scholarly journals Case Report: SAPHO Syndrome Mimicking Bone Metastases During Treatment With Pembrolizumab for Non-small Cell Lung Cancer

2021 ◽  
Vol 8 ◽  
Author(s):  
Yuko Kubo ◽  
Kimiteru Ito ◽  
Yutaka Fujiwara ◽  
Tatsuya Yoshida ◽  
Masahiko Kusumoto
Keyword(s):  
Bone Metastases ◽  
Stage Iv ◽  
Sapho Syndrome ◽  
Bone Lesions ◽  
Thoracic Vertebrae ◽  
Cell Lung Carcinoma ◽  
Abdominal Lymph Node ◽  
Prednisolone Treatment ◽  
Magnetic Resonance Imaging Mri

A 69-year-old female with recurrent stage IV squamous cell lung carcinoma and metastatic abdominal lymph node but not bone metastases was being treated with pembrolizumab. Four months after starting the recurrent treatment, the tumour reduced in size but she began to complain of back pain and palmar rash. A bone scan showed uptake lesions in the left sternocostal joints and vertebrae, while spine magnetic resonance imaging (MRI) showed multiple lesions in the thoracic vertebrae. Her heterogeneous lesions, such as skin and multiple bone manifestations, were comprehensively diagnosed as SAPHO syndrome by different experts. Furthermore, the SAPHO syndrome was suspected to be an immune-related adverse event induced by pembrolizumab, and pembrolizumab withdrawal and prednisolone treatment were performed. Subsequently, her symptoms improved and the follow-up imaging findings showed that the bone lesions had almost disappeared. This case demonstrates that SAPHO syndrome mimicking bone metastases developed during treatment with pembrolizumab. SAPHO syndrome is rare and bone lesions related to the disease may be misdiagnosed as bone metastases. Therefore, it is important in the future for various physicians to have a better understanding of SAPHO syndrome and to consider the potential relationship between this disease and immunotherapy.

scholarly journals Correcting B0 inhomogeneity-induced distortions in whole-body diffusion MRI of bone metastases

2020 ◽  
Author(s):  
Leonardino A. Digma ◽  
Christine H. Feng ◽  
Christopher C. Conlin ◽  
Ana E. Rodríguez-Soto ◽  
Kanha Batra ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastases ◽  
Bone Lesion ◽  
Distortion Correction ◽  
Whole Body ◽  
Bone Lesions ◽  
Thoracic Vertebrae ◽  
Signed Rank ◽  
Spatial Displacements ◽  
T2 Weighted Images

AbstractBackgroundAccurate imaging of bone metastases is necessary for treatment planning and assessing treatment response. Diffusion-weighted magnetic resonance imaging (DWI) can detect bone metastases, but DWI acquired with echo-planar imaging is susceptible to distortions due to static magnetic field inhomogeneities.PurposeEstimate spatial displacements of bone lesions on DWI. Examine whether distortion-corrected DWI more accurately reflects underlying anatomy.Study TypeRetrospective.Subjects18 patients with prostate cancer bone metastases.Field Strength/Sequence3.0 T; DWI and T2-weighted imaging.AssessmentWe first applied the reverse polarity gradient (RPG) technique to estimate spatial displacements of bone metastasis on DWI. Next, we calculated changes in mutual information (MI) between DWI and T2-weighted images after RPG distortion correction. Further, we annotated skeletal landmarks on DWI and T2-weighted images. RPG was again used to estimate displacements of these landmarks. Lastly, we calculated changes in distance between DWI- and T2-defined landmarks (i.e., changes in error) after RPG distortion correction.Statistical TestsMean and bootstrap-derived confidence intervals were used to summarize variables that estimate bone lesion distortions. Wilcoxon signed-rank tests were used to assess change in MI between DWI and T2-weighted images after RPG.ResultsMean (95% CI) displacement of bone lesions was 5.6 mm (95% CI: 4.8-6.5); maximum displacement was 17.1 mm. Corrected diffusion images were more similar to structural MRI, as evidenced by consistent increases in MI after applying RPG (Wilcoxon signed-rank p<10−13). Like bone metastases, our annotated skeletal landmarks also underwent substantial displacement (average, 6.3 mm). Lastly, RPG led to consistent error reductions between DWI and T2 for each skeletal landmark (mean, [95% CI]): thoracic vertebrae (−3.8 mm, [-4.3,-3.3]), abdominal vertebrae (−1.0 mm, [-1.2,-0.71]), pelvic vertebrae (−0.6 mm, [-1.0,-0.17]), and femoral head (−1.2 mm, [-2.1,-0.4]).Data ConclusionsThese findings support the use of distortion correction techniques to improve localization of bone metastases on DWI.Grant SupportThis work was supported by NIH/NIBIB #K08EB026503, American Society for Radiation Oncology, and the Prostate Cancer Foundation. This work was further supported by the National Institute on Aging T35 grant AG26757 (PI: Dilip V. Jeste, MD, and Alison Moore, MD, MPH), and the Stein Institute for Research on Aging and the Center for Healthy Aging at the University of California, San Diego.

