Lymphoma Masquerading as Lung Cancer.

ABSTRACT: Lymphoma typically manifests as lymphadenopathy, with or without solid organ involvement. Lymphomatous masses tend to respect anatomical structures, encasing rather than invading them. Tumor thrombus formation is a rare presentation in lymphoma that has been previously described in the liver and kidneys. We report an unusual presentation of B-cell lymphoma with imaging findings suggestive of metastatic lung cancer with tumor thrombus in the pulmonary vein and left atrium.

Role of plaque inflammation in symptomatic carotid stenosis.

Objective: Prior studies have shown that plaque inflammation on FDG-PET and the symptomatic carotid atheroma inflammation lumen-stenosis (SCAIL) score were associated with recurrent ischemic events, but the findings have thus far not been widely validated. Therefore, we aimed to validate the findings of prior studies. Methods: A single-center prospective cohort study that recruited patients with (1) recent TIA or ischemic stroke within the past 30 days, (2) ipsilateral carotid artery stenosis of ≥50%, and (3) were not considered for early carotid revascularization. The (1) maximum standardized uptake value (SUVmax) of the symptomatic carotid plaque, (2) the SCAIL score, and (3) stenosis severity of the symptomatic carotid artery were measured for all patients. The outcomes were (1) a 90-day ipsilateral ischemic stroke and (2) a 90-day ipsilateral symptomatic TIA or major adverse cardiovascular event (MACE). Results: Among the 131 patients included in the study, the commonest cardiovascular risk factor was hypertension (95 patients, 72.5%), followed by diabetes mellitus (77 patients, 58.8%) and being a current smoker (64 patients, 48.9%). The median (IQR) duration between the index cerebral ischemic event and recruitment to the study was 1 (0, 2.5) days. The median (IQR) duration between the index cerebral ischemic event and FDG-PET was 5 (4, 7) days. A total of 14 (10.7%) patients had a 90-day stroke, and 41 (31.3%) patients had a 90-day TIA or MACE. On comparison of the predictive performances of the SCAIL score and SUVmax, SUVmax was found to be superior to the SCAIL score for predicting both 90-day ipsilateral ischemic stroke (AUC: SCAIL = 0.79, SUVmax = 0.92; p < 0.001; 95% CI = 0.072, 0.229) and 90-day TIA or MACE (AUC: SCAIL = 0.76, SUVmax = 0.84; p = 0.009; 95% CI = 0.020, 0.143). Conclusion: Plaque inflammation as quantified on FDG-PET may serve as a reliable biomarker for risk stratification among patients with ECAD and recent TIA or ischemic stroke. Future studies should evaluate whether patients with significant plaque inflammation as quantified on FDG-PET benefit from carotid revascularization and/or anti-inflammatory therapy.

Mathematical modeling of the outbreak of COVID-19.

The novel coronavirus SARS-Cov-2 is a pandemic condition and poses a massive menace to health. The governments of different countries and their various prohibitory steps to restrict the virus's expanse have changed individuals' communication processes. Due to physical and financial factors, the population's density is more likely to interact and spread the virus. We establish a mathematical model to present the spread of the COVID-19 in India and worldwide. By the simulation process, we find the infected cases, infected fatality rate, and recovery rate of the COVID-19. We validate the model by the rough set method. In the method, we obtain the accuracy for the infected case is 90.19%, an infection-fatality of COVID-19 is 94%, and the recovery is 85.57%, approximately the same as the actual situation reported WHO. This paper uses the generalized simulation process to predict the outbreak of COVID-19 for different continents. It gives the way of future trends of the COVID-19 outbreak till December 2021 and casts enlightenment about learning the drifts of the outbreak worldwide.

"Hot Cord" Sign on 18F-FDG PET/CT in a Patient With Acute Myelitis Due to Neuromyelitis Optica Spectrum Disorder.

