Extensive Drop Metastases From Pineal Gland Tumor: A Case Report.

ABSTRACT: Pineal gland tumors are an infrequent central nervous system manifestation. Their prevalence is only less than 1% of all central nervous system tumors. They generally involve children or young adults aged younger than 40 years. Extracranial or spinal drop metastases are very rare from pineal gland tumors. In this case, 18 FDG PET/CT demonstrates drops in metastases involving the entire length of the spinal as well as multiple other intracranial metastatic lesions.

Extensive Pleural Involvement in Pediatric T-Cell Lymphoblastic Lymphoma.

Lymphoblastic lymphoma (LBL) is the common non-Hodgkin lymphoma in childhood and adolescence. T-cell LBL (T-LBL) usually manifests with an anterior mediastinal mass and disseminated disease. We present a 12-year-old girl with progressive neck swelling and dyspnea for 1 year. Fluorodeoxyglucose positron-emission tomography/computed tomography done for pretreatment staging unveiled hypermetabolic lymph nodes on both sides of the diaphragm with splenic and bone marrow involvement. Apart from these, there was the extensive involvement of the left pleura. Biopsy and immunohistochemistry revealed T-LBL. The extensive secondary pleural involvement in pediatric T-LBL is rarely seen and needs to be reported.

Skeletal Metastases of Unknown Primary: A Rare Presentation of Carcinoma Pancreas on Fludeoxyglucose Positron Emission Tomography-Computed Tomography.

Skeletal metastases of unknown primary represent skeletal metastases where primary tumors remain obscure. They usually arise from lung and prostate cancer. We present a case of a young male who presented with severe bone pains, weight loss, and generalized weakness. Fludeoxyglucose positron emission tomography-computed tomography reveals extensive skeletal metastases, a mass in the pancreas tail, and other metastatic lesions. He had no liver or lung metastases. This case presents a rare presentation of carcinoma pancreas.

Metastatic Urinary Bladder Carcinoma on Palliative Chemotherapy Showing Rapid Progression on Interim Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Bladder cancer (BC) is among the top ten most common cancer types globally. Muscle invasive BC has a high incidence of metastasis. Metastatic BC has a poor prognosis and limited treatment options. Here, we present a middle-aged man with oligometastatic BC, which was treated with palliative chemotherapy. He had significant clinical improvement. However, interim 18F-Fluorodeoxyglucose positron emission tomography/computed tomography demonstrates a rapid disease progression extensive metastasis.

Utero-Ovarian Involvement in Non-Hodgkin's Lymphoma on 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: A Case Series and Literature Review.

Lymphomas are common solid malignancies. They are associated with substantial morbidity and mortality. Hodgkin's lymphoma (HL) and Non-HL (NHL) are subtypes of lymphoma. Lymph nodes are the most common site of involvement, though practically any organ may be involved. NHL has preponderance for extranodal involvement. Primary uterine and ovarian NHL is scarce. However, in advanced systemic disease, secondary utero-ovarian involvement may be seen. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) is a pivotal imaging modality in lymphomas. It abets in pretreatment staging, posttherapy restaging, and surveillance. We present three stage-IV NHL cases with secondary utero-ovarian involvement. FDG PET/CT as a baseline imaging modality established the disease burden and organ involvement.

Port-Site Metastases in Incidentally Detected Carcinoma Gall Bladder: Role of 18F-FDG PET/CT and Patient Outcome.

