ABSTRACT
We describe the case of a 74-year-old female patient previously treated with radiation therapy for a meningioma of the skull base and with surgery for a right tympanic paraganglioma. After the morphological progression of the meningioma demonstrated by magnetic resonance imaging (MRI), the patient underwent somatostatin receptor positron emission tomography/computed tomography (SR-PET/CT) with Gallium-68 DOTATATE for restaging. This examination showed increased somatostatin receptor expression by the meningioma and confirmed its extension as already assessed by MRI (endocranial extension, skull base involvement and invasion of the right orbit). Furthermore, SR-PET/CT detected two small right jugulotympanic pararagangliomas with high somatostatin receptor expression. Lastly, SR-PET/CT demonstrated that this patient would be an ideal candidate for peptide receptor radionuclide therapy (PRRT) that can be used for the treatment of progressive/treatment-refractory meningiomas and relapsed paragangliomas with high somatostatin receptors expression, both conditions coexisting in this case.
ABSTRACT
BACKGROUND: Peliosis hepatis (PH) is a benign condition characterized by sinusoidal ectasia and blood-filled lacunar spaces within the liver parenchyma. The disease has been associated with a number of drugs and illnesses such as immunodeficiency states, infections, malignancy and other miscellaneous diseases. PATIENTS AND METHODS: We describe the association of PH and cancer in two consecutive patients. In case 1, the peliotic lesions mimicked metastatic dissemination of a neuroendocrine tumor in a patient with normal octreoscan and tumor markers, parameters that were abnormal at the initial tumor diagnosis. In case 2, PH mimicked systemic candidiasis complicating the treatment of an acute myeloid leukemia, although in a clinical setting in which an infection was unlikely. RESULTS: Computed tomography (CT) imaging and a high level of clinical suspicion had a major role in the correct identification of this uncommon disorder, avoiding unnecessary antitumor-or anti-infection-oriented diagnostic procedures or therapies. CONCLUSIONS: PH should be considered in the differential diagnosis of new liver lesions in patients in whom the clinical settings do not clearly favor metastasization or infection. The detailed analysis of multiphase CT scan imaging is essential for a correct diagnosis. A liver biopsy should be performed to confirm this entity.
