18F-FDG PET/CT Assessment of Malignant Granular Cell Tumor of the Soft Tissue.

ABSTRACT: Malignant granular cell tumor variant is rare and even more if lower extremities are involved. We present a rare case with images of 18F-FDG PET/CT showing 2 hypermetabolic lesions on the right tight with an elevated SUVmax value of 7.50 and 2 adenopathies with an SUVmax almost as high as the lesions. Histopathologic sample after complete excision confirmed malignant granular cell tumor with lymph node metastases.

Disease-Free Survival for Patients with Thin Melanomas according to the American Joint Committee on Cancer 8th Edition.

BACKGROUND: The recently implemented AJCC 8th edition TNM staging system for malignant melanoma (MM) changed the definition for T1a and T1b tumours. OBJECTIVES: To analyse differences in disease-free survival (DFS) among patients with thin MM staged according to both AJCC 7th and 8th editions. METHODS: An observational study including 285 patients with cutaneous thin MM (thickness ≤1 mm). Cases were staged as T1a and T1b using both 7th and 8th editions. Neither regional nor visceral diseases were present at diagnosis. DFS curves were generated according to the Kaplan-Meier method. RESULTS: An 8% shift of patients from a T1a towards a T1b stage group was observed after applying the AJCC 8th edition. According to this 8th edition, DFS for T1a patients was significantly longer than for T1b patients (log-rank test; p = 0.005); 5-year DFS for T1a and T1b was 100 and 95%, respectively (Wilcoxon test; p = 0.002). According to the AJCC 7th edition, DFS did not significantly differ for T1a and T1b patients; 5-year DFS for T1a and T1b was 99 and 97%, respectively (p > 0.05). CONCLUSIONS: The AJCC 8th edition seems to be a better tool for staging thin melanomas.

Biopsia de médula ósea en el linfoma de Hodgkin. Comparación con la PET-TC en 65 pacientes / Bone marrow trephine biopsy in Hodgkin's lymphoma. Comparison with PET-CT scan in 65 patients

Fundamento y objetivo: Comparar la biopsia de médula ósea (BMO) y la PET/CT en la detección de la afectación medular en el linfoma de Hodgkin. Material y métodos: Análisis retrospectivo de 65 pacientes con realización de ambas pruebas en la estadificación inicial o en recaída con especial atención al patrón de la PET/CT. Resultados: En 3 pacientes (4,6%) la BMO mostró afectación medular, siendo la PET/CT positiva en todos ellos: 2 con patrón difuso+multifocal y uno solo difuso. En 11 pacientes más (total 14/65, 21%) se estimó que había afectación medular ósea por PET/CT al tener un consumo de médula ósea superior al hepático. El patrón fue focal único en 2 casos, multifocal en 5, difuso en 3 casos y difuso+multifocal en uno. En estos últimos 4 casos la BMO mostró una mielopatía inespecífica. Conclusiones: La PET/CT detecta todos los casos con BMO afectada y muchos que se escapan a la biopsia; sin embargo, cuando el patrón de captación es difuso puede ser por afectación o por hiperplasia reactiva y en esos casos debería mantenerse la BMO (AU)

Background and objectives: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma. Material and methods: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern. Results: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy. Conclusions: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done (AU)

Bone marrow trephine biopsy in Hodgkin's lymphoma. Comparison with PET-CT scan in 65 patients. / Biopsia de médula ósea en el linfoma de Hodgkin. Comparación con la PET-TC en 65 pacientes.

BACKGROUND AND OBJECTIVES: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma MATERIAL AND METHODS: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern. RESULTS: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy. CONCLUSIONS: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done.

Clinicopathological characteristics of cutaneous malignant melanoma in patients at a tertiary hospital in Macaronesia. Survival as a function of locoregional prognostic factors per the American Joint Committee on Cancer.

