18F-FDG PET/CT for Staging and Response Evaluation in a Rare Case of Childhood Ovarian Primitive Neuroectodermal Tumor.

ABSTRACT: Primitive neuroectodermal tumor (PNET) is an aggressive small cell malignancy. Apart from the central nervous system, they can arise from peripheral sites as well. Ovarian PNETs are extremely rare neoplasms. We here present a case of childhood ovarian PNET, where 18F-FDG PET/CT was efficiently used for staging and response evaluation.

A rare peritoneal egg: Case report with literature review.

The occurrence of peritoneal loose bodies has been known for hundreds of years. Although rarely, they attain a diameter of more than 5 cm and are then named "giant" peritoneal bodies (gPLBs). Even these huge peritoneal bodies are generally symptom free, but may be linked with chronic symptoms like abdominal pain or discomfort. Many a times, these gPLBs are misinterpreted as intraabdominal tumors or foreign bodies and unnecessary surgical interventions are carried out. We report a rare case of a 75-year-old male, who presented to our tertiary care center emergency department with history of chronic intermittent abdominal discomfort with acute diarrhea and peri-anal pain. Contrast enhanced computed tomography of the abdomen and pelvis revealed round to oval mass in the pelvis measuring 6.2 cm × 5.8 cm. On laparoscopy, a hard, free floating object with the appearance of a boiled egg could just be scooped out from the pelvis. The postoperative pathological examination revealed laminated strands of hyalinized fibro collagenous tissue with central fat necrosis confirming the diagnosis of gPLB. Postoperative period was uneventful. Peritoneal bodies are rare intraabdominal bodies which are either detected incidentally or present with vague symptoms and require interdisciplinary management.

Aggressive laryngeal fibromatosis: A case report and brief review.

We describe a rare case of aggressive fibromatosis of the larynx occurring in a 72-year-old man. The lesion manifested with complaints of dyspnea and stridor. A computerized tomographic scan of the neck revealed irregular polypoidal growth invading right vocal cord, crossing midline. A malignant tumor was suspected. Although several laryngoscopy-driven biopsies were negative for malignancy, total laryngectomy was done since the lesion was not deemed amenable to conservative therapy. Tissue sections featured a moderately cellular lesion composed of spindle cells with bland, elongated nuclei, enmeshed in a variably collagenized ground substance. The spindle cells were immunopositive for vimentin and negative for cytokeratins, PGP-9.5, smooth muscle antigen, CD68, desmin, and S-100 protein and Ki-67 of 4%. No further therapy was administered. Based on the available literature, our data confirm that aggressive laryngeal fibromatosis in adult patients is a locally infiltrating disease. Total laryngectomy with clear margins is needed as to avoid the high risk of local recurrence.

Serendipitous Discovery of Isolated Gastric Metastases From Adenocarcinoma of the Lung on Staging 18F-FDG PET-CT.

Gastric metastasis from lung cancer is rare. We here present the case of a 59-year-old man with lung adenocarcinoma where isolated gastric metastases were discovered on staging F-FDG PET-CT, confirmed with endoscopy and biopsy.

Contralateral contiguous tuberculous lymphadenitis in a case of right breast carcinoma--Diagnostic dilemma.

Coexistence of tuberculosis (TB) in the breast or axillary lymph nodes with breast carcinoma though rare is not unknown. A 55-year-old woman presented with right axillary and left supraclavicular lymphadenopathies with no detectable lesion in either breasts or left axilla. Right axillary lymph node excision biopsy revealed metastatic adenocarcinoma. Diagnostic workup showed intense fluorodeoxyglucose (FDG)-avid lymph nodes on the left side neck at level V, supraclavicular, axillary, subpectoral and para-aortic regions, and low FDG activity in the right breast. Core biopsy of right breast lesion was reported as invasive ductal carcinoma and cytology of multiple left axillary lymphadenopathies as reactive hyperplasia. Excision biopsy of the supraclavicular lymph nodes unveiled the diagnosis of TB. She underwent right-modified radical mastectomy followed by external beam radiotherapy, has completed antituberculous treatment and is on follow-up. Extrapulmonary TB though uncommon; may be found in certain cases. Clinicians must be aware of its existence.

Primary choriocarcinoma of appendix mimicking acute appendicitis.

Choriocarcinoma is a malignant trophoblastic cancer, the incidence of primary choriocarcinoma (PCC) of the gastrointestinal tract (GIT) being extremely rare, with only 14 cases being reported in worldwide literature. Here we present an extremely rare case of PCCof the appendix in a 32-year-old male who presented with acute pain abdomen. Histopathological examination revealed PCC of the appendix. Examination of the testis was unremarkable. Further investigations revealed a very high serum beta-human chorionic gonadotropin (b-HCG) titer with a normal carcinoembryonic antigen (CEA). Radiological imaging showed multiple areas of liver metastasis. Chemotherapy-based treatment with bleomycin, etoposide, and cisplatin (BEP) regime was advised, however the patient failed to follow-up for further management.