The relationship between FDG PET/CT-defined metabolic parameters and the histopathological subtype of oesophageal carcinomas.

PURPOSE: 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) combined with computed tomography (CT) scan is accepted as a standard tool in the staging of oesophageal cancer (OC). Histological subtype of tumour is known to be a major determinant of prognosis and metabolic behaviour. In this study, we aimed to evaluate the effect of histological subtypes of OC on standard uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLG) obtained by PET/CT, and also to compare this effect with prognosis. MATERIAL AND METHODS: Images and clinical course data of 57 patients who were diagnosed with EC and treated in our hospital between 2009 and 2016 were evaluated in a retrospective manner. PET/CT images were re-analysed in terms of metabolic parameters, and observations were compared with histological subtypes. RESULTS: No significant difference was observed between histological subtypes with SUVmax, overall survival (OS), or progression-free survival (PFS). Thus, MTV was observed to be related with histological subtype; MTV values of adenocancer patients were significantly higher than those of squamous cell cancer patients. CONCLUSIONS: Metabolic tumour volume was related with histological subtype of OC, but clinical staging, TLG, and SUVmax values were not related with histological subtype, which may suggest the use of MTV as a routine parameter for OC and inclusion of MTV observations in prognostic scoring.

Recurrent Merkel cell carcinoma of the gluteal region: A case report.

Merkel cell carcinoma (MCC) is a rare malignant tumor of the skin. The development of MCC on non-sun-exposed skin is extremely rare, with few cases reported in the literature. The present authors aimed to highlight the characteristic features and treatment options of this tumor. The present authors present a 50-year-old man who developed MCC on the left gluteal region (non-sun-exposed skin). After surgery with clear margins, adjuvant radiotherapy was given. Three months after radiotherapy, lymphatic recurrence was observed and he was treated with chemotherapy. On follow-up, systemic metastases were found and palliative treatment was planned.

Comparison of clinicopathological features in incidental and nonincidental papillary thyroid carcinomas in 308 patients.

Incidental papillary thyroid carcinomas (IPTCs) consist of a significant portion of increasing incidence in papillary thyroid carcinomas. This study investigated the clinicopathological features of IPTCs from different perspectives and by comparing nonincidental PTCs (NIPTCs) in patients who underwent total thyroidectomy and lymph node dissection. Basic results were as follows. IPTC was present in 27.9% of 308 patients. IPTCs were significantly accompanied by lymphocytic thyroiditis (LT), particularly, multinodular hyperplasia (MNH). IPTCs were more common in older patients (51.3 years vs. 47.2 years) and in female patients. IPTCs significantly differed from NIPTCs in terms of smaller tumour size, lymphatic vessel invasion (2.6% vs. 97.4%), extrathyroidal extension (4.3% vs. 95.7%), lymph node metastasis (3.6% vs. 96.4%), multifocality (21.2% vs. 78.8%), bilaterality (5.3% vs. 94.7%), and BRAFV600 mutation (6.7% vs. 93.3%). Older age, bilaterality, encapsulation, and radioactive iodine (RAI) were significantly more common in IPTCs > 5 mm than in those ≤ 5 mm. In conclusion, IPTCs are more commonly associated with LT and MNH. IPTCs may have a more favourable prognosis than NIPTCs, and tumour size > 5 mm may predict bilaterality and need for RAI. Nevertheless, the patient-based clinical approach in IPTCs may have benefits in the management of IPTCs.

Histological perspective on the effects of tumor-associated macrophages in the tumor microenvironment surrounding papillary thyroid carcinoma.

