The contribution of 18F-FDG PET/CT in a patient with cutaneous metastases of squamous cell carcinoma of the penis / Aportación de la 18F-FDG PET/TC en un paciente con metástasis cutáneas de un carcinoma de células escamosas de pene

A 61-year-old patient was diagnosed with squamous cell carcinoma of the penis (SCCP) and treated with partial penectomy (pT1,N0,M0,G2). Seven months later, a palpable adenopathy was found in the left inguinal region. An 18F-FDG PET/CT exploration showed hypermetabolic lymphadenopathies in inguinal, pelvic, retroperitoneal regions, in both lung hila and in the left supraclavicular regions. At the end of the 4th cycle of chemotherapy (cisplatin + 5FU) the patient developed numerous skin metastases at the root of the left thigh and a pleural effusion in the right lung. In a new exploration with 18F-FDG PET/CT the number, size and metabolic activity of known lymphadenopathies decreased. Right pleural carcinomatosis and intense FDG uptake in cutaneous metastases were observed. Weeks later, the patient died. 18F-FDG-PET/TC may be useful in patients with SCCP and metastatic inguinal lymphadenopathies, to assess the response to chemotherapy and to detect other unsuspected metastases in the rare cases of cutaneous metastases (AU)

Paciente de 61 años diagnosticado de carcinoma de células escamosas de pene (CCEP) tratado mediante penectomía parcial (pT1,N0,M0,G2). Siete meses más tarde, se constata una adenopatía palpable en la región inguinal izquierda. Una exploración 18F-FDG PET/TC demostró adenopatías hipermetabólicas inguinales, pélvicas, retroperitoneales, en ambos hilios pulmonares y en la región supraclavicular izquierda. Al finalizar el 4° ciclo de quimioterapia (cisplatino + 5FU) el paciente desarrolla numerosas letálides en la raíz del muslo izquierdo y un derrame pleural derecho. En una nueva exploración 18F-FDG PET/TC se apreció disminución del número, tamaño y actividad metabólica de las adenopatías conocidas, carcinomatosis pleural derecha e intensa captación de FDG en las metástasis cutáneas. El paciente fallece semanas más tarde. La 18F-FDG-PET/TC puede ser útil en pacientes con CCEP y adenopatías inguinales metastásicas, para valorar la respuesta al tratamiento quimioterápico y en los raros casos de metástasis cutáneas para detectar otras metástasis no sospechadas (AU)

Radioguided surgery in Meckel's diverticulum / Cirugía radiodirigida en el divertículo de Meckel

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel’s diverticulum, whose presence was confirmed by 99mTc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new 99mTc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel’s diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel’s diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure (AU)

Analizamos el caso de un paciente con episodios intermitentes de hemorragia digestiva baja y sospecha de divertículo de Meckel, cuya presencia se confirmó mediante gammagrafía con 99mTc-pertecnetato. Anteriormente se había realizado laparotomía exploradora sin encontrarse el divertículo. Tras a˜nos de control con tratamiento médico, presenta un nuevo episodio de hemorragia digestiva baja con colonoscopía normal. La realización de una nueva gammagrafía con 99mTc-pertecnetato (incluyendo SPECT/TAC) permitió localizar anatómicamente el divertículo de Meckel y plantear su exéresis mediante cirugía laparoscópica radiodirigida. La introducción de la SPECT/TAC en el protocolo diagnóstico del divertículo de Meckel incrementa la seguridad diagnóstica y mejora la localización de la lesión permitiendo la realización de cirugía radiodirigida que facilita la resección de la misma, particularmente en el caso de una reintervención, con un procedimiento más conservador, reduciendo la morbilidad relacionada con la cirugía (AU)

The contribution of ¹8F-FDG PET/CT in a patient with cutaneous metastases of squamous cell carcinoma of the penis.

A 61-year-old patient was diagnosed with squamous cell carcinoma of the penis (SCCP) and treated with partial penectomy (pT1,N0,M0,G2). Seven months later, a palpable adenopathy was found in the left inguinal region. An (18)F-FDG PET/CT exploration showed hypermetabolic lymphadenopathies in inguinal, pelvic, retroperitoneal regions, in both lung hila and in the left supraclavicular regions. At the end of the 4th cycle of chemotherapy (cisplatin+5FU) the patient developed numerous skin metastases at the root of the left thigh and a pleural effusion in the right lung. In a new exploration with (18)F-FDG PET/CT the number, size and metabolic activity of known lymphadenopathies decreased. Right pleural carcinomatosis and intense FDG uptake in cutaneous metastases were observed. Weeks later, the patient died. (18)F-FDG-PET/TC may be useful in patients with SCCP and metastatic inguinal lymphadenopathies, to assess the response to chemotherapy and to detect other unsuspected metastases in the rare cases of cutaneous metastases.

