC) curve was used to determine optimal cut-off point. The findings were compared with histopathology of thyroid specimens. Results: There were 23 benign and 9 malignant lesions (7 papillary and 2 follicular thyroid carcinomas). The mean values of Chol/Cr at 136 and 270 TEs was 2.28 ± 3.65 and 1.52 ± 1.67 respectively and the difference between benign and malignant nodules was only significant at 136 TEs. The study revealed that Chol/ Cr ratio cut-off point of 2.5 best correlates with histopathology results (sensitivity = 75%; specificity = 100%; PPV = 100%; NPV= 92%). Conclusion: This preliminary study showed that 3T magnetic resonance spectroscopy might be a specific modality for the evaluation of thyroid nodules in differentiation of benign from malignant thyroid tissue. However, a larger series would give much greater confidence that this state-of-the-art technology will worth pursuing in clinical practice.

Comparative study of computed tomography (CT) and pathological diagnosis toward mediastinal lymph node metastasis in esophageal carcinoma

Summary Objective: To investigate the diagnostic criteria of mediastinal lymph node metastasis (MLNM) in esophageal carcinoma (EC) by comparing the lymph node sizes measured by computed tomography (CT) and obtained by postoperative pathological examination. Method: A total of 305 EC patients were selected. MLNM location, shortest diameter and number were investigated one week before surgery, and then compared with their pathological findings. Results: The receiver operating characteristic (ROC) curve analysis revealed that the minimum diameters of MLNM in the thoracic cavity was 8 mm (area under curve [AUC] = 0.766, Youden index = 0.424), 5 mm in supraclavicular fossa (AUC = 0.785, Youden index = 0.494), 6 mm in tracheoesophageal groove (AUC = 0.755, Youden index = 0.405); the sensitivity was increased significantly, and the Youden index was increased significantly when compared with 10 mm. Conclusion: The shortest diameter of diagnostic criteria of lymph nodes in EC could be less than 10 mm on CT.

Cáncer de metaplásico de mama: revisión de dos casos clínicos / Metaplastic breast cancer: review of two clinical cases

RESUMEN El carcinoma metaplásico de mama es un tipo de cáncer infiltrante que asemeja un carcinoma de alto grado histológico, pero cuya incidencia es muy baja (< 1%). Desde el punto de vista anatomopatológico presenta un componente mixto epitelial y mesenquimal; siendo lo más característico su comportamiento clínico altamente agresivo junto con unas características anatomopatológicas, inmunohistoquímicas concordantes, como son el HER2/neu negativo, los receptores hormonales negativos, el tamaño tumoral grande y el alto grado histológico. Por todo ello, resulta de especial interés conocer esta entidad, con la finalidad de realizar un diagnóstico preciso y llevar a cabo un tratamiento adecuado en estas pacientes. En el presente artículo se presenta la revisión de dos casos clínicos de cáncer de mama metaplásico, diagnosticados y tratados en nuestro Hospital durante el año 2015 y 2018.

ABSTRACT The metaplastic breast cancer is a subtype of an infiltranting breast cancer and it's usually high grade. However it is a rare subtype of cancer (incidence <1%). This cancer has an epithelial and connective tissues, which has an epithelial invasor ductal breast cancer with high grade and sarcomas breast. The main characteristic of the metaplastic breast cancer is their high agressive behavior as clinical as anatomopathological, which immunohistochemical expression is like a triple negative breast cancer. Because of this we consider that their knowledge is very important with the purpose of being diagnosed in women. In this paper it is showed a revision of two cases of metaplastic breast cancer, whose diagnostic and treatment were reported in our Centre.

Cáncer sincrónico y metacrónico detectado con PET/CT en población oncológica / Multiple primary malignant neoplasms detected by PET/CT in cancer patients

Background Imaging with F18-fluorodeoxyglucose PET/CT is used to determine sites of abnormal glucose metabolism and can be used to characterize and localize many types of tumors. Aim To assess the prevalence of multiple primary malignant neoplasms (MPMN) detected by PET/CT in cancer patients. Material and Methods F18-fluorodeoxyglucose PET/CT scans performed to 800 patients with a newly diagnosed cancer or with already treated tumors were retrospectively reviewed. In patients whose examination described incidental findings not related to the primary tumor, a research was done about further laboratory, imaging or pathological studies. Results In 188 PET/CT scans (23%) an incidental finding was found. Of these, 66 (35%) were considered as MPMN, 12 as atypical metastases of a known primary tumor, 14 as false positive images (inflammatory or physiologic uptake) and 29 as benign or low grade tumors. In 67 cases (36% of all incidental tumors), the finding was not confirmed. Seven percent of patients with a newly diagnosed tumor had a synchronic MPMN detected by PET/CT. Nine percent of patients with treated tumors developed a metachronous MPMN during their follow up. The most common incidental tumors were thyroid cancer in 15 cases, kidney cancer in 13, lung cancer in 10, colorectal carcinoma in 9, breast cancer in 6, prostate cancer in 4, non-Hodgkin lymphoma in 3 and pancreatic cancer in 2. Conclusions A MPMN is detected by PET/CT in a significant number of cancer patients.