Tumor-associated macrophages (TAMs) are one of the most noticeable elements of the tumor microenvironment. The present study investigated the relationships between the density of CD163 immunolabeled M2-like TAMs with other histological properties of the tumor microenvironment and clinipathological features in 90 patients with papillary thyroid carcinomas (PTC). The percentage of TAMs was higher in tumors with significant lymphocytic tumor response (p = 0.020), in tumors with a significant degree of stromal tumor response (p = 0.014), those with infiltrative tumor borders (p = 0.029), in conventional variant papillary carcinoma (p = 0.032), and in patients with autoantibodies for thyroid peroxidase (p = 0.014). The tumors associated with lymphocytic thyroiditis had lower numbers of TAMs (p = 0.027). In conclusion, for the first time, the present study attempts to establish a full assessment of interactions of CD163 expressing M2-like TAMs with the triad of primary tumor- tumor microenvironment- tumor behavior and above all, with markers of autoimmunity. Thus, these alternatively polarized macrophages may act in tumor progression and dissemination according to their various products, which may be ordered by tumor cells or neighboring immune cells. The molecular studies may reveal their roles in various tumors and may improve the therapy strategies targeting TAMs in various malignant tumors, including PTCs.

The Role of 68 Ga PSMA Imaging in Evaluating Adrenal Lesions in Prostate Cancer Patients.

Objectives Gallium-68 prostate-specific membrane antigen ( 68 Ga-PSMA) imaging is valuable for staging because an accurate diagnosis, metastatic or nonmetastatic for prostate cancer patients, is required for deciding to treatment approaches and prognostic assessment. The aim of this study was primarily to distinguish between benign and metastatic adrenal gland lesions detected during 68 Ga-PSMA positron emission tomography (PET)/CT imaging, to evaluate the presence of factors predicting its development, and then to determine the life expectancy of patients with metastatic adrenal lesions. Materials and Methods We performed a database search for PET/CT records generated from June 2016 to February 2021 for "adrenal gland" in report for patients who underwent 68 Ga-PSMA examination with prostate cancer patients. Results Twenty-three patients (10 benign and 13 metastatic) were included in this study. The total prostate-specific antigen, adrenal gland size, adrenal gland density, and maximum standardized uptake (SUVmax) values are significantly different between groups ( p < 0.05). On receiver operating characteristic curve analysis, the SUVmax cutoff value > 6.8 provided both sensitivity and specificity of 100%. However, with 29 mm as the adrenal gland size cutoff and 21.2 as Hounsfield unit, the sensitivity and specificity were 56.2 and 92.3%, and 93.8 and 92.3%, respectively. The survival of the benign and metastatic groups was compared and a statistically significant difference was found ( p = 0.006). The presence of pelvic lymph nodes was statistically negatively affected the surveillance between the groups. Conclusion The presence of atypical metastases such as adrenal gland is not insignificant in prostate cancer patients. Because of this degree of impact on patient management, accurate staging by imaging with 68 Ga-PSMA should be an integral part of prostate cancer management.

Evaluation of the factors affecting survival and local recurrence in thigh soft tissue sarcomas.

OBJECTIVES: The aim of this study was to evaluate the factors affecting local recurrence and survival in patients with soft-tissue sarcomas located in the thigh. PATIENTS AND METHODS: This retrospective cross-sectional study evaluated 41 soft tissue sarcoma patients (21 males, 20 females; mean age: 57.9±13.7 years; range, 18 to 90 years) with thigh involvement between January 2010 and December 2020. All surgical intervention was performed by one surgeon with an experience of 15 years in orthopedic oncologic surgery. Epidemiological, radiological, histopathological, and metabolic features, as well as surgical and oncological treatments and prognoses, were assessed. The data was statistically analyzed to determine factors affecting local recurrence and survival in these cases, staged using Enneking and the American Joint Committee on Cancer classifications. RESULTS: Liposarcomas were the most common type of tumor (39%), followed by undifferentiated pleomorphic sarcomas (32%). Tumors >10 cm were associated with decreased survival rates. High-grade tumors, tumor necrosis, Ki-67 index >20%, and positive surgical margins were also associated with lower survival rates. Metastatic patients had significantly lower survival rates. Local recurrence was significantly more frequent in patients with positive surgical margins. Survival rates were significantly lower in metastatic patients. CONCLUSION: There are many factors that affect local recurrence and survival of soft tissue sarcomas. The size of the mass, the presence of necrosis, a high Ki-67 index, positive surgical margins, and the presence of metastasis are the main factors that should be taken into consideration.

The Impact of Total Tumor Diameter on Lymph Node Metastasis and Tumor Recurrence in Papillary Thyroid Carcinomas.

