Follicular Lymphoma mimicking Metastatic Nodes on the F-18 FDG PET/CT and MRI for Staging of Endometrial Cancer.

A 53-year-old woman was diagnosed with endometrial carcinoma by vaginal bleeding. F-18 fluorodeoxy glucose positron emission tomography PET/CT (F-18 FDG PET/CT) scan for staging showed intense focal FDG uptake in the endometrium suggesting endometrial malignancy. PET/CT showed multiple node uptakes in the pericaval region, paraaortic region, common iliac, and both internal iliac and external iliac regions suggesting multiple pelvic and retroperitoneal node metastases. MRI showed multiple metastatic lymphadenopathy in the retroperitoneum and pelvic cavity. Pathologic diagnosis performed with dissected pelvic and paraaortic nodes was confirmed as a follicular malignant lymphoma positive for B-cell lymphoma-2(Bcl-2) stain, not the metastatic node of primary endometrioid carcinoma.

Extensive Metastases on 18F-FDG PET/CT in Primary Lymphoepithelioma-Like Carcinoma of the Ovary.

We describe extensive metastatic lesions of very rare lymphoepithelioma-like carcinoma originating from the ovary assessed by F-FDG PET/CT. A 59-year-old woman presented with abdominal distention. Pelvis MRI demonstrated a large right ovarian malignant lesion with massive lymphadenopathy suggesting lymphoma. Patient underwent surgical removal. The lymphoepithelioma-like carcinoma arising from the ovary based on immunohistochemistry was pathologically confirmed. Multiple metastases including peritoneum, omentum, and lymph nodes were confirmed. F-FDG PET/CT for staging and evaluation of metastasis after operation showed multiple lymph node metastases. F-FDG PET/CT revealed hepatic metastasis in the dome region of the right liver besides multiple skeletal metastases.

18F-FDG imaging of the primary breast leiomyosarcoma and follow-up lung metastasis.

A 46-year-old woman presented with a large left breast mass. FDG PET/CT demonstrated a large left breast mass (SUV = 28). Preoperative biopsy showed malignant sarcoma. Modified radical mastectomy was performed. Immunohistochemical analysis using h-caldesmon and smooth muscle actin staining established the diagnosis of primary breast leiomyosarcoma. Despite intensive chemotherapy, 3-month follow-up PET/CT revealed a large lung metastasis suggesting aggressiveness and poor response to chemotherapy. Primary leiomyosarcoma of the breast is extremely rare and difficult to diagnose before excisional surgery because of the need for immunohistochemical staining to confirm the diagnosis.

Sonographic findings of uterine cervical lymphoma manifesting as multinodular lesions.

Uterine cervical lymphoma, a very rare condition, has rarely been reported in sonographic findings in the English medical literature. We describe a case of uterine cervical lymphoma which was detected initially and depicted on sonography as a multinodular smoothly lobulated heterogeneous mass with some posterior enhancements.

Laparotomy versus laparoscopy for the treatment of adnexal masses during pregnancy.

BACKGROUND: Laparoscopy has been highlighted as an effective surgical modality for diverse pelvic organ diseases. However, its surgical and obstetric efficacy has not been fully confirmed in pregnant women because of the absence of a large comparative study. The objective of this study was to compare outcomes between laparotomy and laparoscopic surgery for adnexal masses during pregnancy. METHODS: A retrospective analysis of 262 pregnant women who underwent laparotomy or laparoscopic surgery for adnexal masses between 2000 and 2009 was performed. RESULTS: Of the 262 women, 174 (66.4%) underwent laparotomy and 88 (33.6%) underwent laparoscopic surgery for adnexal masses. The laparoscopy group had a significantly shorter mean operative time (60.7 ± 27.1 vs 69.7 ± 24.4 min, P = 0.002) and mean hospital stay (4.7 ± 1.7 vs 6.6 ± 1.3 days, P < 0.001) than the laparotomy group. In multivariate analysis, there was no significant difference between laparoscopy and laparotomy group in obstetric outcomes, including preterm delivery and miscarriage rate, after adjusting for confounding factors, such as gestational age at surgery, emergency surgery and mass size. CONCLUSIONS: The laparoscopic approach appears to offer a suitable alternative to laparotomy, which, in our setting, was associated with shorter operative times and hospital stays than laparotomy.

Clinical usefulness of the fluorodeoxyglucose (FDG)-PET maximal standardized uptake value (SUV) in combination with CT features for the differentiation of adenocarcinoma with a bronchioloalveolar carcinoma from other subtypes of non-small cell lung cancers.

