Vanishing bone disease involving the pelvis.

Vanishing bone disease is a rare condition characterized by progressive osteolysis of the bony structures by vascular tissue and their replacement by fibrous, vascular connective tissue. A 38-year-old lady who had a previous history of angioma of the left iliac bone presented with vague symptoms of a limping gait and pain during walking since 2 years duration. The radiologic findings were suggestive of degenerative changes. A possibility of metastatic disease was also considered. However the biopsy and Positron emission tomography (PET) scan ruled out any active disease. Like in most other cases this was possibly a self-limited disease where bone resorption had spontaneously arrested.

Lymphoscintigraphy in staging and management of breast cancer.

Internal mammary lymphoscintigraphy (IML) is a simple non-invasive and reproducible technique to determine the extent of the parasternal node invasion in patients suffering from breast cancer. A total forty four patients--37 before surgery or any sort of treatment and seven patients after having undergone surgery, chemotherapy and/or radiotherapy were included in this study to assess the potential role of lymphoscintigraphy in the context of the present 'state of the art' of staging and management of breast cancer patients in Bangladesh. The scintigraphic test was done using Technetium 99m (Tc-99m) Antimony sulfide colloid in a dose of 500 microCi injected interstitially into the sub-costal space. Images were obtained after two to three hours on a Gamma Camera and the study findings were then interpreted as normal, abnormal and equivocal. The scintigraphic images obtained in patients who had undergone surgery, chemotherapy and/or radiotherapy were difficult and more challenging to interpret than those images obtained from patients before surgery or other therapy. This was evidenced by the high number (71%) equivocal cases of IML findings in patients after treatment as compared to only 22% equivocal cases in patients studied before surgery or other therapy. Parasternal lymph node involvement was found to occur regardless of the site or size of the primary tumour. Thirty three percent of tumours located in the outer quadrant showed abnormal nodes on IML. When the size was considered, IML was found abnormal in 22.20% patients with tumour size less than 2 cm in diameter. Correlation of IML with clinically palpable lymph nodes showed abnormal scan findings in 18% patients without clinically demonstrable axillary lymph nodes. These findings are in agreement with previously published data and suggests that conventionally classified stage I patients may in effect be in stage II or even in stage III of the disease. In conclusion, when the technique of lymphoscintigraphy is done with a comprehensive overview of the patient, and when the interstitial injection site is correct, it will generally lead to a logical and clinically useful interpretation of the data for more efficient management of the patient with breast cancer.

Somatostatin receptor tumor imaging (Tc 99m P829) in pituitary adenoma.

Technetium 99m P829 (99mTc P829) is a somatostatin like structure labelled with Technetium-99m. Somatostatin receptor positive tumors such as pituitary tumors, neuroendocrine tumors, and lymphomas show positive scintigraphy. Eleven patients suspected of having a pituitary mass (12 studies) were studied with 99mTc P829. Three pituitary adenoma patients (4 studies) showed positive somatostatin receptor tumor imaging. Eight negative somatostatin receptor scintigraphy were one hypothyroid induced pituitary hyperplasia, one craniopharyngioma, one normal pituitary tissue with focal hyperplasia, one ACTH secreting pituitary tumor, one GH, PRL secreting pituitary tumor post transphenoidal partial tumor removal, and no surgery in 3 patients. Finally, somatostatin receptor imaging may be useful as a tumor localizing technique in addition to conventional CT and MRI imaging and identify patients who might potentially benefit from octreotide treatment. In addition, the development of peptide analogs coupling to beta-emitting radiopharmaceutical may lead to a situation in which diagnosis peptide receptor scintigraphy can be followed by radionuclide therapy.

Scintigraphic detection of bile leak and follow-up in a post-cholecystectomy patient with recognition of tail sign.

Early detection of site and extent of biliary tract disruption can significantly reduce mortality and morbidity in a postoperative biliary leak. We report a case in whom extent and location of post surgical biliary leak was detected with the help of 99mTc BULIDA cholescintigraphy and showed a good correlation with "T" tube cholangiography. Cholescintigraphy was also useful in assessing the follow up of this patient. We conclude that 99mTc BULIDA cholescintigraphy is a non-invasive, safe, simple and sensitive procedure in the detection of the site, extent of the leak and in follow up of the postoperative biliary leak.