Risk stratification in diffuse large B-cell lymphoma using lesion dissemination and metabolic tumor burden calculated from baseline PET/CT†.

BACKGROUND: We analyzed the prognostic value of a new baseline positron emission tomography (PET) parameter reflecting the spread of the disease, the largest distance between two lesions (Dmax). We tested its complementarity to metabolic tumor volume (MTV) in a large cohort of diffuse large B-cell lymphoma (DLBCL) patients from the REMARC trial (NCT01122472). PATIENTS AND METHODS: MTVs were defined using the 41% maximum standardized uptake value threshold. From the three-dimensional coordinates, the centroid of each lesion was automatically obtained and considered as the lesion location. The distances between all pairs were calculated. Dmax was obtained for each patient and normalized with the body surface area [standardized Dmax (SDmax)]. RESULTS: From the REMARC trial, 290 patients aged 60-80 years were included: 91% had an advanced stage and 71% International Prognostic Index (IPI) ≥3. High versus low SDmax significantly impacted progression-free survival (PFS) (P < 0.0001) and overall survival (OS) (P = 0.0027). Patients with SDmax > 0.32 m-1 (n = 82) had a 4-year PFS and OS of 46% and 71%, respectively, against 77% and 87%, respectively, for patients with low SDmax. High SDmax and high MTV were independent prognostic factors of PFS (P = 0.0001 and P = 0.0010, respectively) and OS (P = 0.0028 and P = 0.0004, respectively). Combining MTV and SDmax yielded three risk groups with no (n = 109), one (n = 122) or two (n = 59) factors (P < 0.0001 for both PFS and OS). The 4-year PFS were 90%, 63%, 41%, respectively, and the 4-year OS were 95%, 79%, 66%, respectively. In addition, patients with at least two of the three factors including high SDmax, high MTV, Eastern Cooperative Oncology Group (ECOG) ≥2 had a higher number of central nervous system relapse (P = 0.017). CONCLUSIONS: SDmax is a simple feature that captures lymphoma dissemination, independent from MTV. These two PET metrics, SDmax and MTV, are complementary to characterize the disease, reflecting the tumor burden and its spread. This score appeared promising for DLBCL baseline risk stratification.

Expression of factors involved in dental pulp physiopathological processes by nemotic human pulpal fibroblasts.

AIM: To investigate in human dental pulp fibroblasts (HDPF) the expression of factors involved in dental pulp physiopathological processes and in an experimental model of cell activation called nemosis, and to compare the behaviour of pulp cell activation with sound lung fibroblast MRC5, employed as a reference model for nemosis. METHODOLOGY: Nemotic response was induced in three-dimensional cultures of HDPF and lung fibroblasts. The expressions of molecules involved in physiological (alkaline phosphatase, type I collagen) and in inflammatory processes (IL-6, CXCL8, CCL20, COX-2) were studied using real-time PCR. Concentrations of IL-6 and CXCL8 were analysed during 4 days with ELISA. Nonparametric tests were used to determine statistical differences between groups. RESULTS: A significant decrease (P < 0.001) in type I collagen and alkaline phosphatase was observed in MRC5 and HDPF nemotic responses. Although the amounts of mRNA differed between these cell types, there was an increase in CCL20, CXCL8 and COX-2 expression (P < 0.001). Unlike HDPF, MRC5 spheroids displayed significant amounts of IL-6 concentrations and mRNA expression. Notably, increased concentrations of CXCL8 were recorded in all three-dimensional cultures compared with monolayers as a function of time (P < 0.05). CONCLUSION: Although the nemotic responses observed were not identical in the pulpal and lung fibroblasts, similarities occurred in the expression of chemokines and cyclooxygenase-2. Nemotic reactions and inflammatory processes in pulp diseases share similarities in terms of the expression of factors. Thus, this in vitro model could constitute a powerful tool to study intercellular relations within the dental pulp and to develop new local treatments to counteract the inflammatory reaction that occurs during pulpitis.

