Factors Affecting Ablation Success After I-131 Radioactive Iodine Therapy in Low and Intermediate Risk Papillary Thyroid Cancer.

The study was to evaluate the effect of radioactive iodine (RAI) treatment application time and clinical, histopathological factors on ablation success in patients with operated papillary thyroid cancer (PTC) in low and intermediate-risk. One hundred sixty-one patients with PTC in the low and intermediate-risk were evaluated. Most patients (89.4%) were in the low-risk, and 10.6% were in the intermediate-risk. When the patients were divided into two groups according to the date of receiving RAI treatment after surgery, those who received early treatment (≤3 months) constituted the majority of the patients (72.7%). Seventeen patients received 1.85 Gigabecquerel (GBq), 119 3.7 GBq, 25 5.55 GBq RAI. Most patients (82%) achieved ablation success after the first RAI treatment. The time interval between surgery and RAI treatment did not affect ablation success. Stimulated Tg level measured on the RAI treatment day was an independent predictive factor for successful ablation (p<0.001). The cut-off value of Tg found to predict ablation failure was 5.86 ng/ml. It was concluded that 5.55 GBq RAI treatment could predict ablation success compared to 1.85 GBq dose (p=0.017). It was concluded that having a T1 tumor may predict treatment success compared to a T2 or T3 tumor (p=0.001, p<0.001, retrospectively). The time interval does not affect ablation success in low and intermediate-risk PTC. The ablation success rate may decrease in patients who receive low-dose RAI and have high Tg levels before treatment. The most crucial factor in achieving ablation success is giving enough doses of RAI to ablate the residual tissue.

Incidental Tc-99m MDP Uptake in Cortical-subcortical Parietotemporal Cerebral Area in a Patient with a History of Recent Ischemic Cerebrovascular Event who Underwent Whole-body Bone Scan.

The authors present Tc-99m methylene diphosphonate (MDP) uptake in the right parietotemporal area at whole-body bone scan (WBBS) in 75 years male patient with prostate adenocarcinoma Gleason score 3+4 (pT2N0Mx). No residual or metastatic disease was detected in the patient's Gallium-68 prostate-specific membrane antigen positron emission tomography/computed tomography four months before WBBS. The patient had undetectable prostate-specific antigen levels and underwent WBBS to restage prostate cancer due to equivocal findings in previous WBBS. Current WBBS planar views revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and the sphenoid bone in addition to equivocal uptake on the lower lumbar vertebrae. Single-photon emission computed tomography study to identify the MDP-avid lesion on the right cranial area revealed heterogeneous Tc-99m MDP uptake in the right parietotemporal area and sphenoid bone. The patient had a history of transsphenoidal surgery for a hypophyseal tumor two years ago and a recent cerebrovascular event (CVE). Diffusion-weighted magnetic resonance imaging revealed a cortical-subcortical patchy area of restricted diffusion in the parietotemporal region compatible with acute ischemia. Heterogeneous Tc-99m MDP uptake in the right parietotemporal area was attributed to recent CVE and secondary vascular-tissue change-related dystrophic calcification.

A Rare Hernia Mimicking Implant in a Patient with Rectal Adenocarcinoma: Internal Herniation.

Internal herniation may be seen more frequently in patients with intra-abdominal surgery and malignancy history. We presented a 58-year-old male patient diagnosed with rectal adenocarcinoma seven years ago with a history of surgery and pelvic radiotherapy. When the abdominal computed tomography (CT) image was taken during routine oncology follow-up, a lesion mimicking a serosal implant on the anterior abdominal wall was detected. 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging was performed the suspicion of recurrence. It was concluded that the lesion, which was evaluated as an implant in abdominal CT with 18F-FDG PET/CT imaging, was a spontaneously reducing internal herniation. 18F-FDG PET/CT imaging in cancer patients is crucial in illuminating the suspicion of recurrent lesions in these patients and sheds light on the course of the patients in oncology practice.

The Effect of Sarcopenia and Metabolic PET-CT Parameters on Survival in Locally Advanced Non-Small Cell Lung Carcinoma.