Radioguided surgery in Meckel's diverticulum.

We analyze the case of a patient with intermittent episodes of lower gastrointestinal bleeding and suspected Meckel's diverticulum, whose presence was confirmed by (99m)Tc-pertechnetate scintigraphy. A previous exploratory laparotomy had been performed without finding the diverticulum. In spite of years of medical treatment, the patient presented a new episode of lower gastrointestinal bleeding with normal colonoscopy. A new (99m)Tc-pertechnetate scintigraphy (including SPECT/CT) was performed and allowed the anatomical location of a Meckel's diverticulum and enabled its removal by laparoscopic radioguided surgery. The introduction of SPECT/CT in the scintigraphic diagnostic protocol in Meckel's diverticulum increases diagnostic safety and improves lesion location. Furthermore, it favors the performance of radioguided surgery and facilitates the lesion resection, particularly when the patient has suffered previous abdominal surgery, with a more conservative procedure, reducing the morbidity associated with the surgical procedure.

Extenso patrón hipermetabólico por activación de la grasa parda en un paciente diagnosticado de paraganglioma para-vesical secretor de catecolaminas explorado mediante 18F-FDG PET/TC / Extensive hypermetabolic pattern of brown adipose tissue activation on 18F-FDG PET/CT in a patient diagnosed of catecholamine-secreting para-vesical paraganglioma

El uso generalizado de la exploración 18F-FDG PET-TC en pacientes de cáncer ha permitido demostrar la existencia de grasa parda metabólicamente activa, también llamada tejido adiposo pardo (TAP), en sujetos humanos adultos, y conocer su distribución anatómica in vivo. Como determinantes fisiológicos de la captación de 18F-FDG por el TAP se han identificado el sexo, la edad, la temperatura y el índice de masa corporal. Hemos observado una extensa activación del TAP, incluyendo la región mesentérica, en un paciente con un paranganglioma paravesical secretor de catecolaminas. La activación extensa del TAP podría ser secundaria a la estimulación adrenérgica por un exceso de la concentración de noradrenalina circulante (AU)

The widespread use of 18F-FDG PET-CT scanning in oncological patients has allowed to demonstrate the existence of metabolically active brown fat, also called brown adipose tissue (BAT), in adult humans, and specifying its anatomical distribution in vivo. As physiological determinants to BAT 18F-FDG uptake has been identified gender, age, temperature, and body mass index. We have observed extensive activation of the BAT, including the mesenteric region, in a patient with a catecholamine-secreting para-vesical paranganglioma. The extensive BAT activation could be secondary to adrenergic stimulation due to excess of circulating norepinephrine concentration (AU)

Extensive hypermetabolic pattern of brown adipose tissue activation on 18F-FDG PET/CT in a patient diagnosed of catecholamine-secreting para-vesical paraganglioma.

The widespread use of (18)F-FDG PET-CT scanning in oncological patients has allowed to demonstrate the existence of metabolically active brown fat, also called brown adipose tissue (BAT), in adult humans, and specifying its anatomical distribution in vivo. As physiological determinants to BAT (18)F-FDG uptake has been identified gender, age, temperature, and body mass index. We have observed extensive activation of the BAT, including the mesenteric region, in a patient with a catecholamine-secreting para-vesical paranganglioma. The extensive BAT activation could be secondary to adrenergic stimulation due to excess of circulating norepinephrine concentration.

