Pericardial mass in a 71-year-old man

Clinical introductionA 71-year-old man, with a history of chronic aortic regurgitation and negative follow-up after bladder cancer resection 10 months before, had an aortic valve surgery. Two months after, a mass near the right side of the heart had been detected by transthoracic echocardiography performed for dyspnoea, without a cough or fever. The quality of ultrasound images did not allow for an appropriate evaluation due to the outcomes of the sternotomy and the presence of calcified pachypleurite. In order to evaluate this finding, coronary CT (CCT) (figure 1A,B) and positron-emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose (FDG-PET) (figure 1C) were performed. Finally, a cardiac magnetic resonance (CMR) was requested (figure 1D–F, see online supplementary videos).Figure 1(A) Short axis image of early contrast enhancement phase coronary CT (CCT); (B) short axis of delayed phase of the same CCT; (C) lesion on positron-emission tomography with 2-[18F] fluoro-2-deoxy-D-glucose image (white arrow); CMR short axis (D) T2-weighted image with fat saturation; (E) T1-weighted image with fat-saturation; (F) T1-weighted image without fat-saturation.QuestionWhich of the following is the most likely diagnosis of the pericardial mass?Primary pericardial tumour.Pericardial metastasis.Intrapericardial abscess.Intrapericardial haematoma.

Download Full-text

Mid-gut ACTH-secreting neuroendocrine tumor unmasked with 18F-dihydroxyphenylalanine-positron emission tomography

Endocrinology Diabetes and Metabolism Case Reports ◽

10.1530/edm-14-0104 ◽

2015 ◽

Vol 2015 ◽

Cited By ~ 1

Author(s):

Julien Ducry ◽

Fulgencio Gomez ◽

John O Prior ◽

Ariane Boubaker ◽

Maurice Matter ◽

...

Keyword(s):

Positron Emission Tomography ◽

Mitotic Activity ◽

Fdg Pet ◽

Emission Tomography ◽

Metabolic Imaging ◽

Tumor Localization ◽

List Type ◽

Ectopic Acth ◽

Positron Emission ◽

Cortisol Levels

Summary Ectopic ACTH Cushing's syndrome (EAS) is often caused by neuroendocrine tumors (NETs) of lungs, pancreas, thymus, and other less frequent locations. Localizing the source of ACTH can be challenging. A 64-year-old man presented with rapidly progressing fatigue, muscular weakness, and dyspnea. He was in poor condition and showed facial redness, proximal amyotrophy, and bruises. Laboratory disclosed hypokalemia, metabolic alkalosis, and markedly elevated ACTH and cortisol levels. Pituitary was normal on magnetic resonance imaging (MRI), and bilateral inferior petrosal sinus blood sampling with corticotropin-releasing hormone stimulation showed no significant central-to-periphery gradient of ACTH. Head and neck, thoracic and abdominal computerized tomography (CT), MRI, somatostatin receptor scintigraphy (SSRS), and 18F-deoxyglucose-positron emission tomography (FDG-PET) failed to identify the primary tumor. 18F-dihydroxyphenylalanine (F-DOPA)-PET/CT unveiled a 20-mm nodule in the jejunum and a metastatic lymph node. Segmental jejunum resection showed two adjacent NETs, measuring 2.0 and 0.5 cm with a peritoneal metastasis. The largest tumor expressed ACTH in 30% of cells. Following surgery, after a transient adrenal insufficiency, ACTH and cortisol levels returned to normal values and remain normal over a follow-up of 26 months. Small mid-gut NETs are difficult to localize on CT or MRI, and require metabolic imaging. Owing to low mitotic activity, NETs are generally poor candidates for FDG-PET, whereas SSRS shows poor sensitivity in EAS due to intrinsically low tumor concentration of type-2 somatostatin receptors (SST2) or to receptor down regulation by excess cortisol. However, F-DOPA-PET, which is related to amine precursor uptake by NETs, has been reported to have high positive predictive value for occult EAS despite low sensitivity, and constitutes a useful alternative to more conventional methods of tumor localization. Learning points Uncontrolled high cortisol levels in EAS can be lethal if untreated. Surgical excision is the keystone of NETs treatment, thus tumor localization is crucial. Most cases of EAS are caused by NETs, which are located mainly in the lungs. However, small gut NETs are elusive to conventional imaging and require metabolic imaging for detection. FDG-PET, based on tumor high metabolic rate, may not detect NETs that have low mitotic activity. SSRS may also fail, due to absent or low concentration of SST2, which may be down regulated by excess cortisol. F-DOPA-PET, based on amine-precursor uptake, can be a useful method to localize the occult source of ACTH in EAS when other methods have failed.