The treatment of stage III non-small cell lung cancer (NSCLC) is complex. Here, we aimed to examine the prognostic utility of sarcopenia and metabolic muscle volumes and evaluate their relationship with oncological treatments in patients with locally advanced NSCLC. Patients with unresectable stage III NSCLC were evaluated retrospectively. Muscle fields were measured, and metabolic parameters of the psoas were obtained. The skeletal muscle index (SMI), sarcopenia, sarcopenic obesity, and body mass index (BMI)-associated sarcopenia were evaluated. Fifty-three (94.6%) patients were men, and three (5.4%) were women. Sarcopenia was identified in 36 (64.3%) patients. Pretreatment sarcopenia and BMI-associated sarcopenia negatively affected overall survival (p = 0.040 and 0.023, respectively). A high psoas SUVmean (Standardized Uptake Value mean) and low mean psoas HU (Hounsfield unit) were poor prognostic factors (p = 0.009 and 0.014, respectively). SMI and muscle mass decreased after oncological treatment. Advanced age, inability to complete treatment, administration of chemoradiotherapy after chemotherapy, presence of sarcopenia, and a low mean psoas HU decreased survival. In conclusion, sarcopenia and BMI-associated sarcopenia are poor prognostic factors in patients with lung cancer. Oncological treatments can adversely affect muscle mass. The metabolic parameters of the psoas muscle can predict patient prognosis.

The role of metabolic tumor parameters predicting cervical lymph node metastasis in patients with head and neck squamous cell carcinoma.

Purpose: This study aimed to investigate the contribution of metabolic positron emission tomography/computed tomography (PET/CT) parameters of the primary tumor in predicting regional lymph node metastasis (LNM) at initial staging in patients with head and neck squamous cell carcinoma (HNSCC). Methods: A total of 114 patients diagnosed with HNSCC and who underwent PET/CT scanning for staging were included in the study between May 2014 and December 2020. Predictive values of maximum standardized uptake value (SUVmax), maximum standardized uptake ratio (SURmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the primary tumor in the prediction of cervical LNM were evaluated with logistic regression. Results: The patients were diagnosed with cancer of the larynx (46.5%), oropharynx (9.6%), nasopharynx (22.8%), hypopharynx (4.4%), and oral cavity (16.7%). All metabolic parameters of the primary tumor were significantly different between patients with positive and negative LNM (all P < 0.001). MTV (P = 0.022) and TLG (P = 0.007) were significantly higher in patients with contralateral LNM. MTV value of the primary tumor was found as the single significant predictor of regional LNM in patients with HNSCC (OR = 23.17, P < 0.001 vs. OR = 31.1, P < 0.001, respectively) in univariate and multivariate logistic regression analyses. The sensitivity, specificity, and accuracy of MTV were 89%, 80%, and 86%, respectively. Conclusion: MTV of the primary tumor can predict regional LNM and guide the selection of the treatment modalities and clinical decisions in patients with HNSCC at initial staging.

A rare localization of a common disease: Primary uterine Non-Hodgkin lymphoma mimicking leiomyosarcoma.

Genitourinary system lymphomas comprise a small part of extra-nodal lymphomas (ENLs). ENLs of uterine origin are extremely rare and are often confused with gynecological malignancies. We present an 80-year-old female patient diagnosed with diffuse large B-cell lymphoma (DLBCL) with a single focus of the uterus. The patient's only complaint was abnormal uterine bleeding. Magnetic resonance imaging revealed an intramural-subserous-submucous multiple mass lesion with minimal contrast enhancement mimicking leiomyosarcoma. Diffuse pathological 18F-fluorodeoxyglucose uptake was detected in the entire uterus corpus and cervix on positron emission tomography/computed tomography (PET/CT) scanning. The pathology of the endocervical and endometrial curettage material obtained was DLBCL; the patient was diagnosed with ENL, and a single focus was the uterus. ENLs should be considered in the differential diagnosis of gynecological malignancies in patients with abnormal uterine bleeding. PET/CT is crucial in showing metabolically active spread areas in these patients.

