An overview of the neurosurgical implications, pathophysiology, diagnosis and recent treatment strategies for Grade IV idiopathic osteolysis, also known as Gorham-Stout or phantom bone disease.

OBJECTIVE: Gorham-Stout disease (GSD), commonly referred as vanishing bone or phantom bone disease, is a rare disorder characterized by spontaneous bone osteolysis due to proliferation of lymphangiomatous tissue. This disease can involve multiple bones and cause pathologic fractures. The exact cause of GSD is unknown and its severity is unpredictable; the disorder can potentially cause disfigurement or functional disability. According to CARE guidelines, we studied a 46 years old lady with a progressive defect of the skull. Differential diagnosis included: benign and malignant diploic lesions (eosinophylic granuloma of the skull, myeloma, lytic metastasis from unknown primary tumour, etc) and osteomyelitis. A suspicion of GSD was raised by coupling information from laboratory and nuclear medicine investigations, and eventually confirmed histologically. CONCLUSION: We included early in the investigation protocols a total body fluorine-18-fluorodeoxyglucose positron emission tomography (18F-FDG PET) scan that was extremely helpful to promptly rule out malignant or infective nature of osteolysis. An update on the diagnostic and management options available for GSD, with particular reference to the role of nuclear medicine and the latest clinical trials from international patients registries and classification of idiopathic osteolysis is provided.

Enhancing contrast agents and radiotracers performance through hyaluronic acid-coating in neuroradiology and nuclear medicine.

The use of hyaluronic acid nanoshells has been proposed to encapsulate prodrugs and exploit the mechanisms of interactions between living cells, like endocytes or cancer cells and hyaluronic acid, which is a natural component of the extracellular matrix. In this review we describe the potential and the limits of this promising research trend and discuss the theoretical advantages of such an engineering approach. Is it a possible scalability to increase the efficacy and biodegradability of molecules like contrast media and radiotracers especially for neuroradiology and nuclear medicine studies.

Hashimoto's thyroiditis and papillary thyroid carcinoma. Are cytokeratin 19 and P63 proteins of any diagnostic value?

BACKGROUND: The relation between Hashimoto's thyroiditis (HT) and papillary thyroid carcinoma (PTC) remains controversial. We aimed to study the coexistence of PTC and HT and the diagnostic utility of cytokeratin19 and P63 proteins expression in all positive for PTC cases of HT. SUBJECTS AND METHODS: We analyzed data from 343 patients who underwent fine needle aspiration cytology followed by thyroid surgery over a six years period. Thyroid scans and blood measurements for anti-thyroid peroxidase antibodies (TPOAb), thyroid stimulating hormone (TSH), anti-thyroglobulin antibodies (TgAb) and free thyroid hormones were performed. We assessed the expression of monoclonal antibodies against cytokeratin 19 (CK19) and factor P63 in all positive for PTC patients. RESULTS: Hashimoto's thyroiditis was diagnosed by histology in 93 patients. They were: 90 female and 3 male patients. Both HT and PTC were present in 6 female patients (6,7%). All their thyroid scans showed heterogeneous distribution of the tracer with a cold nodule. Laboratory examination showed high levels of TSH as well as of TPOAb in all PTC patients. Cytokeratin 19 showed positive expression in all PTC patients, whereas P63 showed focal positivity in 4/6 cases. We did not estimate the duration of HT in our study. CONCLUSION: This study showed that 6,7% of female patients with HT also had PTC and all had elevated serum TSH, which may be a risk factor for PTC. The age of PTC patients was between 19-42 years.