[Multiple granular cell tumours in a patient with Noonan's syndrome and juvenile myelomonocytic leukaemia]. / Tumeurs à cellules granuleuses multiples chez un enfant atteint d'un syndrome de Noonan compliqué de leucémie myélomonocytaire juvénile.

BACKGROUND: Granular cell tumour (GCT) is a rare form of tumour comprising Schwann cells. Herein, we report a case of a child presenting Noonan syndrome complicated by juvenile myelomonocytic leukaemia (JMML) and who also developed a multiple form of GCT. We discussed the molecular mechanisms that might account for this association. PATIENTS AND METHODS: A six-year-old boy with Noonan syndrome complicated by JMML presented three asymptomatic subcutaneous nodules on his back, forearm and neck. Histological analysis revealed GCT. A literature review revealed seven cases of Noonan syndrome presenting GCT, none of which were associated with JMML. Mutation of gene PTPN11, via hyperactivation of intracellular Ras signalling may cause the development of GCT and JMML in children presenting Noonan syndrome. DISCUSSION: Detailed clinical examination is recommended in children presenting GCT to screen for multiple forms and for signs of malformation suggestive of a genetic syndrome. Ours is the first case to be described of Noonan syndrome complicated by JMML associated with multiple GCT. This association once again raises the important question of the role of the Ras-MAPK signalling pathway in the development of benign and malignant tumours of solid organs or blood, associated with genetic syndromes.

Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio, and non-invasive coronary flow reserve.

To test the usefulness of non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography by comparison to invasive fractional flow reserve (FFR) and instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, in patients with left anterior descending artery (LAD) stenosis of intermediate severity (IS) and stable coronary artery disease. 94 consecutive patients (mean age 68 ± 10 years) with angiographic LAD stenosis of IS (50-70 % diameter stenosis), were prospectively studied. IFR was calculated as a trans-lesion pressure ratio during the wave-free period in diastole; FFR as distal pressure divided by mean aortic pressure during maximal hyperemia (using 180 µg intracoronary adenosine); and CFR as hyperemic peak LAD flow velocity divided by baseline flow velocity using intravenous adenosine (140 µg/kg/min over 2 min). The mean values of IFR, FFR, and CFR were 0.88 ± 0.07, 0.81 ± 0.09, and 2.4 ± 0.6 respectively. A significant correlation was found between CFR and FFR (r = 0. 68), FFR and IFR (r = 0.6), and between CFR and IFR (r = 0.5) (all, p < 0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR ≤ 0.8, n = 31) was IFR ≤ 0.88 with a sensitivity (Se) of 74 %, specificity (Sp) of 73 %, AUC 0.81 ± 0.04, accuracy 72 %; and CFR ≤ 2 with a Se = 77 %, Sp = 89 %, AUC 0.88 ± 0.04, accuracy 85 % (all, p < 0.001). In stable patients with LAD stenosis of IS, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation between CFR and FFR than between CFR and IFR, and a trend to a better diagnostic performance for CFR versus IFR.

Assessment of left anterior descending artery stenosis of intermediate severity by fractional flow reserve, instantaneous wave-free ratio and non-invasive coronary flow reserve.