Relation of whole-body metabolic tumor volume and total lesion glycolysis on fluorodeoxyglucose PET/computed tomography with clinical and laboratory parameters in newly diagnosed multiple myeloma.

OBJECTIVE: This study aims to evaluate the relationships of metabolic fluorodeoxyglucose PET/computed tomography (FDG PET/CT) parameters such as whole-body metabolic tumor volume (WB MTV), WB-total lesion glycolysis (TLG), and bone marrow (BM)-mean standard uptake value (SUVmean) with clinical stage and other prognostic biomarkers in newly diagnosed multiple myeloma (MM) patients. METHODS: Patients who underwent pretreatment PET/CT with the diagnosis of MM were evaluated retrospectively. The number of focal lesions, WB MTV, WB TLG, and BM SUVmean values were measured on FDG PET/CT images. Clinical stages and prognostic laboratory parameters were recorded the pretreatment period. RESULTS: WB MTV and WB TLG values were significantly higher in patients with more than three focal lesions on FDG PET/CT scan (all P < 0.001). According to the Revised International Staging System (R-ISS), all WB MTV, WB TLG, and BM SUVmean values are significantly higher in patients with stage 3 disease than in stages 1-2 ( P = 0.027, P = 0.019, P = 0.001, respectively). Serum creatinine level is positively correlated with WB MTV, WB TLG, and BM SUVmean values ( P = 0.020, P = 0.004, P < 0.001, respectively). In addition, the ß2 microglobulin level, an essential biochemical prognostic parameter, was positively correlated with the BM SUVmean value ( P = 0.013). CONCLUSION: The BM SUVmean, WB MTV, and WB TLG values, which reflect FDG avid WB tumor burden, are associated with prognostic biomarkers and R-ISS stage in newly diagnosed MM patients. It contributes to the identification of high-risk patients at the pretreatment staging.

Contribution of Metabolic Tumor Volume and Total Lesion Glycolysis to Predict Prognosis in Early-Stage Lung Cancer at Preoperative Staging.

OBJECTIVE: To evaluate the effect of metabolic tumor volume (MTV) and total lesion glycolysis (TLG) values of the primary tumor measured by preoperative positron emission tomography/computed tomography (FDG-PET/CT) on survival in patients with operated non-small cell lung cancer (NSCLC). STUDY DESIGN: Cohort study. PLACE AND DURATION OF STUDY: Recep Tayyip Erdogan University, Faculty of Medicine, Department of Medical Oncology from January 2017 to June 2020, Turkey. METHODOLOGY: Patients with operated NSCLC were reviewed retrospectively. Metabolic parameters of FDG-PET/CT such as pathological tumor features, type of operation, MTV/TLG values, and whether they received adjuvant therapy were evaluated. Disease-free survival (DFS) and overall survival (OS) times were calculated. RESULTS: Most of the 77 patients (96.1%) were male. The mean age is 64±8 years. Lobectomy was performed in 66 (85.7%) patients, and pneumonectomy was performed in 11 (14.3%) patients. The mean tumor diameter was 3.7±2.015cm. Squamous cell carcinoma was detected in 37 patients (48.1%) and adenocarcinoma in 35 patients (45.5%). Thirty-eight patients (49.4%) received adjuvant chemotherapy. SUVmax, MTV, and TLG values of the primary tumor were high in patients under 65 years of age and with a tumor diameter of ≥3cm. DFS was nine months (4.5-18), and OS was 19 months (11-29). The 2-year survival rate was 75.6%. It was observed that patients with adenocarcinoma relapsed more frequently, which negatively affected survival (p=0.023, and p=0.024 respectively). High MTV (p=0.01) and TLG (p=0.015) values were associated with poor prognosis. CONCLUSION: NSCLC is a heterogeneous disease, and survival is affected by many factors. Our study showed that the subtype of adenocarcinoma and high MTV and TLG values of the primary tumor are poor prognostic factors in operated early-stage lung cancers. KEY WORDS: Early-stage, Non-small cell lung cancer, MTV, TLG, NSCLC, Survival, FDG-PET/CT.