Endoscopic endonasal approach for mass resection of the pterygopalatine fossa

OBJECTIVES: Access to the pterygopalatine fossa is very difficult due to its complex anatomy. Therefore, an open approach is traditionally used, but morbidity is unavoidable. To overcome this problem, an endoscopic endonasal approach was developed as a minimally invasive procedure. The surgical aim of the present study was to evaluate the utility of the endoscopic endonasal approach for the management of both benign and malignant tumors of the pterygopalatine fossa. METHOD: We report our experience with the endoscopic endonasal approach for the management of both benign and malignant tumors and summarize recent recommendations. A total of 13 patients underwent surgery via the endoscopic endonasal approach for pterygopalatine fossa masses from 2014 to 2016. This case group consisted of 12 benign tumors (10 juvenile nasopharyngeal angiofibromas and two schwannomas) and one malignant tumor. RESULTS: No recurrent tumor developed during the follow-up period. One residual tumor (juvenile nasopharyngeal angiofibroma) that remained in the cavernous sinus was stable. There were no significant complications. Typical sequelae included hypesthesia of the maxillary nerve, trismus, and dry eye syndrome. CONCLUSION: The low frequency of complications together with the high efficacy of resection support the use of the endoscopic endonasal approach as a feasible, safe, and beneficial technique for the management of masses in the pterygopalatine fossa.

Análisis de falsos negativos en la cintigrafía SPECT de paratiroides con sestamibi en pacientes con hiperparatiroidismo primario sometidos a cirugía entre 2008-2015 en hospital universitario / False negative spect parathyroid scintigraphy with sestamibi in patients with primary hyperparathyroidism

Background: 99mTc-sestamibi parathyroid SPECT scintigraphy is a useful tool in the pre-operative study of hyperparathyroidism. False negatives (FN) have been reported in 5.7-14% of the examinations. Aim: To characterize 99mTc-sestamibi FN in cases referred for primary hyperparathyroidism (PHP) to a university hospital. Material and Methods: Descriptive retrospective analysis. We included patients with PHP, studied with SPECT scintigraphy, operated at our center between 2008 and 2015. Clinical and surgical data were recorded; biopsies of the FN were blindly reviewed by one pathologist. Results: One hundred twenty one scintigraphies fulfilled the inclusion criteria. Seven (5.8%) were negative and 114 positive. There was no difference in age, sex and PTH levels between FN and true positive scintigraphies. At surgery, one FN case had two hyperplasic glands and two cases had ectopic glands. Pathology reported adenoma in three cases, hyperplasia in three and carcinoma in one. The largest diameter of the lesion was lower in FN (1.3 and 2.1 cm respectively, p = 0.02) and the proportion of adenomas was higher in true positive cases (29% and 75% respectively; p < 0.01). The interval between scintigraphy and parathyroidectomy was greater in FN with a median of 92 days (range 20 days-3.2 years, p < 0.01). The percentage of oxyphilic cells observed was similar in both groups. Conclusions: FN parathyroid SPECT scintigraphies in PHP are uncommon. They corresponded to lesions under the equipment's resolution limit and resulted in longer time lags between scintigraphy and surgery.

Intrathoracic stomach mimicking bone metastasis from thyroid cancer in whole-body iodine-131 scan diagnosed by SPECT/CT

SUMMARY The whole-body iodine-131 scintigraphy is an imaging technique in monitoring patients with a history of thyroid cancer. Although the rate of false positives is negligible, it is not nonexistent. We report the case of an intervened and treated patient for thyroid cancer with good clinical and biochemical response. Scintigraphic findings were consistent with unsuspected bone metastasis. Fused SPECT/CT data allowed accurate diagnosis of giant diaphragmatic hernia associated with intrathoracic stomach, a very rare pathology that can lead to false positive results.