(1) Introduction: The impact of multifocality/bilaterality on the prognosis of papillary thyroid carcinoma (PTC) is a matter of debate. In order to clarify this debate, several studies have attempted to identify additional parameters associated with poor prognosis, including total tumor diameter (TTD), in the context of multifocal PTCs. In this context, this study was carried out to investigate the impact of TTD on tumor recurrence and lymph node metastasis (LNM) in PTCs. (2) Materials and Methods: The sample of this single-center retrospective study consisted of 706 patients diagnosed with PTC. TTD was calculated as the sum of the largest diameters of tumor foci in multifocal tumors. The resulting TTDs were grouped into TTDs ≤ 10 mm, TTDs > 10 mm, TTDs ≤ 20 mm, and TTDs > 20 mm, using 10 mm and 20 mm as cutoff values. (3) Results: There was no significant difference between multifocal papillary microcarcinomas (PTMCs) with a TTD of >10 mm and unifocal PTCs with a primary tumor diameter (PTD) of >10 mm except for advanced age and lymphovascular invasion (LVI). In addition, perineural invasion (PNI) and TTD > 10 mm were found to be significant risk factors for LNM, and PNI, TTD > 10 mm, TTD > 20 mm, and bilaterality were found to be significant risk factors for recurrence. LVI, and TTD > 10 mm were found to be independent significant predictors for recurrence, and LVI and extrathyroidal extension (ETE) were found to be independent significant predictors for LNM. (4) Conclusions: Considering TTD > 10 mm in recurrence risk categorization models and adopting a clinical approach that takes into account multifocal PTMCs with TTD > 10 mm along with unifocal PTCs with PTD > 10 mm may be more useful in terms of clinical management of the disease.

Assessment of three different radioiodine doses for ablation therapy of thyroid remnants: Efficiency, complications and patient comfort.

I-131 radioiodine (RAI) ablation removes postoperative residual tissue and facilitates follow-up in low- and intermediate-risk differentiated thyroid cancer (DTC). Although low doses have been reported to be as effective as higher doses for ablation, the doses administered still vary depending on the patient and the practitioner. We aimed to evaluate the ablation efficiency, complications, and length of stay (LOS) of patients with DTC treated with 3 different doses for ablation. Patients with DTC who received RAI therapy were retrospectively reviewed. One hundred thirty patients with low-intermediate-risk, according to American Thyroid Association classification, without known lymph nodes or distant metastases were included. Patients were divided into 3 groups as 30 to 50 mCi, 75 mCi, and 100 mCi. Residue thyroid and salivary glands were evaluated from 9 to 12 months post-RAI I-131 scans. No significant difference was found between groups regarding ablation success (P = .795). In multivariable analyses, pretreatment thyroglobulin (hazard ratio = 0.8, 95% confidence interval 0.601-0.952, P = .017) and anti- thyroglobulin antibody (hazard ratio = 1.0, 95% confidence interval 0.967-0.998, P = .024) were 2 independent predictors of ablation success. The mean LOS was 2.1 ±â€…0.3, 2.6 ±â€…0.6, and 2.9 ±â€…0.4 days, respectively, (P = .001). LOS rates of ≥ 3 days were 13.2%, 54.3%, and 84.8%, respectively. Mild decreases in hemoglobin, white blood cell (WBC), and platelet counts were observed in all groups after 6 weeks without any clinically significant findings. A lower rate of change in WBC counts was observed in the 30 to 50 mCi group compared to others. There was no dose-dependent difference regarding the early complaints questioned. Ablation with 30 to 50 mCi provides benefits such as shorter LOS, better patient comfort, less salivary gland dysfunction, and less WBC suppression, thus reducing costs without decreasing efficacy.

Development of a Radiolabeled Folate-Mediated Drug Delivery System for Effective Delivery of Docetaxel.