Distant Metastasis Patterns of Lung Cancer on Positron Emission Tomography/Computed Tomography Association with Age and Histological Subtype.

OBJECTIVE: To investigate whether age or other factors are determinants of distant metastasis in patients with lung cancer. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Nuclear Medicine, Recep Tayyip Erdogan University, Rize, Turkey between December, 2018 and February, 2019. METHODOLOGY: A total of 152 patients with lung cancer, who underwent positron emission tomography/computed tomography (PET/CT) for staging, were included in this study. Patients were grouped according to age (>65 and <65 years) and distant metastasis status. Metastasis localisation of patients was evaluated by PET/CT. Univariate/multivariate regression analyses were performed to determine risk factors for distant metastasis. RESULTS: No significant difference was found when the relation of distant metastasis with stage distribution was examined in both age groups. Distant metastasis rates were significantly higher in female patients than in male patients (p = 0.019) and in patients with small-cell lung carcinoma (SCLC)-adenocarcinoma than in those with other histopathological subtypes (p <0.001). Most of the patients in both groups had a stage 4 disease, and bone distant metastasis was the most common in both age groups. Univariate/multivariate analyses identified that female gender (p = 0.017/p = 0.003), SCLC subtype (p = 0.013/p = 0.008), T3/T4 tumour (p <0.001/p <0.001), and smoking history of >66 pack-years (p = 0.047/p = 0.047) were independent factors for the presence of distant metastasis. CONCLUSION: Although age is not a risk factor for distant metastasis in lung cancer, female gender, T3/4 tumour, SCLC subtype, and smoking history of >66 pack-years are high-risk factors. PET/CT is recommended as the first-choice imaging technique in patients with lung cancer indicated for distant metastasis scanning. Key Word: Lung cancer, PET/CT, Metastases, Histological subtype, T-stage.

Prognostic impact of the 18F-fluorodeoxyglucose positron-emission tomography/computed tomography metabolic parameters and correlation with hematological inflammatory markers in lung cancer.

INTRODUCTION: Hematological inflammatory markers and metabolic parameters in positron-emission tomography/computed tomography (PET/CT) are important indicators predicting the prognosis of the disease in lung cancer as in many cancers. This study aimed to evaluate the correlation between pretreatment hematological inflammatory markers and PET/CT metabolic parameters in nonsmall cell lung cancer (NSCLC) patients and to predict the prognostic value of these parameters. MATERIALS AND METHODS: A total of 132 patients with diagnosed NSCLC who underwent PET/CT at staging were retrospectively evaluated. Hematological parameters were obtained from the hemogram taken no more than 2 weeks prior to PET/CT. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) were recorded. Maximum standard uptake value, SUVmean, metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated. Clinical stage, tumor pathology, and overall survival were analyzed with these parameters. RESULTS: NLR and PLR were significantly positively correlated with MTV and TLG (all P < 0.001), MPV was negatively correlated with TLG (P = 0.021). While TLG, MTV, NLR, and PLR were increased in advanced stage disease, MPV was decreased. Univariate Cox-regression analysis demonstrated that greater age (P = 0.015), advanced stage (P < 0.001), low MPV (P = 0.017), high NLR (P < 0.001), PLR (P < 0.001), MTV (P = 0.004), TLG (P = 0.001) values, multivariate Cox-regression analysis revealed that NLR (P < 0.001) and advanced stage (P < 0.001) were significant predictors of poor prognosis in patients with NSCLC. CONCLUSIONS: There were significant associations between hematological inflammatory markers and PET/CT metabolic parameters in the patients with NSCLC at the time of diagnosis. These indicators can contribute to predicting prognosis in patients with NSCLC.

The Role of Hematological Inflammatory Biomarkers in the Diagnosis of Lung Cancer and in Predicting TNM Stage.

