18F-FDG PET/CT metabolic variability in functioning oncocytic parathyroid adenoma with brown tumors.

A 29-year-old female patient exhibited a solitary neck mass, severe hypercalcemia, and multiple skeletal lytic lesions consistent with metastatic neoplastic disease. Fine-needle aspiration (FNA) cytology of the neck lesion indicated a follicular thyroid neoplasm. CT-guided bone biopsy was non-diagnostic. Subsequent 18F-FDG PET/CT examination demonstrated avid glucose uptake within the neck mass and diffuse bony lesions of variable metabolic activity. Repeat biopsy utilizing PET/CT guidance produced core tissue with classic histologic features of a brown tumor. Postoperative histology revealed an exclusively oncocytic parathyroid adenoma. Atypical radiotracer uptake of this rare functioning adenoma subtype is illustrated with discussion of improved procedural diagnostic yield utilizing PET/CT.

Teaching EBM facilitation using small groups.

The problem-centered, learner-focused, small-group process (PLS) is used by faculty to train learners in evidence-based medicine (EBM). Few affordable and accessible courses exist to train faculty in the PLS process. The results of a novel course to train faculty in the PLS process are described. The course was a one-day workshop consisting of five small group sessions with two facilitators. The participants were seven clinicians and four medical librarians. The initial small-group session was a discussion of concepts and principles related to successful facilitation skills; the subsequent four small groups reinforced these concepts and principles with role-playing and case scenarios using different steps in the EBM process. The course, including the use of the PLS process, scored highly on participant evaluations. The authors conclude that the introductory course effectively taught the PLS process for use in EBM facilitation.