[In-transit sentinel lymph nodes in malignant melanoma. What is their importance?]. / Ganglios centinela ''en tránsito'' en el melanoma maligno. Cuál es su importancia?

UNLABELLED: The sentinel lymph node (SLN) is the first node in a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. AIM: It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. METHOD. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of 99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. RESULTS: The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell deposits were identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. CONCLUSIONS: Lymphoscintigraphy is mandatory in the location of in-transit SLNs. Moreover, although the incidence of these nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases.

Ganglios centinela “en tránsito” en el melanoma maligno. ¿Cuál es su importancia? / In-transit sentinel lymph nodes in malignant melanoma. What is their importance?

El ganglio centinela (GC) es el primer ganglio linfático de un determinado lecho ganglionar que recibe directamente drenaje linfático del tumor primario. Sin embargo, en algunos pacientes existen nódulos linfáticos que se sitúan entre el tumor primario y la primera estación ganglionar regional. Se trata de "ganglios en tránsito" y deben ser considerados GC. Objetivo. Fue determinar el porcentaje y la localización de los GC en tránsito obtenidos de una muestra de pacientes con melanoma maligno y valorar la necesidad de resecar este tipo de ganglios. Método. Se incluyeron en el estudio un total de 900 pacientes con melanoma maligno. El día previo a la cirugía se realizó la linfogammagrafía mediante la administración de 4 inyecciones intradérmicas de 74-111 MBq de 99mTc-Nanocoloide alrededor de la lesión primaria o en la zona de la biopsia escisional. Resultados. Las imágenes revelaron la presencia de GC en tránsito en 80 pacientes (8,9 %). Durante el acto quirúrgico se consiguieron extirpar los GC en tránsito en 77 de los 80 pacientes (96,2 %). En el análisis histológico se hallaron metástasis en 15 pacientes (19,5 %) y, de éstos, 4 no presentaron afectación tumoral del lecho linfático regional. Conclusiones. La linfogammagrafía es imprescindible en la localización de los GC en tránsito. Asimismo, aunque el porcentaje de GC en tránsito en pacientes afectos de melanoma maligno es relativamente bajo, la afectación tumoral de los mismos alcanza un porcentaje significativo. Por ello, creemos que la resección de los GC en tránsito es necesaria en todos los casos

The sentinel lymph node (SLN) is the first nodein a lymph node basin to receive direct drainage from the primary tumour. However, in some cases, lymphoscintigraphy images demonstrate the presence of lymph nodes located in the area between the primary tumour and the first regional lymph node basin. These nodes are called in-transit nodes and have to be considered SLNs as well. Aim. It was to determine the incidence and location of in-transit SLNs in patients with malignant melanoma and to evaluate whether it is necessary to harvest them. Method. Nine hundred patients with malignant melanoma were included. Lymphoscintigraphy was performed on the day before surgery following intradermal injection of 74-111 MBq of99mTc-Nanocolloid in four doses around the primary lesion or the biopsy scar. Results. The presence of in-transit SLNs was revealed in 80 patients. During surgery, in-transit SLNs were identified and excised in all but 3 patients (96.2 %). Metastatic cell depositswere identified in these in-transit SLNs in 15 patients (19.4 %), with 4 patients with no tumour involvement of the regional lymph node basin. Conclusions. Lymphoscintigraphy is mandatory in the locationof in-transit SLNs. Moreover, although the incidence ofthese nodes is relatively low in malignant melanoma, the presence of metastatic cells in these in-transit SLNs reaches a significant percentage. Therefore, excision of in-transit SLNs is necessary in all cases (AU)

Lymphatic mapping and sentinel node biopsy in Merkel's cell carcinoma.

AIM: The purpose of this study was to determine the predictive value of lymphatic mapping with selective lymphadenectomy in patients with Merkel's cell carcinoma. METHODS: Eight patients with biopsy proven Merkel's cell carcinoma underwent sentinel node biopsy. Lymphoscintigraphy was performed the day before surgery following intradermal injection of 74-111MBq of 99mTc-nanocolloid divided into four doses around the biopsy scar. Dynamic and static images were obtained. RESULTS: At least one sentinel node was visualized in all patients. The sentinel node was intra-operatively identified with the aid of a hand-held gamma probe in all cases and patent blue dye in six out of eight cases. During surgery, all sentinel nodes were successfully harvested. Metastatic cell deposits were subsequently identified in three patients (37.5%) and they underwent regional lymphadenectomy. No additional involved lymph nodes were identified. No recurrence has been reported in a median follow-up of 4.6 years (range: 8 months-10 years). CONCLUSIONS: In conclusion, sentinel node biopsy in patients with Merkel's cell carcinoma appears to be a reliable staging technique.