PURPOSE: To evaluate the clinical usefulness of fluorodeoxyglucose (FDG)-PET maximal SUV in combination with CT features for differentiation of adenocarcinoma with bronchioloalveolar carcinoma (BAC) from other subtypes of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: This retrospective study included 125 patients (104 men and 21 women; mean age, 64 years) who underwent CT and subsequent FDG-PET examinations for preoperative evaluation and underwent curative intent operation with the final diagnoses of NSCLC made by surgical histopathology. We categorized NSCLC into adenocarcinoma with BAC feature and other subtypes. Finally, there were 16 cases of adenocarcinoma with BAC and 109 cases of other NSCLC subtypes included in the study. Several CT features of lung cancer were analyzed, including tumor size, presence of spiculation, margin (irregular or smooth), pattern of the mass (pure solid, pure ground glass opacity and mixed), associated pleural effusion and location (center, mid and periphery). Maximal SUV and visual scores of FDG uptakes of primary NSCLC were evaluated. The diagnostic performances of CT alone, PET alone, and combination of two modalities to predict adenocarcinoma with BAC from other subtypes of NSCLC were calculated. RESULTS: A nodule with a mixed pattern with partly solid and ground glass opacity was significantly more frequent CT feature of an adenocarcinoma with BAC (8/16, 50%) as compared with the other subtypes (2/109, 1.8%) (p<0.0001). Maximal SUV of adenocarcinoma with BAC (mean=7.2) was significantly lower than that of other subtypes of NSCLC (mean=13.33) (p<0.0001). Sensitivity, specificity, PPV, and NPV of CT for differentiating adenocarcinoma with BAC from other subtypes was 50% (8/16), 98.2% (107/109), 80% (8/10), and 93% (107/115), respectively. Sensitivity, specificity, PPV, and NPV of FDG-PET was 68.8% (11/16), 86.2% (94/109), 42.3% (11/26), and 94.9% (94/99), respectively. Sensitivity, specificity, PPV, and NPV of combination of two modalities was 81.3% (13/16), 85.3% (93/109), 44.8% (13/29), 96.9% (93/96), respectively. CONCLUSION: Careful combined assessment of the FDG-PET maximal SUV and CT findings have the potential to differentiate an adenocarcinoma with BAC from other NSCLC subtypes, such as a pure BAC. These findings might be useful for imaging interpretations and will help initial planning of NSCLC management.

Cortical metabolic changes in the cerebellar variant of multiple system atrophy: a voxel-based FDG-PET study in 41 patients.

In addition to neuronal loss in the cerebellum and basal ganglia, recent imaging studies have suggested that cortical involvement may be more extensive in patients with MSA. In this study, we focused on cortical metabolic patterns in 41 patients with MSA-C and 30 controls, using statistical parametric mapping analysis to evaluate whether metabolic derangement in MSA-C patients involved the cortical area and correlated cerebral metabolism with clinical parameters. In patients with MSA-C, SPM analysis revealed that, apart from the expected reduction of FDG-uptake in brainstem-cerebellar area, there was a significant hypometabolism in widespread frontal cortex, including inferior orbitofrontal, rectus, middle and superior frontal, and superior mesiofrontal extending to cingulum, and left inferior parietal cortex. In a subgroup analysis of MSA-C patients, metabolic derangement in the cerebral cortex was visible even in the early stages of MSA-C. In advanced stages, the metabolic derangement tended to evolve into the rostral brainstem and into other cortical areas, including left inferior frontal cortex and right inferior orbitofrontal, right anterior and middle cingulate, and anterior portion of superior mesiofrontal gyri. In correlation analysis, reduced FDG-uptake in orbitofrontal area was most significantly correlated with disease severity and duration, followed by the medial frontal, the dorsal portion of the midbrain, and the cerebellum. Our study demonstrated that there were widespread areas of decreased metabolism in the cerebral cortex and, as the disease progressed, the pattern of metabolic derangement tended to evolve into other frontal areas without significant changes in cerebellar metabolism, suggesting that reduced FDG-uptake in cortical area may be associated with the primary disease process.

Cardiac 123I-MIBG scintigraphy in patients with essential tremor.

In some cases, it is difficult to differentiate essential tremor (ET) from Parkinson's disease (PD), especially in the early stages of the disease. We investigated cardiac sympathetic dysfunction using (123)I-metaiodobenzylguanidine (MIBG) myocardial scintigraphy in 22 patients with ET, in comparison with early PD and tremor-dominant PD (TDPD). The mean ratio of (123)I-MIBG uptake in the region of interest in the heart to that in the mediastinum (H/M ratio) was significantly greater in patients with ET (1.99 +/- 0.21) than in those with either TDPD (1.28 +/- 0.11) or early PD (1.28 +/- 0.17; each P < 0.001). The H/M ratio in all patients with ET was greater than two standard deviations above the range of the ratio in the patients with early PD or TDPD.

F-18 FDG positron emission tomography findings in primary pancreatic lymphoma.

The usefulness of F-18 2'-deoxy-2-fluoro-D-glucose (FDG) positron emission tomography (PET) has been well established for lymphoma staging. Although involvement of the pancreas occurs in more than one third of patients with non-Hodgkin lymphoma, primary lymphoma of the pancreas accounts for less than 1% of extranodal non-Hodgkin lymphomas. Because patients with primary pancreatic lymphoma require a different therapeutic approach and have a better prognosis than those with pancreatic adenocarcinoma, the accurate diagnosis is important. However, conventional imaging modalities cannot differentiate between adenocarcinoma and other less common neoplasms such as lymphoma. We report a 67-year-old man who had a primary pancreatic lymphoma in which FDG PET imaging revealed round, intense FDG uptake in the center of the midabdomen.