Mycobacterial Lymphadenitis in a Human Immunodeficiency Virus-Infected Patient: Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography for Diagnosis and Monitoring the Response to Treatment.

Lymphadenitis, due to typical or atypical Mycobacterium, is a clinical condition frequently associated with human immunodeficiency virus (HIV) infection. Differential diagnosis between benign and malignant causes may be a challenge for clinicians. In this regard, the role of positron emission tomography (PET) with 18F-fluorodeoxyglucose (18F-FDG) has still not been fully explored. We describe a case of 30-year-old male, infected by HIV, with mycobacterial lymphadenitis, in which 18FDG-PET and PET-derived parameters resulted useful for guiding diagnosis and monitoring the response to treatment.

Tumor thrombus in the renal vein from an adrenal metastasis of lung cancer: 18FDG PET/CT findings.

Tumor thrombus is a rare complication of solid cancer. The authors report a case of a 76-year-old woman presenting a thick walled cystic mass in the lower lobe of the left lung. 18FDG positron emission tomography (PET)/computed tomography (CT) was performed, showing tracer accumulation in the wall of the pulmonary lesion and in the mediastinal and hilar lymph nodes. Moreover, PET/CT depicted a gross mass in the left adrenal gland and a hypermetabolic focus corresponding to the anatomic location of the left renal vein. Contrast-enhanced CT, subsequently performed, confirmed PET findings in the lung, lymph nodes, and adrenal glands, also demonstrating marginal enhancement and intraluminal filling defect in the left renal vein, which was interpreted as tumor thrombus due to the 18FDG uptake at PET scan. CT-guided biopsy of the mass was positive for poorly differentiated carcinoma. 18FDG PET can be useful to diagnose tumor thrombus in oncological patients.

Correlation between semiquantitative sonoelastography and immunohistochemistry in the evaluation of testicular focal lesions.

BACKGROUND: Sonoelastography is a novel and promising imaging tool, which has been applied to breast, thyroid, and prostate tissues. The aim of this study was to evaluate focal lesions of the testes with diameters of <10 mm using sonoelastography, B-mode sonography (US), and colour Doppler ultrasonography (CDU). METHODS: Thirty patients who were referred to our outpatient clinics for varicocoeles, scrotal pain, scrotal enlargements, epididymitis, palpable testicular nodules, or infertility, were prospectively enrolled into this study. Ultrasound evaluations had revealed that 27 subjects had focal testicular lesions with diameters of <10 mm and 3 subjects had 10-mm spherical non-homogeneous testicular nodules. All lesions were evaluated using semiquantitative sonoelastography, and the patients underwent orchifunicolectomies. The testicular lesions were examined histopathologically. The vascularization of the lesions and the surrounding testicular parenchyma was evaluated by analysing the immunohistochemical distribution of the cluster of differentiation 31 and by calculating the vascular indices (VI). Potential associations between the strain ratios (stiffness of the lesions) and the VI were tested. RESULTS: Analyses of the strain fields obtained using semiquantitative sonoelastography yielded different values for the masses and the surrounding tissues, which led to significant increases in the strain ratios. Sonoelastography upheld all of the diagnoses that were suspected when the patients were physically examined, when the serum markers were analysed, and after the patients had undergone US and CDU. Histopathological examinations confirmed the neoplastic characteristics of these masses. A significant inverse correlation was determined between the sonoelastographic strain ratio and the VI (Pearson correlation coefficient, r, = - 0.93; P < 0.001). CONCLUSION: Our investigation shows that semiquantitative sonoelastography may provide additional objective information to support the algorithm used to diagnose testicular lesions. This might be of crucial diagnostic importance for lesions with diameters of <10 mm, particularly if they are not palpable, are negative for serum tumour markers, and if the findings from ultrasonography and CDU are equivocal. The findings from semiquantitative sonoelastography might indicate the need for surgical exploration. Further investigations with larger numbers of patients are required to corroborate these data and to support the use of semiquantitative sonoelastography in the evaluation of testicular lesions.

Sequential Use of (90)Y Microspheres Radioembolization and (177)Lu-Dotatate in Pluri-Metastatic Neuroendocrine Tumors: A Case Report.

(90)Y radioembolization and peptide-receptor radionuclide therapy (PRRT) with(177)Lu-DOTATATE are both effective treatments for patients with inoperable neuroendocrine metastatic tumors (NET). We report the case of a 72-year-old man with severe functional syndrome due to a metastatic NET. (68)Ga-DOTATOC positron-emission tomography (PET) revealed high somatostatin receptor expression in a gross liver metastasis, in one abdominal lymph node and in several skeletal lesions. The patient underwent liver radioembolization with (90)Y-resin microspheres followed by four cycles of PRRT with(177)Lu-DOTATATE. After 3 months, a complete remission of the functional syndrome was observed. (68)Ga-DOTATOC PET demonstrated a complete response for skeletal and lymph nodal lesions with a residual bulky mass in the liver. Therefore a further (90)Y radioembolization was performed as consolidation treatment for the hepatic lesion. Six months after these combined treatments, (68)Ga-DOTATOC PET demonstrated complete metabolic response in liver and stable extrahepatic lesions. No significant long-term adverse reactions were registered. To our knowledge, the sequential use of (90)Y radiembolization before and after PRRT in a liver-dominant advanced NET has not been reported in the literature and this case suggests that these combined treatments can be safe and effective.