OBJECTIVE: The aim of study is to investigate whether hematological inflammatory biomarkers could be useful to detect patients with lung cancer. METHODS: The contribution of hematological biomarkers to the diagnosis of lung cancer and prediction of TNM was examined. RESULTS: NLR, PLR, MPV values were found to be higher in patients with lung cancer (all p < .001). NLR and PLR were found to be high, MPV was found to be lower in disease of advanced stage (p < .001). CONCLUSIONS: This study found that NLR, PLR and MPV values were significantly higher in patients with lung cancer.

An urban legend: Malignant transformation caused by radiotherapy in patients with presacral ganglioneuroma. The necessity and first-time administration of radiotherapy. Case report and literature review.

Ganglioneuromas (GNs) are well-differentiated, rare benign tumors of neural crest origin and are, for the most part, considered to be the benign equivalent of neuroblastomas. There are very few cases of GN reported to be at presacral location in the literature. The standard form of treatment is the total surgical excision. However, total resection of GN is not always possible depending on the neuron, from which it originates, and its localization. Moreover, adjuvant radiotherapy (RT) or chemotherapy is not recommended even though patients are still symptomatic after subtotal resection. This view is based on the urban legend that it undergoes a malignant transformation although it is a benign tumor. Moreover, there are no data indicating that the GN cases reported in the literature have undergone RT. Therefore, articles about the suspicion that GN may undergo spontaneous or malignant transformation after RT are absolutely controversial. Based on our case, we present here, we believe that we will explain the valid necessity of application of RT that we administered for the first time and that with the clarification of this controversial topic, a significant gap will be closed in the literature.

18F-FDG PET/CT Imaging of Metastatic Testicular Choriocarcinoma Mimicking Gastric Cancer which Initial Symptom is Melena

Gastric metastasis of choriocarcinoma is rarely reported in the literature. This case report presents the case of multiple metastatic testicular choriocarcinoma mimicking gastric cancer, with melena as the initial symptom. In this case, 18fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) showed that the testis was the primary focus. The contribution of PET/CT is significant to primary focus detection in metastatic diseases of unknown primary origin that presented gastrointestinal bleeding. In addition to its use in staging of testicular carcinoma, PET/CT provides significant benefit in evaluating patients with increased levels of tumor markers and in detecting recurrence.

Diagnostic Value of 18F-FDG PET/CT in Patients with Carcinoma of Unknown Primary

Objective: The aim of this study is to investigate the clinical role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of unknown primary (CUP). Methods: One hundred twenty one patients with a diagnosis of CUP who underwent whole body 18F-FDG PET/CT imaging were included in this retrospective study. The final diagnoses were confirmed either histopathologically or by clinical follow-up. Results: The 18F-FDG-PET/CT successfully detected the primary tumor in 59 out of 121 (49%) patients. The most common primary tumor as detected by 18F-FDG PET/CT was lung cancer (n=31). In a patient, two primary tumors (colon and prostate) were detected on PET/CT imaging. Bone marrow biopsy revealed prostate cancer in this patient and the colon cancer was accepted as a synchronous second primary tumor. 18F-FDG PET/CT findings were false-positive in 11 patients. 18F-FDG PET/CT could not detect any primary lesion in 51 patients, whose conventional work-up detected a primary tumor in 11 and thus considered as false-negative. The sensitivity, specificity rate and accuracy of 18F-FDG PET/CT in detection of primary tumor were identified as 84%, 78% and 82%, respectively. Conclusion: Whole body 18F-FDG PET/CT is an effective method for detecting the primary tumor in patients with CUP. In addition to detecting the primary tumor, it can also help determine disease extent and contribute to patient management.

Laryngeal Tuberculosis Mimicking Laryngeal Carcinoma on 18F-FDG PET/CT Imaging.

Laryngeal tuberculosis is a rare presentation of tuberculosis. It can mimic laryngeal carcinoma with its clinical and imaging findings. A 51-year old woman underwent 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) imaging for clinically suspected carcinoma of the larynx. PET/CT revealed lung lesions consistent with tuberculosis in additional to hypermetabolic focus on larynx. The patient was histopathologically diagnosed with lung and laryngeal tuberculosis.

