The role of bone scanning in severe frostbite of the feet in a mountaineer / La gammagrafía ósea en un alpinista con congelaciones de los pies

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[Papillary thyroid carcinoma synchronous with breast cancer: an incidental finding in an (18)F-FDG PET-CT study carried out in a search for occult breast cancer]. / Carcinoma papilar de tiroides sincrónico con cáncer de mama: hallazgo casual en una exploración (18)F-FDG PET-TAC por búsqueda de un cáncer oculto de mama.

The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of (18)F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in (18)F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy.

Carcinoma papilar de tiroides sincrónico con cáncer de mama: hallazgo casual en una exploración 18F-FDG PET-TAC por búsqueda de un cáncer oculto de mama / Papillary Thyroid Carcinoma synchronous with breast cancer: An incidental finding in an 18F-FDG PET-CT study carried out in a search for occult breast cancer

La causa más frecuente de afectación metastásica de los ganglios linfáticos axilares en mujeres es una neoplasia en la mama ipsilateral. La definición de neoplasia oculta de mama se ha modificado con el tiempo. Actualmente, hay que considerar una neoplasia oculta de mama cuando coincide una linfadenopatía axilar metastásica aislada en ausencia de una tumoración palpable en la mama ipsilateral, una mamografía no diagnóstica para un tumor mamario y la no detección de una neoplasia primaria fuera de la mama, que potencialmente pudiera afectar a los ganglios axilares. En estos casos, el valor de la exploración 18F-FDG-PET-TAC no está establecido, aunque puede ser de utilidad en pacientes con una RM no diagnóstica. No es infrecuente que, en una exploración 18F-FDG-PET-TAC, se identifique de forma casual una imagen hipermetabólica focal en tiroides. La elevada prevalencia de cáncer en este tipo de lesiones, aconseja practicar una exploración con US y/o PAAF(AU)

The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of 18F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in 18F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy(AU)

Resistencia al tratamiento de primera línea de quimioterapia en un paciente diagnosticado de linfoma de Hodgkin de predominio linfocítico nodular identificada mediante 18F-FDG PET/TAC: implicaciones diagnósticas y terapéuticas / Resistance to first line chemotherapy treatment in a patient diagnosed of nodular lymphocyte-predominant Hodgkin's lymphoma identified by 18F-FDG PET/CT: diagnostic and therapeutic implications

El linfoma de Hodgkin de predominio linfocítico nodular (LHPLN) es una rara entidad que representa menos del 5% de los casos de linfoma de Hodgkin (LH) con rasgos morfológicos, inmunofenotípicos, genéticos y de comportamiento clínico distintos del LH clásico. En una minoría de pacientes, la evolución del LHPLN se complica por transformación a un linfoma no Hodgkin difuso B de células grandes (LNHDBCG) con implicaciones pronósticas y terapéuticas. Los cambios metabólicos precoces observados mediante 18F-FDG PET en pacientes con LH y LNH, después de 1-3 ciclos de quimioterapia predicen la respuesta final al tratamiento y la supervivencia libre de progresión. En el caso que presentamos, tanto si se trata de LHPLN transformado a LNHDBCG o la coexistencia de los dos tipos de linfoma en el mismo paciente, la exploración 18F-FDG PET/TAC fue determinante para identificar la resistencia del tumor a la primera línea de quimioterapia, orientar la toma de una segunda biopsia y modificar el régimen de quimioterapia(AU)

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by 18F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the 18F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen(AU)

[Resistance to first line chemotherapy treatment in a patient diagnosed of nodular lymphocyte-predominant Hodgkin's lymphoma identified by 18F-FDG PET/CT: diagnostic and therapeutic implications]. / Resistencia al tratamiento de primera línea de quimioterapia en un paciente diagnosticado de linfoma de Hodgkin de predominio linfocítico nodular identificada mediante (18)F-FDG PET/TAC: implicaciones diagnósticas y terapéuticas.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by (18)F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the (18)F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen.

Identificación preoperatoria mediante SPECT/TAC de un ganglio centinela intramamario en una paciente con cáncer de mama. Significado y relevancia clínica / Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance

Presentamos el caso de una paciente con cáncer de mama a la que se le realizó biopsia selectiva de ganglio centinela. En la linfogammagrafía preoperatoria se identificó mediante SPECT/TAC un ganglio centinela intramamario. Describimos nuestro procedimiento diagnóstico-terapéutico en relación con este hallazgo y la revisión bibliográfica para evaluar el significado clínico de su identificación y de su afectación metastásica, sobre todo en cuanto al manejo axilar más apropiado. Son necesarios estudios más amplios y con mayor significación estadística para dilucidar la actitud más adecuada ante la detección linfogammagráfica de un ganglio centinela intramamario(AU)

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy(AU)

[Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance]. / Identificación preoperatoria mediante SPECT/TAC de un ganglio centinela intramamario en una paciente con cáncer de mama. Significado y relevancia clínica.

