Asunto(s)
Manejo de la Enfermedad , Neoplasias/mortalidad , Neoplasias/enfermería , Cuidados Paliativos/normas , Pediatría/normas , Calidad de la Atención de Salud/normas , Cuidado Terminal/normas , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Predicción , Humanos , Lactante , Recién Nacido , Masculino , Cuidados Paliativos/tendencias , Pediatría/tendencias , Calidad de la Atención de Salud/tendencias , Cuidado Terminal/tendenciasRESUMEN
The classification of thyroid nodules in children is often difficult, especially in pretreated patients with metastatic disease. In osteosarcoma patients, Tc-MDP SPECT/CT is used for primary and follow-up staging. Bone and soft tissue metastases can be revealed because of Tc-MDP imaging of osteoid-producing metastases. We present Tc-MDP SPECT-CT, CT, and ultrasound images of a highly suspicious calcified thyroid lesion in a 17-year-old boy with osteosarcoma. High uptake in Tc-MDP SPECT-CT provides diagnosis of thyroid metastasis of osteosarcoma, which was proven by histopathology.
Asunto(s)
Neoplasias Óseas/patología , Osteosarcoma/patología , Tomografía Computarizada por Tomografía Computarizada de Emisión de Fotón Único , Medronato de Tecnecio Tc 99m , Neoplasias de la Tiroides/diagnóstico por imagen , Neoplasias de la Tiroides/secundario , Adolescente , Humanos , Masculino , Estadificación de Neoplasias , Neoplasias de la Tiroides/patología , UltrasonografíaRESUMEN
UNLABELLED: Following diagnosis of acute lymphoblastic leukaemia (ALL) in a 10-year-old girl, routine coagulation screening including von Willebrand factor antigen (VWF:Ag), ristocetin cofactor activity (VWF:RCo) and factor VIIIC (FVIII:C) detected no pathological findings. After the first HR2' element of the high-risk group of the ALL-BFM 2000 protocol, the patient demonstrated extensive bleeding symptoms and acquired von Willebrand syndrome was diagnosed. VWF:Ag (13%), VWF:RCo (13%) and FVIII:C (27%) were decreased. Multimer analysis showed a loss of large multimers and a loss in triplet structures. The observed pattern was thought to be typical for monoclonal IgG gammopathy; however, in this case, unexpectedly, biclonal IgM gammopathy (κ and λ) was detected. After treatment with intravenous immunoglobulin over 5 days, coagulation factors increased to normal levels. Although this effect was assumed to be at best only temporary, especially in a case of IgM gammopathy, no further bleeding symptoms have been observed. TRIAL REGISTRATION NUMBER: M208.