Effect of Ceftiofur on Hyperalgesia and Allodynia in a Rat Neuropathic Pain Model: The Role of Immune Processes.

OBJECTIVE: Inflammatory and immune mechanisms play important roles in the pathogenesis of neuropathic pain. Ceftiofur, a third-generation cephalosporin, has anti-inflammatory effects by inhibiting tumor necrosis factor (TNF)-α, interleukin (IL)-1ß, nuclear factor (NF)-κB, and mitogen-activated protein kinase (MAPK) signaling. This study aimed to investigate the effect of ceftiofur on hyperalgesia and allodynia in neuropathic rats and to define the possible contribution of immune mechanisms to this effect. METHODS: A neuropathic pain model was performed by ligating the right sciatic nerve. Mechanic hyperalgesia and allodynia were measured using an analgesia meter and dynamic plantar esthesiometer, respectively. Following sciatic nerve ligation, ceftiofur was administered intraperitoneally (10 and 20 mg/kg/day) for 14 days. The control group received saline. Pain thresholds were recorded pre- and postoperatively on days 3, 7, 10, and 14. Protein was extracted from lumbar spinal cord tissue on day 14, and TNF-α, IL-1ß, p65 NF-κB, p38 MAPK, and inducible nitric oxide synthase (iNOS) were evaluated by Western blotting. RESULTS: Neuropathic rats showed decreased pain thresholds in analgesia meter and esthesiometer measurements. Ceftiofur 20 mg/kg/day significantly alleviated hyperalgesia, but not allodynia, and the increased iNOS and IL-1ß expression was attenuated in neuropathic rats at both doses while decreasing p38 MAPK expression only at 20 mg/kg/day. TNF-α and p65 NF-κB expression remained unchanged 14 days after surgery. CONCLUSIONS: Ceftiofur has anti-inflammatory effects by decreasing iNOS, IL-1ß, and p38 MAPK expression in lumbar spinal cord, and treatment of neuropathic rats with repeated doses of ceftiofur for 14 days results in antihyperalgesic effects.

Hashimoto's thyroiditis is not associated with increased risk of thyroid cancer in patients with thyroid nodules: a single-center prospective study.

BACKGROUND: The risk of thyroid carcinoma in patients with thyroid nodules associated with Hashimoto's thyroiditis (HT) is a debatable issue. The studies defining the true risk of thyroid malignancy are scanty and mainly depend on retrospective series. To eliminate inherent bias of retrospective studies, this prospective study was carried out to evaluate the true malignancy rate of unselected thyroid nodules in patients with HT who underwent fine-needle aspiration cytology (FNAC). METHODS: These prospective data were gathered on all patients newly diagnosed with thyroid nodules who were sent for FNAC between May 2006 and August 2009. All patients were evaluated for the presence of HT diagnosis by measuring thyroid autoantibodies. If a patient had at least one positive thyroid autoantibody, then the patient was defined as HT with thyroid nodules. There were 164 patients (147 women and 17 men) with thyroid nodules associated with HT (HT group). There were 551 patients (432 women and 119 men) with thyroid nodules without HT (control group). All patients underwent FNAC and ultrasonography (US). RESULTS: The malignancy rate was 1.0% in HT group (2 out of 191 nodules) and 2.7% in the control group (19 out of 713 nodules), a not significant (p = 0.19) difference. In the two cytologically malignant nodules in HT group and 19 in the control group, papillary thyroid carcinoma was diagnosed after thyroidectomy and histopathological examination. US features of nodule echogenicity, structure, margin, and Doppler flow were similar between the two groups. US features of microcalcification and absence of peripheral halo were more prominent in the nodules of the control group (p = 0.002 and p < 0.001, respectively). CONCLUSIONS: On the basis of cytopathological criteria, thyroid nodules in patients with HT are no more likely to be malignant than in those without HT. Many of the US features of benign thyroid nodules are similar in patients with and patients without HT.