The contribution of ¹8F-FDG PET/CT in a patient with cutaneous metastases of squamous cell carcinoma of the penis.

A 61-year-old patient was diagnosed with squamous cell carcinoma of the penis (SCCP) and treated with partial penectomy (pT1,N0,M0,G2). Seven months later, a palpable adenopathy was found in the left inguinal region. An (18)F-FDG PET/CT exploration showed hypermetabolic lymphadenopathies in inguinal, pelvic, retroperitoneal regions, in both lung hila and in the left supraclavicular regions. At the end of the 4th cycle of chemotherapy (cisplatin+5FU) the patient developed numerous skin metastases at the root of the left thigh and a pleural effusion in the right lung. In a new exploration with (18)F-FDG PET/CT the number, size and metabolic activity of known lymphadenopathies decreased. Right pleural carcinomatosis and intense FDG uptake in cutaneous metastases were observed. Weeks later, the patient died. (18)F-FDG-PET/TC may be useful in patients with SCCP and metastatic inguinal lymphadenopathies, to assess the response to chemotherapy and to detect other unsuspected metastases in the rare cases of cutaneous metastases.

Radioguided surgery in Meckel's diverticulum.

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel's diverticulum, whose presence was confirmed by (99m)Tc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new (99m)Tc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel's diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel's diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure.

[18F-FDG PET/CT diagnosis of liver cyst infection in a patient with autosomal dominant polycystic kidney disease and fever of unknown origin]. / Diagnóstico mediante 18F-FDG PET-TAC de infección quística hepática en paciente con enfermedad poliquística renal autosómica dominante y fiebre de origen desconocido.

The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of (18)F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The (18)F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The (18)F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin.

[Papillary thyroid carcinoma synchronous with breast cancer: an incidental finding in an (18)F-FDG PET-CT study carried out in a search for occult breast cancer]. / Carcinoma papilar de tiroides sincrónico con cáncer de mama: hallazgo casual en una exploración (18)F-FDG PET-TAC por búsqueda de un cáncer oculto de mama.

The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of (18)F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in (18)F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy.

[Resistance to first line chemotherapy treatment in a patient diagnosed of nodular lymphocyte-predominant Hodgkin's lymphoma identified by 18F-FDG PET/CT: diagnostic and therapeutic implications]. / Resistencia al tratamiento de primera línea de quimioterapia en un paciente diagnosticado de linfoma de Hodgkin de predominio linfocítico nodular identificada mediante (18)F-FDG PET/TAC: implicaciones diagnósticas y terapéuticas.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by (18)F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the (18)F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen.

Identificación preoperatoria mediante SPECT/TAC de un ganglio centinela intramamario en una paciente con cáncer de mama. Significado y relevancia clínica / Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance

Presentamos el caso de una paciente con cáncer de mama a la que se le realizó biopsia selectiva de ganglio centinela. En la linfogammagrafía preoperatoria se identificó mediante SPECT/TAC un ganglio centinela intramamario. Describimos nuestro procedimiento diagnóstico-terapéutico en relación con este hallazgo y la revisión bibliográfica para evaluar el significado clínico de su identificación y de su afectación metastásica, sobre todo en cuanto al manejo axilar más apropiado. Son necesarios estudios más amplios y con mayor significación estadística para dilucidar la actitud más adecuada ante la detección linfogammagráfica de un ganglio centinela intramamario(AU)

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy(AU)

[Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance]. / Identificación preoperatoria mediante SPECT/TAC de un ganglio centinela intramamario en una paciente con cáncer de mama. Significado y relevancia clínica.

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy.