Extragestational βHCG Secretion Due to an Isolated Lung Epithelioid Trophoblastic Tumor: Microsatellite Genotyping of Tumoral Cells Confirmed Their Placental Origin and Oriented Specific Chemotherapy

2014 ◽  
Vol 99 (10) ◽  
pp. 3515-3520 ◽  
Author(s):  
Patrick Fénichel ◽  
Cécile Rouzier ◽  
Catherine Butori ◽  
Patrick Chevallier ◽  
Anne-Gaelle Poullot ◽  
...  
Keyword(s):  
Lung Tumor ◽  
Abnormal Uterine Bleeding ◽  
Normal Pregnancy ◽  
Whole Body ◽  
Microsatellite Genotyping ◽  
Trophoblastic Tumor ◽  
Positron Emission ◽  
Isolated Lung ◽  
Epithelioid Trophoblastic Tumor ◽  
Tumoral Cells

Abstract Context: Persistent secretion of β-human chorionic gonadotropin (βHCG) in the absence of an ongoing or recent pregnancy and without persistent uterine gestational disease is a rare but challenging situation that requires locating the extrauterine secreting tumor and distinguishing between extragestational choriocarcinoma and gestational trophoblastic neoplasms. Case Presentation: An unexplained, persistent extragestational βHCG secretion occurring in a 29-year-old, nonsmoking woman with abnormal uterine bleeding 4 years after a normal pregnancy and without persistent gestational disease led to the discovery by whole-body computed tomography/positron emission tomography of an isolated pulmonary tumor. Objective: Characterization of paternal alleles in tumoral cells in order to establish their fetal origin, which may be helpful for the diagnosis and treatment of such tumors. Methods and Results: After the surgical procedure, clinical, histological, and immunocytochemical analysis ruled out primary or metastatic bronchopulmonary carcinoma or choriocarcinoma and supported the diagnosis of an isolated, primary, epithelioid trophoblastic tumor. Microsatellite genotyping of tumoral cells identifying paternal alleles confirmed their placental origin and their migration to the lungs, with likely secondary malignant transformation, and guided the choice of postsurgical chemotherapy needed to completely eradicate βHCG secretion. Conclusion: Persistent extragestational secretion of βHCG in a young nonsmoking woman with a precedent pregnancy and an isolated lung tumor suggests the diagnosis of epithelioid trophoblastic tumor, a very rare malignant tumor for which placental origin needs to be confirmed, especially when occurring several years after the patient's last pregnancy. Simple microsatellite genotyping of tumoral cells will allow this confirmation of diagnosis and help in personalizing chemotherapy.

scholarly journals Primary pulmonary epithelioid sarcoma: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Eiki Mizutani ◽  
Riichiro Morita ◽  
Keiko Abe ◽  
Makoto Kodama ◽  
Shogo Kasai ◽  
...  
Keyword(s):  
Tumor Cells ◽  
Lung Tumor ◽  
Smooth Muscle Actin ◽  
Asbestos Exposure ◽  
Epithelioid Sarcoma ◽  
Whole Body ◽  
Health Examination ◽  
Positron Emission ◽  
Primary Lung Tumor ◽  
The Right

Abstract Background Epithelioid sarcoma most frequently occurs in the dermal or subcutaneous area of the distal extremities. To date, there have been three cases of primary pulmonary epithelioid sarcoma reported. We report a case of epithelioid sarcoma that is considered a primary lung tumor. Case presentation A 65-year-old asymptomatic Asian male patient underwent chest radiography during a routine health examination, and an abnormal mass was detected. His past medical history was unremarkable. He smoked 40 cigarettes every day and had slightly obstructive impairment on spirometry. He worked as an employee of a company and had no history of asbestos exposure. He underwent partial resection of the right lung by thoracoscopy. A histological examination of the tumor revealed a cellular nodule of epithelioid and spindle-shaped cells. Some of the tumor cells displayed rhabdoid features and reticular arrangement in a myxomatous stroma. Immunohistochemically, the tumor cells were positive for vimentin, smooth muscle actin (SMA), CD34, and epithelial membrane antigen (EMA); loss of the BAF47/INI1 protein in the tumor cells was also confirmed. A diagnosis of epithelioid sarcoma was established. Careful screening by whole-body positron emission tomography for another primary lesion after surgery did not detect any possible lesion. He had no cutaneous disease. Conclusion To our knowledge, this is the fourth case of a proximal-type epithelioid sarcoma considered as a primary lung tumor.

scholarly journals Epithelioid trophoblastic tumor coexisting with choriocarcinoma around an abdominal wall cesarean scar: a case report and review of the literature