Diagnóstico mediante 18F-FDG PET-TAC de infección quística hepática en paciente con enfermedad poliquística renal autosómica dominante y fiebre de origen desconocido / 18F-FDG PET/CT diagnosis of liver cyst infection in a patient with autosomal dominant polycystic kidney disease and fever of unknown origin

El diagnóstico, la localización y el tratamiento de los quistes renales o hepáticos infectados en pacientes con enfermedad poliquística renal autosómica dominante (EPRAD) sigue siendo un reto clínico. Comunicamos los hallazgos de la 18F-FDG PET-TAC en un paciente diagnosticado de EPRAD, trasplantado renal hace 5 años, que presentó episodios repetidos de bacteriemia sin foco conocido en las exploraciones radiológicas practicadas. La exploración con 18F-FDG PET-TAC demostró numerosas imágenes hipermetabólicas de morfología focal o anular relacionadas con el contenido y la pared de alguno de los quistes hepáticos. La mayor actividad metabólica se localizó en los segmentos vi y vii . Se procedió a la punción y drenaje de uno de los quistes del segmento vi extrayendo 110 cc de un líquido purulento en el que creció Escherichia coli (E. coli) BLEE. La exploración de la 18F-FDG PET-TAC debería incluirse en el algoritmo diagnóstico para detectar quistes hepáticos infectados en pacientes con EPRAD y fiebre de origen desconocido(AU)

The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of 18F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The 18F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The 18F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin(AU)

The role of bone scanning in severe frostbite of the feet in a mountaineer / La gammagrafía ósea en un alpinista con congelaciones de los pies

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[18F-FDG PET/CT diagnosis of liver cyst infection in a patient with autosomal dominant polycystic kidney disease and fever of unknown origin]. / Diagnóstico mediante 18F-FDG PET-TAC de infección quística hepática en paciente con enfermedad poliquística renal autosómica dominante y fiebre de origen desconocido.

The diagnosis, localization and treatment of infected cysts in the kidney or liver of patients with autosomal dominant polycystic kidney disease (ADPKD) remain a clinical challenge. We report the findings of (18)F-FDG PET-CT in an ADPKD diagnosed patient who required renal transplantation five years before and in his follow up presented repeated episodes of bacteriemia without known focus on radiological tests performed. The (18)F-FDG PET-CT scan showed numerous hypermetabolic images with focal or ring-shaped morphology related to the content and the wall of some hepatic cysts. The increased metabolic activity was localized on segments VI and VII. We proceeded to drainage of one cyst in segment VI, removing 110 cc of purulent fluid which grew E. Coli BLEE. The (18)F-FDG PET/CT scan should be included in the diagnostic algorithm for detecting infected liver cysts in patients with ADPKD and fever of unknown origin.

[Papillary thyroid carcinoma synchronous with breast cancer: an incidental finding in an (18)F-FDG PET-CT study carried out in a search for occult breast cancer]. / Carcinoma papilar de tiroides sincrónico con cáncer de mama: hallazgo casual en una exploración (18)F-FDG PET-TAC por búsqueda de un cáncer oculto de mama.

The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of (18)F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in (18)F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy.

Carcinoma papilar de tiroides sincrónico con cáncer de mama: hallazgo casual en una exploración 18F-FDG PET-TAC por búsqueda de un cáncer oculto de mama / Papillary Thyroid Carcinoma synchronous with breast cancer: An incidental finding in an 18F-FDG PET-CT study carried out in a search for occult breast cancer

La causa más frecuente de afectación metastásica de los ganglios linfáticos axilares en mujeres es una neoplasia en la mama ipsilateral. La definición de neoplasia oculta de mama se ha modificado con el tiempo. Actualmente, hay que considerar una neoplasia oculta de mama cuando coincide una linfadenopatía axilar metastásica aislada en ausencia de una tumoración palpable en la mama ipsilateral, una mamografía no diagnóstica para un tumor mamario y la no detección de una neoplasia primaria fuera de la mama, que potencialmente pudiera afectar a los ganglios axilares. En estos casos, el valor de la exploración 18F-FDG-PET-TAC no está establecido, aunque puede ser de utilidad en pacientes con una RM no diagnóstica. No es infrecuente que, en una exploración 18F-FDG-PET-TAC, se identifique de forma casual una imagen hipermetabólica focal en tiroides. La elevada prevalencia de cáncer en este tipo de lesiones, aconseja practicar una exploración con US y/o PAAF(AU)

The most common cause of metastatic involvement of axillary lymph nodes in women is ipsilateral breast cancer. The definition of occult breast malignancy has changed over time. Nowadays, it is considered to exist when it coincides with an isolated metastatic axillary abnormal lymph node in the absence of a palpable tumor in the ipsilateral breast, non-diagnostic breast tumor mammography and no detection of other malignancies outside the breast which could potentially affect the axillary nodes. The value of 18F-FDG PET/CT scan in these patients has not been established, but it could be useful in those patients with a non-diagnostic MRI. It is not uncommon in 18F-FDG PET/CT studies to identify incidental hypermetabolic focal image in the thyroid. The high prevalence of cancer in these lesions makes it recommendable to perform a US study and/or FNAP biopsy(AU)