A 44-year-old woman presented with prolonged low-grade fever, bilateral upper limb weakness, and hyperesthesia. MRI showed hyperintense T2 signal and enhancement of the cervicothoracic spinal cord. F-FDG PET/CT was requested to investigate pyrexia of unknown origin. It demonstrated diffusely increased FDG uptake along the entire spinal cord, suggestive of extensive acute myelitis. Initial blood work was positive for antinuclear antibodies and anti-Ro/SSA antibodies. Cerebrospinal fluid analysis revealed lymphocytosis and detected the presence of neuromyelitis optica aquaporin-4-immunoglobulin G antibodies, fulfilling the criteria for diagnosis of neuromyelitis optica spectrum disorder.

Integration of Antiangiogenic Therapy with Cisplatin and Gemcitabine Chemotherapy in Patients with Nasopharyngeal Carcinoma.

PURPOSE: Induction cisplatin and gemcitabine chemotherapy is a standard treatment for locally advanced nasopharyngeal carcinoma (NPC). Inhibition of VEGF axis has been shown to promote maturation of microvasculature and improve perfusion. We conducted a four-arm study to assess the effect of two doses of either sunitinib or bevacizumab with chemotherapy in NPC. PATIENTS AND METHODS: Patients with treatment-naïve locally advanced NPC were treated with three cycles of 3-weekly cisplatin and gemcitabine preceded by 1 week of anti-VEGF therapy for each cycle, followed by standard concurrent chemoradiation: arm A patients received 7 days of 12.5 mg/day sunitinib; arm B 7 days of 25 mg/day sunitinib; arm C bevacizumab 7.5 mg/kg infusion; arm D bevacizumab 2.5 mg/kg infusion. Patients with metastatic NPC were treated with up to six cycles of similar treatment without concurrent chemoradiation. RESULTS: Complete metabolic response (mCR) by whole body 18FDG PET was highest in arm C (significant difference in four groups Fisher exact test P = 0.001; type 1 error = 0.05), with 42% mCR (95% confidence interval, 18-67) and 3-year relapse-free survival of 88% in patients with locally advanced NPC. Significant increase in pericyte coverage signifying microvascular maturation and increased immune cell infiltration was observed in posttreatment tumor biopsies in Arm C. Myelosuppression was more profound in sunitinib containing arms, and tolerability was established in arm C where hypertension was the most significant toxicity. CONCLUSIONS: Bevacizumab 7.5 mg/kg with cisplatin and gemcitabine was well tolerated. Promising tumor response was observed and supported mechanistically by positive effects on tumor perfusion and immune cell trafficking into the tumor.

Imaging findings on contrast-enhanced ultrasound, magnetic resonance imaging and hybrid positron emission tomography in Takayasu arteritis: a case report.

This case report demonstrates the potential of contrast-enhanced ultrasound (CEUS) in diagnosing active arterial wall inflammation in a symptomatic patient with Takayasu arteritis (TA). To our knowledge, this is the first case which demonstrates pictorial correlation of arterial wall neovascularity on CEUS with mural edema on magnetic resonance imaging and metabolic activity on positron emission tomography - computed tomography in the same patient. As TA is a chronic disease which requires long-term follow-up, CEUS could be the potential imaging modality of choice as it is radiation-free, non-nephrotoxic and easily available.

A mathematical model of adiponectin resistance.

Adiponectin is often associated with obesity. The obese body displays a significant decrease in adiponectin expression and plasma levels. Higher adiponectin also results in lower expression of pro-inflammatory cytokine TNF-α from adipose tissue. Low adiponectin levels show to exist significantly in the case of insulin resistance. Adiponectin levels are found to be significantly lower in people with type 2 diabetes. In this paper, we proposed a mathematical model of the adiponectin - adiponectin receptors framework, based on the assumption that the secretion of adiponectin is inversely proportional to fat mass. Here, we show that an increase in obesity or adiposity results in a decrease in the adiponectin plasma level, which contributes to the development of adiponectin resistance. In this model, we have used different parameters and their default values, to perform a simulation based on the model. Further, experimentally, the plasma adiponectin concentration is ( ≈  0.015) significantly lowered in the diabetic group compared to the non-diabetic group. In this model, we have obtained the plasma adiponectin concentration level ( ≈  0.014) in the simulation process. So this model is only differing from 1 × 10-3 significant digits. We have achieved the degree of accuracy of adiponectin resistance is 93.33%. Therefore, these advances offer novel insights into the mathematical approach.