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Chunfeng Yang ◽  
Jianqi Li ◽  
Yuanyuan Zhang ◽  
Hanzhen Xiong ◽  
Xiujie Sheng
Keyword(s):  
Abdominal Wall ◽  
Chorionic Gonadotropin ◽  
Human Chorionic Gonadotropin ◽  
Unknown Origin ◽  
Exploratory Laparotomy ◽  
Cesarean Scar ◽  
Trophoblastic Tumor ◽  
Epithelioid Trophoblastic Tumor ◽  
Trophoblastic Tumors ◽  
Wall Lesion

Abstract Background Mixed gestational trophoblastic neoplasms are extremely rare and comprise a group of fetal trophoblastic tumors including choriocarcinomas, epithelioid trophoblastic tumors, and placental site trophoblastic tumors. We present a case of a patient with extrauterine mixed gestational trophoblastic neoplasm adjacent to the abdominal wall cesarean scar. On the basis of a literature review, this type of case has never been reported before due to the unique lesion location and low incidence. Case presentation Our patient was a 39-year-old Chinese woman who had a history of two cesarean sections and one miscarriage. She had a recurrent anterior abdominal wall mass around her cesarean scar, and the mass was initially suspected of being choriocarcinoma of unknown origin. The patient had concomitant negative or mildly increased serum β-human chorionic gonadotropin at follow-up and no abnormal vaginal bleeding or abdominal pain. However, she underwent local excision twice and had two courses of chemotherapy with an etoposide and cisplatin regimen. She finally opted for exploratory laparotomy with abdominal wall lesion removal, subtotal hysterectomy, bilateral salpingectomy, and left ovarian cyst resection, which showed the abdominal wall lesion, whose components were revealed by microscopy and immunohistochemical staining to be approximately 90% epithelioid trophoblastic tumors and 10% choriocarcinomas from a solely extrauterine mixed gestational trophoblastic neoplasm around an abdominal wall cesarean scar. Conclusions It is worth noting whether epithelioid trophoblastic tumor exists in the setting of persistent positive low-level β-human chorionic gonadotropin. More studies are required to provide mechanistic insights into these mixed gestational trophoblastic neoplasms.

Clinicopathological correlation of pre-biopsy quantitative PSMA uptake in patients with persistently raised serum PSA: initial experience in 74 patients with simultaneous 68-Ga PSMA PET/MRI

2020 ◽  
pp. 205141582095640
Author(s):  
Malik A Rouf ◽  
Rajesh Taneja ◽  
Venkatesh Kumar
Keyword(s):  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Whole Body ◽  
Characteristic Analysis ◽  
Positron Emission ◽  
Psma Pet ◽  
Significant Difference ◽  
Magnetic Resonance Imaging Mri ◽  
Normal Urine ◽  
Delayed Phase

Objective: To analyze 68-Ga prostate-specific membrane antigen (PSMA) uptake pattern of the prostate and its correlation with prostate-specific antigen (PSA), digital rectal examination (DRE), and Gleason’s score in the diagnosis of carcinoma of the prostate (CaP). Methods: This was a retrospective study conducted between June 2015 and August 2017. Patients who had undergone whole body 68-Ga PSMA HBED-CC simultaneous positron emission tomography (PET) or magnetic resonance imaging (MRI) for the diagnosis or staging of CaP were eligible. Patients who presented with persistently raised serum PSA (>4 ng/mL) and normal urine routine and negative culture were included in the study. Results: A total of 74 patients were included in the study. Significant positive correlation was observed between PSMA delayed uptake with the Prostate Imaging Reporting and Data System (PI-RADS) score ( p<0.001, ρ=0.750), PSA level ( p<0.001, ρ=0.414), DRE ( p<0.002, ρ=0.400), and Gleason’s score ( p<0.300, ρ=0.02). There was a significant difference between early and delayed phase of PSMA uptake in malignant prostatic lesions ( p<0.001). Delayed phase of PSMA uptake was able to characterize prostate lesions with an area under curve (AUC) of 0.91. Combined receiver operating characteristic analysis of PI-RADS score derived from multiparametric MRI and differential PSMA uptake to characterize prostatic lesions improved AUC to 0.94. Conclusion: Results demonstrated that the correlation with clinicopathological features (PSA, DRE, and Gleason’s score) could be used in prognostication of prostatic lesion along with PSMA PET/MRI.

scholarly journals Clinical practice guidelines for high-resolution breast PET, 2019 edition

2021 ◽  
Vol 35 (3) ◽  
pp. 406-414
Author(s):  
Yoko Satoh ◽  
Masami Kawamoto ◽  
Kazunori Kubota ◽  
Koji Murakami ◽  
Makoto Hosono ◽  
...  
Keyword(s):  
High Resolution ◽  
Practice Guidelines ◽  
Breast Imaging ◽  
Japanese Society ◽  
Insurance Coverage ◽  
Whole Body ◽  
Positron Emission Mammography ◽  
Dedicated Breast Pet ◽  
Positron Emission ◽  
Different Types