[Usefulness of 111In-oxine labelled platelets in the management of febrile syndrome in dialysis patients with non-functional renal allografts]. / Utilidad de la gammagrafía con plaquetas marcadas con 111In-oxina en el manejo del síndrome febril en pacientes en diálisis portadores de injerto renal no funcionante.

AIM: To evaluate the usefulness of 111In-oxine-labelled platelet scan in the therapeutic management of prolonged febrile syndrome in dialysis patients with a non-functional renal allograft. MATERIAL AND METHODS: One hundred and fifty-eight patients (94 men, 64 women; mean age 44 +/- 9 years) were studied. Duration of fever was 42 days (range 7-112). A total of 68 % of the patients (107/158) were on low doses of corticosteroids (<10 mg/day). Platelet scans were performed 48 hours after reinjection of 111In-ixone-labelled platelets. A platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft by the cpm/pixel in a mirror background. A PUI > or = 1.5 was considered as threshold for immunological fever. The final diagnosis of immunological fever was established when it disappeared after transplantectomy, embolization or high doses of corticosteroid therapy. Fever of non-immunological origin was established when it disappeared after antibiotic therapy. RESULTS: In 102/158 patients the fever was considered of immunological origin. In 56/158 patients the fever was considered of non immunological origin. Sensitivity and the specificity of the platelet scan was 80 % and 100 %, respectively. All those patients considered as having fever of immunological origin who had PUI <1.5 had been using corticosteroids during platelet scan. CONCLUSION: 111In-labelled platelet scintigraphy is a useful technique in the therapeutic management of prolonged febrile syndrome in dialysis patients with non-functional renal allograft. The use of corticosteroids can reduce the sensitivity of 111In- labelled platelet scan.

Utilidad de la gammagrafía con plaquetas marcadas con 111In-oxina en el manejo del síndrome febril en pacientes en diálisis portadores de injerto renal no funcionante / Usefulness of 111In-oxine labelled platelets in the management of febril syndrome in dialysis patients with non functional renal allograft

Objetivo. Determinar si la gammagrafía con plaquetas marcadas con oxina- 111In (GP- 111In) puede tener un impacto en la decisión terapéutica en pacientes con síndrome febril portadores de trasplante renal no funcionante. Material y métodos. Se estudiaron 158 pacientes (94 hombres y 64 mujeres) con una edad de 44 ± 9 años. La duración de la fiebre fue de 42 días (rango 7-112). Un 68 % de los pacientes (107/158) estaba tomando dosis bajas de corticoides (< 10 mg/día). Se obtuvieron imágenes 48 horas tras la reinyección de las plaquetas marcadas con GP- 111In. Se calculó el índice de captación plaquetaria (ICP) dividiendo las cpm/píxel alrededor del injerto por las cpm/píxel en un área de fondo especular. Se consideró fiebre de origen inmunológico cuando el ICP fue ≥ 1,5 y de otra causa con un ICP < 1,5. El diagnóstico de fiebre inmunológica se estableció tras la curación con trasplantectomía, embolización o bolus con dosis altas de corticoides y no inmunológica al desaparecer tras antibioticoterapia. Resultados. La fiebre fue de origen inmunológico en 102/ 158 pacientes y no inmunológica en 56/158 pacientes. La sensibilidad y especificidad de la GP- 111In fue del 80 % y del 100 % respectivamente. Todos los pacientes con ICP < 1,5 y fiebre inmunológica recibían dosis de mantenimiento de corticoides durante la realización de la GP- 111In. Conclusiones. La GP- 111In es útil en el manejo terapéutico del síndrome febril en pacientes en hemodiálisis portadores de un injerto renal no funcionante. El uso de corticoides durante la realización de la GP- 111In puede reducir significativamente la sensibilidad de esta técnica

