Biopsia de médula ósea en el linfoma de Hodgkin. Comparación con la PET-TC en 65 pacientes / Bone marrow trephine biopsy in Hodgkin's lymphoma. Comparison with PET-CT scan in 65 patients

Fundamento y objetivo: Comparar la biopsia de médula ósea (BMO) y la PET/CT en la detección de la afectación medular en el linfoma de Hodgkin. Material y métodos: Análisis retrospectivo de 65 pacientes con realización de ambas pruebas en la estadificación inicial o en recaída con especial atención al patrón de la PET/CT. Resultados: En 3 pacientes (4,6%) la BMO mostró afectación medular, siendo la PET/CT positiva en todos ellos: 2 con patrón difuso+multifocal y uno solo difuso. En 11 pacientes más (total 14/65, 21%) se estimó que había afectación medular ósea por PET/CT al tener un consumo de médula ósea superior al hepático. El patrón fue focal único en 2 casos, multifocal en 5, difuso en 3 casos y difuso+multifocal en uno. En estos últimos 4 casos la BMO mostró una mielopatía inespecífica. Conclusiones: La PET/CT detecta todos los casos con BMO afectada y muchos que se escapan a la biopsia; sin embargo, cuando el patrón de captación es difuso puede ser por afectación o por hiperplasia reactiva y en esos casos debería mantenerse la BMO (AU)

Background and objectives: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma. Material and methods: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern. Results: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy. Conclusions: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done (AU)

Bone marrow trephine biopsy in Hodgkin's lymphoma. Comparison with PET-CT scan in 65 patients. / Biopsia de médula ósea en el linfoma de Hodgkin. Comparación con la PET-TC en 65 pacientes.

BACKGROUND AND OBJECTIVES: To compare bone marrow biopsy (BMB) and PET/CT in detecting bone marrow involvement in Hodgkin's lymphoma MATERIAL AND METHODS: Retrospective analysis of 65 patients with both tests in the initial staging or in relapse with special attention to the PET/CT uptake pattern. RESULTS: In 3 patients (4.6%), the BMB showed bone marrow involvement with the PET/CT being positive in them all: 2 with diffuse+multifocal pattern and one diffuse only. In 11 additional patients (total 14/65, 21%), bone marrow involvement was diagnosed by PET/CT because bone marrow uptake was above hepatic one. The pattern was focal only in 2 cases, multifocal in 5, diffuse in 3 and diffuse+multifocal in one. In these last 4 cases the BMB showed an unspecific myelopathy. CONCLUSIONS: PET/CT detects all cases with BMB affected and many that escape to biopsy, however when the uptake pattern is diffuse it could be by involvement or reactive hyperplasia and in those cases the BMB should be done.

Unsuspected uterine metastasis of breast carcinoma diagnosed by 18F-FDG PET/CT.

A 50-year-old woman with a history of bilateral lobular carcinoma of the breast in 1995 and 2001 was treated with mastectomy, axillary lymphadenectomy, chemotherapy, and hormone therapy which achieved a complete response. In 2009, the patient developed a progressive elevation of tumor markers. A CT scan was performed showing no suspicious malignant lesions. She was referred for (18)F-FDG PET/CT and the images revealed highly increased tracer uptake in the uterus suggestive of malignancy. The patient underwent hysterectomy with bilateral double adnexectomy and a histopathological diagnosis of massive carcinomatous infiltration of breast lobular carcinoma was done.

Imagen fotopénica secundaria a derrame pleural masivo visualizada en la fase precoz de una gammagrafía ósea / Photon-deficient right hemithorax on blood pool images in a pleural effusion

Presentamos un paciente con derrame pleural maligno visualizado como una área fotopénica en la imagen precoz de una gammagrafía ósea en 2 fases.

We present a patient with chondrosarcoma. In the blood pool phase of a bone scintigraphy we saw a cold area in the right hemithorax. This image was secondary to a malignant pleural effusion.

Feocromocitoma bilateral diagnosticado mediante 123I-MIBG en un paciente afecto de MEN 2b / Bilateral pheochromocytoma diagnosed by 123I-MIBG in a patient with multiple endocrine neoplasia type 2b

Presentamos el caso de un paciente varón de 29 años con sospecha clínica de feocromocitoma previamente diagnosticado de una Neoplasia Endocrina Múltiple (MEN) tipo 2b. Se realizó una gammagrafía con 123I-metaiodobelcilguanidina (MIBG) que mostró captación patológica en ambas suprarrenales, sugestiva de feocromocitoma bilateral. El estudio de resonancia magnética (RMN) determinó la localización anatómica. El paciente fue sometido a suprarrenalectomía bilateral confirmándose el diagnóstico de feocromocitoma bilateral en anatomía patológica.

We report a case of 29 years old man who was referred with the clinical symptoms of pheochromocytoma in a Multiple Endocrine Neoplasia (MEN) type 2b. 123I- metaiodobenzylguanidine (MIBG) scan revelead pathologic adrenal bilateral uptake described in bilateral pheochromocytoma. Anatomical localization was achieved by Magnetic Resonance (MRI). The patient was submitted to surgery for bilateral adrenal removal. Surgical pathology confirmed the diagnostic of pheochromocytoma in both adrenal glands.