Restoration of reproductive capacity in a male patient with congenital adrenal hyperplasia and bilateral testicular adrenal rest tumors (TARTs) after six months of glucocorticoid intensification: A case report.

RATIONALE: Congenital adrenal hyperplasia (CAH) is considered one of the most common inherited disorders. In about more than 95% of all CAH cases, the deficient enzyme is 21-hydroxylase. Infertility is an important complication of this disease, and although this topic has been studied more frequently in females, cases, and literature reviews of the causes of infertility in male patients are constantly increasing. PATIENT CONCERNS: A 28 old male with congenital adrenal hyperplasia (we assume to be a nonclassical type) presented to our institution with infertility and suspected bilateral testicular masses after 4 years of stopping dexamethasone. DIAGNOSIS: Testicular adrenal rest tumors. INTERVENTIONS: Dexamethasone was reapplied in a supraphysiologic dose (1.5 mg before bedtime) with periodic monitoring of the patient. OUTCOMES: Treatment with supraphysiologic dose of dexamethasone led to regression of these tumors and significant improvement in sperm count, resulting in being capable of having a child. LESSONS: There are many suspected causes of reduced male fertility in male CAH patients and the presence of testicular adrenal rest tumors is the main cause of infertility in this population. These benign tumors are believed to arise from ectopic adrenal cells in the testes, that grow under adrenocorticotropic hormone stimulation in poorly controlled patients. Annual scrotal ultrasound is recommended in all males with CAH for detection and treatment of these tumors as early as possible before they cause permanent damage to the seminiferous tubules and irreversible infertility.

Experimental evaluation of seven quality control phantoms for digital breast tomosynthesis.

PURPOSES: The introduction of digital breast tomosynthesis (DBT) into the French breast cancer screening program is forecast by the authorities. The aim of the present study was to evaluate image quality phantoms to be used as internal quality controls. METHODS: Seven breast phantoms dedicated to quality control in mammography were evaluated on reconstructed DBT images: ACR Model 015, BR3D, DBT QC model 021, Mam/Digi-EPQC, MTM100, TOMOMAM® and TOMOPHAN®. Two representative image parameters of DBT images were studied: image score and z-resolution, when inserts were included in the phantom, on five DBT systems of three different brands. Three observers were involved. RESULTS: The MTM100, Mam/Digi-EPQC, BR3D, DBT QC model 021 phantoms' images presented artefacts affecting the image score. The ACR Model 015, TOMOMAM® and TOMOPHAN® phantoms appeared to be pertinent for DBT image score analysis. Due to saturation artefacts, Z-resolution results were not coherent with the theory for all phantoms except by using aluminium beads in the TOMOMAM® phantom. CONCLUSIONS: Phantom manufacturers should be encouraged to collaborate with DBT system manufacturers in order to design universal phantoms suitable for all systems for more complete quality control. From our study we can propose several specifications for an ideal and universal phantom designed for internal quality control in DBT. Phantoms should allow sensitive image score measurements. The background structure should be realistic to avoid artefacts. Phantoms should have a standard breast-like shape and size.

Diagnostic Dilemma in Two Cases of Hyperandrogenism.

Hirsutism is a common endocrine complaint affecting about 10 percent of women. It may be caused by multiple etiologies including adrenal and ovarian disorders. Usually, it is a result of a benign entity such as PCOs and idiopathic hirsutism. However, sometimes especially when it is severe and rapid in progression an androgen-secreting tumor should be excluded. Sertoli-Leydig cell tumors constitute fewer than 0.5 percent of ovarian tumors and it may be benign or malignant. In this article, we present two cases of hyperandrogenism caused by occult ovarian Leydig cell tumors. one of them was confounded by the presence of coincidental bilateral adrenal nodules that complicated the diagnostic process. Tumor dissection was curative in both cases and the diagnosis was confirmed by pathological and hormonal testing after surgery.

False-positive radioiodine accumulation in a huge pelvic mass after thyroidectomy for papillary carcinoma, a case report from Syria.

Iodine has always been connected to thyroid gland, and the fact that thyroid tissue traps, organificates and stores iodine more than other tissues is well known, hence the use of radioiodine as a diagnostic and therapeutic tool for thyroid disorders. However, false-positive cases do occur. We present a case of a 34-year-old patient who underwent total thyroidectomy for papillary carcinoma. Results of follow up TSH, thyroglobulin and thyroglobulin antibody tests after surgery lead to two rounds of radioactive iodine. After that, a radioiodine whole-body scan showed high uptake in the pelvis above bladder. Computed tomography scan showed a pelvic heterogeneous mass with some calcifications. Surgical removal and subsequent pathology confirmed the absence of metastasis. The final pathological diagnosis was serous cystadenoma, endometriosis cyst and leiomyoma. As the real cause behind false-positive iodine uptake by these tissues has yet to be determined, careful assessment should be considered in any suspicious case.

