ABSTRACT
Objetivo La asociación entre la endocarditis infecciosa (EI) por Streptococcus gallolyticus y las lesiones malignas del tracto gastrointestinal está bien descrita. Asumimos que otros microorganismos enteropatógenos, como el Streptococcus viridans y Enterococcus faecalis también pueden estar relacionados con la enfermedad colorrectal. Nuestro objetivo fue determinar la frecuencia de depósitos focales de la [18F]FDG en localización colorrectal, sugestivos de lesiones tumorales, y su correlación con la enfermedad de colon y recto en pacientes con infección causada por diferentes microorganismos comensales del tracto gastrointestinal. Métodos Examinamos retrospectivamente 61 pacientes con diagnóstico de bacteriemia y de EI (posible o concluyente) según los criterios de Duke y causada por microorganismos enteropatógenos, y que fueron sometidos a una PET/TC de cuerpo entero con [18F]FDG en nuestra institución. Buscamos depósitos de la [18F]FDG en localización colorrectal, así como la presencia de lesiones morfológicas. A todos los pacientes con EI se les realizó una colonoscopia completa y los resultados histológicos se clasificaron según 4 grupos: lesión maligna, lesión premaligna, lesión benigna y ausencia de lesión. Se evaluó la correlación existente entre los hallazgos de la PET/TC con [18F]FDG y el diagnóstico histopatológico y el microorganismo implicado. Resultados La PET/TC detectó 20 depósitos de [18F]FDG en localización colorrectal (32,79%-OR: 47,28), 2 de ellos en pacientes con bacteriemia (16,7%) confirmados como lesiones malignas y premalignas y 18 en el grupo con EI (36,6%), 17 de ellos correspondientes a enfermedad colorrectal: 11 lesiones malignas, 5 premalignas y una benigna. En el subgrupo con EI la colonoscopia detectó lesiones colorrectales en el 51,02% de los pacientes: 11 malignas, 8 premalignas y 6 benignas. En el subgrupo de Streptococcus spp. se detectó una mayor incidencia de depósitos de [18F]FDG en localización colorrectal (AU)
Objective Association between Streptococcus gallolyticus infective endocarditis (IE) and malignant lesions of the gastrointestinal tract is well described. We hypothesize that other enteropathogenic microorganisms, such as Streptococcus viridans and Enterococcus faecalis are also related with colorectal pathology. Our aim is to determine the frequency of focal colorectal FDG deposits, suggestive of tumoral lesions and their correlation with colorectal pathology, in patients with infection caused by different commensal microorganisms of the gastrointestinal tract. Methods We retrospectively examined 61 patients diagnosed with bacteremia (BSI) and IE (possible or definite) according to Duke's criteria, caused by enteropathogenic microorganisms, who underwent a full-body [18F]FDG-PET/CT in our institution. We looked for colorrectal FDG deposits and morphological lesions. All IE patients underwent a complete colonoscopy and the histological results were classified into four groups: malignant lesion, premalignant lesion, benign lesion and no lesion. We evaluated the correlation between the findings of the [18F]FDG-PET/CT with the histopathological diagnosis and the involved microorganism. Results PET/CT detected 20 colorectal FDG deposits (32.79%-OR: 47.28), 2 within bacteriemic patients (16.7%) confirmed as malignant and premalignant lesions and 18 in IE group (36.6%), 17 of them corresponding to colorrectal pathology: 11 malignant, 5 premalignant and 1 benign lesions. In the IE subgroup, the colonoscopy detected colorectal lesions in 51.02% of the patients: 11 malignant, 8 premalignant and 6 benign. We found a higher incidence of colorectal FDG deposits in Streptococcus spp. subgroup. Regarding the anatomopathological colonic findings there was a predominance of patients affected by S. viridans, followed by E. faecalis and S. gallolyticus (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Positron-Emission Tomography , Fluorodeoxyglucose F18 , Endocarditis, Bacterial/complications , Bacteremia/complications , Colonic Diseases/diagnostic imaging , Colonic Diseases/microbiology , Endocarditis, Bacterial/microbiology , Bacteremia/microbiology , Retrospective Studies , Cross-Sectional StudiesABSTRACT