Endoscopic prediction of tumor invasion depth in early gastric neoplasia: a prospective study in Peru / Predicción endoscópica de invasión tumoral en neoplasia gástrica temprana: Estudio prospectivo en Perú

Introduction: Endoscopic resection is the first option treatment of early gastric cancer with invasion to mucosa or superficial submucosa, because the risk of nodal metastasis is negligible. Then the prediction of tumor invasion is cardinal. Objectives: Determine the accuracy of endoscopic prediction for tumor invasion depth in early gastric neoplasia and define endoscopic characteristics associated with massive submucosal invasion. Materials and methods: Prospective sudy of diagnostic test validation. We included patients with early gastric neoplasias that were endoscopically or surgically resected from January 2012 to May 2016. Every lesion was looked for the presence of these features: margin elevation, central elevation, irregular surface, enlarged folds, size > 30mm and rigidity. The invasion prediction was categorized in: M-Sm1 when none feature was present, Sm2 when 2 or more features were present, and indeterminated when only one feature was present. We compared endoscopic prediction to pathological staging and determined diagnostic accuracy. Results: The global accuracy for endoscopic prediction was 98.2%. Sensitivity, specificity, positive and negative predictive values for M-Sm1 prediction were 97.6, 100, 100 y 92.8%, and for Sm2 prediction were 100, 97.6, 92.8 y 97.6%, respectively. Rigidity, irregular Surface, margin elevation and enlarged folds were associated with Sm2 invasion. Conclusions: Endoscopic prediction of tumor invasion depth in early gastric neoplasia is very accurate. The main endoscopic feature associated with Sm2 invasion is rigidity.

Introducción: La resección endoscópica constituye el tratamiento de elección del cáncer gástrico temprano con invasión a la mucosa o submucosa superficial, pues tiene riesgo casi nulo de metástasis ganglionar. Por tanto, la predicción de invasión tumorales cardinal. Objetivos: Determinar la precisión de la predicción de invasión tumoral de neoplasia gástrica temprana por endoscopía convencional y definir características endoscópicas asociadas a invasión submucosa masiva. Material y métodos: Estudio prospectivo de validación de una prueba diagnóstica. Se incluyeron todos los pacientes con neoplasias gástricas tempranas que fueron resecadas endoscópica o quirúrgicamente de enero 2012 a mayo 2016. En cada lesión se definió la presencia de las siguientes características: Elevación de márgenes, elevación central, irregularidad de la superficie, engrosamiento de pliegues, tamaño >30 mm y rigidez. La predicción de invasión se categorizó en: M-Sm1 cuando no tenía ninguna característica, Sm2 cuando tenía 2 o más características, e indeterminada cuando sólo tenía una característica. Se comparó la predicción endoscópica con el estadiaje patológico de los especímenes y se determinó su precisión diagnóstica. Resultados: La precisión global de la predicción endoscópica fue de 98,2%. La sensibilidad, especificidad, VPP y VPN para la predicción M-Sm1 fue 97,6, 100, 100 y 92,8%, y para la predicción Sm2 fue 100, 97,6, 92,8 y 97,6%, respectivamente. La rigidez, irregularidad en la superficie, elevación de los márgenes y engrosamiento de pliegues, se asociaron significativamente con invasión Sm2. Conclusiones: La predicción endoscópica de invasión tumoral en neoplasia gástrica temprana es muy precisa. La principal característica endoscópica asociada a invasión Sm2 es la rigidez.

PET/MRI: a novel hybrid imaging technique. Major clinical indications and preliminary experience in Brazil / PET/RM: um novo método de imagem híbrida. Principais indicações clínicas e experiência preliminar no Brasil

ABSTRACT In recent years, medical imaging with hybrid techniques has widely accepted and employed in clinical routine. PET/MRI offers significant advantages, including excellent contrast and resolution and reduced ionizing radiation, as compared to well-established PET/CT. Therefore, PET/MRI is a promising modality for oncologic imaging of some regions, such as brain, head and neck, liver and pelvis. This article set out to analyze clinical conditions that could benefit from PET/MRI imaging based on our caseload. The potential of PET/MRI to become the imaging modality of choice for assessment of neurologic and oncologic conditions associated with soft tissues is highlighted. Clinical aspects of PET/MRI and its application to clinical cases are illustrated with examples extracted from the authors’ preliminary experience.

RESUMO Nos últimos anos, imagens médicas com tecnologias híbridas tornaram-se amplamente aceitas e utilizadas na prática clínica. O PET/RM possui vantagens importantes, incluindo excelentes contrastes e resolução, e menor radiação ionizante, em comparação ao PET/TC. Por isto, é uma modalidade promissora para exames de imagem de pacientes oncológicos, para avaliar o cérebro, cabeça e pescoço, o fígado e a pelve. O objetivo deste artigo foi analisar as situações clínicas que se beneficiariam de exames de PET/RM a partir de uma casuística. Destacamos o potencial desta técnica se tornar o método de imagem de escolha para doenças neurológicas e oncológicas que envolvam partes moles. Os aspectos clínicos de PET/RM e sua aplicação aos casos clínicos são ilustrados com exemplos da experiência inicial dos autores.