Assessment of the functional significance of left anterior descending coronary artery (LAD) stenosis of intermediate severity is challenging and often based on fractional flow reserve (FFR). The instantaneous wave-free ratio (IFR), a new vasodilator-free index of coronary stenosis severity, and non-invasive coronary flow reserve (CFR) by transthoracic Doppler echocardiography are also potentially useful. A direct comparison of FFR, IFR, and non-invasive CFR has never been performed. Our objective was to test the usefulness of non-invasive CFR by comparison to invasive FFR and IFR in patients with LAD stenosis of angiographic intermediate severity and stable coronary artery disease. METHODS: Ninety-four stable consecutive patients (mean age, 68±10years; 19 women) with angiographic proximal or mid LAD stenosis of intermediate severity (40-70% diameter stenosis on quantitative coronary angiography), were prospectively studied. They underwent IFR that was calculated as a trans-lesion pressure ratio during a specific period of baseline diastole, FFR with intracoronary bolus adenosine (180µg), and CFR using intravenous adenosine (140µg/kg/min over 2min) in the distal part of the LAD, the same day. CFR was defined as hyperemic peak diastolic LAD flow velocity divided by baseline flow velocity and FFR as distal pressure divided by mean aortic pressure during maximal hyperemia. RESULTS: The mean values of IFR, FFR, and CFR were 0.88±0.07, 0.81±0.09, and 2.4±0.6 respectively. A significant correlation was found between CFR and FFR (R=0.63, curvilinear relationship), FFR and IFR (R=0.6, linear relationship), and between CFR and IFR (R=0.5) (all, P<0.01). Using a ROC curve analysis, the best cut-off to detect a significant lesion based on FFR assessment (FFR≤0.8, N=31) was IFR≤0.88 with a sensitivity (Se) of 74%, specificity (Sp) of 73%, AUC 0.81±0.04; and CFR≤2 with a Se=77%, Sp=89%, AUC 0.88±0.04, (all, P<0.001). Based on these cut-offs, discordant results between CFR and FFR were observed in 14 cases (agreement 85%), between CFR and IFR in 26 cases (agreement 72%), and between IFR and FFR in 26 cases (agreement 72%). CONCLUSION: In stable patients with LAD stenosis of intermediate severity, non-invasive CFR is a useful tool to detect a significant lesion based on FFR. Furthermore, there was a better correlation and agreement between CFR and FFR than with IFR.

[Voluminous thrombus straddling the patent foramen oval in the setting of massive pulmonary embolism, treated successfully by surgery]. / Volumineux thrombus enclavé dans le foramen ovale au cours d'une embolie pulmonaire massive, traité avec succès par chirurgie.

Paradoxical embolism is rarely demonstrated, often suggested, and the diagnosis has been largely presumptive in most cases. The patent foramen ovale (PFO) is an important predisposing anatomic factor for such a complication. We describe a case where a voluminous thrombus straddling the PFO was diagnosed by echocardiography including the 3D modality, in the setting of acute massive pulmonary embolism. The treatment is not codified in this setting, and the thrombus was successfully removed by surgery, associated with PFO closure, and anticoagulation.

[Regional recurrence of triple-negative breast cancer: interest of systematic adjuvant lymph node irradiation?]. / Récidives régionales chez les patientes présentant un cancer du sein triple-négatif : intérêt d'une irradiation ganglionnaire adjuvante systématique ?

OBJECTIVE: To evaluate the percentage of regional recurrence (RR) in patients with triple-negative (TN) N0 breast cancer in order to consider the interests of a systematic adjuvant nodal irradiation. PATIENTS AND METHODS: Between February 1996 and June 2009, 249 patients were treated for TN breast cancer in Léon-Bérard center (Lyon, France). All patients received first surgical treatment followed or not by chemotherapy or radiotherapy. We excluded patients with metastasis at diagnosis, patients who were initially irradiated regional lymph node, patients which ER, PR and/or HER2 status was not known and patients who didn't have standard treatment. Ultimately, 100 patients were included. RESULTS: Two patients (2%) developed regional recurrence (1 sub and supraclavicular recurrence and 1 supraclavicular recurrence). The median follow-up was 34 months (95% CI: 29,2 to 37,4). The survival rate at 3 years was 98% (95% CI: 90-99). Our study showed no differences in terms of RR between TN cancers and not TN cancers for a median followed up of 34 months. CONCLUSION: The results of our study do not suggest that patients with TN breast cancer should receive systematic nodal adjuvant radiotherapy.

Characterization of a programmed necrosis process in 3-dimensional cultures of dental pulp fibroblasts.

