A Rare Case of Renal Malakoplakia Incidentally Detected on 18F-FDG PET/CT in a Patient With Concomitant Breast Cancer and Lymphoma.

ABSTRACT: Malakoplakia is a rare inflammatory disease that most frequently affects the urinary tract. We present the case of a patient who had been receiving treatment for breast cancer, who later on went on to develop diffuse large B-cell lymphoma for which she was started on RCHOP therapy. It was during her treatment that she underwent a whole-body 18F-FDG PET/CT for response evaluation and was incidentally diagnosed to have bilateral renal malakoplakia, which resolved after a prolonged course of antibiotic therapy.

Suspecting and diagnosing transthyretin amyloid cardiomyopathy (ATTR-CM) in India: An Indian expert consensus.

Transthyretin cardiac amyloidosis (ATTR-CM) is a rare and under-recognized disorder characterized by the aggregation of transthyretin-derived insoluble amyloid fibrils in the myocardium. Heterogeneity of symptoms at presentation, makes its diagnosis often delayed. An expert panel gathered on a virtual platform across India to conduct a meeting for developing a guiding tool for ATTR-CM diagnosis. The panel recommended younger age (≥40 years) for suspecting ATTR-CM and thick-walled non-dilated hypokinetic ventricle was considered as one of the important red flags. Electrocardiogram (ECG) and echocardiography (ECHO) findings were recommended as primary tests to raise the suspicion while nuclear scintigraphy and hematological tests were recommended to confirm the diagnosis and rule out amyloid light-chain (AL) amyloidosis. Cardiac magnetic resonance (CMR) and biopsy were recommended in case of ambiguity in the presence of red flags. Considering the lack of expert guidelines in the Indian scenario, a standardized diagnostic algorithm was also proposed.

High failure rate of ChAdOx1-nCoV19 immunization against asymptomatic infection in healthcare workers during a Delta variant surge.

Immunization is expected to confer protection against infection and severe disease for vaccines while reducing risks to unimmunized populations by inhibiting transmission. Here, based on serial serological studies of an observational cohort of healthcare workers, we show that during a Severe Acute Respiratory Syndrome -Coronavirus 2 Delta-variant outbreak in Delhi, 25.3% (95% Confidence Interval 16.9-35.2) of previously uninfected, ChAdOx1-nCoV19 double vaccinated, healthcare workers were infected within less than two months, based on serology. Induction of anti-spike response was similar between groups with breakthrough infection (541 U/ml, Inter Quartile Range 374) and without (342 U/ml, Inter Quartile Range 497), as was the induction of neutralization activity to wildtype. This was not vaccine failure since vaccine effectiveness estimate based on infection rates in an unvaccinated cohort were about 70% and most infections were asymptomatic. We find that while ChAdOx1-nCoV19 vaccination remains effective in preventing severe infections, it is unlikely to be completely able to block transmission and provide herd immunity.

Reactive changes with microfilaria in a suspected metastatic axillary lymph node on positron emission tomography-computed tomography in breast malignancy: An interesting finding.

Positron emission tomography-computed tomography (PET-CT) has evolved as an important diagnostic tool in the diagnosis and management of breast carcinoma. PET/CT can help in staging as well as detecting metastases to mediastinal, axillary, and internal mammary nodes. However, PET-CT is not useful in differentiating between inflammation and malignancy.

Parasitic Leiomyoma on PET-CT in A Suspected Case of Uterine Sarcoma - Report on Diagnosis and Management.

This case is a very good example of how a multimodality approach was taken in diagnosis and management of patient with suspected uterine sarcoma, which turned out to be uterine leiomyoma with parasitic leiomyoma mimicking the pararenal deposit. There has been an increased use of fluorodeoxyglucose avid positron emission tomography-computed tomography in pelvic malignancies, especially in the cases where there is suspected extrapelvic spread. It was an interesting finding of parasitic leiomyoma, which can be easily thought to be as deposit/mass in a patient with pelvic malignancy.

Primary ovarian carcinoid and dotanoc positron emission tomography-computed tomography scan.

Primary ovarian carcinoids are very rare tumors, representing only <1% of all carcinoid tumors and <0.1% of all ovarian neoplasm. Here, we present a case report where DOTANOC positron emission tomography-computed tomography scan helped in diagnosis and management of rare entity.

Sternal Foramina in Patient with Hepatocellular Carcinoma: A Diagnostic Dilemma on Bone Scan.

Presenting known treated case of hepatocellular carcinoma, complaining of non specific backache. 99mTc methylene diphosphonate bone scan showed photopenic area in sternal body, which could be easily thought of osteolytic metastasis from hepatocellular carcinoma; however CT scan revealed it to be sternal foramina- a normal variant of sternum. The possibility of a sternal foramen should be mentioned to the clinician because infiltration, biopsy or acupuncture of this area may lead to fatal cardiac complications. Knowledge of the existence of such anatomic variants is important to avoid misdiagnosis as an osteolytic process.

Detection of Diffuse Infiltrative Primary Hepatic Lymphoma on FDG PET-CT: Hallmarks of Hepatic Superscan.

Primary hepatic lymphoma (PHL) is an extremely rare entity with scarce information in evidence-based literature. Few case reports have described the role of 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-CT) in the diagnosing and staging of PHL. We report the case of a 78-year-old man with PHL who initially presented with weight loss and nonspecific fatigue. FDG PET-CT proved to be a beneficial tool in arriving at the diagnosis of this patient with nonspecific clinical presentation and also in the staging of PHL. Physiological uptake of FDG in the liver can be a potential cause of misinterpretation in such cases. Hence, knowing the imaging hallmarks can increase the accuracy in PET image interpretation.