Medullary Thyroid Carcinoma with Ectopic Adrenocorticotropic Hormone Syndrome

Ectopic adrenocorticotropic hormone (ACTH) syndrome is caused most frequently by a bronchial carcinoid tumor or by small cell lung cancer. Medullary thyroid carcinoma (MTC) is a rare etiology of ectopic ACTH syndrome. We describe a case of Cushing syndrome due to ectopic ACTH production from MTC in a 48-year-old male. He was diagnosed with MTC 14 years ago and underwent total thyroidectomy, cervical lymph node dissection and a series of metastasectomies. MTC was confirmed by the pathological examination of the thyroid and metastatic mediastinal lymph node tissues. Two years after his last surgery, he developed Cushingoid features, such as moon face and central obesity, accompanied by uncontrolled hypertension and new-onset diabetes. The laboratory results were compatible with ectopic ACTH syndrome. A bilateral adrenalectomy improved the clinical and laboratory findings that were associated with Cushing syndrome. This is the first confirmed case of ectopic ACTH syndrome caused by MTC in Korea.

A Case of Recurrent Pulmonary Inflammatory Myofibroblastic Tumor with Aggressive Metastasis after Complete Resection / 결핵및호흡기질환

An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.

PACS in Nuclear Medicine / 대한핵의학회잡지

PACS (Picture Archiving and Communication System) is being rapidly spread and installed in many hospitals, but most of the system do not include nuclear medicine field. Although additional costs of hardware for nuclear medicine PACS is low, the complexity in developing viewing software and little market have made the nuclear medicine PACS not popular. Most PACS utilize DICOM 3.0 as standard format, but standard format in nuclear medicine has been Interfile. Interfile should be converted into DICOM format if nuclear images are to be stored and visualized in most PACS. Nowadays, many vendors supply the DICOM option in gamma camera and PET. Several hospitals in Korea have already installed nuclear PACS with DICOM, but only the screen captured images are supplied. Software for visualizing pseudo-color with color lookup tables and expressing with volume view should be developed to fulfill the demand of referring physicians and nuclear medicine physicians. PACS is going to integrate not only radiologic images but also endoscopic and pathologic images. Web and PC based PACS is now a trend and is much compatible with nuclear medicine PACS. Most important barrier for nuclear medicine PACS that we encounter is not a technical problem, but indifference of investor such as administrator of hospital or PACS. Now it is time to support and invest for the development of nuclear medicine PACS.