RESUMEN
â¢HaNDL syndrome may be a condition probably underdiagnosed in pediatric age.â¢A differential diagnosis with viral, vascular or autoimmune etiology is necessary.â¢Epileptiform alterations in EEG could be possible in this infrequent syndrome.â¢99mTc-HMPAO SPECT provides a potential role in the differential diagnostic and management.
RESUMEN
We present the case of a 69-year-old man with history of prostate carcinoma treated with prostatectomy and subsequently with external beam radiotherapy and hormone therapy because of biochemical recurrences. More than 10 years after the diagnosis, follow-up Tc-HDP bone scans and SPECT/CT images demonstrated an incidental diagnosis of osteoblastic pleural plaques that quickly evolve to mesothelioma. PET/CT achieved the definitive diagnosis by guiding the biopsy to the highest and most accessible focus of glucidic hypermetabolism. Our case report raises the association between prostate cancer patients treated with external beam radiotherapy and the development of pleural mesothelioma despite having no history of exposure to asbestos.
Asunto(s)
Neoplasias Pulmonares/diagnóstico por imagen , Mesotelioma/diagnóstico por imagen , Neoplasias Pleurales/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Próstata/complicaciones , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Anciano , Difosfonatos , Fluorodesoxiglucosa F18 , Humanos , Neoplasias Pulmonares/complicaciones , Masculino , Mesotelioma/complicaciones , Mesotelioma Maligno , Compuestos de Organotecnecio , Neoplasias Pleurales/complicaciones , Neoplasias de la Próstata/sangre , RadiofármacosRESUMEN
We present a 62-year-old woman who, after a catarrhal episode, underwent a chest xray and a chest CT, identifying a pleural-based mass in the left lower lobe. This lesion presented a mixed pattern with solid and peripheral ground-glass attenuation, and an air-bronchogram sign. Despite de suspicion of bronchopneumonia, a lung neoplasm like a predominantly lepidic adenocarcinoma could not be ruled. A 18 F-FDG PET/CT showed a focal radiotracer uptake with SUVmax of 5.34 in the pulmonary lesion, supporting the neoplastic etiology. Consequently, a lower lobectomy was performed and histological examination concluded that the final diagnosis was a B lymphoid hyperplasia-type Castleman disease. Castleman's disease is an uncommon disorder that can be easily misdiagnosed as lymphoma, neoplasm or infection. Unicentric Castleman's disease (UCD) usually presents a hyaline-vascular histological subtype and is usually asymptomatic. Extranodal involvement is very rare. Only a few cases of solid organ involvement such us spleen or parotid gland have been described. UCD originating in the lung is extremely rare and should be considered in the differential diagnosis of a primary pulmonary malignant tumor.
