Spindle epithelial tumor with thymus-like differentiation of the thyroid.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) of the thyroid is a rare tumor that occurs habitually in children and young adults. To date, about 20 cases of SETTLE have been reported in the English medical literature. It is considered to be a tumor of low malignancy with a favorable outcome, but delayed blood-borne metastases have been reported (sometimes over 20 years after initial treatment). In the current report, the authors describe an interesting case of SETTLE in a young woman. Double phase Tc-99m tetrofosmin scintigraphy showed accumulation of the tracer in the thyroid mass.

Isotopic exploration of hepatic hydrothorax: ten cases.

OBJECTIVE: The aim of this retrospective study was to evaluate the performance of peritoneal scintigraphy for the diagnosis of peritoneopleural communication in patients with cirrhosis and to discuss its role in therapeutic management. PATIENTS AND METHODS: Ten patients with cirrhosis and pleural effusion were included in this study. Cirrhosis was due to viral hepatitis in eight patients, auto-immune disease in one patient and of unknown origin in one. The pleural effusion was right-sided in nine patients and bilateral in one. 99m-technetium sulfur colloid peritoneal scintigraphy was performed in all patients. RESULTS: Scintigraphy revealed peritoneopleural communication in nine patients. In four patients, radioactivity appeared in the pleural cavity within a few minutes after injection of the radiotracer. In three of them, a large diaphragmatic defect was demonstrated by ultrasonography, magnetic resonance imaging or thoracoscopy. Complete response to medical treatment was observed in four patients. Scintigraphy revealed rapid radioactivity migration in four patients; diuretic treatment led to resolution of the hydrothorax in one of them. Three patients whose hydrothorax was refractory to medical treatment were treated by pleurodesis with talc. Resolution of the hydrothorax was achieved in one of them. CONCLUSION: Peritoneal scintigraphy is a simple non-invasive method enabling confirmation of peritoneopleural communication in cirrhotic patients. The importance of the diaphragmatic defect can also be evaluated, providing a significant contribution to therapeutic decision-making.

Large diaphragmatic defect as the cause of hydrothorax in a cirrhotic patient: demonstration with peritoneal scintigraphy and magnetic resonance imaging.

A 52-year-old man with history of post-hepatitic cirrhosis presented with ascitis and respiratory distress. Chest X-ray on admission showed a large right hydrothorax. Thoracentesis yielded a large volume of a clear transudate fluid. Peritoneal scintigraphy showed rapid migration of radiotracer into the right pleural cavity, confirming the abdominal origin of the pleural fluid and suspecting a large diaphragmatic defect. MR imaging study using ultrafast sequences confirmed the large diaphragmatic defect.

Preoperative scintigraphic visualization of an orbital metastasis before identification of carcinoma in a nonfunctioning thyroid nodule.

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. The authors report the case of a 51-year-old woman with follicular thyroid carcinoma revealed by a right orbital metastasis. I-131 scintigraphy performed before thyroidectomy showed intense uptake in an orbital metastasis despite the presence of an intact thyroid gland.

Preoperative scintigraphic visualization of lymph nodes and pulmonary metastases from papillary thyroid carcinoma.

Preoperative accumulation of Tc-99m pertechnetate and radioiodine in metastases of well-differentiated thyroid carcinoma is uncommon. We report herein the case of a 39-year-old woman with occult papillary thyroid cancer revealed by widespread miliary lung metastases. Ultrasonography revealed the presence of an infracentimetric hypoechoic nodule and cervical lymph nodes. Scintigraphy, realized with Tc-99m pertechnetate and I-131 prior to thyroidectomy, failed to delineate the primary thyroid tumor, but revealed functional cervical nodes on the central and left lateral compartments, with pulmonary accumulation.

Scintigraphic findings in a case of bilateral urinomas and ascites secondary to posterior urethral valves.

The authors present the scintigraphic findings in a case of bilateral urinomas and ascites secondary to posterior urethral valves in a 9-day-old boy. There was progressive tracer accumulation in the urinomas and ascites with a distinct urine jet medially from the upper left kidney, which suggested direct urinary egress into the peritoneal cavity.

Hypothyroidism presenting as a hot pertechnetate nodule.

The authors report an uncommon finding of hot nodule on Tc-99m sodium pertechnetate thyroid scan in three patients with hypothyroidism. Data indicate that hypothyroidism is secondary to Hashimoto's disease (HD). There was a concordant aspect on I-131 scan in two; a nodular discrepancy (cold nodule with I-131) was associated with the highest microsomal antibodies titer. The findings of thyroid scan and ultrasonographic findings indicate that hot nodules may be observed either on initial or advanced stages of HD. Color flow Doppler sonography, showed an absence of internal increase of vascularization. These data suggest that the observed hot nodules correspond to localized hyperplasia of the less diseased portions secondary to chronic stimulation by TSH.

Incidental discovery of pulmonary metastases during I-131 scintigraphy after total thyroidectomy.

We report the case of a 40-year-old man with radiographically silent pulmonary metastases of papillary thyroid cancer discovered during I-131 scintigraphy following total thyroidectomy performed 10 years after unilateral lobectomy. The residual lobe was histologically normal. After a dose of 11.1 GBq (300 mCi), there was no I-131 uptake in the thyroid bed and lung metastases, and serum thyroglobulin became undetectable. Conservative therapy could be associated with a delay in the possibility of diagnosing and treating extrathyroidal metastases.

Radionuclide bone scan in initial staging of breast cancer.

Radionuclide bone scans of 100 patients with newly diagnosed breast cancer were retrospectively analysed. The number and topography of increased area of uptake were noted. Diagnosis criterion was defined by at least four foci of increased uptake, outside peripheral articular joints. In case of a number between one and three, the result was considered doubtful and radionuclide bone scan was confronted to available standard X Rays or/and radionuclide bone scan follow-up. Correlations of radionuclide bone scans with T, N and the clinical stage were assessed using chi-square methods. Metastases were present in 9 patients (9%). In five of these cases, the pattern was manifestly metastatic without the need to other investigation. In the other cases, interpretation required complementary investigation. The yield of metastases was very low in localized stages, this pointed out the difficulty in interpretation of radionuclide bone scans for localized stages, probably due to a less skeletal extension.