Many preclinical studies are carried out with the aim of developing new formulations for the effective delivery of taxane class drugs, one of the most important anticancer drugs used clinically today. In this study, a radiolabeled folate-mediated solid lipid magnetic nanoparticle (SLMNP) system was developed by loading superparamagnetic iron oxide nanoparticles (MNP) and docetaxel (DTX) into the solid lipid nanoparticles as a drug delivery system that will function both in cancer treatment and diagnosis. For this purpose, first, SLMNP was synthesized by the hot homogenization method, and the surface of the particles was modified with a folate derivative to carry the particles to tissues with folate receptors. The synthesized magnetic solid lipid nanoparticles were loaded with DTX, and then radiolabeling was carried out with technetium-99 m (99mTc-DTX-SLMNP). Structural characteristics of these nanoparticles were determined by characterization methods. According to the TEM images of MNPs, SLN, and SLMNPs, MNPs were observed between 25and 35 nm, SLNs between 400 and 500 nm, and SLMNPs between 350 and 450 nm. The drug entrapment efficiency of SLMNPs loaded with DTX was found to be 19%, and the percentage efficiency of radiolabeling was found to be 98.0 ± 2.0%. The biological behavior of this radiolabeled system was investigated in vitro and in vivo. Folate receptor-positive SKOV-3 and folate receptor-negative A549 cancer cell lines were studied. The IC50 values of DTX-SLMNP in SKOV-3 and A549 cells were 50.21 and 172.27 µM at 48 h, respectively. Gamma camera imaging studies of 99mTc-DTX-SLMNP and magnetically applied 99mTc-DTX-SLMNP compounds were performed on tumor-bearing CD-1 nude mice. The uptake in the folate receptor-positive tumor region was higher than that in the folate receptor negative tumor region. We proposed that the drug delivery system we prepared in this study be evaluated for preclinical studies of new drug carrier formulations of the taxane class of anticancer drugs.

Experimental Breast Cancer Models: Preclinical Imaging Perspective.

BACKGROUND: Breast cancer is the leading cause of cancer in women. 13% of breast cancer patients are at a distant stage and mortality is due to metastases rather than primary disease. The unique genetic structure and natural process of breast cancer make it a very suitable area for targeted therapies. Experimental tumor models are validated methods to examine the pathogenesis of cancer, the onset of the neoplastic process and progression. OBJECTIVE: This study aims to review the current literature on experimental breast cancer models and to bring a new perspective to the use of these models in teranostic preclinical studies in terms of the imaging. METHODS: Search for relevant literature from academic databases using keywords (Breast cancer, theranostic, preclinical imaging, tumor models, animal study, and tailored therapy) was conducted. The full text of the articles was reached and reviewed. Current scientific data has been reevaluated and compiled according to subtitles. RESULTS AND CONCLUSION: The development of animal models for breast cancer research has been done in the last century. Imaging methods used in breast cancer are used for tumor localization, quantification of tumor mass, imaging of genes and proteins, evaluation of tumor microenvironment, evaluation of tumor cell proliferation and metabolism and treatment response evaluation. Since human breast cancer is a heterogeneous group of diseases in terms of genetics and phenotype; it is not possible for a single model to adequately address all aspects of breast cancer biology. Considering that each model has advantages and disadvantages, the most suitable model should be chosen to verify the thesis of the study.

68Ga-PSMA-I&T-PET/CT interobserver and intraobserver agreement for prostate cancer: a lesion based and subregional comparison study among observers with different levels of experience.