Aim. To evaluate the usefulness of 111In-oxine-labelled platelet scan in the therapeutic management of prolonged febrile syndrome in dialysis patients with a non-functional renal allograft. Material and methods. One hundred and fifty-eight patients (94 men, 64 women; mean age 44 ± 9 years) were studied. Duration of fever was 42 days (range 7-112). A total of 68 % of the patients (107/158) were on low doses of corticosteroids (< 10 mg/day). Platelet scans were performed 48 hours after reinjection of 111In-ixone-labelled platelets. A platelet uptake index (PUI) was calculated by dividing the cpm/pixel in the allograft by the cpm/pixel in a mirror background. A PUI ≥ 1.5 was considered as threshold for immunological fever. The final diagnosis of immunological fever was established when it disappeared after transplantectomy, embolization or high doses of corticosteroid therapy. Fever of non-immunological origin was established when it disappeared after antibiotic therapy. Results. In 102/158 patients the fever was considered of immunological origin. In 56/158 patients the fever was considered of non immunological origin. Sensitivity and the specificity of the platelet scan was 80 % and 100 %, respectively. All those patients considered as having fever of immunological origin who had PUI < 1.5 had been using corticosteroids during platelet scan. Conclusion. 111In-labelled platelet scintigraphy is a useful technique in the therapeutic management of prolonged febrile syndrome in dialysis patients with non-functional renal allograft. The use of corticosteroids can reduce the sensitivity of 111In- labelled platelet scan

[Usefulness of bone scintigraphy for staging in a case of histiocytosis of the temporal bone]. / La gammagrafía ósea demuestra ser útil para el diagnóstico de extensión en un caso de histiocitosis X del hueso temporal.

We present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRI.

La gammagrafía ósea demuestra ser útil para el diagnóstico de extensión en un caso de histiocitosis X del hueso temporal / Usefulness of bone scintigraphy for staging in a case of histiocytosis od the temporal bone

Exponemos el caso de un varón de 43 años diagnosticado de diabetes insípida e hipogonadismo hipogonadotropo, que en la RM craneal de control se objetivó una lesión extraaxial temporal derecha, motivo por el que fue ingresado. Se realizó una gammagrafía ósea que describió un aumento de captación de Tc99m-HMDP en región temporal derecha con extensión esfenoidal, coincidente con la RM. Además, en región temporal izquierda se observó una hipercaptación de menor intensidad y tamaño. Se realizó biopsia sobre úlceras bucales de nueva aparición en mucosa yugal que mostró células de Langerhans, estableciéndose el diagnóstico de histiocitosis X. Al cabo de 6 meses se realizó una nueva RM que demostró progresión de la enfermedad, con afectación temporal bilateral. Los hallazgos de la gammagrafía ósea, dieron lugar en este caso a un diagnóstico de extensión de la enfermedad más preciso que la RM

We present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of Histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRIWe present the case of a 43-year-old man diagnosed of insipid diabetes and hypogonadotropic hypogonadism in whom a right temporal bone lesion was observed in the control MRI, thus leading to his admission. A bone scintigraphy with 99mTc-HMDP showed increased uptake in the right temporal region with sphenoidal extension, coinciding with the MRI. In addition, increased uptake having less intensity and size was observed in the left temporal region. A biopsy on the newly appearing mouth ulcers in the jugal mucous was performed and showed Langerhan's cells, the diagnosis of Histiocytosis X being confirmed. Six months later a new MRI indicated disease progression with bilateral temporal involvement. The bone scan findings in this case provided a more exact extension diagnosis of the disease than the MRI

[Usefulness of pilocarpine in the prevention of xerostomia in patients with head and neck cancer treated with radiotherapy. Assessment with gammagraphy and salivary flow]. / Utilidad de la pilocarpina como profiláctico de xerostomía en pacientes con cáncer de cabeza y cuello tratados con radioterapia. Valoración mediante gammagrafía y flujo salivar.

AIM: To assess the utility of salivary gland scintigraphy and salivary flow to quantify salivary function and to evaluate the usefulness of pilocarpine in the treatment of radiation-induced xerestomia in head and neck cancer patients. METHOD: Thirty two patients with head and neck tumor treated with radiotherapy (RDT) were studied. Patients were classified into two groups: pilocarpine group (P), that received prophylactic pilocarpine before RDT and during the first year after treatment. No pilocarpine group (NP) that received RDT without pilocarpine. Salivary gland scintigraphy and salivary flow were performed before RDT and during one year after treatment. Parotid and submaxillary uptake and excretion were calculated. Salivary flow after stimulation during five minutes was also obtained. RESULTS: Uptake and excretion in both salivary glands decreased after RDT. There were no statistical differences comparing P and NP groups (p < 0.001). However, in group P a trend to recovery was observed in parotid uptake values at 12 months after treatment, but it was not statistically significant. In both groups the salivary flow decreased after RDT and a good correlation (r = 0.8) between salivary flow and submaxillary excretion and parotid excretion was found. CONCLUSIONS: Salivary gland scintigraphy and salivary flow could be useful to evaluate salivary gland function in patients with head and neck irradiated tumors. Although better results on the salivary uptake at 12 months were noted, pilocarpine did not significantly improve salivary gland function.