18F-fluorodeoxyglucose positron emission tomography-computed tomography imaging of leiomyomatosis peritonealis disseminata.

Leiomyomatosis peritonealis disseminata (LPD) is a rare benign condition characterized by multiple smooth muscle implants in the peritoneal cavity. The clinical presentation is usually nonspecific abdominal discomfort and nontender abdominal mass. Preoperative imaging usually points to suggests malignancy due to its unusual location, but the diagnosis can only be confirmed by histopathological examination. We share 18F-Fluorodeoxyglucose positron emission tomography-computed tomography images of a 43-year-old woman diagnosed with LPD and briefly discuss the clinical aspects of this disease.

The findings of 18F-fluorodeoxyglucose positron emission tomography-computed tomography scan in patients with hidradenitis suppurativa in Malaysia: A multicenter study.

Hidradenitis suppurativa (HS) is known to have association with systemic diseases with chronic inflammation such as psoriasis. We aim to describe the concomitant systemic inflammation in patients with HS using 18F-fluorodeoxyglucose positron emission tomography-computed tomography (18F-FDG PET/CT) scan. This was a case-control study conducted in three tertiary hospitals in Northern Malaysia from January to December 2017, involving HS patients aged 18 years and above. Thirty-two HS patients with age- and sex-matched controls were recruited with a mean age of 31.4 years (range: 18-56). Numerous cutaneous inflammatory foci were detected on FDG-PET/CT scan in clinically unapparent sites (27/32, 84.4%). Approximately 90.6%, 93.8%, and 50.0% of the patients had significantly higher cutaneous uptake over nasal, mandibular, and scalp regions, respectively (P < 0.0001). PET/CT scan did not detect any systemic inflammation unlike those found in psoriasis. Three (9.4%) patients had thyroid nodules with high uptake (maximum standard uptake values ranging from 2.9 to 11.3). Two of them were confirmed to have papillary thyroid carcinoma, while the third patient has inconclusive finding. 18F-FDG PET/CT scan may be useful to map disease burden of HS. Nonlesional inflammatory foci on the skin of the nose, mandibular, and scalp are probably significant. The association of thyroid carcinoma in HS warrants further evaluation.

Unexpected rare metastases of renal cell carcinoma.

Renal cell carcinomas (RCCs) commonly metastasize to the lungs and bones and rarely to the parathyroid, maxillary sinus, and adrenals. It is indeed very rare to have these all these metastases occurring simultaneously in an individual. We share a case of 67-year-old woman provisionally treated for parathyroid carcinoma but subsequently found to actually have metastatic RCC to the left maxillary sinus, parathyroid, lungs, and adrenals on 18F-fluorodeoxyglucose positron emission tomography-computed tomography.

Renal Pelvis Urothelial Carcinoma With Bowel Metastases.

Urothelial carcinoma is the fourth most common genitourinary tumor with the majority of the tumor involving the urinary bladder. Only 5% involves the renal pelvis and ureter. Metastatic urothelial carcinoma of the renal pelvis frequently involves the lymph nodes, lung, liver, bone, and peritoneum. We share rare interesting F-FDG PET/CT images of a 60-year-old man with metastatic urothelial carcinoma of the renal pelvis to the bowel.

A rare case of minimally invasive follicular thyroid cancer with intraluminal superior vena cava and right atrium metastases.

Follicular thyroid cancers are known to spread hematogenously to the bones and lungs and rarely presenting with massive angioinvasion. We report a case of a middle-aged female who had undergone total thyroidectomy for minimally invasive follicular thyroid cancer with angioinvasion in 2014. She was noted to have a large tumor thrombus extending from the superior vena cava to the right atrium on whole body scan post-Iodine-131 (131I) remnant ablation therapy. We discuss the various imaging modalities, treatment options, and difficulties in managing such massive angioinvasion in patients with well-differentiated thyroid cancers.

18F-FDG PET/CT in Metastatic Extramammary Paget's Disease.

Extramammary Paget's disease (EMPD) is a rare disease with an estimated prevalence of 0.1 to 2.4 per 1,000,000 person-years. Metastatic EMPD has a poor prognosis with a 5-year survival of approximately 7%. Local therapy is the only curative option with surgery being recommended for resectable disease. It is therefore crucial to be able to stage such patients appropriately. The utility of F-FDG PET/CT for this disease is not well established. We share a case on how F-FDG PET/CT was used to stage metastatic EMPD.

Correction to: Bone Scintigraphy and Tenofovir-Induced Osteomalacia in Chronic Hepatitis B.

[This corrects the article DOI: 10.1007/s13139-016-0395-z.].