Lymphoma Recurrence Along the Lymphatic Tract on 18F-FDG PET/CT Presenting as Lower Limb Swelling.

A 66-year-old woman with a known history of diffuse large B-cell lymphoma presented with left lower limb swelling following recent long-distance air travel. Ultrasound Doppler showed no evidence of deep vein thrombosis. In view of her medical history, an F-FDG PET/CT was ordered that found a soft tissue mass following the course of the femoral neurovascular bundle along the anteromedial aspect of the left thigh down to the popliteal fossa and the lateral calf muscle. This was confirmed to be tumor recurrence.

Rough set method accurately predicts unknown protein class/family of Leishmania donovani membrane proteome.

Leishmania donovani is the primary cause of a fatal disease visceral leishmaniasis (VL) in East Africa and in the Indian subcontinent. Human beings are the only known reservoir of L. donovani and due to the emergence and the spread of drug resistance control for this disease is become worse. Therefore, identification of novel drug target is very important to develop new drug and combat drug resistance issue. Experimental determination of target is costly and time-consuming, hence it is necessary to first identify the efficient target with the accurate mathematical method and then further go for in vitro/in vivo study. Earlier we have predicted the role of protein in term of the target with Naïve Bayes probabilistic classifier on the proteins identified in our L. donovani membrane proteomics study. This time we have used alternative and the popular method named as a Rough Set method (an important part of soft computing method relevance in many real-world applications) and tried to re-visit/validate our earlier findings of L. donovani membrane proteomics and additionally decipher the unknown class/family of membrane proteins as known one. Comparing this result with other classifiers (NB, SVM, RF, C4.5 decision tree) Rough Set method has outperformed and we found the accuracy was 89.28%. This study further validates our previous finding strongly and predicts the class/family of unknown proteins which are very important for the identification and selection toward some novel drug target (still unexplored) and ultimately move in the direction of development of effective antileishmanials.

18F-FDG Uptake in Parsonage-Turner Syndrome.

A 55-year-old man with large B-cell lymphoma developed atraumatic left shoulder pain. F-FDG PET/CT revealed new left supraspinatus and infraspinatus muscle uptake while the initial disease resolved. Given the discrepancy between initial disease treatment response and new left shoulder findings, an MRI scan was performed. This demonstrated diffuse supraspinatus and infraspinatus muscle edema and enhancement with no focal lesion. Muscle biopsy was negative for lymphoma, but features of muscle denervation were seen. Overall, clinical and imaging findings were compatible with Parsonage-Turner syndrome (acute brachial neuritis), an uncommon condition that presented as a false-positive finding on PET/CT.

18F-FDG PET/CT Scan Can Predate Clinical Presentation in Acute Appendicitis.

Acute appendicitis is a clinical diagnosis typically presenting with right lower quadrant pain. We describe the case of an asymptomatic 53-year-old man with stage 2A diffuse large B-cell lymphoma, who underwent F-FDG PET/CT at the completion of chemotherapy. The scan showed complete lymphomatous disease remission. Incidentally, there was increased FDG uptake in a tubular structure adjacent to the cecum. Clinical examination was negative. Subsequently, the patient presented 6 days later with typical acute appendicitis symptoms. This case is interesting wherein increased FDG uptake in the appendix predated the appearance of clinical symptoms.

Putative Drug and Vaccine Target Identification in Leishmania donovani Membrane Proteins Using Naïve Bayes Probabilistic Classifier.

