[Osteoscintigraphy and dynamic studies of the kidneys using 99mTc-pyrophosphate in tumors of the retroperitoneal space in children]. / Osteostsintigrafiia i dinamicheskie issledovaniia pochek s 99mTc-pirofosfatom pri opukholevykh porazheniiakh zabriushinnogo prostranstva u detei.

Osteoscintigraphy and dynamic scintigraphy of the kidneys with 99mTc-pyrophosphate were used for investigation of 24 pediatric patients with tumorous involvement of the retroperitoneal space. Bone metastases were detected by osteoscintigraphy in 8 patients, pathological changes of the kidneys and urinary tract in 9 patients. Dynamic investigation of the kidneys with 99mTc-pyrophosphate performed in the first 20 min. after the drug injection showed disorders of renal evacuatory function of a varied degree of expression in all 24 patients. Dynamic investigation of the kidneys with 99mTc-pyrophosphate was not accompanied by an increase in radiation exposures therefore it was recommended at the first stage of radionuclide investigation of children with tumorous involvement of the retroperitoneal space followed by osteoscintigraphy.

Nontraumatic avulsion of the lesser trochanter: a pathognomonic sign of metastatic disease?

Isolated avulsion fractures of the lesser trochanter resulting from trauma are most commonly seen in adolescent athletes and are rare in adults. Standard therapy is nonsurgical with bedrest and immobilization of the leg. However, when this lesion is seen in the adult without significant trauma, it should be regarded as secondary to metastatic neoplasm until proven otherwise. Treatment should be surgical with prophylactic internal fixation of the hip to help prevent the commonly associated subtrochanteric pathologic fracture. In a patient without a known primary malignancy, biopsy should be carried out before therapy. We describe four patients with isolated avulsion fracture of the lesser trochanter due to metastatic carcinoma. Radiologists should be aware of this lesion because its presence has a decisive effect on therapy.

Intramedullary spinal cord metastasis in Hodgkin's disease. Rapid diagnosis and treatment resulting in neurologic recovery.

Intramedullary spinal cord metastases are uncommon in Hodgkin's disease and have a poor prognosis. This prognosis reflects the refractory or widely disseminated status of the disease at the time of development of neurological symptoms and difficulties in diagnosis. Computerized tomography and magnetic resonance imaging have enabled more rapid and specific diagnosis of spinal cord diseases. The authors report a patient who presented with Brown-Sequard syndrome due to intramedullary spinal cord infiltration from Hodgkin's disease. This patient was diagnosed promptly and with rapid initiation of radiation and chemotherapy, she has had neurologic recovery.

[Computed tomography and MR tomography before and after radiotherapy of primary and secondary CNS lymphoma]. / Computertomographie und MR-Tomographie vor und nach Strahlentherapie primärer und sekundärer Lymphome des ZNS.

CT scans were made prior to and following radiotherapy in eleven patients with primary or secondary malignant lymphomas of the CNS. Six patients were additionally submitted to MR tomography with calculated T1 and T2 images. Radiotherapy induced a very rapid regression of the lymphomas. A measurable quantitative influence of the irradiation could thus not be visualized in the MR scans. The survival curve of our patients was calculated, too. The median survival after radiotherapy is 17.4 months.

[Cerebral manifestations in non-Hodgkin lymphoma and in lymphogranulomatosis on the CT image]. / Zerebrale Manifestationen der Non-Hodgkin-Lymphome und der Lymphogranulomatose im CT.

Primary or secondary cerebral non-Hodgkin-lymphoma or Hodgkin's disease are very rare. The incidence varies from 0.2 to 4%. There is a predilection for the basal ganglia, corpus callosum, thalami and subependymal regions. Hodgkin's disease involving the brain usually infiltrates from the meninges. Solitary tumors are rare, multifocal tumors are extremely unusual. The typical CT appearances of intracranial lymphomas are described in three cases. These consist of isodense or hyperdense intracerebral lesions with marked increase in density on contrast enhancement. Periventricular tumor expansion in NHL is characteristic.

[Skeletal involvement in malignant lymphoma]. / Der Skelettbefall bei malignen Lymphomen.