Reevaluation of the Usefulness of Systematic Bone Scanning in Initial Staging and follow-up of Small Cell Lung Carcinoma, Taking into Account the Serum Levels of Neuron-Specific Enolase

1997 ◽  
Vol 12 (4) ◽  
pp. 148-153 ◽  
Author(s):  
V. Gendreau ◽  
F. Montravers ◽  
C. Philippe ◽  
J.N. Talbot
Keyword(s):  
Bone Metastases ◽  
Lung Carcinoma ◽  
Small Cell Lung Carcinoma ◽  
False Negative ◽  
Neuron Specific Enolase ◽  
Small Cell ◽  
Small Cell Lung ◽  
Cell Lung Carcinoma ◽  
Initial Staging

The prescription of bone scans (BS) in the initial staging and follow-up of small cell lung carcinoma (SCLC) is a traditional attitude. The availability of the serum neuron-specific enolase (NSE) assay and budget limitations led us to evaluate retrospectively, in 57 patients, the consequences of a more selective attitude, namely to perform BS only in those patients with abnormal serum NSE levels. Both BS and NSE assays were performed in 47 patients referred for initial staging of SCLC; NSE levels were normal in 8 but in 2 of these cases (25%) secondary bone localizations with great clinical significance were discovered at BS. During follow-up, 59 BS were performed in conjunction with NSE assays; 45 NSE levels were in the normal range whereas 17 (38%) corresponding BS were suggestive of bone metastases. In conclusion, due to the frequent occurrence of false-negative results in patients with bone metastases, serum NSE levels proved to be useless in the selection for BS of patients suffering from SCLC.

Clinical Insignificance of [18F]PSMA-1007 Avid Non-specific Bone Lesions: A Retrospective Evaluation

2021 ◽  
Author(s):  
Evyn G. Arnfield ◽  
Paul A. Thomas ◽  
Matthew J. Roberts ◽  
Anita M. Pelecanos ◽  
Stuart C. Ramsay ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Clinical Outcomes ◽  
Gleason Score ◽  
Malignant Lesion ◽  
Common Finding ◽  
Bone Lesions ◽  
Retrospective Audit

Abstract Purpose: [18F]PSMA-1007 offers advantages of low urinary tracer excretion and improved resolution for imaging prostate cancer. However, non-specific bone lesions (NSBLs), defined as mild to moderate focal bone uptake without a typical morphological correlate on CT, are a common finding on [18F]PSMA-1007 PET/CT. The purpose of this study was to investigate the clinical outcomes of patients with [18F]PSMA-1007 avid NSBLs, to determine whether patients with NSBLs represent a higher risk clinical cohort, and to determine whether SUVmax can be used as a classifier of bone metastasis.Methods: A retrospective audit of 214 men with prostate cancer was performed to investigate the clinical outcomes of [18F]PSMA-1007 avid NSBLs according to defined criteria. We also compared the serum PSA, Gleason score and uptake time of patients with [18F]PSMA-1007 avid NSBLs to patients without [18F]PSMA-1007 avid bone lesions. Finally, we assessed whether SUVmax is a good classifier of bone metastases using ROC curve analysis.Results: No [18F]PSMA-1007 avid NSBLs met criteria for a likely malignant or definitely malignant lesion after a median 15.8-month follow-up interval (11.9% definitely benign, 50.3% likely benign, and 37.7% equivocal). There were no statistically significant differences in serum PSA, Gleason score and uptake time between patients with [18F]PSMA-1007 avid NSBLs and those without [18F]PSMA-1007 avid bone lesions. All NSBLs with adequate follow-up had SUVmax ≤11.1. When comparing NSBLs to definite prostate cancer bone metastases, the highest SUVmax value recorded was a good classifier of bone metastasis, and an SUVmax cut-point of ≥7.2 maximised the Youden’s index.Conclusion: [18F]PSMA-1007 avid NSBLs rarely represent prostate cancer bone metastases. When identified in the absence of definite metastatic disease elsewhere, it is appropriate to classify those with SUVmax <7.2 as likely benign. NSBLs with SUVmax 7.2-11.1 may be classified as equivocal or metastatic, with patient clinical risk factors, scan appearance, and potential management implications used to guide interpretation.

