[The usefulness of 11C-Choline-positron emission tomography in the diagnosis of sclerosing hemangioma of the lung--a case report].

A 64-year-old woman was admitted to our hospital for further examination of an abnormal shadow in the left lung, that had grown slowly for 9 years. Bronchial brushing cytology was performed under bronchoscopy, but was negative for malignancy and for other significant findings. 11C-Choline-positron emission tomography (11C-Choline-PET) showed medium-level uptake in the mass lesion in the S 6 lobe of the left lung, but 18F-fluorodeoxyglucose-positron emission tomography (18FDG-PET) did not yield any such result. These findings suggested the presence of a slowly growing benign tumor, or a neoplastic disease, such as a potentially malignant tumor or a low-grade malignancy. To arrive at a diagnosis, a left partial lobectomy was performed on January 29, 2001. The microscopic findings of this mass lesion showed a solid, hemorrhagic pattern; papillary projections into spaces covered or lined by cuboidal cells, and sheets of round to polygonal cells. The histological diagnosis of this tumor was a sclerosing hemangioma. Recently, 18FDG-PET has been proven to be a clinically useful tool for the detection and staging of malignant tumors, and the follow-up of malignant diseases after treatment; while 11C-choline was recently reported to be a new PET tracer used to visualize various malignancies. The uptake of 11C-choline in tumors represents the rate of tumor cell duplication. It is suggested that 11C-choline-PET may be useful in the diagnosis of sclerosing hemangioma, as in this case.

[A case of multiple bone and joint tuberculosis which had been misdiagnosed as the rheumatoid arthritis and treated with prednisolone for eleven months].

A 34-year-old man had a multiple arthralgia for about eleven months. The swelling of his right wrist and foot had appeared in the dorsal side, and he had been misdiagnosed as the rheumatoid arthritis. He was treated with prednisolone in the dosages of 2.5 mg per day for one month, and 10 mg per day for ten months. When he admitted to our hospital, the bone X-ray examinations of the wrist and foot revealed the marked atrophy and destruction of the carpal and tarsal bones. The aspiration fluid from the swelling around his wrist and foot was positive for acid-fast bacilli on smear and Mycobacterium tuberculosis was found on culture. He was treated with isoniazid, rifampicin, ethambutol and pyrazinamide, however, these medication was not adequately effective to his complications of tuberculous arthritis. Curettage, irrigation and synovectomy of his right carpal and tarsal bone were performed in order to control his bone and joint infection. He recovered from his arthritis and tenosynovitis after these operations. The clinical practitioners should not omit tuberculosis from the differential diagnosis of persistent osteoarthralgia.