Malignant epidermoid arising from the third ventricle: A case report.

BACKGROUND: Third epidermoid tumors are a rare finding. The appearance of these tumors often makes them difficult to diagnose, and thus they require multimodality imaging. CASE SUMMARY: A 48-year-old male patient reported to our hospital with complaints of vomiting and severe headache. The patient also complained of involuntary micturition for the past five days. We used a combination of computed tomography (CT) and magnetic resonance imaging (MRI) imaging modalities to confirm the presence of a malignant epidermoid cyst arising from the third ventricle. A contrast-enhanced CT of the head demonstrated minimal perilesional enhancement while an MRI revealed a large, lobulated and septated T2 hyperintense mass arising from the third ventricle. The maximum size of the lesion measured 73 mm × 65 mm × 64 mm in size. CONCLUSION: Malignant epidermoid arising from the third ventricle in an adult male was reported using a combination of CT, MRI, and MR spectroscopy.

18F-FDG PET/CT in the evaluation of cancer cervix: Where do we stand today?

The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus. The staging procedure is purely clinical (i.e. gynecologic examination under general anesthesia) according to the International Federation of Gynaecology and Obstetrics classification. Earlier, with the nonavailability of sophisticated medical equipment and imaging specialists, oncologists relied heavily on clinical examination. However, anatomical and functional imaging has been proven to be considerably superior in understanding parametrial involvement and nodal/distant metastases in the cancer cervix than clinical examination alone. Data are evolving on the usage of F-FDG PET/CT in initial staging, treatment planning, and monitoring therapy response for gynecological malignancies. Prognostic information derived from the primary lesion such as the maximum standardized uptake value, metabolic tumor volume, and extent of para-aortic nodal metastatic disease plays a critical role in tailoring therapy on the basis of patient tumor-specific factors rather than on International Federation of Gynaecology and Obstetrics stage alone. Thus, F-FDG PET/CT needs to be listed not only under the panel of pretherapy investigations for Ca cervix but also for recurrence and therapy response assessments. It allows a more confident approach to patient management at initial staging, especially in terms of the decision to choose surgical versus palliation measures.

Papillary carcinoma thyroid with uveal metastases.

Ocular metastases secondary to thyroid cancer are extremely uncommon, typically affecting the orbit rather than the globe and uvea. Within the uveal structures, the choroid is more commonly involved than the iris and ciliary body. We present a 56-year-old male patient who underwent total thyroidectomy for metastatic papillary thyroid carcinoma (PTC), solid variant. Whole-body(131) I (WBI) scintigraphy was performed and the patient was treated twice with high-dose (131)I therapy. WBI after the second treatment demonstrated right orbital activity. The patient developed sudden onset of right eye diminished vision and was diagnosed with uveal (choroidal) metastases from PTC.

Random synchronous malignancy in male breast: a case report.

We report here a case of a random synchronous male breast malignancy in a patient with a known base of tongue malignancy that was incidentally detected on a whole body 18-fluorine deoxyglucose positron emission tomography and computed tomography ((18)F-FDG PET/CT). Patient was referred to us for PET/CT staging and radiotherapy planning for a poorly differentiated squamous cell carcinoma of base of tongue. Histopathologically, the incidentally detected breast lesion was proven to be an invasive ductal carcinoma. (18)F-FDG PET/CT being a whole body imaging modality is known to detect a considerable number of synchronous primaries. Synchronous malignancies in the head and neck area and the upper aerodigestive tract are well established. However, synchronous malignancy in male breast is reportedly uncommon. Our case is unique for the fact that a random synchronous dual malignancy of base of tongue and breast in a male patient was detected during a whole body (18)F-FDG PET/CT imaging.

Enhanced myocardial fluorodeoxyglucose uptake following Adriamycin-based therapy: Evidence of early chemotherapeutic cardiotoxicity?

AIM: To analyze changes in myocardial glucose metabolism using fluorodeoxyglucose (FDG)-positron emission tomography (PET) in patients treated with adriamycin and to investigate the clinical significance of these changes. METHODS: Considering that FDG-PET scanning has the ability to show changes in glucose metabolism in the myocardium, we retrospectively analyzed the FDG-PET studies of 18 lymphoma patients treated with adriamycin-based chemotherapy in both the pre- and post-therapy setting. Cardiac contractile parameters such as left ventricular ejection fraction were not available for correlation in all patients due to the short duration and the level of cumulative dose administered in these patients during the time of the follow-up FDG-PET study. The change in myocardial glucose utilization was estimated by change in standard uptake values (SUV) in the myocardium. RESULTS: We observed a significant change in SUVmean values in the myocardium (defined as more than ± 20% change in cardiac SUVmean between pre- and post-chemotherapy PET) in 12 patients, whereas 6 patients did not show any significant cardiac FDG uptake in both pre- and post-therapy PET scans. Patients were divided into three groups based on the changes observed in myocardial tracer uptake on the follow-up (18)F-FDG-PET study. Group A (n = 8): showed an increase in cardiac (18)F-FDG uptake in the post-therapy scan compared to the baseline scan carried out prior to starting adriamycin-based chemotherapy. Group B (n = 6): showed no significant cardiac (18)F-FDG uptake in post-therapy and baseline PET scans, and group C (n = 4): showed a fall in cardiac (18)F-FDG uptake in the post-therapy scan compared to the baseline scan. Mean cumulative adriamycin dose (in mg/m(2)) received during the time of the follow-up FDG-PET study was 256.25, 250 and 137.5, respectively. CONCLUSION: Our study shows three different trends in the change in myocardial glucose metabolism in patients undergoing adriamycin-based chemotherapy. A further prospective study with prolonged follow-up of ventricular function is warranted to explore the significance of enhanced FDG uptake as a marker of early identification of adriamycin-induced cardiotoxicity.