AIM: To analyse and compare the expression of necrosis markers in human lung and dental pulp fibroblasts and to determine whether this process differs by the type of mesenchymal cell. METHODS: Human dental pulp fibroblasts were obtained from unerupted third molars. Sound lung and pulpal fibroblasts were cultured in vitro as spheroids to determine the expression of the necrosis hallmark cyclooxygenase-2 (COX-2) mRNA using RT-PCR and the concentrations of vascular endothelial growth factor (VEGF) and hepatocyte growth factor/scatter factor (HGF/SF) proteins using an ELISA test. Cell viability within spheroids was also compared with spheroid diameters over time. RESULTS: Increased expression of COX-2 and VEGF was found in all spheroids compared with corresponding monolayers. Although HGF/SF was highly expressed in MRC5 cells, dental pulp fibroblasts aggregates maintained only a basal level compared with monolayer cultures. Further, the observed progressive loss of viable cells explained the decreased diameters of spheroids over time. The results demonstrate that necrosis occurs in sound lung and pulpal fibroblasts. This cell death also displays differences between these two different cell types, as they do not produce the same growth factors quantity release. CONCLUSIONS: The necrosis process occurred in human dental pulp fibroblasts and is different between the two cell types studied. This in vitro experimental necrosis model could become an interesting inflammatory tool. More investigations are needed to compare necrosis process in dental pulp fibroblast and inflammation during pulpitis.

[Non-invasive coronary flow reserve is an independent predictor of exercise capacity after acute anterior myocardial infarction]. / La réserve coronaire non invasive est un prédicteur indépendant de la capacité d'exercice après infarctus antérieur aigu.

BACKGROUND: After acute myocardial infarction (MI) coronary microvascular impairment and reduced exercise capacity are both determinant of prognosis. OBJECTIVE: We tested whether non-invasive coronary flow reserve (CFR) performed after MI predicts post-MI exercise capacity (EC). METHODS: Fifty consecutive patients (pts) (mean age 56.5±11years, 30% women) with a first reperfused ST-elevation anterior MI, and sustained TIMI 3 flow after mechanical reperfusion, underwent prospectively non-invasive CFR in the distal part of the left anterior descending artery (LAD), using intravenous adenosine infusion (0.14mg/kg per minute, within 2min), within 24h after successful primary coronary angioplasty (CFR 1), and 4±1.6months later after a period of convalescence and a cardiac rehabilitation program (CFR 2). CFR was defined as peak hyperaemic LAD flow velocity divided by baseline flow velocity. All pts also underwent semi-supine exercise stress echocardiography (ESE) the same day of CFR 2. ESE was performed at an initial workload of 25-30watts with a 20watts increase at 2-minute intervals. Beta-blockers were withheld 24h before ESE. RESULTS: The mean CFR 2 increased significantly when compared to CFR 1 (2.9±0.65 versus 1.9±0.4, P<0.01). During ESE, percentage of maximal predict heart rate achieved was 82±12%, maximal workload 95±30watts, exercise duration 486±155s, the ratio of double product 3.1±0.8, and EC 5.8±1.1 metabolic equivalents. No ischemia was induced during ESE in all pts, and the degree of mitral regurgitation did not differ significantly between rest and exercise. CFR 2 was significantly correlated to all indices related to EC (all, P<0.01), whereas CFR 1 was correlated to LV systolic function at follow-up (P<0.05) but not to EC. In multivariate analysis including age, sex, and body mass index, CFR 2 remained an independent predictor of EC (P<0.01). CONCLUSION: Contrarily to acute CFR, CFR at follow-up is an independent predictor of EC after reperfused anterior MI. This suggests that the improvement of the coronary microcirculation is closely linked to the physical aptitude after MI.