BACKGROUND: Despite suffering high ultraviolet radiation levels, few data on malignant melanoma (MM) in Macaronesia are available. METHODS: Observational study of cutaneous MM cases diagnosed during a period of 12 years at a tertiary hospital in Canary Islands. RESULTS: A total of 532 patients (female/male = 1.4) with an average age of 56 years were included; 5% developed more than one MM, and 7% reported family history of MM. Phototype II (43%), dark eyes (41%), and dark hair (41%) predominated. There was a lower frequency of light-colored hair and eyes in those born in the Canary Islands. The most frequent locations of MM were on the back for men (37%) and on the lower extremities for women (35%). Among the infiltrating tumors (83%), the (median) thickness was 1.07 mm (women, 0.90 mm; men, 1.21 mm). Anatomopathological ulceration (AU) and a mitotic rate ≥1 mitosis/mm2 (HMR) were recorded in 27% of patients. Patients with regional disease constituted 12% of the population. The most common stage was IA (34%). Melanoma-specific survival (MSSV) decreased significantly with thickness, presence of AU, HMR, and sentinel lymph node disease. These four variables were independent prognostic factors. The five-year MSSV varied between 100% (stage IA) and 39% (stage IIIC). CONCLUSIONS: The characteristics of the patients were similar to those published in datasets from continental Europe, although the pigmentary features were darker in those originating from Macaronesia. The prognostic parameters described in the 7th edition of the American Joint Committee on Cancer (AJCC) independently predict MSSV in our patients.

Unsuspected uterine metastasis of breast carcinoma diagnosed by 18F-FDG PET/CT.

A 50-year-old woman with a history of bilateral lobular carcinoma of the breast in 1995 and 2001 was treated with mastectomy, axillary lymphadenectomy, chemotherapy, and hormone therapy which achieved a complete response. In 2009, the patient developed a progressive elevation of tumor markers. A CT scan was performed showing no suspicious malignant lesions. She was referred for (18)F-FDG PET/CT and the images revealed highly increased tracer uptake in the uterus suggestive of malignancy. The patient underwent hysterectomy with bilateral double adnexectomy and a histopathological diagnosis of massive carcinomatous infiltration of breast lobular carcinoma was done.

Imagen fotopénica secundaria a derrame pleural masivo visualizada en la fase precoz de una gammagrafía ósea / Photon-deficient right hemithorax on blood pool images in a pleural effusion

Presentamos un paciente con derrame pleural maligno visualizado como una área fotopénica en la imagen precoz de una gammagrafía ósea en 2 fases.

We present a patient with chondrosarcoma. In the blood pool phase of a bone scintigraphy we saw a cold area in the right hemithorax. This image was secondary to a malignant pleural effusion.

Feocromocitoma bilateral diagnosticado mediante 123I-MIBG en un paciente afecto de MEN 2b / Bilateral pheochromocytoma diagnosed by 123I-MIBG in a patient with multiple endocrine neoplasia type 2b

Presentamos el caso de un paciente varón de 29 años con sospecha clínica de feocromocitoma previamente diagnosticado de una Neoplasia Endocrina Múltiple (MEN) tipo 2b. Se realizó una gammagrafía con 123I-metaiodobelcilguanidina (MIBG) que mostró captación patológica en ambas suprarrenales, sugestiva de feocromocitoma bilateral. El estudio de resonancia magnética (RMN) determinó la localización anatómica. El paciente fue sometido a suprarrenalectomía bilateral confirmándose el diagnóstico de feocromocitoma bilateral en anatomía patológica.

We report a case of 29 years old man who was referred with the clinical symptoms of pheochromocytoma in a Multiple Endocrine Neoplasia (MEN) type 2b. 123I- metaiodobenzylguanidine (MIBG) scan revelead pathologic adrenal bilateral uptake described in bilateral pheochromocytoma. Anatomical localization was achieved by Magnetic Resonance (MRI). The patient was submitted to surgery for bilateral adrenal removal. Surgical pathology confirmed the diagnostic of pheochromocytoma in both adrenal glands.

Lesiones óseas por sobrecarga: shin splint y fractura de estrés / Bone injuries: shin splint and stress fracture

En el ámbito deportivo se producen múltiples lesiones por estrés en las extremidades inferiores, y la patología que presentamos es una de las mas frecuentes en pacientes jóvenes y niños que entrenan excesivamente. La clínica que presentan estos pacientes supone dolor y tirantez durante el ejercicio. En la etiología podrían estar implicadas las fibras de inserción de los músculos tibiales y sóleo (fibras de Sharpey), sin poder descartar la coexistencia de periostitis y miositis como cofactores. Con relativa frecuencia los "shin splints" se asocian a fracturas de estrés en diferentes estadíos que son también patología típica de sobreentrenamiento y pueden mostrar una semiología similar. La gammagrafía ósea en dos fases ha sido ampliamente descrita como una técnica de ayuda para el diagnóstico correcto y en consecuencia el buen manejo de este tipo de pacientes.