A case of classical carcinoid tumor of the gallbladder: review of the Japanese published works.

A 58 year-old man was admitted to Kimitsu Chuo Hospital complaining of epigastralgia. Abdominal ultrasound and computed tomography revealed a polypoid lesion at the neck of the gallbladder. Given the pre-operative diagnosis of gallbladder carcinoma, we resected the gallbladder along with the extrahepatic bile duct. There was a papillary tumor (25 x 16 mm) at the neck of the gallbladder. Histopathological examinations showed a subserosal nodular proliferation of uniform small tumor cells. Grimelius staining was slightly positive and Fontana-Masson staining was negative. Most of the tumor cells stained positively for chromogranin A and neuron-specific enolase (NSE), and some of the tumor cells were positive for pancreatic polypeptide. The presence of neurosecretory intracytoplasmic granules was proven ultrastructurally. It was diagnosed as a classical carcinoid tumor of the gallbladder. We reviewed the Japanese reported cases and discussed the difference in clinicopathological findings between classical and atypical carcinoid tumors of the gallbladder. Classical carcinoids of the gallbladder have neither a metastatic nor invasive character, and an extremely favorable prognosis compared with atypical carcinoids. The difference in character between classical and atypical carcinoids of the gallbladder is thought to be derived from their histogenetic origin.

[Tumor imaging in nuclear medicine].

Tumor imaging in nuclear medicine has been improved by imaging instruments and newly developed radiopharmaceuticals. One of the imaging developments is a SPECT system using three-detector system. Its each detector rotates 120 degrees when SPECT projection data are acquired and we can save the scanning time and get a high resolution image which is less than 10 mm FWHM. About radiopharmaceuticals 99mTc MDP and 57Ga-citrate are used most commonly for detecting early metastatic lesions in the body. 201Tl chloride and 99mTc MIBI as used for cardiac imaging are also used for tumor detection. 111In-DTPA-D-Phe-octreotide are developed for detection of somatostatin receptor and will be used for many kinds of tumor such as small cell lung cancer, meningioma, malignant lymphoma and gastrointestinal hormone producing tumor.

[111In-labeled leukocyte scintigraphy in patients with inflammation of unknown focus].

This study evaluates the usefulness of 111In-labeled leukocyte scintigraphy to localize inflammatory foci that cannot be determined by clinical symptoms and other imaging studies. Patients with persistent fever following abdominal surgery (n = 20), suspected post-traumatic osteomyelitis associated with multiple fractures (n = 5), and fever of unknown origin (n = 22) were recruited. In all patients, the exact location of inflammatory foci could not be determined by clinical symptoms and conventional imaging studies. In patients with post-surgical fever, leukocyte scintigraphy localized responsible foci in 65% of patients and provided clinically useful information for the treatment. In patients with multiple fractures, the location of osteomyelitis was diagnosed confidently in only one case (20%). In patients with fever of unknown origin, responsible foci were detected in 18% of patients. Although in those patients positive leukocyte studies provided clinically useful information, overall usefulness seemed to be limited. Leukocyte scintigraphy is able to detect inflammatory foci in patients with post-surgical fever, but less likely to localize responsible foci for post-traumatic osteomyelitis or fever of unknown origin when patients have been examined carefully by clinical symptoms and conventional imaging studies.

[Correlation 111In-labeled leukocyte scintigraphy with clinical and laboratory findings].

This study was evaluated relationship 111In-labeled leukocyte scintigraphy and clinical information and laboratory findings in twenty-four patients with bone infection and thirty-five patients with abdominal infection. Fifty-nine scintigrams were retrospectively reviewed and classified into positive or negative results. As the laboratory findings, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR) at sixty minutes, and peripheral blood leukocyte counts (WBCC) were evaluated. Clinical information such as presence of fever and administration of antibiotics was also compared. No significant relationship between the scintigraphic results and clinical as well as laboratory findings was observed in bone infection patients. CRP levels in positive scintigraphic patients were significantly higher than those in negative scintigraphic patients in the abdominal infection group, otherwise the other indices were not correlated with the scintigraphic results. A few patients with slightly increased CRP (mostly chronic cases) did not show positive scintigrams, suggesting an increased false negative rate of leukocyte scintigraphy in such circumstances. These results suggest that it is inappropriate to determine the application of leukocyte scintigraphy depending on clinical as well as laboratory findings, and leukocyte scintigraphy would yield additional information different from other indices when evaluating inflammatory foci.

[A case of frontal lobe syndrome followed by serial 123I-IMP SPECT].