[Influence of leukocytes on coronary flow reserve, left ventricular systolic function, and in-hospital events, in patients with acute anterior myocardial infarction treated by primary angioplasty]. / Influence des leucocytes sur la réserve coronaire, la fonction systolique ventriculaire gauche, et les complications hospitalières, dans l'infarctus antérieur aigu traité par angioplastie primaire.

OBJECTIVE: To assess the relationship between leukocyte count, non invasive coronary flow reserve (CFR), left ventricular systolic function, and in-hospital adverse events in acute anterior myocardial infarction (AMI) treated by primary angioplasty. METHODS: Leukocyte count at admission and within 24h after angioplasty, and differential count at admission were obtained in 72 consecutive patients with a first AMI (mean age 56±12 years) successfully treated by primary angioplasty. Transthoracic Doppler echocardiography was performed within 24h after angioplasty and 3 months later to assess the CFR (using intravenous adenosine), in the left anterior descending artery (LAD), left ventricular ejection fraction (LVEF) and the wall motion score index using the nine segments assigned to the LAD territory (WMSi-lad). In hospital events were defined as death, heart failure (Killip≥2) and reinfarction. RESULTS: Leukocyte count was higher before and after angioplasty in patients with impaired acute CFR (<1.7), when compared to patients without such impairment (P≤0.01), and a significant correlation was found between CFR and leukocyte, neutrophil and monocyte count (P<0.05). Leukocyte (before and after angioplasty), and neutrophil count, were lower in patients with recovery of global and regional LV function (P<0.05). A significant correlation was found between leukocyte count before and after angioplasty, and, initial and follow-up LVEF, and WMSi-lad (all, P≤0.01). Leukocyte (before and after angioplasty) and monocyte count were higher in patients with in-hospital events (n=14), by comparison to patients without events (all, P<0.01). In multivariate analysis, leukocyte count after angioplasty was an independent predictor of CFR, and in-hospital events, and neutrophil count of WMSi-lad at follow-up (all, P<0.05). CONCLUSION: In the first AMI treated successfully by primary angioplasty, leukocyte count is inversely correlated to CFR, and global and regional LV systolic function at follow-up. These links are higher after than before reperfusion. And, leukocyte count after angioplasty is an independent predictor of in-hospital adverse events.

[Quantitated thyroid scan (123I) of the thyroid nodule: a new molecular imaging]. / Scintigraphie thyroïdienne quantifiée (123I) du nodule thyroïdien: une nouvelle imagerie moléculaire.

Thyroid nodules are a common clinical finding which often indicates, aside from cancer, a more diffuse disease, such as multinodular goiter, auto-immune thyroid disease or thyroid autonomy. Recent reports suggest that the overall prognosis of thyroid autonomy compares with that of pT2/pT3 thyroid cancer, even in patients with low to normal TSH levels. The thyroid scan (I123) can be quantified, thus offering a powerful tool to diagnose thyroid hyperfunction when local uptake measurements appear innappropriately high as regards to TSH levels. Finally, correlation with ultrasound reduces the number of FNA to suspicious nodules only and optimizes follow-up and specific treatment (lT4, I131) of most benign nodular thyroid diseases.

Chemical composition and in vitro antifungal and antioxidant activity of the essential oil and methanolic extract of Teucrium sauvagei Le Houerou.

The chemical composition and the in vitro antifungal and antioxidant activity of the essential oil and the methanolic leaf extracts of Teucrium sauvagei Le Houerou, an endemic medicinal plant growing in Tunisia, have been studied. More than 35 constituents having an abundance >or=0.2% were identified in the oil. beta-Eudesmol, T-cadinol, alpha-thujene, gamma-cadinene, and sabinene were the prevalent constituents. Results of the antifungal activity tests indicated that the methanolic extract inhibited the in vitro growth of seven dermatophytes, whereas the essential oil showed average inhibition against only three dermatophytes. In vitro antioxidant properties of the essential oil and the methanolic extract were determined by DPPH (2,2-diphenyl-1-picrylhydrazyl) and ABTS (2,2'-azinobis(3-ethylbenzothiazoline-6-sulphonic acid)) assays and compared to those of the synthetic antioxidant Trolox. Due to their antifungal and antioxidant properties, the essential oil and the methanolic extract of T. sauvagei may be of use as natural preservative ingredients in food and/or pharmaceutical industries.

