A Rare Case of Occult Advanced Uterine Adenocarcinoma With a Neoplastic Enterouterine Fistula on Presentation.

Enterouterine fistula is a rare complication of endometrial carcinoma, typically associated with a clinical presentation of malodorous vaginal discharge. We present a case of occult metastatic endometrial cancer with an initial presentation of embolic stroke, further complicated by an incidental finding of enterouterine fistula on imaging. This case uniquely describes a patient with no symptoms suggestive of uterine malignancy or enterouterine fistula, highlighting a rare presentation of this occult malignancy and further emphasizing the importance of preventative screening.

Volumetric parameters from [18 F]FDG PET/CT predicts survival in patients with high-grade gastroenteropancreatic neuroendocrine neoplasms.

A positive fluorine-18 labelled 2-deoxy-2-fluoroglucose ([18 F]FDG) positron emission tomography/computed tomography (PET/CT) has been associated with more aggressive disease and less differentiated neuroendocrine neoplasms (NEN). Although a high maximum standardized uptake value (SUVmax ) predicts poor outcome in NEN, volumetric parameters from [18 F]FDG PET have not been evaluated for prognostication in a pure high-grade gastroenteropancreatic (GEP) NEN cohort. In this retrospective observational study, we evaluated the volumetric PET parameters total metabolic tumour volume (tMTV) and total total lesion glycolysis (tTLG) for independent prognostication of overall survival (OS). High-grade GEP NEN patients with [18 F]FDG PET/CT examination and biopsy within 90 days were included. Total MTV and tTLG were calculated using an adaptive thresholding software. Patients were dichotomised into low and high metabolic groups based on median tMTV and tTLG. OS was compared using Kaplan-Meier estimator and log-rank test. Uni and multivariable Cox regression was used to estimate effect sizes and adjust for tumour differentiation and SUVmax . Sixty-six patients (median age 64 years) were included with 14 NET G3 and 52 NEC cases after histological re-evaluation. Median tMTV was 208 cm3 and median tTLG 1899 g. Median OS in the low versus high tMTV-group was 21.2 versus 5.7 months (HR 2.53, p = 0.0007) and 22.8 versus 5.7 months (HR 2.42, p = 0.0012) in the tTLG-group. Adjusted for tumour differentiation and SUVmax , tMTV and tTLG still predicted for poor OS, and both tMTV and tTLG were stronger prognostic parameters than SUVmax . Both regression models showed a strong association between volumetric parameters and OS for both neuroendocrine tumours (NET) G3 and neuroendocrine carcinomas (NEC). OS for the tTLG low metabolic NEC was much higher than for the tTLG high metabolic NET G3 (18.3 vs. 5.7 months). High-grade GEP NEN patients with high tMTV or tTLG had a worse OS regardless of tumour differentiation (NET G3 or NEC). Volumetric PET parameters were stronger prognostic parameters than SUVmax .

A Rare Case of Aggressive Systemic Mastocytosis With Skeletal Osteosclerotic Lesions on Presentation: A Diagnostic Conundrum.

Systemic mastocytosis (SM) is a heterogeneous group of disorders caused by mast cell proliferation. SM often presents with non-specific symptoms making it a diagnostic challenge. Moreover, presentation with bone involvement is highly uncommon. Here, we report a rare case of SM in a 68-year-old female who initially presented with gastrointestinal symptoms and was later found to have sclerotic bone lesions on imaging. This case highlights an unusual presentation of SM, informing clinicians of the importance of keeping this disease process on the differential list of diagnostic conundrums.

Applications of Hybrid PET/Magnetic Resonance Imaging in Central Nervous System Disorders.

PET with 18F-fluorodeoxyglucose (FDG) is used to assess a wide array of inflammatory and neoplastic disorders. FDG-PET has shown particular utility in the evaluation of disorders of the central nervous system (CNS). Although fused PET/computed tomography (CT) is frequently used across the globe for these diseases, recent evidence has pointed to PET/magnetic resonance (MR) imaging as a more sensitive and specific molecular imaging modality. This article reviews the literature regarding the advantages of PET/MR imaging compared with PET/CT imaging, especially in CNS disease. It also introduces a new concept for PET-based evaluation of patients with neurodegenerative disorders: global disease assessment.

Atypical clinical and radiological presentation of multiple sclerosis: A case report.

A 59-year-old, previously healthy Caucasian female patient presented to the ED with a sudden onset of focal neurological deficit, with stable vital signs. Her initial physical examination revealed left-sided facial nerve palsy and right lower extremity weakness. The CT head was negative for intracranial bleeding. Subsequently, during her hospital stay, the MRI brain with contrast demonstrated extensive white matter cystic lesions with vasogenic edema. However, after carefully ruling out stroke, metastatic disease, and infectious diseases like neurocysticercosis with radiological and serological tests, the diagnosis of demyelinating condition was presumed, and it was proven by consequent MRI of the brain and elevated IgG levels in the CSF. The patient's initial clinical presentation was pointing towards the diagnosis of ischemic stroke, while her initial MRI brain suggested the diagnosis of the space-occupying lesions, however, rapid recovery of the focal neurological deficit with steroids, and subsequent MRI brain and spine, and CSF tests confirmed the diagnosis of a demyelinating condition. The objective of this case report is to inform physicians that the clinical and radiological presentation of multiple sclerosis can be challenging; therefore, physicians should keep a high index of suspicion.