Breast adenomyoepithelioma: a case report with malignant proliferation of epithelial and myoepithelial elements.

BACKGROUND: Breast adenomyoepithelioma is an unusual tumor characterized by a biphasic proliferation of epithelial and myoepithelial cells. Most breast adenomyoepitheliomas are considered to be benign or to have a low-grade malignant potential, characterized by propensity for local recurrence. Malignant changes arising in this lesion are extremely rare and may involve one or both cellular components. CASE REPORT: We discuss a case of a 60 year-old woman who began to experience pain in her right breast in January 2009. Breast ultrasound and mammography were performed showing a rounded, hypoechoic solid lesion with ill-defined margins in the right inner-inferior quadrant, suspicious of malignancy. Quadrantectomy of the inner-inferior quadrant of the right breast with sampling of ipsilateral axillary lymph nodes was performed. The histological analysis confirmed the diagnosis of adenomyoepithelioma with focal malignant change of the epithelial component, associated with high-grade malignant myoepithelial change. The patient was treated with adjuvant radiotherapy and her right breast received a dose of Gy 50 with a boost of Gy 10 to the tumor bed. At present, the patient shows no sign of tumor recurrence. CONCLUSION: Breast malignant adenomyoepithelioma is a rare tumor which should be considered in the differential diagnosis of other solid breast lesions. Only few cases have been reported in the literature. Diagnosis, optimal therapy and predicting the outcome are problematic issues due to the rarity of this disease which appears to have hematogenous rather than lymphatic spread and usually occurs in primary tumors ≥ 1.6 cm in size.

Phosphorylated ezrin is located in the nucleus of the osteosarcoma cell.

The survival of osteosarcoma patients is connected to metastasis. The ezrin expression is associated with the development of metastasis and poor outcome in osteosarcoma. Ezrin is present in the cytoplasm and after phosphorylation assumes an active form and links F-actin to the cell membrane. This study evaluated ezrin and phosphorylated ezrin at site Tyr354 and Thr567 expression and its subcellular localization in osteosarcoma. We studied 50 osteosarcoma patients (mean follow-up 9.8 years). Ezrin expression was assessed using immunohistochemical and immunofluorescence analysis on tissue microarray and cultured cells of human osteosarcoma 143B. The western blot analysis was carried out on cultured cells. The majority of osteosarcomas, showing cytoplasmic positivity for ezrin, phosphorylated and unphosphorylated, were associated with membranous and nuclear positivity for phosphorylated ezrin Thr567 and phosphorylated ezrin Tyr354, respectively. Ezrin expression was associated with high-grade osteosarcoma (P=0.04), with metastasis (P=0.04) and with tumors that developed metastasis (P=0.04); phosphorylated ezrin Thr567 expression was present mostly in tumors with metastasis (P=0.01) and in osteosarcomas that did not develop metastasis (P=0.002). The osteosarcoma patients with ezrin expression have a short survival. The cytoplasmic ezrin expression in osteosarcoma matches its role of membrane-cytoskeleton linker protein. The subcellular trafficking of ezrin is not blocked and it is linked to ezrin phosphorylation, also in cancer. The phosphorylated ezrin Tyr354 nuclear localization suggests its possible role as a nuclear factor in osteosarcoma. The phosphorylated ezrin Thr567 phosphorylation may not be necessary in osteosarcoma metastatic progression but it was modulated. The ezrin expression is associated with more aggressive osteosarcomas and with metastasis.

Cavernous hemangioma of the tympanic membrane and external ear canal.

OBJECTIVES: The aims of this study are to document the occurrence of a cavernous hemangioma of the tympanic membrane (TM) and external auditory canal (EAC) that invaded the middle ear spaces and to review the relevant literature. METHODS: The clinical presentation, imaging studies, operative report, and histologic findings of this new case of cavernous hemangioma are reviewed. RESULTS: A cavernous hemangioma of the TM and EAC involving the middle ear spaces was surgically excised without complications. The pulsatile tinnitus, which affected our patient at the same ear where the lesion was situated, disappeared after surgery. Our case represents the first documented cavernous hemangioma of the TM and EAC that invaded the middle ear spaces and the eighth case of cavernous hemangioma of the EAC/TM. Computed tomography is the method of choice in evaluating this lesion. CONCLUSIONS: Hemangiomas of the EAC and/or TM are extremely rare entities amenable to surgical excision. With magnetic resonance imaging, there is difficulty in defining the exact location of the tumor and degree of soft tissue involvement.