Assessment of radiation exposure in the uranium mining and milling area of Mailuu Suu, Kyrgyzstan.

The area of the town of Mailuu Suu, Kyrgyzstan, is polluted by radionuclides and heavy metals from tailing dumps and heaps resulting from the historic exploitation of uranium mines. In the frame of a European Commission-TACIS funded project, radiological assessment was performed for critical group members living in the city of Mailuu Suu, located downstream the tailings, or in the village of Kara Agach, partially located on a uranium mine waste dump. The actual external exposure is around 1.2 mSv a(-1) at both locations and exposure from radon is around 3 mSv a(-1) at Mailuu Suu and around 10 mSv a(-1) at Kara Agach. Ingestion dose was negligible for a critical group member living at Mailuu Suu. At Kara Agach, however, under the hypothesis that all food and fodder is cultivated locally, exposure from ingestion is much higher ( approximately 10-30 mSv a(-1)). In case of an accidental scenario [(part of) Tailing 3 content thrust to river], estimated additional maximum doses result in 45 and 77 mSv for an adult and a child, respectively.

A case of stunning of lung and bone metastases of papillary thyroid cancer after a therapeutic dose (3.7 GBq) of 131I and review of the literature: implications for sequential treatments.

Thyroid stunning is usually defined as the inhibition or suppression of iodide trapping by remnant thyroid tissue or by functioning metastases following a diagnostic dose of 131I. The risk of stunning increases progressively with larger doses. Because the threshold above which this effect occurs in thyroid remnants seems to be between 37 MBq and 111 MBq of 131I, therapeutic 131I doses of 3.7 GBq may cause stunning. We describe stunning of papillary thyroid cancer lung and bone metastases after a therapeutic dose of 131I (3.7 GBq). A T1 bone metastasis and bilateral lung metastases were diagnosed by post-therapeutic dose whole-body scan. Nuclear MRI detected another lesion at T4, whose 131I fixation was not obvious. An additional 0.7 GBq were given after recombinant TSH, 37 days after the therapeutic dose; 24 h later, uptake by the lung and T1 metastases had disappeared, but trapping was again seen 6 months later on the post-therapeutic scan. This re-appearance is evidence in favour of the transitory and reversible character of stunning, and confirms its correspondence to the decreased ability of viable thyroid cells to trap iodine and not to their destruction. A better understanding of stunning would make it possible, in the event of rapidly progressing disease and in conjunction with recombinant thyroid stimulating hormone (TSH), to give several therapeutic doses of 131I in close succession without each dose hampering the effectiveness of the subsequent one.

[Sudden death disclosing abnormal origin of the left coronary vessel from the pulmonary artery trunk]. / Mort subite révélant une naissance anormale de la coronaire gauche à partir du tronc de l'artère pulmonaire.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital abnormality with a poor prognosis in the newborn. Adult forms are, therefore, very rare, presenting with angina, cardiac failure or sudden death. The authors report the case of a 41 year old woman who was asymptomatic until admitted as an emergency after ventricular fibrillation. Coronary angiography established the diagnosis. Despite the absence of reversible ischaemia on exercise myocardial scintigraphy, the patient underwent coronary bypass surgery of the left anterior descending artery with a pediculated internal mammary artery graft and closure of the left coronary ostium on the pulmonary artery. The echocardiographic abnormalities regressed within a few weeks. An automatic defibrillator was not implanted. The physiopathology of this rare cardiac lesion, the mechanisms of sudden death and the different techniques of surgical repair are discussed.

Conversion from ministernotomy to full sternotomy in aortic valve replacement.