scholarly journals The Value of 68Ga-PSMA PET/CT Following Equivocal 18F-NaF PET/CT in Prostate Cancer Patients

Diagnostics ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. 352
Author(s):  
Claus Madsen ◽  
Peter Østergren ◽  
Christian Haarmark
Keyword(s):  
Bone Metastases ◽  
Bone Lesions ◽  
Prostate Specific Membrane Antigen ◽  
Psma Pet ◽  
Pet Ct ◽  
Bone Scans ◽  
Sensitivity Specificity ◽  
Specific Membrane ◽  
Inclusion Period

Background: Inconclusive bone scans are a challenge but there is no consensus about follow-up imaging. We evaluated the use of 68gallium-labelled prostate-specific membrane antigen (68Ga-PSMA) PET/CT if 18F-sodium fluoride (18F-NaF) PET/CT was inconclusive. Methods: This retrospective study included patients with no previously known bone metastases who had one or more equivocal bone lesions on 18F-NaF PET/CT and underwent additional 68Ga-PSMA PET/CT. The bone lesions were deemed as true metastases or not based on follow-up by surveying supplemental imaging modalities and hospital records. A subgroup of patients with “most valid follow-up” was created, which included patients with unmeasurable PSA after prostatectomy or subsequent imaging (additional 18F-NaF PET/CT, 68Ga-PSMA PET/CT, CT, or MRI). Results: Of the 2918 patients referred for 18F-NaF PET/CT from the department of urology in the inclusion period, 51 (1.7%) were inconclusive regarding bone metastases and underwent additional 68Ga-PSMA PET/CT. Thirteen of these patients (25%) were ultimately diagnosed with bone metastases. Patient-based sensitivity, specificity, and accuracy of additional 68Ga-PSMA PET/CT were 100%, 95%, and 96%, respectively. In patients with “most valid follow-up”, the same parameters were 100%, 93%, and 94%, respectively. Conclusion: 68Ga-PSMA PET/CT is an excellent complementary modality in when 18F-NaF PET/CT is equivocal.

scholarly journals Large cell neuroendocrine carcinoma with a solitary brain metastasis and low Ki-67: a unique subtype

2019 ◽  
Vol 8 (12) ◽  
pp. 1600-1606 ◽  
Author(s):  
B C M Hermans ◽  
J L Derks ◽  
H J M Groen ◽  
J A Stigt ◽  
R J van Suylen ◽  
...  
Keyword(s):  
Brain Metastasis ◽  
Small Cell Lung Carcinoma ◽  
Stage Iv ◽  
Large Cell ◽  
Small Cell ◽  
Small Cell Lung ◽  
Ki 67 ◽  
Cell Lung Carcinoma ◽  
Solitary Brain Metastasis

Introduction Stage IV large cell neuroendocrine carcinoma (LCNEC) of the lung generally presents as disseminated and aggressive disease with a Ki-67 proliferation index (PI) 40–80%. LCNEC can be subdivided in two main subtypes: the first harboring TP53/RB1 mutations (small-cell lung carcinoma (SCLC)-like), the second with mutations in TP53 and STK11/KEAP1 (non-small-cell lung carcinoma (NSCLC)-like). Here we evaluated 11 LCNEC patients with only a solitary brain metastasis and evaluate phenotype, genotype and follow-up. Methods Eleven LCNEC patients with solitary brain metastases were analyzed. Clinical characteristics and survival data were retrieved from medical records. Pathological analysis included histomorphological analysis, immunohistochemistry (pRB and Ki-67 PI) and next-generation sequencing (TP53, RB1, STK11, KEAP1 and MEN1). Results All patients had N0 or N1 disease. Median overall survival (OS) was 12 months (95% confidence interval (CI) 5.5–18.5 months). Mean Ki-67 PI was 59% (range 15–100%). In 6/11 LCNEC Ki-67 PI was ≤40%. OS was longer for Ki-67 ≤40% compared to >40% (17 months (95% CI 11–23 months) vs 5 months (95% CI 0.7–9 months), P = 0.007). Two patients were still alive at follow-up after 86 and 103 months, both had Ki-67 ≤40%. 8/11 patients could be subclassified, and both SCLC-like (n = 6) and NSCLC-like (n = 2) subtypes were present. No MEN1 mutation was found. Conclusion Stage IV LCNEC with a solitary brain metastasis and N0/N1 disease show in the majority of cases Ki-67 PI ≤40% and prolonged survival, distinguishing them from general LCNEC. This unique subgroup can be both of the SCLC-like and NSCLC-like subtype.