Single photon emission computed tomography (SPECT) studies with N-isopropyl-p-[123I]iodoamphetamine (IMP) were performed in a 58-year-old man with frontal lobe syndrome. He had abulia and personality changes suggesting frontal lobe impairment. Six follow-up SPECT studies were conducted during 18 months from the onset. On the first scan, no abnormal pattern of regional cerebral blood flow (rCBF) was found. On the second scan, a mild reduction of rCBF was observed in bilateral frontal lobes. Through the third to sixth scans, a progressed reduction of rCBF in bilateral frontal lobes was confirmed by a semi-quantitative regions-of-interest analysis. Contrarily, abulia was improved, and personality change was not progressed during that period. Magnetic resonance imaging on admission revealed only a small subdural hematoma and high intensity areas in the right frontal lobe, which were resolved at the time of the sixth SPECT scan. It is suggested that rCBF studies by SPECT is not necessary concordant with psychiatric symptoms, and has possible limitations in pathophysiological evaluation for psychiatric disorders.

[Visualization of the female breast in bone scintigraphy].

Breast cancer incidence rates in Japan have more than doubled in the decade between 1975 and 1985 due to a well-established and affluent Western life-style. One hundred patients having breast cancer, 107 patients having mastectomies, and 243 patients having no breast cancer were reviewed for whole body and spot views of bone scintigraphy with 99mTc-MDP. The frequency of positive breast uptake in patients with no breast cancer showed a maximum in those patients between the ages of 30 and 40, with a progressive rise and fall before and after the peak, respectively. Patients between the ages of 50 and 60 with breast cancer showed a maximum uptake of 83%, while those patients between the ages of 70 and 80 with breast cancer showed an uptake higher than 50%. There was a markedly higher breast uptake ratio in the breast cancer group compared to the breast cancer free group. Although this scanning agent was of no value in recognition of tumor localization from breast uptake, we have to suspect a high incidence of cancer existence whenever there was unilateral increased breast activity. Even though the mechanism of 99mTc-MDP uptake by breast tissue is unknown, breast concentration of 99mTc-MDP appears to be influenced by hormones, especially estrogen.

[A case of subacute cerebral infarction demonstrating hyperemia and crossed cerebellar diaschisis in I-123 IMP SPECT].

SPECT with N-isopropyl-p-[I-123]iodoamphetamine were performed in a 81-year-old man with cerebral infarction. In the subacute phase, the radioactivity was increased in the infarct area where fogging effect and remarkable contrast enhancement was demonstrated in X-ray CT. The contralateral cerebellar hemisphere showed reduced activity due to crossed cerebellar diaschisis (CCD). In the chronic phase, the decrement of the activity in the infarct was observed. Increased activity in the subacute phase was thought to reflect the hyperemia in the infarct, while CCD suggested the decreased metabolic activity in the lesion. The coexistence of the hyperemia and the CCD indicates flow and metabolic uncoupling, which means "luxury perfusion". This case was also thought to demonstrate atypical findings of CCD in SPECT imaging.

The complementary role of indium-111 labeled leukocyte imaging, ultrasonography and computed tomography in the evaluation of postoperative infection or abscess.

We report our experiences with the combined use of indium-111 labeled leukocyte imaging (In-III WBC scan.), computed tomography (CT) and ultrasonography (US) for evaluation of suspected postoperative infection or abscess, and discuss the complementary roles of these modalities. Postoperative abscesses or infections were diagnosed in 9 of 20 patients. All patients were correctly diagnosed by In-111 WBC imaging and 4 patients could not be diagnosed by US because of bowel gas. One false-positive CT examination and another artifact on CT images due to respiratory movements were obtained. The three modalities were found to be complementary: CT and US were efficient imaging methods for diagnosis and treatment of abscess. In-111 WBC imaging could estimate the activity of inflammation.

[Transarterial embolization in metastatic retroperitoneal tumor].

A case of retroperitoneal metastasis of a malignant testicular tumor treated by transarterial embolization (TAE) is reported. The tumor feeders were the intercostal and lumbar arteries. Improvement of the patient's condition could be obtained by TAE. It is suggested that TAE has some effectiveness for chemoresistant, radio-resistant or inoperable cases of metastatic retroperitoneal tumors.

Indium-111 leukocyte imaging in patients with rheumatoid arthritis.

This study evaluates the usefulness of labeled leukocyte imaging in patients with rheumatoid arthritis. In 33 patients, the incidence of pain and swelling in 66 wrist joints and 66 knee joints was compared with the accumulation of [111In]leukocytes. No accumulation of [111In]leukocytes was seen in any of the patients' wrists (0/12) or knee joints (0/14) when both pain and swelling were absent. In contrast, 93% (25/27) of wrist joints and 80% (24/30) of knee joints with both pain and swelling were positive by [111In]leukocyte scintigraphy. There was little correlation between the stage of the disease, as determined by radiography, and [111In]leukocyte accumulation. This study suggests that [111In]leukocyte imaging may be a reliable procedure for monitoring the activity of rheumatoid arthritis, especially for confirming the lack of an ongoing inflammatory response.