Download Full-text

Investigation and management of the unknown primary with metastatic neck disease: United Kingdom National Multidisciplinary Guidelines

The Journal of Laryngology & Otology ◽

10.1017/s0022215116000591 ◽

2016 ◽

Vol 130 (S2) ◽

pp. S170-S175 ◽

Cited By ~ 33

Author(s):

K Mackenzie ◽

M Watson ◽

P Jankowska ◽

S Bhide ◽

R Simo

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Emission Tomography ◽

Whole Body ◽

Unknown Primary ◽

List Type ◽

Concomitant Chemotherapy ◽

Neck Disease ◽

Positron Emission

AbstractThis is the official guideline endorsed by the specialty associations involved in the care of head and neck cancer patients in the UK. It discusses the evidence base pertaining to the management of metastatic neck disease in the setting of an unknown primary and provides recommendations on the work up and management for this group of patients receiving cancer care.Recommendations•All patients presenting with confirmed cervical lymph node metastatic squamous cell carcinoma and no apparent primary site should undergo: ○Positron emission tomography-computed tomography whole-body scan. (R)○Panendoscopy and directed biopsies. (R)○Bilateral tonsillectomy. (R)•Tongue base mucosectomy can be offered if facilities and expertise exists. (G)•Concomitant chemotherapy with radiation should be considered in patients with an unknown primary. (R)•Concomitant chemotherapy with radiation should be offered to suitable patients in the post-operative setting, where indicated. (R)•Neo-adjuvant chemotherapy can be used in gross ‘unresectable’ disease. (R)•Patients should be followed up at least two months in the first two years and three to six months in the subsequent years. (G)•Patients should be followed up to a minimum of five years with a prolonged follow up for selected patients. (G)•Positron emission tomography–computed tomography scan at three to four months after treatment is a useful follow-up strategy for patients treated by chemoradiation therapy. (R)

Download Full-text

Efficacy of Positron Emission Tomography in Diagnosis of Lateral Lymph Node Metastases in Patients with Rectal Cancer: A retrospective study

10.21203/rs.3.rs-119898/v1 ◽

2020 ◽

Author(s):

Ryohei Yukimoto ◽

Mamoru Uemura ◽

Takahiro Tsuboyama ◽

Tsuyoshi Hata ◽

Shiki Fujino ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Rectal Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Emission Tomography ◽

Short Axis ◽

Cutoff Value ◽

Positron Emission ◽

Pet Ct

Abstract Background The presence of lateral pelvic lymph node (LLN) metastasis is an essential prognostic factor in rectal cancer patients. Thus, preoperative diagnosis of LLN metastasis is clinically important to determine the therapeutic strategy. The aim of this study was to evaluate the efficacy of preoperative positron emission tomography/computed tomography (PET/CT) in the diagnosis of LLN metastasis. Methods Eighty-six patients with rectal cancer who underwent LLN dissection at Osaka University were included in this study. The maximum standardized uptake value (SUVmax) of the primary tumor and LLN were preoperatively calculated using PET/CT. Simultaneously, the short axis of the lymph node was measured using multi-detector row computed tomography (MDCT). The presence of metastases was evaluated by postoperative pathological examination. Results Of the 86 patients, LLN metastases developed in the left, right, and both LLN regions in 7, 8, and 2 patients, respectively. The diagnosis of the metastases was predicted with a sensitivity of 84%, specificity 94%, positive predictive value 62%, and negative predictive value 98% when the cutoff value of the LLN SUVmax was set at 1.5. The cutoff value of the short axis set at 7 mm on MDCT was most useful in diagnosing LLN metastases, but SUVmax was even more useful in terms of specificity.Conclusions The cutoff value of 1.5 for lymph node SUVmax in PET is a reasonable measure to predict the risk of preoperative LLN metastases in rectal cancer patients.

Download Full-text

Efficacy of positron emission tomography in diagnosis of lateral lymph node metastases in patients with rectal Cancer: a retrospective study

BMC Cancer ◽

10.1186/s12885-021-08278-6 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Ryohei Yukimoto ◽

Mamoru Uemura ◽

Takahiro Tsuboyama ◽

Tsuyoshi Hata ◽

Shiki Fujino ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Rectal Cancer ◽

Lymph Node ◽

Cancer Patients ◽

Emission Tomography ◽

Short Axis ◽

Cutoff Value ◽

Positron Emission ◽

Pet Ct

Abstract Background The presence of lateral pelvic lymph node (LLN) metastasis is an essential prognostic factor in rectal cancer patients. Thus, preoperative diagnosis of LLN metastasis is clinically important to determine the therapeutic strategy. The aim of this study was to evaluate the efficacy of preoperative positron emission tomography/computed tomography (PET/CT) in the diagnosis of LLN metastasis. Methods Eighty-four patients with rectal cancer who underwent LLN dissection at Osaka University were included in this study. The maximum standardized uptake value (SUVmax) of the primary tumor and LLN were preoperatively calculated using PET/CT. Simultaneously, the short axis of the lymph node was measured using multi-detector row computed tomography (MDCT). The presence of metastases was evaluated by postoperative pathological examination. Results Of the 84 patients, LLN metastases developed in the left, right, and both LLN regions in 6, 7, and 2 patients, respectively. The diagnosis of the metastases was predicted with a sensitivity of 82%, specificity of 93%, positive predictive value of 58%, negative predictive value of 98%, false positive value of 7%, and false negative value of 18% when the cutoff value of the LLN SUVmax was set at 1.5. The cutoff value of the short axis set at 7 mm on MDCT was most useful in diagnosing LLN metastases, but SUVmax was even more useful in terms of specificity. Conclusions The cutoff value of 1.5 for lymph node SUVmax in PET is a reasonable measure to predict the risk of preoperative LLN metastases in rectal cancer patients.

Download Full-text