[Increased glucose uptake by seborrheic keratosis on PET scan]. / Hyperfixation intense d'une kératose séborrhéique en TEP-TDM.

BACKGROUND: Positron emission tomography (PET) is an examination based upon the uptake of a radioactive tracer by hypermetabolic cells. It is primarily used in tandem with tomodensitometry (PET-TDM) for cancer staging because of its high sensitivity and specificity for the detection of metastases. However, unusually high uptake may occur with benign tumours, including skin tumours. Herein, we report an extremely rare case of pathological uptake levels resulting from seborrhoeic keratosis. PATIENTS AND METHODS: A 55-year-old male patient with oesophageal squamous-cell carcinoma was referred to us following the discovery of an area of high marker uptake following PET-TDM and corresponding to a pigmented skin lesion. No other areas of suspect high uptake were seen. The lesion was surgically excised and histological examination indicated seborrhoeic keratosis. The histological appearance was that of standard seborrhoeic keratosis without any notable mitotic activity. DISCUSSION: PET-TDM is an examination that enables diagnosis of malignancy. However, rare cases have been described of increased marker uptake by benign cutaneous tumours such as histiocytofibroma, pilomatricoma and condyloma. To date, there have only been only very few cases of increased uptake due to seborrhoeic keratosis. CONCLUSION: This extremely unusual case of increased glucose uptake in PET-TDM due to seborrhoeic keratosis confirms that the hypermetabolic activity detected by this examination is not necessarily synonymous with malignancy and that confirmation by clinical and histological findings is essential. The reasons for increased metabolic activity within such benign tumours are not known.

[An analysis of 20 consecutive patients treated with stereotactic body radiotherapy on Novalis Tx(®) for stage I non-small-cell lung cancer]. / Analyse des résultats d'une série de 20 patients traités par irradiation hypofractionnée en conditions stéréotaxiques par Novalis Tx(®) pour un cancer bronchopulmonaire non à petites cellules de stade I.

PURPOSE: Recent clinical results of dose escalation with stereotactic body radiation therapy to increase local tumour control for patients with stage I non-small-cell lung cancer who either refuse surgery or are medically inoperable resulted in making it a standard treatment in this setting. This treatment technique was implemented at the Paul-Strauss Centre, Strasbourg, in 2010. The objective of this study is to describe and analyze the data of the first 20 treated patients. PATIENTS AND METHODS: From October 2010 to May 2012, 20 patients were treated with this technique for T1N0M0 or T2N0M0 lung tumour. The indication was proposed by the multidisciplinary thoracic oncology team meeting, and approved by the technical committee of the Department of Radiotherapy. After the realization of a dosimetric CT Scan (4DCT or three phases-free breathing and deep breath-hold inspiration and expiration) and after performing a ((18)F)-FDG PET scan in the treatment position, all patients were treated on Novalis Tx(®) linear accelerator, with arctherapy or modulated intensity radiotherapy (IMRT). A protocol has been defined for the prescribed dose, depending on the size and location of the tumor, central or peripheral. The patients underwent follow-up during treatment and at 1 month, 3-4 months, 6 and 9 months to assess outcomes and toxicities. RESULTS: The mean age was 72.6 years (52-89). Seventeen patients had one or more pulmonary comorbidities. The mean delivered dose was 59.9 Gy (40-70) in 4 Gy to 17.5 Gy fractions. The mean gross tumour volume was 14.9 mL (median 7.2, 0.9 to 73.5) and the mean planning target volume was 77.8 mL (median 49.5; 17-300). The mean initial SUV max was 7.7 (1.8 to 16.7). Dose constraints and planning target volume coverage recommended by the protocol were achieved in the majority of cases. The mean lung V20 was 7.63% (1.2 to 17.7) and the mean dose delivered to the planning target volume was 94.6% (88-99). The duration of treatment was 21 days (median: 23; 8-27), and no change or interruption of prescribed treatment has occurred. Median follow-up was 6.6 months, and crude rates of objective response for patients evaluated were 85% (11/13 patients) at 3 months and 100% at 6 and 9 months. The complete response rate at 3 and 6 months were 0 (0/13 patients) and 50% (5/10 patients). Two patients had metastatic disease in the 6 months following treatment. Concerning pulmonary toxicity at 3 months, 6 patients developed G2 radiation pneumonitis and three patients G3, with positive evolution. CONCLUSION: The analysis of the results of this series, comparable with those described in literature, shows that lung stereotactic radiotherapy is an effective and well-tolerated treatment for inoperable patients. The extension of the indications could be envisaged based on the results of ongoing trials.