OBJECTIVE: 68Ga-PSMA-PET/CT is a relatively new technique, that is rapidly becoming widespread. We aimed to contribute interobserver-intraobserver agreement of 68Ga-PSMA-PET/CT, among low/high-experienced interpreters. METHODS: 68Ga-PSMA-PET/CT of 56 patients with prostate cancer were evaluated blindly by four observers. Visual interpretation of malignant disease and SUVmax for lymph node (LN) regions, local tumor, bones and visceral organs were recorded. Cohen's Kappa and Fleiss' Kappa analyses were used to measure agreement between low/high/all-experienced observers. Variations were compared for regions, and the effect of prostate-specific antigen or Gleason score on the results was investigated. RESULTS: Interobserver agreement was almost perfect for all LN regions (LN1 low-experienced κ: 0.84/0.84, high-experienced 0.89/0.96; LN2 low-experienced κ: 0.88/0.79, high-experienced 0.95/0.95; LN3 low-experienced κ: 0.84/0.89, high-experienced 0.87/0.94, first/second readings, respectively) and bone lesions (low-experienced κ: 0.88/0.88, high-experienced 0.92/0.92, first/second readings, respectively). For local tumor, interobserver agreement was substantially-almost perfect among a high-experienced group (κ: 0.74/0.89, first/second readings, respectively), and was moderate-substantial among a low-experienced group (κ: 0.62/0.56, first/second readings, respectively). Intraobserver agreement was almost perfect for three observers for all regions and substantial for the observer with the lowest experience in LN3, local and visceral lesions (κ: 0.74/0.79/0.62, respectively). CONCLUSION: Interpretation of prostate-specific membrane antigen (PSMA) for prostate cancer is acceptably consistent among observers, but some details are noteworthy. The evaluation should be done more algorithmically for local tumors, since all observers showed relatively lower agreement. The agreement increased as prostate-specific antigen and Gleason score increased. The observer with PSMA experience <30 readings showed lower reliability, distinct from the others. This indicates that although a reader may be familiar with other PET agents, a more consistent interpretation of 68Ga-PSMA-PET/CT requires training with a small number of identified cases.

Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study.

OBJECTIVE: This study aimed to investigate the clinical, pathological, and prognostic characteristics of acral metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival. METHODS: In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type, localization of acral metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acral metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Bone and Soft Tissue Tumors Council and categorized into 3 groups: excisional surgery (amputations and resections), palliative surgery (prophylactic fixation, intralesional curettage, and bone cement augmentation), and non-surgical treatment (chemotherapy, radiotherapy, and hormone therapy). RESULTS: A total of 16 acral metastases (25%) were identified in the upper extremity and 48 (75%) in the lower extremity. The most common primary tumor site was the lungs (32.6%), and the most common tumor type was adenocarcinoma (43.2%). The most frequent symptom and the primary reason for admission was pain (58.7%). The mean duration between the diagnosis of primary tumor and the diagnosis of acral metastasis was 19.1 (range, 0-124) months. No significant correlation was determined between the primary tumor types and duration from the diagnosis of primary tumor to the diagnosis of acral metastasis (p=0.278). Acral metastases were treated by excisional surgery in 15 (32.6%) patients, palliative surgery combined with non-surgical treatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up, 30 (65.2%) patients were dead owing to the disease. The mean overall survival of the entire study group was 24.9 (range, 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012). CONCLUSION: When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival. LEVEL OF EVIDENCE: Level IV, Prognostic study.

Validation of Cymbasoma turcorum and Monstrillopsis pontoeuxinensis, two monstrilloids from Turkey described by Suárez-Morales amp; Üstün in 2018 (Crustacea: Copepoda: Monstrilloida).

Recently, Suárez-Morales Üstün (2018) described two new species of monstrilloid copepods, Cymbasoma turcorum and Monstrillopsis pontoeuxinensis from Turkish coastal waters of the Black Sea. The morphological descriptions, illustrations, and type designations presented in that paper fully characterized both new species; however, the journal issue in which the description appeared was published only online, with no print version (Suárez-Morales Üstün 2018), and the article in which these new names were introduced did not include a ZooBank registration number (LSID) for the article or any other evidence of such registration. This is currently required by Article 8.5 of the International Code of Zoological Nomenclature for an electronic work to be deemed "published" under the Code (International Commission on Zoological Nomenclature 2012). Inasmuch as Suárez-Morales Üstün (2018) is an "unpublished work", the specific names turcorum and pontoeuxinensis proposed in it are unavailable. The present note is intended to fully validate these two names by proposing them once again as new while also fulfilling all of the Code's current conditions for nomenclatural availability of this work itself and the two new names. The date and authorship of these two specific names will, accordingly, be those of this note, not Suárez-Morales Üstün (2018).

