A case of primary gastric undifferentiated high-grade pleomorphic sarcoma diagnosed with chief complaint of fever: a case report and literature review.

BACKGROUND: Undifferentiated high-grade pleomorphic sarcoma in gastrointestinal tract is extremely rare, and its prognosis is poor. CASE PRESENTATION: An 82-year-old man visited a previous hospital complaining of fever, general fatigue, and shaking chill, for which he received antibiotics therapy. As the fever continued, he was referred to our hospital, where computed tomography and upper gastrointestinal endoscopy showed a 6-cm gastric tumor. A preoperative biopsy was consistent with a malignant mesenchymal tumor, but could not provide a definitive pathological diagnosis nor prove a cause-and-effect relationship between the chief complaint and the gastric tumor. The gastric tumor had grown to 8 cm in diameter within a month so we performed a partial gastrectomy. The pathological postoperative diagnosis was undifferentiated high-grade pleomorphic sarcoma that produced granulocyte colony-stimulating factor. The patient's fever quickly improved, and he showed a good postoperative course. CONCLUSIONS: We herein report a case of rapidly growing, undifferentiated, high-grade pleomorphic gastric sarcoma, which presented as a chief complaint of fever.

Determinants of extraaortic arterial 18F-FDG accumulation in asymptomatic cohorts: sex differences in the association with cardiovascular risk factors and coronary artery stenosis.

UNLABELLED: The objective of this study was to evaluate extraaortic arterial (18)F-FDG accumulation in asymptomatic cohorts by sex and to clarify the association between extraaortic arterial (18)F-FDG accumulation and cardiovascular risk factors (CRFs) and coronary artery stenosis (CAS). METHODS: Five hundred twenty-one asymptomatic individuals (351 men and 170 women) who underwent cancer and CAS screening were enrolled. We evaluated extraaortic arterial (18)F-FDG accumulation in the carotid artery (CA) and iliofemoral artery (IFA) and classified the accumulation patterns into 3 types. Type 1 patients had no extraaortic arterial (18)F-FDG accumulation, type 2 had accumulation in either the CA or the IFA, and type 3 had accumulation in both the CA and IFA. CRFs (age, low-density lipoprotein [LDL] and high-density lipoprotein [HDL] cholesterol, triglyceride concentration, visceral abdominal fat, hypertension, diabetes, and smoking) and significant CAS were examined in relation to each accumulation type. RESULTS: The men showed more extensive extraaortic arterial (18)F-FDG accumulation than the women. Type 3 accumulation (60.4% vs. 37.1%, P < 0.0001) was more frequently observed in men, whereas type 2 (34.2% vs. 44.7%, P = 0.02) and type 1 (5.4% vs. 18.2%, P < 0.0001) accumulation were more frequent in women. The CRFs other than smoking tended to be worse with extensive extraaortic arterial (18)F-FDG accumulation. A multivariate logistic regression analysis showed that hypertension, age, LDL cholesterol, triglyceride, and visceral abdominal fat were significantly associated with type 3 accumulation in men, and LDL cholesterol and HDL cholesterol (inversely) were significantly associated with type 3 accumulation in women. CAS was found in 4.2% (9/212) of male patients and in 1.6% (1/63) of female patients with type 3 accumulation, whereas no CAS was found in the other 2 types. CONCLUSION: The men showed more extensive extraaortic arterial (18)F-FDG accumulation than the women. LDL cholesterol was associated with extensive extraaortic arterial (18)F-FDG accumulation in both sexes, but the other CRFs associated with extensive extraaortic (18)F-FDG arterial accumulation differed between the sexes. The type 3 accumulation was considered to pose a risk of CAS, especially in male patients, whereas non-type 3 accumulation presented little risk.

Assessment of FDG retention differences between the FDG-avid benign pulmonary lesion and primary lung cancer using dual-time-point FDG-PET imaging.

PURPOSE: The aim of this study was to clarify FDG retention differences between FDG-avid benign pulmonary lesions (BPLs) and primary lung cancers (PLCs), and between tuberculous and non-tuberculous BPLs using dual-time-point FDG-PET imaging. METHODS: Thirty-four BPLs and 47 PLCs with a maximal standardized uptake value (SUVmax) >2.5 and a maximal axial diameter >10 mm were enrolled. We compared the retention index (RI) among different types of lesions, and evaluated the relationship between RI and SUVmax at 1 h (SUV1). Glucose transporter-1 (Glut-1) and hexokinase (HK)-2 expression was assessed in eight non-tuberculous BPLs. RESULTS: BPLs and PLCs showed similar high RIs (mean ± SD 33.6 ± 22.6 and 32.5 ± 23.7, respectively; p = 0.95). In BPLs, both tuberculous and non-tuberculous lesions showed high RIs (39.1 ± 25.8 and 30.3 ± 20.3, respectively; p = 0.43). However, BPLs and PLCs exhibited a different relationship between RI and SUV1. BPLs tended to show lower RIs with higher SUV1s, and a mild negative correlation, whereas PLCs showed persistent high RIs and no significant correlation. Glut-1 and HK-2 expression was found in 75 and 12.5 % of non-tuberculous BPLs, respectively. CONCLUSIONS: FDG-avid BPLs could show high RIs regardless of their being tuberculous and non-tuberculous lesions, and no significant difference with PLC RIs was found. FDG-avid BPLs and PLCs showed different relationships between RI and SUV1, and it seemed to be related with different mechanisms of high FDG retention. However, the mechanisms of high FDG retention in FDG-avid BPLs remain unclear, and this matter requires further investigation.

FDG-PET/CT findings of peritoneal lymphomatosis.

Peritoneal lymphomatosis (PL) is an extensive lymphomatous infiltration of the intraperitoneal portion of the subperitoneal space, which is a rare presentation of lymphoma. Using CT or MRI findings alone, it is difficult to differentiate between lymphomatosis, carcinomatosis, and other pathological entities.We experienced two PL cases and herein report the FDG-PET/CT findings. High FDG uptakes were found in omental and peritoneal infiltration, gastric wall involvement, and lymph node involvement in the epiphrenic region, although retroperitoneal lymph node involvement was absent. Systemic abnormal FDG uptakes suggested PL rather than carcinomatosis, and FDG-PET/CT findings were useful for the diagnoses.

Protein-losing gastropathy with hypertrophic gastric folds: endosonographic findings.

We present a case of protein-losing gastropathy with hypertrophic gastric folds. A 38-year-old man was hospitalized for severe epigastric pain suggestive of hypoproteinemia. Endoscopic and radiologic examination revealed enlarged gastric folds on the greater curvature of the stomach. Endoscopic sonography revealed marked thickening of the second layer on the greater curvature of the stomach. Endoscopic mucosal resection was performed, and the diagnosis was hypertrophic gastritis. After prednisolone treatment, hypoproteinemia and the enlarged gastric folds of the stomach resolved.