Conversion (C) from ministernotomy (M.S.) to full sternotomy was necessary in 5% of the cases in a series of 100 patients consecutively operated for Aortic Valve Replacement (A.V.R.) Analysis of the demographics and surgical techniques indicate older age, aortic fragility, diffuse coronary disease, chronic renal failure and left vent insertion as contributing factors. Despite increased operative blood losses, extra-corporeal circulation (E.C.C.) times, intensive care unit (I.C.U.) stay and hospital stay, no mortality was observed in the conversion group, as compared to 4.2% mortality in the total ministernotomy (MS) population. Preoperative patients selection, avoidance of technical pitfalls, and knowledge of alternative surgical measures are suggested to further decrease the incidence of conversions.

[The heart surgery department]. / Le Service de Chirurgie Cardiaque.

The initial development of cardiac surgery at Erasme Hospital was closely related to the achievements in thoracic organ transplantation, with numerous synergies between other clinical and research units of the Faculty of Medicine. New advances in biology and biotechnology have met the challenges of modern cardiology, in the fields of advanced heart failure, refractory angina, rhythm disturbances or minimally invasive surgery. Fundamental aspects of clinical practice have been the subject of laboratory investigations, resulting in fruitful interactions and promising scientific outlooks.

SIMS evidence that carbimazole enhances spatial heterogeneity of thyroid iodine storage and targeting in a woman with Graves' disease.

Antithyroid drugs (ATD) are known to reduce 131I efficacy in thyrotoxicosis, though the underlying mechanism remains misunderstood. To study the impact of long term administration of carbimazole on both iodine stores (127I, secondary ion mass spectrometry microscopy) and targeting (125I, radioautography) at the intraglandular level in a woman who underwent surgery for Graves' disease. 125I distribution was dramatically heterogenous and large areas of the sample appeared poorly or no stained at all. This may correspond to flat follicles, hypofunctioning or ATD blocked ones and to the various histological changes related to the thyroiditis. SIMS counting showed huge variations of the interfollicular iodine stores (0 to 1.18 microg/mg) and lower mean values than those observed in nodular goiters. SIMS imaging depicted iodine free areas and others with preserved thyroglobulin synthesis, as assessed via 32S- mapping, but low to undetectable 127I, suggesting focal organification defects. Since ATD reduce iodine storage and uptake capabilities and enhance the iodine heterogeneity of interfollicular targeting, a related enhancement of the spatial 131I dose distribution is unavoidable. ATD may reduce 131I efficacy by variably reducing the number of follicles which can be actually or significantly targeted, e.g. irradiated (antirecruitement effect).

Upper retropharyngeal node involvement in differentiated thyroid carcinoma demonstrated by 131I scintigraphy.

We report four patients with papillary thyroid cancer who had upper retropharyngeal node involvement demonstrated by 131I scintigraphy. Three patients presented with a thyroid nodule and enlarged jugular nodes. Total thyroidectomy was performed with node dissection. Pathology demonstrated papillary carcinoma with several metastatic nodes. 131I scanning 4 weeks after surgery demonstrated increased uptake in an upper retropharyngeal node. In one patient, thyroidectomy had been performed 21 years previously. Increased thyroglobulin level led to 131I scanning, which showed focal retropharyngeal uptake. All four patients had asymmetrical uptake at mouth level with focal uptake close to the sagittal plane. A lateral projection showed focal uptake between the base of the skull and the mandibular angle, behind the region of the mouth and nose. CT in all cases and MRI in one case confirmed the presence of an enlarged node. The mass was removed surgically in two patients and pathology confirmed the papillary nature of the metastatic node. Two patients were treated by 131I. Focal uptake of 131I in the region of the mouth is ambiguous, since salivary uptake of 131I is a common finding on scintigraphy. In cases of asymmetrical uptake in the region of the mouth, a lateral projection of the head therefore allows the correct diagnosis.