Of 114 patients with Hodgkin's disease reviewed, 13 (11%) had bone involvement. The typical osseous lesion in Hodgkin's disease is a secondary manifestation in the axial skeleton. The lesions are mainly lytic; there is no relation between the site of the affection and the character of the lesion. Of 261 patients with non-Hodgkin lymphoma, 19 (7.3%) had bone involvement. Non-Hodgkin lymphoma very rarely affects the bone primarily; these lesions are lytic. Involvement of the appendicular skeleton is reported to by typical; this cannot be confirmed by our study. Most secondary osseous lesions in non-Hodgkin lymphoma are found in the cranium, the spine and the sternum; this pattern of distribution as well as the mainly lytic appearance can be considered typical.

[Imaging of neoplastic changes in the spine using MR tomography]. / Die Darstellung neoplastischer Wirbelveränderungen durch die MR-Tomographie.

The value of MR tomography for examining vertebral infiltration by malignant disease and the use of various techniques was examined retrospectively in a material of 68 examinations in 62 patients suffering from metastases, plasmacytomas, primary vertebral tumours and vertebral infiltration from extra-osseous tumours. It was shown that the method is superior to all other imaging methods for demonstrating changes in the bone marrow. The extent of the disease and involvement of neighbouring structures is shown more completely in cases where the disease extends beyond the vertebrae. Improved soft tissue contrast and the availability of various planes are definite advantages, as compared with CT. Tissue diagnosis, however, is not improved by MRT.

Carcinoma metastatic to the thyroid: prevalence and diagnosis by fine-needle aspiration cytology.

Although metastatic involvement of the thyroid is not commonly considered in the differential diagnosis of a patient with a thyroid mass, such involvement may be more frequent than has been previously appreciated. To evaluate the prevalence of this disorder, all patients with thyroid nodules referred in a 12-month period underwent fine-needle aspiration, regardless of history or scan results. Seventy patients were studied, six of whom had a previous history of malignant disease. Two of the latter had coincidental thyroid disease, but four (5.7% of the total series) had carcinoma metastatic to the thyroid gland. Two of these patients had had no evidence of malignancy for years prior to the appearance of the thyroid metastases. In one case, the metastasis was a functioning nodule. Fine-needle aspiration cytology provided prompt and accurate diagnosis in all patients. We conclude that metastatic carcinoma to the thyroid is not rare, its presentation may be confused with primary thyroid disease, and fine-needle aspiration cytology is the procedure of choice in such cases, and should be done early in the evaluation of all patients with thyroid nodules, regardless of the presumed etiology or function by scan.

Secondary involvement of genitourinary organs in malignant lymphoma.

We examined 322 patients who had died of malignant lymphoma at our institute between 1958 and 1985 in order to study secondary involvement of genitourinary organs (GUO). Secondary involvement of GUO was more common in non-Hodgkin lymphoma (NHL) than in Hodgkin's disease. The most commonly affected GUO was the kidney, which was secondarily involved in 121 out of 322 patients (37.6%). The adrenal gland was the second most commonly affected organ: 58 cases (18%) were affected by the disease and 40 of them were associated with renal involvement. Third and fourth were the urinary bladder (8.4%) and the testis (5.9%). Secondary involvement of the bladder in NHL was often accompanied with that of other GUO. Next, the relationship between metastases and histological characteristics in NHL was investigated. However, no significant correlation proved to exist between histological grade and metastases to the GUO.

Pseudometastases secondary to film static artifact.

Low density areas in the liver on computed tomography (CT) may be produced by cysts, abscesses, or tumors. A case is reported in which film static resulted in multiple focal low density areas in the liver in a patient with lymphoma. This potential pitfall in CT interpretation can be avoided by taking proper measures to avoid film artifacts and by reviewing all cases on the cathode ray tube (CRT) display as well as the hard copy film.

[Sonographic and computed tomographic diagnosis of liver metastases. A review]. / Sonographische und computertomographische Diagnostik von Lebermetastasen. Eine Ubersicht.

This article reviews the diagnosis of liver metastases by sonography and computed tomography. The ultrasonographic and computer tomographic features of hepatic metastases are described emphasizing the various signs of malignancy and the differential diagnosis of focal liver disease. The advantages and disadvantages of each imaging technique as well as a diagnostic approach in the evaluation of hepatic tumors are discussed.

[Skeletal manifestations of malignant, nonosseous tumors in childhood]. / Skelettmanifestationen von malignen, nichtossären Tumoren im Kindesalter.

Skeletal involvement in childhood nonosseous tumors can be due to primary involvement, arrosion or metastasis, secondary due to therapy induced alterations or osteomyelitis following diminished immunity. The occurence of bone changes differs widely from those in adults. Neuroblastoma, rhabdomyosarcoma and malignant lymphoma are discussed in detail. Rare tumors are listed for synopsis. As diagnostic screening method skeletal scintigraphy is recommended, whereas in localized disease X-rays should be performed. Beside roentgenmorphology-particularly in primary disease-localisation, frequency and age dependency may give essential diagnostic hints. Prognosis depends on primary tumor.