18F-NaF PET/CT and Extraordinary Involvement: Non-calcific Brain Involvement in a Prostate Cancer Case

With the increase in the diagnosis of the cancer, the frequency of using imaging methods for diagnosis and for staging is also increased. Because of the complex structure of cancer and tumor behavior, the assessment methods have been updated and metabolic imaging has gained weight. The most popular of these techniques is hybrid positron emission tomography/computed tomography (PET/CT) systems. Prostate cancer is the second most common cancer in the world, is the fifth common type in cancer-related male deaths. Estimation of prognosis and treatment planning of the patients are based on the TNM classification. Bone metastasis is a prognostic factor of morbidity and mortality in prostate cancer. Sodium fluoride (NaF) PET/CT is a promising imaging modality in evaluation of skeletal system. This article will review the involvement of 18F-NaF in extra-osseous tissues in the prostate cancer and reveal the fundamental differences between 18F-NaF imaging and 18F-FDG imaging in these areas.

The relation between BRAFV600E mutation and clinicopathological characteristics of papillary thyroid cancer.

Aim BRAF mutation inhibits many tumour suppressor genes, increases pro-angiogenic molecules and reduces radioactive iodine uptake of tumour in papillary thyroid cancer (PTC), giving it more aggressive clinical characteristics. In this study, we aimed to evaluate the effect of BRAF V600E mutation on the clinicopathological features in patients with PTC. Methods The laboratory and clinical findings of 256 PTC patients who were referred to our clinic between 2007 and 2017 were assessed. Subjects involved in the study were divided into two groups depending on the presence of BRAF V600E mutation. Results BRAF V600E mutation testing gave positive results for 65 (25.4%) out of 256 patients. No significant correlation between BRAF V600E mutation, age and gender was detected. There was no difference between the groups in terms of tumour variant, tumour localization, tumour focality, and perineural invasion. In terms of histopathologic characteristics, presence of tumour capsular invasion (p=0.027), extrathyroidal extension (ETE) (p=0.002), absence of pathologically detected lymphocytic thyroiditis (p=0.006) and radio iodine I-131 treatment (p=0.001) were significantly higher in BRAF V600E (+) patients. During a followup period, four patients with BRAF V600E (+) and two patients with BRAF V600E (-) status underwent lateral neck dissection due to lymph node metastasis (p=0.01). Conclusion The presence of BRAF V600E mutation was proved to be a poor prognostic factor. However, in order to further assess the prognostic effect of BRAF V600E mutation in this group of patients and particularly its effect on mortality, long term followup results must be evaluated.

Comparison of clinicopathological features in patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer.

INTRODUCTION: Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly defined entity accepted as a tumor precursor. OBJECTIVES: We aimed to examine the features of patients diagnosed with follicular variant papillary thyroid carcinoma (FVPTC), which are classified as NIFTP in the recent classification. This study compares clinical, radiological, histopathological, and molecular featur es of NIFTP and FVPTC. PATIENTS AND METHODS: A total of 247 patients with FVPTC were retrospectively examined and pathology specimens were reviewed. RESULTS: Patients were divided into 2 groups (NIFTP group: 107 patients; FVPTC group: 140 patients). There was a difference in terms of the percentage of pathologic nodules with irregular borders detected on preoperative neck ultrasonography (NIFTP group: 6.5%, FVPTC group: 15.7%; P = 0.02). Central lymph node dissection specimens of 50 patients in the NIFTP group were normal, while 4 of 70 patients (5.7%) in the FVPTC group had lymph node metastasis (P = 0.14). In addition, multivariable analysis (binary logistic regression) showed that FVPTC was positively associated only with irregular borders and extrathyroidal extensions (P = 0.02 and P <0.001, respectively). CONCLUSIONS: We suggest that patients diagnosed with NIFTP according to the new classification are considered lowrisk, and margin characteristics of the nodule detected on preoperative ultrasonography may be helpful in the differential diagnosis.

Histopathological and scintigraphic comparisons of the protective effects of L-carnitine and amifostine against radiation-induced late renal toxicity in rats.