Predicting the role of protein is one of the most challenging problems. There are few approaches available for the prediction of role of unknown protein in terms of drug target or vaccine candidate. We propose here Naïve Bayes probabilistic classifier, a promising method for reliable predictions. This method is tested on the proteins identified in our mass spectrometry based membrane protemics study of Leishmania donovani parasite that causes a fatal disease (Visceral Leishmaniasis) in humans all around the world. Most of the vaccine/drug targets belonging to membrane proteins are represented as key players in the pathogenesis of Leishmania infection. Analyses of our previous results, using Naïve Bayes probabilistic classifier, indicate that this method predicts the role of unknown/hypothetical protein (as drug target/vaccine candidate) significantly with higher precision. We have employed this method in order to provide probabilistic predictions of unknown/hypothetical proteins as targets. This study reports the unknown/hypothetical proteins of Leishmania membrane fraction as a potential drug targets and vaccine candidate which is vital information for this parasite. Future molecular studies and characterization of these potent targets may produce a recombinant therapeutic/prophylactic tool against Visceral Leishmaniasis. These unknown/hypothetical proteins may open a vast research field to be exploited for novel treatment strategies.

(68)Ga-DOTA-peptide: A novel molecular biomarker for nasopharyngeal carcinoma.

BACKGROUND: Increased somatostatin receptor (SSTR) expression in patients with undifferentiated nasopharyngeal carcinoma (NPC) has been demonstrated with receptor autoradiography, (111) In-Octreotide scintigraphy, and (68) Ga-DOTA-TOC positron emission tomography (PET)/CT imaging. We sought to compare and correlate the uptake of fluorodeoxyglucose (FDG) and DOTA-NOC in undifferentiated NPC to ascertain the possible role of (68) Ga-DOTA-NOC PET/CT as a new imaging biomarker and to assess whether targeted peptide receptor radionuclide therapy is a feasible treatment option. METHODS: After obtaining approval from our institutional review board, 4 patients with biopsy proven nonkeratinizing undifferentiated NPC who had just undergone routine staging/restaging (18) F-FDG PET/CT imaging were prospectively and consecutively recruited for (68) Ga-DOTA-NOC PET/CT imaging. Of these 4 patients, 3 were newly diagnosed with untreated NPC, whereas 1 patient was diagnosed with a case of recurrent NPC with previous treatment. These patients subsequently underwent (68) Ga-DOTA-NOC PET/CT within 10 days from the (18) F-FDG PET/CT to ensure lesion comparability. Tracer uptake in tumor lesions were assessed visually and semiquantitatively by measuring maximum standardized uptake values (SUVmax). RESULTS: There were 12 FDG-avid lesions of which 7 showed avid uptake of DOTA-NOC greater than liver uptake, whereas 5 showed low uptake of DOTA-NOC less than liver uptake. Subset analysis of the FDG-avid lesions at the primary and recurrent sites showed that all the FDG-avid primary tumors in the nasopharynx showed avid uptake of DOTA-NOC. On the contrary, the case of recurrent NPC showed avid FDG uptake but low DOTA-NOC uptake. Subset analysis of the suspicious FDG-avid cervical lymph nodes showed that 50% of them demonstrated avid DOTA-NOC uptake greater than liver uptake, whereas the remaining demonstrated low-grade DOTA-NOC uptake less than liver uptake. The 2 subcentimeter cervical lymph nodes that showed low-grade uptake of FDG lower than mediastinal blood pool activity were deemed to be reactive/inflammatory and showed low-grade uptake of DOTA-NOC. CONCLUSION: This study highlights the potential of (68) Ga-DOTA-peptide PET/CT as a new molecular biomarker for newly diagnosed undifferentiated NPC, and less so for recurrent NPC and metastatic nodes. This potentially opens up new diagnostic and therapeutic options in the management of undifferentiated NPC.

Incidental possible diagnosis by 18F-fluorocholine PET/CT of Meckel's diverticulum and potential pitfalls.