Magnetic resonance imaging of hepatic lymphoma.

The livers of 13 patients with histologically proven hepatic lymphomatous involvement were studied with both magnetic resonance imaging (MRI) and computed tomography (CT). MRI and CT demonstrated a focal abnormality in only one case. In the other 12 cases in which a focal abnormality was not demonstrated with MRI or CT, calculated T1 and T2 relaxation times in regions of interest in the liver were within 1 SD of their respective normal means. The inability to detect hepatic involvement in most cases was probably due to the diffuse microscopic distribution of lymphoma in the liver and the methodology used for calculating relaxation factors. Thus, with current imaging technology, MRI does not seem to be better than CT for evaluating the liver for lymphomatous involvement.

Management of Hodgkin's disease in western India.

The authors report a retrospective analysis of 441 patients with Hodgkin's disease seen at the Tata Memorial Hospital, Bombay, over a 4-year period from 1975 to 1978. Clinicopathologic features seem to vary from those reported in the western literature, but are similar to the patterns observed in Africa and South America. Thirty-three percent of all malignant lymphomas were Hodgkin's disease. Histologically, the mixed cell (MC) type (40%) and the lymphocytic predominant (LP) type (24%) were the most common, with 52% of patients presenting in Stages III and IV. The nodular sclerosis (NS) variant occurred in only 11% of the cases. Systemic symptoms were present in 24% of clinical Stage I patients, and increased steadily to 85% in Stage IV patients. Bone marrow biopsies in 242 patients were found to be of little value in Stages I and II. Thirty of 34 patients with positive bone marrow biopsy were in clinical Stages III B and IV, whereas 24 of 34 patients showed MC and LD patterns. Lymphangiography in 104 patients altered the clinical staging of Stages I and II in 27% of the cases with accuracy of 80%. Staging laparotomy performed in 93 patients altered the stage in 45% of clinical Stage I and 62% of Stage II patients. Splenic involvement was common in the presence of systemic symptoms (67%) and MC/LD histology (82%). The incidence of liver involvement was 16% in 15 patients with all, but one, associated with splenic pathology. The clinical stage and histopathologic variants of the disease bear an excellent correlation with a significant impact on treatment responses and total survival. The survival rates for Stage I were 81%, Stage II 76%, Stage IIIA 71%, and Stage IIIB and IV 46% at 48 months. The LP type had the best prognosis with 85% survival at 48 months, whereas the survival in the depleted variety was only 56%. Surprisingly, the MC type did better with a 64% survival, while the nodular sclerosis group had 59% surviving at 48 months.

[Cutaneous localization of Hodgkin's disease. Description of 4 cases and review of the literature]. / Les localisations cutanées de la maladie de Hodgkin. Description de quatre cas et revue de la littérature.

Cutaneous involvement is uncommon in Hodgkin disease. Among 167 Hodgkin patients, we observed skin lesions in four. Clinical and histopathological features are discussed and compared with those of 40 other well-documented cases previously reported in the literature. The wide spectrum of clinical patterns and variability of outcome are underlined. Skin biopsy is mandatory and provides cardinal evidence for diagnosis; however, the Reed Sternberg cell is not absolutely specific and caution must be taken in affirming a disease which implies major therapy. In most observations, skin involvement obviously has no bearing on prognosis. We believe that the reality of specific Hodgkin skin lesions is subject to major reservations.

Total, dialyzable, and nondialyzable postabsorptive hydroxyproline. Values in patients with cancer.

The postabsorptive urinary total (T), dialyzable (D), and nondialyzable (ND) hydroxyproline (HYPRO) tests were evaluated to determine whether the patterns of excretion varied according to the predominance of osteoblastic v osteolytic bone involvement in 58 patients with neoplastic disease. In patients with osteolytic lesions from multiple myeloma, elevated T and D levels with normal ND HYPRO values were observed, along with elevated D/ND ratios. In prostate cancer, the T, D, and ND values were all elevated and the D/ND ratio was normal. Patients with Hodgkin's disease had elevated T, D, and ND HYPRO levels, and the D/ND ratio was in the range of patients with prostate cancer. The data suggest that these collagen markers may be useful in the long-term evaluation of these neoplasms in patients.