A Review of TENIS Syndrome in Hospital Pulau Pinang.

INTRODUCTION: The treatment for differentiated thyroid cancers (DTCs) has always been radioactive iodine 131I therapy after definitive surgical management. Clinicians are faced with therapeutic challenges when dealing with patients having thyroglobulin-elevated negative iodine scintigraphy (TENIS) syndrome (elevated serum thyroglobulin [Tg] levels but negative whole-body scans [WBSs]). OBJECTIVE: The aim of the study was to determine the prevalence of TENIS syndrome in our local setting and to evaluate the use of 18-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in the management. METHODOLOGY: The data from DTC patients treated in the Department of Nuclear Medicine, Hospital Pulau Pinang from December 1, 2010, to November 30, 2016, with negative WBS and elevated Tg were reviewed. These patients should have undergone 18F-FDG PET-CT to be included in the study. RESULTS: Only forty (10.4%) out of a total of 386 patients treated in Hospital Pulau Pinang during the study fulfilled the inclusion criteria. There were 28 women (70%) with median age of 59 years old. Thirty-four patients (85%) had papillary thyroid cancer (PTC) and six patients had follicular thyroid cancer. The use of 18F-FDG PET-CT revealed 23 patients (57.5%) with 18F-FDG avid metastases suggesting dedifferentiation of thyroid cancers. Based on this study, the probability of detecting FDG-avid disease is higher (P = 0.03) if 18F-FDG PET-CT was performed when Tg ≥15 ng/mL. CONCLUSION: TENIS syndrome constitutes a significant number of cases in our setting. Our data suggest a cutoff Tg ≥15 ng/mL for performing 18F-FDG PET-CT for these patients would be more beneficial than the currently American Thyroid Association recommended cutoff of 10 ng/mL.

Incidental Finding of Lipomatous Hypertrophy of the Interatrial Septum during 18F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography for Cervical Cancer.

Lipomatous hypertrophy of the interatrial septum is a benign but less recognized pathology of the heart caused by benign fatty infiltration of the interatrial septum which most often spares the fossa ovalis. We share images of the incidentally detected fluorodeoxyglucose (FDG) uptake in the interatrial septum during the restaging of 18F-FDG positron emission tomography/computed tomography scan of cervical cancer.

Posterior Layering of Fluorine-18 Fluorodeoxyglucose in the Urinary Bladder.

An 89-year-old man undergoing fluorine-18 fluorodeoxyglucose positron emission tomography/ computed tomography (18F-FDG PET/CT) study posttherapy for hepatocellular carcinoma was noted to have 18F-FDG posterior layering of the urinary bladder. This phenomenon of posterior layering of 18F-FDG in the urinary bladder during PET/CT studies is physiological, and it is important to recognize to avoid misinterpretation and unnecessary investigations. The hypotheses for the cause of this phenomenon are highlighted in these interesting images including the reversed phenomenon where there is anterior layering of 18F-FDG.

Bone Scintigraphy and Tenofovir-Induced Osteomalacia in Chronic Hepatitis B.

Tenofovir, used in the treatment of chronic hepatitis B and HIV, is known for its side effects on the kidneys and bones. We share interesting images of a patient with tenofovir-induced osteomalacia on Technetium-99 m hydroxymethyelene (Tc-99 m HDP) bone scintigraphy. Pattern recognition of this bone scintigraphy and correlation with the clinical history is essential to avoid misdiagnosis.

Recurrent Endometrioid Adenocarcinoma of Endometrium With Bone Metastases.

Endometrial cancer, a common cancer affecting women, has the tendency to metastasize to the lung and liver. Bone metastases in endometrial cancers are rare and accounts for less than 1% of the overall incidence of metastases. We report a case of a 30-year-old single nulliparous woman with metastatic recurrence of endometrioid adenocarcinoma of the endometrium involving the pelvic bone, and the role of bone scintigraphy in detection and staging of the disease.

Incidental Sclerosing Pneumocytoma Detected on Bone Scintigraphy.

Nonosseous uptake in Tc-hydroxymethylene bone scintigraphy should always be evaluated for any possibility of pathological changes. We share interesting images of a 60-year-old woman initially investigated for suspected osteomyelitis of the left femur but found to have an extraosseous uptake in the right hemithorax on bone scintigraphy. Plain chest radiograph followed by contrast-enhanced CT of the thorax revealed the presence of a lung mass in the right lower lobe with no lymphadenopathy. CT-guided biopsy yielded fibrocollagenous tissue, partly lined by benign pneumocytes. The F-FDG-avid lung mass was confirmed to be sclerosing pneumocytoma postlobectomy.