Three-dimensional personalized Monte Carlo dosimetry in 90Y resin microspheres therapy of hepatic metastases: nontumoral liver and lungs radiation protection considerations and treatment planning optimization.

UNLABELLED: In the last decades, selective internal radiation therapy (SIRT) has become a real alternative in the treatment of unresectable hepatic cancers. In practice, the activity prescription is limited by the irradiation of organs at risk (OAR), such as the lungs and nontumoral liver (NTL). Its clinical implementation is therefore highly dependent on dosimetry. In that context, a 3-dimensional personalized dosimetry technique--personalized Monte Carlo dosimetry (PMCD)-based on patient-specific data and Monte Carlo calculations was developed and evaluated retrospectively on clinical data. METHODS: The PMCD method was evaluated with data from technetium human albumin macroaggregates ((99m)Tc-MAA) evaluations of 10 patients treated for hepatic metastases. Region-of-interest outlines were drawn on CT images to create patient-specific voxel phantoms using the OEDIPE software. Normalized 3-dimensional matrices of cumulated activity were generated from (99m)Tc-SPECT data. Absorbed doses at the voxel scale were then obtained with the MCNPX Monte Carlo code. The maximum-injectable activity (MIA) for tolerance criteria based on either OAR mean absorbed doses (D(mean)) or OAR dose-volume histograms (DVHs) was determined using OEDIPE. Those MIAs were compared with the one recommended by the partition model (PM) with D(mean) tolerance criteria. Finally, OEDIPE was used to evaluate the absorbed doses delivered if those activities were injected to the patient and to generate the corresponding isodose curves and DVHs. RESULTS: The MIA recommended using D(mean) tolerance criteria is, in average, 27% higher with the PMCD method than with the PM. If tolerance criteria based on DVHs are used along with the PMCD, an increase of at least 40% of the MIA is conceivable, compared with the PM. For MIAs calculated with the PMCD, D(mean) delivered to tumoral liver (TL) ranged from 19.5 to 118 Gy for D(mean) tolerance criteria whereas they ranged from 26.6 to 918 Gy with DVH tolerance criteria. Thus, using the PMCD method, which accounts for fixation heterogeneities, higher doses can be delivered to TL. Finally, absorbed doses to the lungs are not the limiting criterion for activity prescription. However, D(mean) to the lungs can reach 15.0 Gy. CONCLUSION: Besides its feasibility and applicability in clinical routine, the interest for treatment optimization of a personalized Monte Carlo dosimetry in the context of SIRT was confirmed in this study.

Evaluation of absorbed and effective doses to patients from radiopharmaceuticals using the ICRP 110 reference computational phantoms and ICRP 103 formulation.

In diagnostic nuclear medicine, mean absorbed doses to patients' organs and effective doses are published for standard stylised anatomic models. To provide more realistic and detailed geometries of the human morphology, the International Commission on Radiological Protection (ICRP) has recently adopted male and female voxel phantoms to represent the reference adult. This work investigates the impact of the use of these new computational phantoms. The absorbed doses were calculated for 11 different radiopharmaceuticals currently used in diagnostic nuclear medicine. They were calculated for the ICRP 110 reference computational phantoms using the OEDIPE software and the MCNP extended Monte Carlo code. The biokinetic models were issued from ICRP Publications 53, 80 and 106. The results were then compared with published values given in these ICRP Publications. To discriminate the effect of anatomical differences on organ doses from the effect of the calculation method, the Monte Carlo calculations were repeated for the reference adult stylised phantom. The voxel effect, the influence of the use of different densities and nuclear decay data were also investigated. Effective doses were determined for the ICRP 110 adult reference computational phantom with the tissue weighting factor of ICRP Publication 60 and the tissue weighting factors of ICRP Publication 103. The calculation method and, in particular, the simulation of the electron transport have a significant influence on the calculated doses, especially, for small and walled organs. Overestimates of >200 % were observed for the urinary bladder wall of the stylised phantom compared with the computational phantoms. The unrealistic organ topology of the stylised phantom leads to important dose differences, sometimes by an order of magnitude. The effective doses calculated using the new computational phantoms and the new tissue weighting factors are globally lower than the published ones, except for some radiopharmaceuticals, where the differences can reach 60 % higher than the published values. This study analyses the first set of absorbed and effective doses with the new ICRP male and female reference computational phantoms for different radiopharmaceuticals. It highlights the importance of taking into account the electron transport and the realism of the shape and inter-organ distances of the anthropomorphic model used.