INTRODUCTION AND OBJECTIVE: Neuroendocrine tumors (NETs) debut in 75% of cases with liver metastases (LMNETs), whose therapeutic approach includes surgical resection and liver transplantation, while liver radioembolization with 90 Y-microspheres (TARE) is reserved for non-operable patients usually due to high tumor burden. We present the accumulated experience of 10 years in TARE treatment of LMNETs in order to describe the safety and the effectiveness of the oncological response in terms of survival, as well as to detect the prognostic factors involved. MATERIAL AND METHODS: Of 136 TARE procedures, performed between January 2006 and December 2016, 30 LMNETs (11.1%) were retrospectively analyzed. The study variables were: Tumor response, time to liver progression, survival at 3 and 5 years, overall mortality and mortality associated with TARE. The radiological response assessment was assessed using RECIST 1.1 and mRECIST criteria. RESULTS: An average activity of 2.4 ± 1.3 GBq of 90 Y was administered. No patient presented postembolization syndrome or carcinoid syndrome. There were also no vascular complications associated with the procedure. According to RECIST 1.1 criteria at 6 months, 78.6% presented partial response and 21.4% stable disease, there was no progression or complete response (1 by mRECIST). Survival at 3 and 5 years was 73% in both cases. CONCLUSION: TARE treatment with 90 Y-microspheres in LMNETs, applied within a multidisciplinary approach, is a safe procedure, with low morbidity, capable of achieving a high rate of radiological response and achieving lasting tumor responses.
ABSTRACT
La radioembolización hepática con 90Y es una terapia locorregional cada vez más ampliamente empleada en el tratamiento del carcinoma hepatocelular. Recientemente, se ha descrito su potencial beneficio como tratamiento de downstaging, logrando una disminución de la carga tumoral que permite rescatar a los pacientes para tratamientos más radicales como el trasplante hepático. Presentamos el caso de un paciente con el diagnóstico de carcinoma hepatocelular estadio intermedio de la Barcelona Clinic Liver Cancer (BCLC), multicéntrico y bilobar, en quien el tratamiento de radioembolización con 90Y consiguió una adecuada respuesta radiológica, reduciéndose de forma muy significativa la carga tumoral, permitiendo su rescate con trasplante hepático (AU)
Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation (AU)
Subject(s)
Humans , Male , Middle Aged , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular , Liver Transplantation , Embolization, Therapeutic/methods , Microspheres , Fluorodeoxyglucose F18/analysis , Hepatic Artery , Catheterization/instrumentationABSTRACT
Hepatic radioembolization with 90Y is an increasingly widely used locoregional therapy in the treatment of hepatocellular carcinoma. Its potential benefit has recently been described as a downstaging treatment, achieving a decreased tumour burden and allowing patients to be rescued for more radical treatments, such as liver transplantation. The case is presented of a patient diagnosed with multifocal bilobar hepatocellular carcinoma, Barcelona Clinic Liver Cancer (BCLC) intermediate stage, in whom treatment with 90Y achieved a satisfactory radiological response with a very significant reduction of tumour burden, allowing rescue with liver transplantation.