AbstractBreast positron emission tomography (PET) has had insurance coverage when performed with conventional whole-body PET in Japan since 2013. Together with whole-body PET, accurate examination of breast cancer and diagnosis of metastatic disease are possible, and are expected to contribute significantly to its treatment planning. To facilitate a safer, smoother, and more appropriate examination, the Japanese Society of Nuclear Medicine published the first edition of practice guidelines for high-resolution breast PET in 2013. Subsequently, new types of breast PET have been developed and their clinical usefulness clarified. Therefore, the guidelines for breast PET were revised in 2019. This article updates readers as to what is new in the second edition. This edition supports two different types of breast PET depending on the placement of the detector: the opposite-type (positron emission mammography; PEM) and the ring-shaped type (dedicated breast PET; dbPET), providing an overview of these scanners and appropriate imaging methods, their clinical applications, and future prospects. The name “dedicated breast PET” from the first edition is widely used to refer to ring-shaped type breast PET. In this edition, “breast PET” has been defined as a term that refers to both opposite- and ring-shaped devices. Up-to-date breast PET practice guidelines would help provide useful information for evidence-based breast imaging.

scholarly journals Bilateral Renal Colic as an Initial Presentation of Erdheim-Chester Disease

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Julien Sarkis ◽  
Fady Haddad ◽  
Sarah Nasr ◽  
Elie Hanna ◽  
Ahmad Mroueh ◽  
...  
Keyword(s):  
Renal Colic ◽  
Kidney Injury ◽  
Term Treatment ◽  
Whole Body ◽  
Ct Guided ◽  
Erdheim Chester Disease ◽  
Positron Emission ◽  
Long Term Treatment ◽  
Erdheim Chester ◽  
Chester Disease

Erdheim-Chester disease (ECD) is a rare non-Langerhans cells histiocytosis characterized by multiorgan involvement, with renal-ECD documented in over one-third of patients. Renal disease is generally asymptomatic, rarely causing hydronephrosis and kidney impairment. In addition, the diverse clinical picture of Erdheim-Chester disease arises slowly with sequential manifestations. We present a rare case of a 75-year-old woman on long-term treatment for panhypopituitarism and steroid therapy for vasculitis, presenting to the emergency department with bilateral renal colic and acute kidney injury. Abdominopelvic CT scan revealed renal infiltration with signs of retroperitoneal fibrosis and hydronephrosis. Kidney CT-guided biopsy and 18-fluorodeoxyglucose (FDG) positron emission tomography whole body scan as well as the history of hypopituitarism and vasculitis confirmed the diagnosis of Erdheim-Chester disease. Proper therapy with interferon-α was started. This case describes the multifaced manifestation of this disease and the difficulty to establish the diagnosis, as well as the pivotal role that a urologist can play in its management.

scholarly journals Imaging Medullary Thyroid Carcinoma with Persistent Elevated Calcitonin Levels

2007 ◽  
Vol 92 (11) ◽  
pp. 4185-4190 ◽  
Author(s):  
Anne Laure Giraudet ◽  
Daniel Vanel ◽  
Sophie Leboulleux ◽  
Anne Aupérin ◽  
Clarisse Dromain ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Medullary Thyroid Carcinoma ◽  
Bone Scintigraphy ◽  
Axial Skeleton ◽  
Whole Body ◽  
Liver Imaging ◽  
Calcitonin Level ◽  
Medullary Thyroid ◽  
Positron Emission ◽  
Work Up

Abstract Purpose: Because calcitonin level remains elevated after initial treatment in many medullary thyroid carcinoma (MTC) patients without evidence of disease in the usual imaging work-up, there is a need to define optimal imaging procedures. Patients and Methods: Fifty-five consecutive elevated calcitonin level MTC patients were enrolled to undergo neck and abdomen ultrasonography (US); neck, chest, and abdomen spiral computed tomography (CT); liver and whole-body magnetic resonance imaging (MRI); bone scintigraphy; and 2-[fluorine-18]fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/CT scan (PET). Results: Fifty patients underwent neck US, CT, and PET, and neck recurrence was demonstrated in 56, 42, and 32%, respectively. Lung and mediastinum lymph node metastases in the 55 patients were demonstrated in 35 and 31% by CT and in 15 and 20% by PET. Liver imaging with MRI, CT, US, and PET in 41 patients showed liver in 49, 44, 41, and 27% patients, respectively. Bone metastases in 55 patients were demonstrated in 35% by PET, 40% by bone scintigraphy, and 40% by MRI; bone scintigraphy was complementary with MRI for axial lesions but superior for the detection of peripheral lesions. Ten patients had no imaged tumor site despite elevated calcitonin level (median 196 pg/ml; range 39–816). FDG uptake in neoplastic foci was higher in progressive patients but with a considerable overlap with stable ones. Conclusion: The most efficient imaging work-up for depicting MTC tumor sites would consist of a neck US, chest CT, liver MRI, bone scintigraphy, and axial skeleton MRI. FDG PET scan appeared to be less sensitive and of low prognostic value.

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