BACKGROUND: Incidentally detected gall bladder carcinoma (IGBC) is occasionally encountered after cholecystectomy for benign gall bladder disease. Rarely these patients may present with port-site metastases (PSM) in follow-up. We retrospectively assessed the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) in them. We aimed to determine the clinical outcome and correlate the survival based on FDG PET/CT findings. MATERIAL AND METHOD: We did a single-center retrospective study in IGBC patients presented with histopathologically proven PSM. FDG PET/CT was done for restaging. The metastatic burden was evaluated. Survival after PSM and overall survival (OS) were assessed in different disease groups. RESULTS: A total of 22 patients (51.86 ± 12.04 years) were included in the study. The mean interval between LC and PSM was 336.7 ± 501.9 days. On FDG PET/CT, isolated single PSM was noted in 21 (95.5%) patients. Apart from PSM, abdominal lymph nodes, GB fossa lesion, and liver metastases were noted in the 10 (45.5%), 6 ( 27.3%), and 7 (31.8%) patients, respectively. FDG PET/CT revealed intra-abdominal disease and visceral metastasis in 11 (50%) and 10 (45.5%) patients. Nineteen (86.4%) patients died in follow-up with a median survival of 328.50 (225.25-804.0) day after PSM. Median OS after LC was 687.00 (362.50-1047.0) days. Patients with PSM plus disease (432.0 days, 255.9-608.1), extra-abdominal metastases (400.0 days, 316.9-483.1), and visceral metastases (400.0 days, 296.2-503.8) had significantly lower OS compared to isolated PSM (1763 days, p = 0.013), the intra-abdominal disease (996.0 days, 753.2-1238.8, p = 0.0340), and non visceral metastasis (807.0 days, 467.5-1146.4, p = 0.037). IGBC presenting as PSM is a distinct clinical entity. FDG PET/CT as functional imaging evaluates the local and metastatic disease burden. There is significantly lower survival in patients with PSM plus disease, extra-abdominal metastases, or visceral metastases. FDG PET/CT was an important prognostic marker in these patients and could help in management.

Relapsed Carcinoma Cervix Presented with Multiple Rare Visceral Metastases: Role of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Carcinoma cervix spread to locoregional lymph nodes. Distance metastases are uncommon and occur through hematogenous routes in advanced stages. The common sites include bone and lungs. Another organ involvement is uncommon. Computed tomography (CT) and magnetic resonance imaging have a crucial role in diagnosing local and distant metastasis. 18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT) is a sensitive molecular imaging modality for various cancers, including gynecological ones. We present a case of recurrent cervical carcinoma presented with cervical mass and several rare visceral metastases. 18F-FDG PET/CT is a whole-body modality that accurately localized all lesions in a single study.

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Case of Subcutaneous T-cell Lymphoma Presenting as Breast Mass and Panniculitis-Like Features: A Rare Entity.

Subcutaneous panniculitis-like T-cell lymphoma (SPTCL) is an unusual subtype of cutaneous lymphoma and clinically appears as erythematous, subcutaneous infiltrates, and recurrent papulonodules. It is defined as a rare cytotoxic a/b T-cell lymphoma characterized by primary involvement of subcutaneous tissue-mimicking panniculitis and a predominant CD3+/CD4/CD8+ phenotype in (2005) the World Health Organization-European Organization for Research and Treatment of Cancer classification for cutaneous lymphomas. On metabolic imaging, these lesions are invariably fluorodeoxyglucose (FDG) avid. SPTCL which presents as a breast mass is a rare entity. Here, we present a case of SPTCL presents as FDG avid breast mass and subcutaneous nodules.

Contiguous Multilevel Vertebral Metastasis in Carcinoma Breast Mimicking Spondylodiscitis.

A 59-year old female presented with a lump in the right breast for 6 months. She developed progressively increasing backache for 3 months. Magnetic resonance imaging spine was suggestive of hypointense heterogeneous signal intensity in multiple dorsal vertebrae (D3-D8) and suggestive of Pott's spine. Sonomammography suggested a lesion with irregular margin in the retro-areolar region. Fine-needle aspiration cytology was infiltrating duct carcinoma. Fluorodeoxyglucose (FDG) positron-emission tomography-computed tomography revealed mass in the right breast with axillary lymph node. FDG-avid lytic destructive contiguous lesion was noted in mid-dorsal vertebrae. Apart from it, FDG-avid lytic lesion was also noted in the right iliac bone. The patient underwent vertebral lesion biopsy consistent with metastatic breast carcinoma. This case report demonstrates rare contiguous involvement of multiple vertebrae masquerading Pott's spine.

Incidental Diagnosis of Multiple Paragangliomas by Ga-68 DOTANOC Positron Emission Tomography-Computed Tomography.