Subject(s)
Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/therapy , Embolization, Therapeutic/methods , Liver Neoplasms/pathology , Liver Neoplasms/therapy , Yttrium Radioisotopes/therapeutic use , Carcinoma, Hepatocellular/surgery , Humans , Liver Neoplasms/surgery , Liver Transplantation , Male , Microspheres , Middle Aged , Neoplasm StagingABSTRACT
Objetivo. Determinar el comportamiento metabólico de la paniculitis mesentérica (PM), los posibles patrones de presentación en la imagen 18F-FDG-PET/TAC y conocer si es una técnica diagnóstica fiable para diferenciar enfermedad tumoral y patología inflamatoria en este contexto. Material y métodos. Dos mil seiscientas sesenta y seis exploraciones PET/TAC fueron evaluadas de forma prospectiva desde abril de 2012 hasta agosto de 2013. Se incluyeron en nuestro estudio a 30 pacientes (37 exploraciones) que presentaban signos radiológicos de PM, 8 mujeres y 22 hombres, con edades comprendidas entre 39 y 81 años. Según la captación de 18F-FDG en las lesiones mesentéricas, expresado como SUVmax, los pacientes fueron clasificados en dos grupos: Grupo A: conformado por 10 pacientes con captación aumentada, SUVmax ≥ 2 o superior a la actividad hallada en el tejido mesentérico sano circundante y Grupo B (conformado por 20 pacientes): SUVmax < 2 o indistinguible del tejido sano. Resultados. En el 80% de los pacientes del Grupo A (media de SUVmax 7,11) no se demostraron criterios de afectación tumoral mesentérica durante un seguimiento medio de 13 meses (falsos positivos), exceptuando a dos pacientes de este grupo que sí mostraron signos de afectación tumoral (SUVmax 7,57 y 9,46), obteniéndose un valor predictivo positivo de 49,79%. En el 100% de los pacientes del Grupo B se confirmó ausencia de afectación tumoral mesentérica. Conclusiones. Ante la presencia de signos radiológicos de PM, un aumento del metabolismo glucídico, incluso intenso y focal en estas lesiones, aunque no excluye la posibilidad de afectación tumoral, puede corresponder, con una alta probabilidad, a actividad inflamatoria (AU)
Aim. To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in 18F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. Material and methods. A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the 18F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax < 2 or indistinguishable from healthy tissue. Results. No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. Conclusions. The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity (AU)
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Panniculitis, Peritoneal/diagnosis , Fluorodeoxyglucose F18 , Positron-Emission Tomography/instrumentation , Positron-Emission Tomography/methods , Positron-Emission Tomography , Prospective Studies , Panniculitis, Peritoneal/complications , Panniculitis, Peritoneal/physiopathology , Predictive Value of TestsABSTRACT
AIM: To assess the metabolic behavior of mesenteric panniculitis (MP), possible manifestation patterns in ¹8F-FDG PET/CT imaging and to discover if it is a reliable diagnostic method to differentiate tumor disease from inflammatory condition in this context. MATERIAL AND METHODS: A total of 2,666 PET/CT scans were evaluated prospectively from April 2012 to August 2013. Thirty patients were included (37 scans) with radiological signs of MP. There were 8 women and 22 men, aged between 39 and 81 years, in the sample. According to the ¹8F-FDG uptake in the mesenteric lesions, expressed as SUVmax, patients were classified into two different groups: Group A consisted of 10 patients with increased uptake, SUVmax ≥ 2 or greater than the activity found in the surrounding healthy mesenteric tissue, and Group B (20 patients) SUVmax <2 or indistinguishable from healthy tissue. RESULTS: No signs of mesenteric tumour involvement were demonstrated during a mean follow up of 13 months (false positives) in 80% of the Group A patients (mean SUVmax 7.11). Signs of the presence of tumor were only demonstrated in two patients of Group A (SUVmax 7.57 and 9.46) with a positive predictive value of 49.79%. All Group B patients were confirmed to be free of mesenteric involvement. CONCLUSIONS: The presence of radiological signs of suggestive of MP, increase in glycidic metabolism, even intense and focal in these lesions, which may not exclude the possibility of an ongoing tumour process, would have a high likelihood of being indicative of intense inflammatory activity.
