Isolated splenic sarcoidosis: a rare cause of hypercalcaemia in a patient with type 1 diabetes

A 30-year-old man was admitted to Intensive Therapy Unit (ITU) with status epilepticus secondary to severe hypoglycaemia on a background of type 1 diabetes. CT of the brain showed generalised cerebral oedema. He was successfully stepped down to a medical ward after 2 weeks. He was noted to have persistently high calcium, which required multiple doses of pamidronate. Parathyroid hormone level was appropriately low. CT of the thorax, abdomen and pelvis showed mild hepatosplenomegaly with small pathological lymph nodes throughout the abdomen. Bone marrow biopsy was unremarkable. Lymph node biopsy was difficult to achieve, and therefore a positron emission tomography scan was arranged. This showed an enlarged and hypermetabolic spleen. Differential diagnoses at this point included lymphoma and sarcoidosis. He underwent diagnostic splenectomy, and the diagnosis of sarcoidosis was confirmed histologically. Calcium level remained normal 17 months after splenectomy.

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The changing spectrum of TSH-secreting pituitary adenomas: diagnosis and management in 43 patients

Acta Endocrinologica ◽

10.1530/eje.0.1480433 ◽

2003 ◽

Vol 148 (4) ◽

pp. 433-442 ◽

Cited By ~ 169

Author(s):

HV Socin ◽

P Chanson ◽

B Delemer ◽

A Tabarin ◽

V Rohmer ◽

...

Keyword(s):

Pituitary Adenomas ◽

Somatostatin Analogs ◽

Pituitary Tumors ◽

Positron Emission Tomography Scan ◽

First Line ◽

Chi Square ◽

Diagnosis And Management ◽

Positron Emission ◽

Tomography Scan

OBJECTIVE: Our aim was to report the recent changes in diagnosis and management of TSH-secreting pituitary adenomas. METHODS: We retrieved 43 consecutive patients with TSH-secreting pituitary tumors (23 male and 20 female) among 4400 pituitary adenomas followed between 1976 and 2001 in six Belgian and French centers. RESULTS: TSH was elevated in 18/43 and alpha subunit in 13/32 patients. In patients with intact thyroid (n=30), mean free tri-iodothyronine was 13.1 pmol/l (range 3.5-23) and mean free thyroxine was 38.4 pmol/l (range 10.2-62.7). Hyperprolactinemia and acromegaly were associated in 9/43 and 8/43 cases. The number of associated hypersecretions was higher in macroadenomas than in microadenomas (Chi square = 11.2, P<0.01). Two women had sporadic multiple endocrine neoplasia type 1-associated syndrome. The proportion of microadenomas versus macroadenomas was 1/11 (period 1974-1986) and 8/32 (period 1987-2001). Bilateral petrosal sinus sampling, (111)In-pentreotide scintigraphy and ((11)C)-l-methionine positron emission tomography scan confirmed diagnosis in four questionable microadenomas. Macroadenomas with extrasellar extension (31 cases) had a tendency to be medially located. Medical treatment with somatostatin analogs was initiated as first-line treatment in 26 patients. TSH levels were reduced by more than 50% in 23/26 cases. A tumoral shrinkage of more than 20% was observed in 5/13 cases. Surgery was performed in 36 patients. After 1 year, 21 of them (58.3%) met the criteria of surgical favorable outcome. Pituitary radiotherapy (n=8) and somatostatin analogs allowed normalization in cases not cured by surgery. CONCLUSION: Ultrasensitive methods for TSH measurement led to an earlier recognition of TSH-secreting pituitary tumors. In this series, we observed that TSH-secreting pituitary tumors are today more frequently found at the stage of microadenomas, medially located, without associated hypersecretions and needing new exploration methods as compared with older series. This changing spectrum in the presentation of TSH-secreting pituitary tumors and the excellent response to somatostatin analogs has been accompanied by an improvement in the prognosis of the disease.

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Faculty Opinions recommendation of Interim [18F]fluorodeoxyglucose positron emission tomography scan in diffuse large B-cell lymphoma treated with anthracycline-based chemotherapy plus rituximab.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.13414985.14789086 ◽

2011 ◽

Author(s):

Nicolas Mounier

Keyword(s):

Cell Lymphoma ◽

B Cell Lymphoma ◽

Emission Tomography ◽

Fluorodeoxyglucose Positron Emission Tomography ◽

Positron Emission Tomography Scan ◽

Large B Cell Lymphoma ◽

Positron Emission ◽

Tomography Scan ◽

Large B Cell ◽

Fluorodeoxyglucose Positron Emission

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Liver rheumatoid nodules imitating liver malignancy: a rare occurrence

BMJ Case Reports ◽

10.1136/bcr-2020-234366 ◽

2020 ◽

Vol 13 (12) ◽

pp. e234366

Author(s):

Jason Wee ◽

Salar Sobhi ◽

Bastiaan De Boer ◽

Dan Xu

Keyword(s):

Histological Analysis ◽

Granulomatous Inflammation ◽

Needle Aspiration ◽

Upper Respiratory Tract ◽

Positron Emission Tomography Scan ◽

Liver Malignancy ◽

Positron Emission ◽

Right Lobe ◽

Upper Respiratory ◽

Tomography Scan

We describe a case of a 61-year-old man with a background of rheumatoid arthritis who presented to the emergency department with a single-reported episode of haemoptysis on the background of an upper respiratory tract infection. A CT scan revealed an incidental 40 mm mass in upper right lobe of the liver abutting the diaphragmatic surface. A subsequent positron emission tomography scan confirmed the mass and raised the possibility of another lesion in the liver raising the suspicion of malignancy. The case was complicated by the inability to perform a fine needle aspiration biopsy due to the mass’ proximity to the diaphragm. After discussion with the patient, it was decided to resect the affected liver segment. Histological analysis of the mass revealed localised necrotising granulomatous inflammation suggestive of a rheumatoid nodule, which is seldom reported in the literature.

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