UNLABELLED: A 61 years old man with a history of prostate cancer Gleason 3+4, treated with radical prostatectomy, underwent fluorine-18-fluorocholine positron emission tomography/computed tomography ((18)F-FCH PET/CT) imaging to investigate rising serum prostate specific antigen (PSA) levels. (18)F-FCH PET/CT showed a focus of linear increased uptake by a possible Meckel's diverticulum in the right hemi-pelvis, which was an incidental finding in this asymptomatic patient. Uptake of (18)F-FCH by Meckel's diverticulum has not been reported before and thus the mechanism of uptake has not been established. Two postulations may explain this uptake. First, since Meckel's diverticulum is a true diverticulum containing all layers of the intestinal wall, the uptake may be related to physiological bowel-related uptake. Second, the uptake may be due to heterotopic pancreatic tissue in Meckel's diverticulum, especially since the intensity of uptake we have noticed was similar to that of physiological pancreatic uptake. As (18)F-FCH PET/CT scan is often used for evaluating prostate cancer, (18)F-FCH uptake by Meckel's diverticulum in the pelvis or lower abdomen may be mistaken for tumor involvement/recurrence. The identification by imaging of Meckel's diverticulum relies on the identification of a blind ending tubular structure, arising from the distal ileum. The identification of this structure may be best appreciated on the axial, coronal or sagittal plane. CONCLUSION: In this particular case, we managed to clearly demonstrate the presence of a tubular blind ending structure arising from the distal ileum on the sagittal images. The careful identification of this structure indicated that tracer uptake was in a Meckel's diverticulum and not within a pelvic lymph node or pelvic organ hence excluding recurrent disease.

A man with pleural effusion and ascites.

A male lifelong nonsmoker aged 58 years with no prior asbestos exposure complained of gradual worsening breathlessness over 3 months. This was associated with abdominal and leg swelling and a 2-kg weight loss. He had no fever, night sweats, hemoptysis, joint pain, rash, abdominal pain, chest pain, or orthopnea. The patient had no recent travel or contact with pulmonary TB. He had stage I left-side testicular seminoma treated with left-sided radical orchidectomy 10 years previous and recently received a diagnosis of Child's B alcoholic liver cirrhosis. His hepatitis B and C screen result was normal.

Asymptomatic metastasis to cricoid from prostate carcinoma: an incidental finding detected on 18F-choline PET/CT.

Metastases to the larynx from prostate carcinoma are rare. We describe a case of asymptomatic prostate carcinoma metastasis to the right cricoid cartilage detected on 18F-fluorocholine PET/CT. This was histologically proven on open biopsy and the patient was offered local radiotherapy.

Glomerular filtration rates in healthy Asians without kidney disease.

AIM: The Chronic Kidney Disease Collaboration - Epidemiology (CKD-EPI) glomerular filtration rates (GFR) estimation equation is believed to estimate GFR more accurately in healthy people but this has not been validated in Asians. We studied the distribution of GFR in a multi-ethnic Asian population without CKD, and compared the performance of measures of GFR estimation, including the CKD-EPI equation, Cockroft-Gault equation, and 24-hour urine creatinine clearances. MATERIALS AND METHODS: A total of 103 healthy volunteers without a history of kidney disease, hypertension, or diabetes underwent GFR measurement using 3-sample plasma clearance of (99m) Tc-DTPA. Cockroft-Gault estimated GFR and 24-hour urine creatinine clearances were normalized to body surface area. RESULTS: The mean measured GFR was 101 ± 15.8 mL/min per 1.73 m(2) and was lowest in Indians (93 ± 12.3 mL/min per 1.73 m(2); P < 0.001). The CKD-EPI equation appears to be more accurate for healthy participants. Estimated GFR correlated with measured GFR (r = 0.57, P < 0.001), and the mean difference is 3.72 ± 14.43 mL/min per 1.73 m(2) (P < 0.001). However, estimating GFR using self-directed 24-hour urine creatinine clearances is poorer than using the CKD-EPI equation. CONCLUSIONS: GFR estimation using self-directed 24-hour urine collection for creatinine clearance is less accurate than using the CKD-EPI equation. A larger study is required to clarify GFR in healthy Asians, and the association of health outcomes of Asian kidney donors with lower GFR thresholds.