Resistencia al tratamiento de primera línea de quimioterapia en un paciente diagnosticado de linfoma de Hodgkin de predominio linfocítico nodular identificada mediante 18F-FDG PET/TAC: implicaciones diagnósticas y terapéuticas / Resistance to first line chemotherapy treatment in a patient diagnosed of nodular lymphocyte-predominant Hodgkin's lymphoma identified by 18F-FDG PET/CT: diagnostic and therapeutic implications

El linfoma de Hodgkin de predominio linfocítico nodular (LHPLN) es una rara entidad que representa menos del 5% de los casos de linfoma de Hodgkin (LH) con rasgos morfológicos, inmunofenotípicos, genéticos y de comportamiento clínico distintos del LH clásico. En una minoría de pacientes, la evolución del LHPLN se complica por transformación a un linfoma no Hodgkin difuso B de células grandes (LNHDBCG) con implicaciones pronósticas y terapéuticas. Los cambios metabólicos precoces observados mediante 18F-FDG PET en pacientes con LH y LNH, después de 1-3 ciclos de quimioterapia predicen la respuesta final al tratamiento y la supervivencia libre de progresión. En el caso que presentamos, tanto si se trata de LHPLN transformado a LNHDBCG o la coexistencia de los dos tipos de linfoma en el mismo paciente, la exploración 18F-FDG PET/TAC fue determinante para identificar la resistencia del tumor a la primera línea de quimioterapia, orientar la toma de una segunda biopsia y modificar el régimen de quimioterapia(AU)

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by 18F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the 18F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen(AU)

[Resistance to first line chemotherapy treatment in a patient diagnosed of nodular lymphocyte-predominant Hodgkin's lymphoma identified by 18F-FDG PET/CT: diagnostic and therapeutic implications]. / Resistencia al tratamiento de primera línea de quimioterapia en un paciente diagnosticado de linfoma de Hodgkin de predominio linfocítico nodular identificada mediante (18)F-FDG PET/TAC: implicaciones diagnósticas y terapéuticas.

Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare entity that accounts for less than 5% of the cases of Hodgkin lymphoma (HL) with morphological, immunophenotypical, genetic and clinical behavior traits different from the classic HL. In a minority of patients, the NLPHL course is complicated by a transformation to a non-Hodgkin diffuse large B-cell lymphoma (NHDLBCL) with prognostic and therapeutic implications. Early metabolic changes observed by (18)F-FDG PET in patients with HL and NHL, after 1-3 cycles of chemotherapy, predict the final response to treatment and progression-free survival. In the case we are presenting herein, whether NLPHL is transformed to NHDLBCL or the two types of lymphoma co-exist in the same patient, the (18)F-FDG PET/CT scan was crucial for the identification of tumor resistance to first line chemotherapy and to guide a second biopsy decision and therefore modify the chemotherapy regimen.

Identificación preoperatoria mediante SPECT/TAC de un ganglio centinela intramamario en una paciente con cáncer de mama. Significado y relevancia clínica / Intramammary sentinel lymph node preoperative identification with SPECT/CT in a patient with breast cancer. Clinical meaning and relevance

Presentamos el caso de una paciente con cáncer de mama a la que se le realizó biopsia selectiva de ganglio centinela. En la linfogammagrafía preoperatoria se identificó mediante SPECT/TAC un ganglio centinela intramamario. Describimos nuestro procedimiento diagnóstico-terapéutico en relación con este hallazgo y la revisión bibliográfica para evaluar el significado clínico de su identificación y de su afectación metastásica, sobre todo en cuanto al manejo axilar más apropiado. Son necesarios estudios más amplios y con mayor significación estadística para dilucidar la actitud más adecuada ante la detección linfogammagráfica de un ganglio centinela intramamario(AU)

We present the case of a patient with breast cancer who underwent selective sentinel lymph node biopsy. An intramammary sentinel lymph node was identified with SPECT/CT in the preoperative lymphoscintigraphy. We describe our diagnostic and therapeutic procedure regarding this finding and the literature review to evaluate the clinical significance of their identification and metastases, especially in regards to more appropriate axillary management. Further studies with more statistical significance are necessary to elucidate the most suitable attitude when an intramammary sentinel lymph node is identified with the lymphoscintigraphy(AU)