Subject(s)
Fluorine Radioisotopes/pharmacokinetics , Fluorodeoxyglucose F18/pharmacokinetics , Lymphatic Metastasis/diagnostic imaging , Mesentery/diagnostic imaging , Panniculitis, Peritoneal/diagnostic imaging , Positron Emission Tomography Computed Tomography/methods , Radiopharmaceuticals/pharmacokinetics , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Male , Middle Aged , Panniculitis, Peritoneal/metabolism , Prospective StudiesABSTRACT
La esplenosis es un hallazgo frecuente tras las la rotura traumática del bazo o esplenectomía terapéutica, definiéndose como un autotrasplante heterotópico del bazo por la superficie y cavidad peritoneal. En pacientes esplenectomizados por enfermedad hematológica, la esplenosis puede llevar a recidiva de la enfermedad. Presentamos un caso de esplenosis en un paciente con púrpura trombocitopénica idiopática (PTI) que presentó una recidiva tras esplenectomía. Para su localización se realizaron pruebas de imagen convencional y gammagrafía con hematíes desnaturalizados marcados con 99mTc, donde se apreciaron al menos 5 focos esplénicos. Dada la difícil localización intraoperatoria de dichos nódulos, se practicó cirugía radioguiada, con excelente localización y extirpación de los nódulos conocidos y de múltiples implantes peritoneales de tamaño milimétrico no visualizados previamente. Concluimos que la cirugía radioguiada es una excelente herramienta para la localización de focos de esplenosis peritoneal de difícil acceso y visualización, evitando así una recurrencia precoz de la enfermedad (AU)
Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with 99mTc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease (AU)
Subject(s)
Humans , Splenosis , Splenic Rupture , Splenectomy , Postoperative Complications , TechnetiumABSTRACT
Splenosis is a common finding after traumatic rupture of the spleen or therapeutic splenectomy, defined as a heterotopic autotransplantation of the spleen in peritoneal cavity and surface. In splenectomized patients due to hematologic disease, splenosis can lead to disease recurrence. We present a case of splenosis in a patient with idiopathic thrombocytopenic purpura who relapsed after splenectomy. For its localization, conventional imaging and scintigraphy with (99m)Tc-denatured red cells was performed, and at least five splenic foci were observed. Given the difficult intraoperative localization of these nodules, radioguided surgery was performed, with excellent localization and removal of all known nodules and multiple peritoneal implants of millimeter size that were not previously observed. We conclude that radioguided surgery is an excellent tool for locating foci of peritoneal splenosis, which have difficult access, thus avoiding early recurrence of the disease.
Subject(s)
Splenosis/diagnostic imaging , Splenosis/surgery , Surgery, Computer-Assisted , Adolescent , Humans , Male , Radionuclide Imaging , TechnetiumABSTRACT
El mesotelioma pleural maligno es un tumor relativamente raro pero altamente agresivo, con una expectativa media de vida entre 9 y 17 meses, relacionado con la exposición al asbesto. El dolor torácico y la disnea son sus manifestaciones clínicas más frecuentes. La terapia más empleada es la cirugía acompañada de tratamiento quimioterápico. La valoración prequirúrgica, tras el tratamiento quimioterápico, ha sido realizada a través de la resonancia magnética y la tomografía axial computarizada (TAC). Sin embargo, estas técnicas no permiten predecir de forma precoz la respuesta a la terapia, dada la lenta modificación estructural del tumor. La presentación de esta nota clínica invita a revisar y conocer la creciente utilidad de la imagen PET-TAC, con 18F-FDG, en la estadificación prequirúrgica del mesotelioma pleural maligno y su influencia en la selección del tipo de cirugía más apropiada(AU)
Malignant pleural mesothelioma is a relatively rare, but highly aggressive, tumor, associated to exposure to asbestos, with a life expectancy between 9 and 17 months. Chest pain and dyspnea are the most frequent symptoms. The most commonly used therapy is surgery accompanied by chemotherapy. Preoperative assessment, after chemotherapy, has been done using magnetic resonance imaging and computed tomography (CT). However, these techniques cannot predict early response to therapy, because of the slow structural change of the tumor. The aim of this case report is to review and learn about the growing use of PET-CT imaging with 18F-FDG in the preoperative staging of malignant pleural mesothelioma and its influence in selecting the most appropriate type of surgery(AU)
Subject(s)
Humans , Male , Female , Positron-Emission Tomography , Fluorodeoxyglucose F18 , Pleural Neoplasms/drug therapy , Pleural Neoplasms , Neoadjuvant Therapy/methods , Dyspnea/complications , Dyspnea , /methods , Asbestos/adverse effects , Chest Pain/complications , Chest Pain/diagnosis , Chest Pain/etiologyABSTRACT
Malignant pleural mesothelioma is a relatively rare, but highly aggressive, tumor, associated to exposure to asbestos, with a life expectancy between 9 and 17 months. Chest pain and dyspnea are the most frequent symptoms. The most commonly used therapy is surgery accompanied by chemotherapy. Preoperative assessment, after chemotherapy, has been done using magnetic resonance imaging and computed tomography (CT). However, these techniques cannot predict early response to therapy, because of the slow structural change of the tumor. The aim of this case report is to review and learn about the growing use of PET-CT imaging with (18)F-FDG in the preoperative staging of malignant pleural mesothelioma and its influence in selecting the most appropriate type of surgery.
