Pneumonitis Related to Melanoma Immunotherapy.

Several regimens of immunotherapy have recently proven successful for multiple cancers, due to increased survival and quality of life. Rarely, immunotherapy with anti-programmed cell death protein 1 and programmed death-ligand 1 antibodies across cancer may cause immune-related pulmonary toxicity, with a low overall incidence, being particularly low among patients with melanoma and highest among individuals with lung cancer. In this vein, pulmonary toxicity is staged at 4 degrees according to the severity of the clinic and radiological findings, and its management is based on suppression of immunotherapy and administration of glucocorticoids. We report a case of pulmonary toxicity related to melanoma immunotherapy observed by F-FDG PET/CT.

Virchow Node From Prostate Carcinoma by 18F-Choline PET/CT.

F-choline PET/CT is increasingly being used during the follow-up of prostate cancer and is bringing us valuable information for the delineation of local and distant nodal recurrence in patients with hormone-resistant poorly differentiated cell types. Lymphatic spreading usually involves pelvic and retroperitoneal levels, being unusual at supraclavicular levels. We report a 75-year-old man with unsuspected involvement of Virchow node from prostate cancer observed using F-choline PET/CT.

Esophageal Cancer Diagnosed by Thyroid Scintigraphy.

We report a 34-year-old man referred because of increasing dysphagia secondary to goiter. Thyroid scintigraphy and SPECT/CT images helped to recognize an unsuspected esophageal dilation due to a poorly differentiated adenocarcinoma arising at the lower end of the esophagus. Further examinations are mandatory when abnormal activities are observed during thyroid scintigraphy.

Thymic uptake after high-dose I-131 treatment in patients with differentiated thyroid carcinoma: A brief review of possible causes and management / Captación tímica después del tratamiento a dosis elevadas con I-131 en pacientes con carcinoma diferenciado de tiroides: revisión breve de posibles causas y manejo

PURPOSE: To report five cases of patients diagnosed with differentiated thyroid carcinoma (DTC) with uptake in the thymic area after high-dose treatment with I-131 and to evaluate the potential causes and therapeutic management. METHODS: Five cases of young female patients with a mean age of 36.6 years (24-43) who had been treated with a mean dose of 106mCi of I-131 (100-150mCi) showing tracer uptake in the thymic area are reported. An I-131 whole-body scan (131I-WBS) was performed 7 days after therapeutic dose administration to each patient. Anterior and posterior planar images, followed by SPECT/CT of the head, neck and superior mediastinum were acquired in all patients. Thyroglobulin levels were measured with and without hormone replacement therapy in all cases. Samples taken from the superior mediastinum were sent to pathology for analysis, which confirmed the presence of thymic tissue. Results: Two patients underwent elective total thymectomy due to the gross characteristics of the gland, local 131-I uptake, and high thyroglobulin levels. The remaining three patients had already undergone thymectomy as part of neck dissection during initial surgery, and no further invasive interventions were therefore performed. Pathological examination revealed no metastases in these five patients. CONCLUSIONS: Thymus visualization in young patients after administration of therapeutic doses of I-131 seems to be a more common finding than usually thought. Absence of metastasis in the thymus despite high thyroglobulin levels was confirmed in all cases. Based on these results, we suggest that a more expectant and less aggressive therapeutic approach could be used. We also suggest that I-131 therapy for DTC should be considered in classification of the potential causes of true thymic hyperplasia in the subgroup of patients recovering from a stressor

OBJETIVOS: Descripción de cinco casos de pacientes diagnosticados de carcinoma diferenciado de tiroides (CDT) con captación en el área del timo después de un tratamiento con alta dosis de I-131, y evaluar las posibles causas y manejo terapéutico. MÉTODOS: Presentamos cinco casos de mujeres jóvenes con una edad media de 36,6 años (24-43), que fueron tratadas con una dosis media de 106mCi de I-131(100-150) que mostraron captación del trazador en las región tímica. Se ralizaron rastreos de cuerpo completo a los 7 días de la administración de la dosis a todos los pacientes, se realizaron imágenes planares de cuerpo completo en proyecciones anterior, posterior y SPECT/TAC de cabeza, cuello y mediastino superior. Valorándose también los niveles de tiroglobulinas con y sin tratamiento sustitutivo hormonal. En todos los casos se confirmó mediante anatomía patológica que la captación visualizada en el mediastino superior correspondía a tejido tímico. RESULTADOS: Dos pacientes fueron sometidas a una timectomía total debido a las características macroscópicas de la glándula, la captación de I-131 y los altos niveles de tiroglobulina. En los otros tres pacientes la timectomía ya se había realizado previamente como parte de la disección del cuello en el tratamiento quirúrgico inicial por lo que se deciden no reintervenir. Los cinco casos fueron informados por anatomía patológica como negativos para metástasis. CONCLUSIONES: La visualización del timo en pacientes jóvenes tras la administración de dosis terapéuticas de I-131 es un hallazgo más frecuente de lo que pudiéramos pensar. En todos los casos se confirmó la ausencia de metástasis en el timo a pesar de los niveles elevados de tiroglobulinas. A la vista de estos resultados planteamos la posibilidad de una actitud terapéutica menos agresiva y expectante. También proponemos que la terapia metabólica para el CDT se debe tomar en cuenta en la clasificación de las causas probables de la hiperplasia tímica verdadera en el subgrupo que incluye a los pacientes en recuperación que han sido sometidos a un factor estresante

Thymic uptake after high-dose I-131 treatment in patients with differentiated thyroid carcinoma: a brief review of possible causes and management.

PURPOSE: To report five cases of patients diagnosed with differentiated thyroid carcinoma (DTC) with uptake in the thymic area after high-dose treatment with I-131 and to evaluate the potential causes and therapeutic management. METHODS: Five cases of young female patients with a mean age of 36.6 years (24-43) who had been treated with a mean dose of 106 mCi of I-131 (100-150 mCi) showing tracer uptake in the thymic area are reported. An I-131 whole-body scan (131I-WBS) was performed 7 days after therapeutic dose administration to each patient. Anterior and posterior planar images, followed by SPECT/CT of the head, neck and superior mediastinum were acquired in all patients. Thyroglobulin levels were measured with and without hormone replacement therapy in all cases. Samples taken from the superior mediastinum were sent to pathology for analysis, which confirmed the presence of thymic tissue. RESULTS: Two patients underwent elective total thymectomy due to the gross characteristics of the gland, local 131-I uptake, and high thyroglobulin levels. The remaining three patients had already undergone thymectomy as part of neck dissection during initial surgery, and no further invasive interventions were therefore performed. Pathological examination revealed no metastases in these five patients. CONCLUSIONS: Thymus visualization in young patients after administration of therapeutic doses of I-131 seems to be a more common finding than usually thought. Absence of metastasis in the thymus despite high thyroglobulin levels was confirmed in all cases. Based on these results, we suggest that a more expectant and less aggressive therapeutic approach could be used. We also suggest that I-131 therapy for DTC should be considered in classification of the potential causes of true thymic hyperplasia in the subgroup of patients recovering from a stressor.