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy.

Adenoma ectópico de paratiroides: detección gammagráfica y cirugía radioguiada / Ectopic parathyroid adenoma: Scintigraphic detection and radioguided surgery

Objetivo. Determinar el valor de la gammagrafía de paratiroides con 99mTc-MIBI y de la cirugía radiodirigida en el diagnóstico y tratamiento del hiperparatiroidismo primario (HPP) por adenoma ectópico. Material y métodos. Se han revisado 105 paratiroidectomías radiodirigidas practicadas entre marzo de 2004 y diciembre de 2008. Para el presente trabajo se han incluido 20 pacientes (19%) operados por adenoma ectópico. Los pacientes tenían diagnóstico de HPP, gammagrafía positiva, detección radiodirigida de adenoma ectópico, confirmación anatomopatológica de adenoma y seguimiento clínico de al menos 1 año desde la cirugía. La gammagrafía con 99mTc-MIBI consistió en imágenes planares en doble fase y tomográficas (SPECT o SPECT/TAC). Durante la paratiroidectomía se determinó PTH basal y a los 7, 15 y 30 minutos de la exéresis. El seguimiento se realizó mediante determinaciones de PTH, calcio, fósforo y vitamina D séricos y función renal. Resultados. La gammagrafía detectó todos los adenomas. La localización gammagráfica coincidió con la quirúrgica en 18 pacientes (90%). La localización definitiva fue: 9 paraesofágicos, 5 timicocervicales, 4 cervicomediastínicos posteriores, 1 mediastínico anterior y 1 paratimo. La paratiroidectomía radiodirigida identificó todos los adenomas y se efectuó mediante cirugía mínimamente invasiva en 12 pacientes, cervicotomía unilateral en 2, cervicotomía bilateral en 4 y esternotomía en 2. No se observó persistencia/recurrencia del HPP durante el seguimiento clínico. Conclusiones. La gammagrafía (SPECT/TAC) y la cirugía radiodirigida son métodos de gran eficacia en la localización y tratamiento del HPP debido a adenoma ectópico de paratiroides. En nuestra serie se detectaron y extirparon todos los adenomas, sin observarse hiperparatiroidismo persistente o recurrente(AU)

Aim. The aim of this study was to evaluate the role of 99mTc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas. Methods. We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function. Results. Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up. Conclusions. Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up(AU)

[Ectopic parathyroid adenoma: Scintigraphic detection and radioguided surgery]. / Adenoma ectópico de paratiroides: detección gammagráfica y cirugía radioguiada.

AIM: The aim of this study was to evaluate the role of (99m)Tc-MIBI parathyroid scintigraphy and radioguided parathyroidectomy on the diagnosis and treatment of primary hyperparathyroidism (PHP) due to ectopic adenomas. METHODS: We reviewed 105 consecutive patients who underwent radioguided parathyroidectomy due to adenomas between March 2004 and December 2008. Of this group we studied 20 patients (19%) with ectopic adenomas. All patients had biochemical evidence of PHP, a positive parathyroid scintigraphy, radioguided detection with histolopathological confirmation of adenoma and at least 1 year-follow up. The parathyroid scintigraphy consisted on dual-phase planar and tomographic images (SPECT or SPECT/CT). During the parathyroidectomy, intraoperative PTH determinations (0, 7, 15 and 30 min after the parathyroidectomy) were done. The follow up consisted on blood examinations of PTH, calcium, phosphorus and vitamin D and assessment of renal function. RESULTS: Parathyroid scintigraphy detected all adenomas. Scintigraphic and surgical findings were coincident in 18 cases (90%). The final adenoma localization was paraesophagic in 9 patients, cervicothymic in 5, posterior cervicomediastinal in 4, anterior mediastinal in 1 and parathymic in 1. The parathyroidectomy consisted on 12 minimally invasive surgeries, 2 unilateral cervicotomies, 4 bilateral cervicotomies and 2 sternotomies. No case of persistent or recurrent PHP was observed during the follow up. CONCLUSIONS: Parathyroid scintigraphy (SPECT/CT) and radioguided surgery are effective methods on the localization and treatment of PHP due to ectopic adenomas. In our study the radioguided parathyroidectomy was successful in all cases and there was no evidence of persistent or recurrent hyperparathyroidism on the follow up.