[Morpho-functional imaging in a patient with hyperparathyroidism and multifocal maxillary brown tumor]. / Imagerie morphologique et fonctionnelle des tumeurs brunes. À propos d'un cas de localisation maxillo-mandibulaire.

INTRODUCTION: Brown tumors are uncommon osteolytic lesions directly related to the increased osteoclastic activity due to hyperparathyroidism. CASE REPORT: A 37-year-old woman presented with hypercalcemia related to primary hyperparathyroidism. Multiple and bilateral maxillary osteolytic lesions showing intense fluorodesoxyglucose (FDG) uptake were noted in a positron emission tomography computed tomography (PET-CT). Diagnosis of maxillary brown tumors was discussed and confirmed by both orthopantomogram and magnetic resonance imaging. Left inferior parathyroid adenoma was detected by both cervical ultrasonography and parathyroid scintigraphy, and then surgically treated with consequent improvement of hyperparathyroidism. CONCLUSION: Our case emphasizes the necessity of a multidisciplinary diagnostic approach to optimize the interpretation of the available imaging, especially in unusual and unrecognized pathology as brown tumors.

Aire deficiency causes increased susceptibility to streptozotocin-induced murine type 1 diabetes.

Aire-deficient mice are a model of the human monogenic disorder autoimmune polyendocrine syndrome type I (APS I) characterized by a progressive autoimmune destruction of multiple endocrine glands such as the adrenal cortex, the parathyroids and the beta-cells of the pancreas. The disease is caused by mutations in the autoimmune regulator (AIRE) gene, a putative transcription factor expressed in thymic medullary epithelial cells and in antigen-presenting cells of the myeloid lineage in peripheral lymphoid organs. As Aire(-/-) mice do not spontaneously develop endocrinopathies, we wanted to evaluate the autoimmune multiple low-dose streptozotocin (MLDSTZ) diabetes model in Aire(-/-) mice. Surprisingly, Aire heterozygote mice were most susceptible to MLDSTZ-induced diabetes, whereas Aire(-/-) mice displayed an intermediate sensitivity to diabetes. Furthermore, Aire(-/-) macrophages produced higher levels of TNF-alpha and lower levels of IL-10 following streptozotocin stimulation, and Aire(-/-) mice developed a higher frequency of islet cells autoantibodies as a sign of increased activation. However, the number of islet infiltrating F4/80(+) Aire(-/-) macrophages was significantly decreased which was attributed to an increased susceptibility to streptozotocin cytotoxicity of Aire(-/-) macrophages. In conclusion, Aire(-/-) macrophages display an increased activation after STZ stimuli, but suffer from increased susceptibility to STZ cytotoxicity. These results support an important function of Aire in the control of peripheral tolerance through myeloid antigen-presenting cells.

Risk factors for cardiovascular diseases among Swedish Sami--a controlled cohort study.

OBJECTIVE: To investigate the occurrence of clinical, psychosocial and behavioural risk factors for cardiovascular diseases (CVD) among reindeer herding (RS) and non-reindeer herding Sami (NRS). STUDY DESIGN: A retrospective cohort study, comparing risk factors behind CVD between Sami and non-Sami, RS and NRS, and Sami men and women. METHODS: A cohort of 611 Swedish Sami (276 men and 335 women) was constructed from national population registers. A twice as large control cohort of non-Sami was created, matched by age, gender and area of residence. Information on risk factors was obtained from a database containing clinical and psychosocial-behavioural data from a regional CVD preventive programme for the period 1990-2001. RESULTS: The Sami and the non-Sami showed similar risk factor patterns. The main differences were related to working conditions and lifestyle factors of the RS. The RS men had lower blood pressure, were more physically active and had higher job demand and decision latitude. The RS women showed more negative scores on the indices of the job strain model. CONCLUSIONS: Previously reported differences in CVD mortality between Sami and non-Sami, and Sami men and women, can only partly be explained by different exposure to the psychosocial and behaviour risk factors investigated in this study.

Determination of Lufenuron in canine skin layers by radioluminography.

In a bioavailability study in dogs we investigated the quantity of [14C]-Lufenuron and its metabolites in the skin by radioluminography. Two Beagle dogs were orally administered 10 mg [14C]-Lufenuron per kg body weight. 21 days later they were euthanized. Skin specimens were taken at 6 different sites. Sections of these skin specimens were exposed on a phosphorus imaging plate and the radiolabeled Lufenuron content visualized. Radioluminographical analysis showed that [14C]-Lufenuron appeared in the subcutaneous layer of the skin. We did not discover any activity on the skin surface.