1. The aim of the present study was to compare the protective effects of L-carnitine and amifostine against radiation-induced late nephrotoxicity using technetium-99m diethylenetriaminepentaacetic acid scintigraphy and histopathological examination. 2. Seventy-one Albino rats were randomly divided into six groups as follows: (i) AMI + RAD (n = 15), 200 mg/kg, i.p., amifostine 30 min prior to irradiation (a single dose of 9 Gy); (ii) LC + RAD (n = 15), 300 mg/kg, i.p., L-carnitine 30 min prior to irradiation; (iii) LC (n = 10), 300 mg/kg, i.p., L-carnitine 30 min prior to sham irradiation; (iv) AMI (n = 10), 200 mg/kg, i.p., amifostine 30 min prior to sham irradiation; RAD (n = 11), 1 mL/kg, i.p., normal saline 30 min prior to irradiation; and (vi) control (n = 10), 1 mL/kg, i.p., normal saline 30 min prior to sham irradiation. Scintigraphy was performed before treatment and again 6 months after treatment. Kidneys were examined by light microscopy and a histopathological scoring system was used to assess the degree of renal damage. 3. The main histopathological findings were proximal tubular damage and interstitial fibrosis. Glomerular injury was similar in all groups. Tubular degeneration and atrophy were less common in the AMI + RAD group than in the RAD group (P = 0.011 and P = 0.015, respectively), as well as in the LC + RAD group compared with the RAD group (P = 0.028 and P = 0.036, respectively). Interstitial fibrosis in the AMI + RAD and LC + RAD groups was significantly less than that in the RAD group (P = 0.015 and P = 0.015, respectively). The highest total renal injury score (9) was seen in the RAD group. On scintigraphy, there were significant differences in post-treatment time to peak count (T(max)) and time from peak count to half count (T((1/2))) values (P = 0.01 and 0.02, respectively) between groups in the right kidney. In the control and RAD groups, the T((1/2)) of the right kidney was 8 +/- 2 and 21 +/- 2 min, respectively. The T(max) values for the AMI + RAD and LC + RAD groups (2.8 +/- 0.2 and 3.2 +/- 0.2 min, respectively) were similar to those in the control group (2.5 +/- 0.3 min). 4. Based on the results of the present study, L-carnitine and amifostine have comparable and significant protective effects against radiation-induced late nephrotoxicity.

The Clinical Significance of Incidental Parotid Uptake in a PET/CT Study: A Diagnostic Algorithm.

BACKGROUND: Patients diagnosed with cancer do not have sufficient clinical data for the management of incidental parotid lesions. We aimed to reveal the importance of randomized parotid lesions encountered during oncologic F-18 fluorodeoxyglucose positron emission tomography (FDG PET/CT) imaging in our clinical practice and the diagnostic algorithm of such lesions. METHODS: We performed a database search of PET/CT records generated from 2009 to 2015 for "parotid" in reports of patients who underwent PET/CT examination for a known malignancy elsewhere, or cancer screening. RESULTS: Incidental parotid FDG uptake on PET/CT had a prevalence of 1.1%. The incidence of parotid metastasis in our series was 36.4%, and 75% of them had malign melanoma metastasis. Of the 11 cases, 5 were of Warthin tumours, and Warthin tumours showed stronger GLUT1 expression than metastatic parotid lesions. CONCLUSION: In patients with malignancy elsewhere, focal involvement of FDG by the parotid gland, especially if malignant melanoma or SCC is absent, should not be considered a metastatic disease without histopathologic confirmation. If parotid disease would change the patient's treatment plan and disease stage, the parotid lesion should be evaluated by additional methods, such as fine needle aspiration biopsy.

Liver Metastasis of Lung Cancer Detected with Similar Uptake Pattern on Bone Scintigraphy and Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: What's the Pathophysiologic Mechanism?

Bone scintigraphy with 99mTc diphosphonates may exhibit extraosseous lesions in addition to metastatic lesions. Multiple factors can affect extraosseous 99mTc methylene diphosphonate (MDP) uptake. Similar uptake pattern of 99mTc MDP and fluorine-18 fluorodeoxyglucose (18F FDG) in hepatic metastasis was not already notified. In our case, initial tumor necrosis and subsequent intracellular calcification resulted in similar 99mTc MDP and 18F FDG accumulation in the metastatic area.