Determination of the segmental hepatic clearance rate of 99mTc-mebrofenin and its application in the functional assessment of future liver remnant after liver resection.

99mTc-mebrofenin hepatobiliary scintigraphy with SPECT/CT (HBS-M) has become an important quantitative method to evaluate global liver function and future liver remnant (FLR) function in patients who are candidates for resective liver surgery. The purpose of this work was to describe the method in the prediction of post-surgical liver failure. The overall liver function and that of the FLR are obtained by analysis of the initial dynamic phase of the scan. Liver volume to be preserved is expressed as a percentage of the total liver volume measured in both CT sections. HBS-M is able to accurately gauge regional liver function abnormalities that could be represented as normal liver tissue parenchyma in the CT study. This technique can provide very valuable prognostic information for the estimation of the postoperative risk of liver failure in all patients who are candidates for resective liver surgery.

Disease-Free Survival for Patients with Thin Melanomas according to the American Joint Committee on Cancer 8th Edition.

BACKGROUND: The recently implemented AJCC 8th edition TNM staging system for malignant melanoma (MM) changed the definition for T1a and T1b tumours. OBJECTIVES: To analyse differences in disease-free survival (DFS) among patients with thin MM staged according to both AJCC 7th and 8th editions. METHODS: An observational study including 285 patients with cutaneous thin MM (thickness ≤1 mm). Cases were staged as T1a and T1b using both 7th and 8th editions. Neither regional nor visceral diseases were present at diagnosis. DFS curves were generated according to the Kaplan-Meier method. RESULTS: An 8% shift of patients from a T1a towards a T1b stage group was observed after applying the AJCC 8th edition. According to this 8th edition, DFS for T1a patients was significantly longer than for T1b patients (log-rank test; p = 0.005); 5-year DFS for T1a and T1b was 100 and 95%, respectively (Wilcoxon test; p = 0.002). According to the AJCC 7th edition, DFS did not significantly differ for T1a and T1b patients; 5-year DFS for T1a and T1b was 99 and 97%, respectively (p > 0.05). CONCLUSIONS: The AJCC 8th edition seems to be a better tool for staging thin melanomas.

Clinicopathological characteristics of cutaneous malignant melanoma in patients at a tertiary hospital in Macaronesia. Survival as a function of locoregional prognostic factors per the American Joint Committee on Cancer.

BACKGROUND: Despite suffering high ultraviolet radiation levels, few data on malignant melanoma (MM) in Macaronesia are available. METHODS: Observational study of cutaneous MM cases diagnosed during a period of 12 years at a tertiary hospital in Canary Islands. RESULTS: A total of 532 patients (female/male = 1.4) with an average age of 56 years were included; 5% developed more than one MM, and 7% reported family history of MM. Phototype II (43%), dark eyes (41%), and dark hair (41%) predominated. There was a lower frequency of light-colored hair and eyes in those born in the Canary Islands. The most frequent locations of MM were on the back for men (37%) and on the lower extremities for women (35%). Among the infiltrating tumors (83%), the (median) thickness was 1.07 mm (women, 0.90 mm; men, 1.21 mm). Anatomopathological ulceration (AU) and a mitotic rate ≥1 mitosis/mm2 (HMR) were recorded in 27% of patients. Patients with regional disease constituted 12% of the population. The most common stage was IA (34%). Melanoma-specific survival (MSSV) decreased significantly with thickness, presence of AU, HMR, and sentinel lymph node disease. These four variables were independent prognostic factors. The five-year MSSV varied between 100% (stage IA) and 39% (stage IIIC). CONCLUSIONS: The characteristics of the patients were similar to those published in datasets from continental Europe, although the pigmentary features were darker in those originating from Macaronesia. The prognostic parameters described in the 7th edition of the American Joint Committee on Cancer (AJCC) independently predict MSSV in our patients.

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.

Tiroides ectópico sublingual con hipotiroidismo: revisión de la literatura y caso clínico / Sublingual ectopic thyroid gland with hypothyroidism: clinical case and review of the literature

Las ectopias tiroideas son una patología poco frecuente pero de una trascendencia clínica importante por el papel que juegan las hormonas tiroideas en el desarrollo del niño. Por ello tanto el clínico como el médico nuclear y el radiólogo deben estar atentos a la hora de establecer el diagnóstico. El clínico por la necesidad de instaurar un tratamiento precoz, y los dos últimos por la necesidad de ser cautos a la hora de evaluar toda la zona en la que puede encontrarse el tiroides ectópico en un niño, es decir, es básico examinar con cualquiera de las técnicas disponibles desde la boca hasta el mediastino. Exponemos un caso visto en nuestro hospital.

Lesiones óseas por sobrecarga: shin splint y fractura de estrés / Bone injuries: shin splint and stress fracture

En el ámbito deportivo se producen múltiples lesiones por estrés en las extremidades inferiores, y la patología que presentamos es una de las mas frecuentes en pacientes jóvenes y niños que entrenan excesivamente. La clínica que presentan estos pacientes supone dolor y tirantez durante el ejercicio. En la etiología podrían estar implicadas las fibras de inserción de los músculos tibiales y sóleo (fibras de Sharpey), sin poder descartar la coexistencia de periostitis y miositis como cofactores. Con relativa frecuencia los "shin splints" se asocian a fracturas de estrés en diferentes estadíos que son también patología típica de sobreentrenamiento y pueden mostrar una semiología similar. La gammagrafía ósea en dos fases ha sido ampliamente descrita como una técnica de ayuda para el diagnóstico correcto y en consecuencia el buen manejo de este tipo de pacientes.