Cáncer diferenciado de tiroides en tiroides lingual, presentación de un caso / Differentiated thyroid cancer in the lingual thyroid, presentation of a case

The lingual thyroid carcinoma is very uncommon neoplasia with an incidence of less than 1 percent. The papillary variant is the most frequent. Cervical MRI helps differentiate muscle from thyroid tissue. The definitive diagnosis is given by histology. Management is similar to that of orthotopic thyroid cancer. We present the case of a 23-year-old woman with hypothyroidism undergoing treatment with dysphagia and sensation of pharyngeal foreign body and malodorous oral bleeding. Nasopharyngoscopy showed a rounded mass at the base of the tongue; the biopsy was compatible with thyroid neoplasia. Image study with ultrasound confirms empty thyroid bed with presence of lingual ectopic thyroid. The team of surgeons performed surgery with Trotter Technique, they removed a tumor of 4 centimeters of diameter. The definitive biopsy concludes minimally invasive follicular carcinoma. The treatment was completed with 100 mCi of radioiodine. Systemic screening at 7 days was negative, as the post-operative thyroglobulin (Tg)

Una lesión en el cintigrama renal DMSA 6 meses post fase aguda de una pielonefritis representa siempre una cicatriz: un debate abierto / Evolution of scintigraphic renal lesions in children after an episode of acute pyelonephritis

Background: Abnormal Dimercaptosuccinic acid (DMSA) renal scintigraphy performed six months after an acute pyelonephritis (AP) is generally interpreted as scarring. Aim: To perform a follow up of childhood patients showing scintigraphic renal lesions during the acute phase of pyelonephritis (within 7 days from the beginning of fever). Material and Methods: A scintigraphic control was carried out at 5-7 months and, in case of persistent lesions, an additional late scintigraphy at 10-13 months. All patients were followed clinically for one year and those with a relapse of urinary tract infection were excluded from the study. Results: Eighty five patients with a median age of 8 months were included. Among these, the first scintigraphic control was normal in 59 (69%) and abnormal in 26 patients (31%). In five of these 26 patients (5/26:19%-5/85: 6%), a considerable regression of the lesions was obvious on the early control, and normalized completely on the late control. When expressing the results in kidney units, 107 showed lesions during the acute phase of infection; 69% was normal at the early control. Thirty three showed lesions persisting at the early control (31%) and 7 out of these 33 (21%) became normal on the late control (7/107: 7%). In total, 25% of the children included in the study (24% of the kidney units) remained with renal sequelae one year after the initial episode of AP. Conclusions: The persistence of scintigraphic lesions six months after an episode of AP, does not necessarily correspond to permanent scars, since normalization can sometimes be observed on late controls.

Evaluación de la actividad de 99mTc-DMSA efectivamente inyectada en pacientes pediátricos / Evaluation of the activity of 99mTc-DMSA effectively delivered in pediatric patients

Objetivo. Evaluar el porcentaje de dosis inyectada de 99mTc-DMSA que ingresa efectivamente al paciente. Método. Se analizaron cintigramas renales con 99mTc-DMSA realizados en de 2 centros, con métodos de punción diferente, con y sin llave de tres pasos (Centros 1 y 2 respectivamente). Adquisición de jeringa llena, vacía (y/o sistema extra) y sitio de inyección, calculando actividad ingresada al paciente con y sin considerar sitio de inyección y evaluando la actividad persistente en él. Se aplicó el T test. Resultados. Se analizaron estudios de 65 pacientes, 71 por ciento mujeres, edad promedio 61 meses. Todas las imágenes obtenidas fueron de buena calidad según observadores experimentados. El porcentaje ingresado promedio fue 87,70 por ciento al sustraer sitio de inyección y 91,02 por ciento sin restarlo (p<0,05). Actividad en sitio de inyección: 1,5 por ciento en centro 1 y 3,27 por ciento en centro 2 (p<0,05). Conclusiones. Con ambas técnicas de inyección se obtiene adecuado porcentaje de actividad ingresada, que permite obtener imágenes óptimas y poca extravasación.

Aim- To evaluate the percentage of the injected dose of 99mTc-DMSA that is effectively delivered to the patient. Methods. Renal DMSA scintigrams from 2 centers with different puncture methods: direct puncture with a needle or with a three-way stop-cock (Centers 1 and 2). Acquisition of filled and empty syringe (and/or additional system) and injection site, calculating entered dose to the patients considering and not considering the injection site, and assessing the persistent activity. T test was applied. Results. Studies from 65 patients were analyzed, 71 percent female, mean age 61 months. All images were of good quality, according to experienced observers. Average percentage of entered dose by substracting the injection site was 87.70 percent and 91.02 percent with no subtraction (p<0.05). Injection site activity was 1.5 percent for center 1 and 3.27 percent for center 2 (p<0.05). Conclusions: Appropriate percentage of activity is delivered with both injection techniques, which allows optimum images and little extravasation.

Correlación entre cintigrama renal DMSA (CR) planar y tomográfico en 180° y 360° / Correlation between Tc99m-DMSA renal planar scintigraphy and tomography technique in 180 degrees and 360 degrees

El C.R. planar es un examen habitual en la práctica clínica , cuya sensibilidad y especificidad han sido validadas en el estudio de infección urinaria en niños. El uso de técnica tomográfica es discutido , por lo que quisimos correlacionar los resultados obtenidos en el CR planar versus estudios tomográficos,considerando el planar nuestro gold estándar. 25 pacientes referidos por estudio de infección urinaria fueron estudiados con técnica planar habitual y el mismo día, tomografía en 180 ° y en 360°. Se analizaron independientemente las imágenes planares de las tomográficas .Se realizó una tabla de correlación entre el CR planar y cada tomografía para evaluar las coincidencias (análisis Kappa). La mayor concordancia se observó entre el CR planar y la tomografía de 180º, índice kappa de 0.66, vs. 0.50 con la tomografía en 360º. Conclusión: Si se realiza tomografía renal ésta debe ser en 180º.

Planar DMSA scintigraphy is a well established method for evaluating kidney in the urinary tract infection. There is no agreement of the utility of SPECT DMSA imaging. We compared the results of planar DMSA scintigraphy with tomography technique ( gold standard was planar DMSA). 25 children were evaluated with planar DMSA, 180º posterior and 360º full tomography in the same day. Images were interpreted independently in a blinded fashion. We made a correlation table and Kappa analysis were aplicated. The best concordancy were obtained between planar and 180º SPECT, with a Kappa index : 0.66 vs 0.50 with the 360º tomography. Conclusion: the 180º acquisition technique is preferable for kidney tomography.