A 65-year-old man presented with intermittent abdominal pain for three months. Abdominal ultrasonography revealed a mass in the body of the pancreas. Moreover, abdominal contrast-enhancing computed tomography revealed a homogenously enhancing mass in the body of the pancreas. Scan findings were in favor of the neuroendocrine tumor, and the serum chromogranin level was slightly raised (111.9 ng/ml, normal <98). He had no history of vomiting, jaundice, melena, hematemesis, constipation, diarrhea, weight gain, weight loss, loss of appetite, and fever. He also had no symptoms related to the excessive production of catecholamines, such as hypertension. The patient was referred for Ga-68 DOTANOC positron emission tomography-computed tomography (Ga-68 DOTANOC PET-CT) for further evaluation. The scan was done to rule out metastatic disease or other synchronous lesions to plan surgical excision. The Ga-68 DOTANOC PET-CT revealed a pancreatic lesion with no other abdominal lesions. We noted multiple tracer avid soft tissue lesions on both sides of the neck that were not diagnosed previously. This case report demonstrates a rare case with multiple paragangliomas diagnosed by the Ga-68 DOTANOC PET-CT. This finding could lead to changes in patient management.

18FDG-Positron Emission Tomography in patients with Tuberculous Meningitis: A Prospective Evaluation.

Lower yield of available diagnostic tests for tuberculous meningitis (TBM) frequently causes delay in diagnosis. Recently, 18F-fluorodeoxyglucose positron emission tomography (FDG PET) has been used in infectious disorders such as pulmonary tuberculosis; however, it is rarely used in TBM. This study was aimed to ascertain the role of FDG PET in the diagnosis and determination of the extent of disease and prognosis in patients with TBM. After excluding unsuitable patients, 25 patients were subjected to whole-body PET-computed tomography (CT) image acquisition along with separate brain protocol with an integrated PET-CT device. FDG PET was found to be abnormal in 92% patients. Extracranial FDG uptake was observed in 80% patients. Most common extracranial site of involvement was lymph nodes (60%), followed by lung (56%), vertebral body (8%), genitourinary organs (8%), and spleen (4%). FDG PET observed extracranial involvement had 80% sensitivity and 20% specificity in detecting definite TBM cases. In conclusion, FDG PET may be a useful test in TBM evaluation.

Renal Cell Carcinoma with Unusual Visceral and Cutaneous Metastasis.

Renal cell carcinoma is a common urogenital malignancy. It often metastasizes to the lungs, liver, bone, adrenal glands, and brain in the advanced stage. However, the involvement of the skin and subcutaneous region of the head and neck is rare. We report a case of a middle-aged man presented with extensive metastases to post radical nephrectomy. The nose and lower lip metastasis with submental lymph nodal mass is not previously reported. He also had metachronous prostatic adenocarcinoma. The case highlights the excellent capability of molecular imaging using fluorodeoxyglucose-positron-emission tomography/computed tomography to pick up all metastatic lesions and find metachronous prostate malignancy.

Lymphoscintigraphy In a Case of Recurrent Chylopericardium.

Chylopericardium is an uncommon and benign condition in which triglyceride-containing chylous fluid collects in the pericardial cavity at high concentrations. Usually, chylopericardium occurs due to congenital malformation of lymphatic vessels or secondary to any trauma, surgeries, neoplasms, etc. However, if exact aetiology cannot be identified, the condition is referred to as Idiopathic chylopericardium which is a very rare presentation in day-to-day clinical practice. General physical examination, routine blood investigations and various anatomical imaging modalities may give a clue in the diagnosis, however, diagnosis can be challenging as they have a variable presentation. Also, optimal treatment poses greater difficulty as it remains controversial in most cases. We report a 47-year-old gentleman who presented with recurrent chylous pericardial effusion with no history of trauma, thoracic surgeries, cardiac disease and neoplasm in the past. Lymphoscintigraphy confirmed the communication between the lymphatic trunk and the pericardial space. The patient was managed conservatively with pericardial drainage and the patient recovered is doing well at present.