scholarly journals Adult onset asynchronous multifocal eosinophilic granuloma of bone: an 11-year follow-up

2015 ◽  
Vol 4 (2) ◽  
pp. 204798161455221
Author(s):  
Benjamin Dallaudière ◽  
Joseph Kerger ◽  
Jacques Malghem ◽  
Christine Galant ◽  
Frederic E Lecouvet
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Therapeutic Approach ◽  
Eosinophilic Granuloma ◽  
Bone Lesions ◽  
Adult Onset ◽  
Resonance Imaging ◽  
Magnetic Resonance Imaging Mri ◽  
Eosinophilic Granuloma Of Bone

Multifocal eosinophilic granuloma (EG) is a rare observation within the spectrum of histiocytosis X, generally described in children. We report the case of a 33-year-old man with multifocal EG showing an asynchronous evolution of bone lesions during a follow-up of 11 years. We also present the therapeutic approach chosen for this patient and the repeated magnetic resonance imaging (MRI) examinations used to monitor the disease with a final favorable outcome.

MCA Serum Determination in Breast Carcinoma Patients for the Diagnosis of Bone Metastases

1993 ◽  
Vol 8 (4) ◽  
pp. 203-207 ◽  
Author(s):  
L. Dominguez-Ġadea ◽  
LM. Martin-Curto ◽  
A. Crespo ◽  
C. Avila
Keyword(s):  
Breast Carcinoma ◽  
Bone Metastases ◽  
Risk Groups ◽  
Bone Lesions ◽  
Benign Lesions ◽  
Receiver Operating Characteristic Curves ◽  
Complementary Method ◽  
Bone Scans ◽  
Selection Of

Serum MCA levels were determined in 173 consecutive patients with breast cancer in order to assess the clinical utility of MCA for the detection of bone metastases. Bone pathology was diagnosed by scintigraphy, radiology and clinical follow-up. Metastases were found in 37 patients, benign lesions in 25, and in 111 no bone lesions were found. Eighteen of the 173 bone scans were considered indeterminate for metastases. Based on the receiver-operating characteristic curves (ROC) analysis, the cut-off level for MCA was set at 20 U/ml. Only in 4 of the 37 patients with bone metastases MCA was below 20 U/ml. All 4patients had completed their chemotherapy course within six months before MCA determination. Only in 6 patients of the 136 without bone metastases MCA levels were above 20 U/ml. Of the 18 patients with indeterminate bone scans, 15 had benign lesions and all of them had MCA levels below 20 U/ml. MCA determination is a sensitive method for the detection of bone metastases in breast carcinoma. We encourage the use of this procedure for the selection of high-risk groups or as a complementary method for the interpretation of bone scintigraphy.

131J-speichernde pulmonale und ossäre Metastasen differenzierter Schilddrüsenkarzinome bei niedrigem Serum-Thyreoglobulinspiegel – Ausnahme in der Tumornachsorge?

1987 ◽  
Vol 26 (03) ◽  
pp. 139-142 ◽  
Author(s):  
G. Arning ◽  
O. Schober ◽  
H. Hundeshagen ◽  
Ch. Ehrenheim
Keyword(s):  
Serum Level ◽  
Thyroid Carcinoma ◽  
Bone Metastases ◽  
Differentiated Thyroid Carcinoma ◽  
Serum Thyroglobulin ◽  
Thyroglobulin Level ◽  
Low Serum

In the follow-up of differentiated thyroid carcinoma it is discussed whether the tumormarker thyroglobulin can replace the1311 scan, especially when the thyroglobulin serum level is normal. A positive1311 scan of metastases in the follow-up of patients with differentiated thyroid carcinoma combined with a low serum thyroglobulin level is extremely rare. The literature shows a frequency of about 4%. Recently we found 3 cases with a positive1311 scan demonstrating pulmonary and bone metastases whereas the serum thyroglobulin level was low.

Desmoid tumour of the distal forearm involving the distal radioulnar joint

2020 ◽  
Vol 13 (11) ◽  
pp. e237097
Author(s):  
Apoorv Sehgal ◽  
Pratyush Shahi ◽  
Avijeet Prasad ◽  
Manoj Bhagirathi Mallikarjunaswamy
Keyword(s):  
Distal Radioulnar Joint ◽  
Treatment Modalities ◽  
Desmoid Tumour ◽  
X Rays ◽  
Distal Forearm ◽  
Left Wrist ◽  
Radioulnar Joint ◽  
Magnetic Resonance Imaging Mri ◽  
Epidemiology Investigation

A 32-year-old woman presented with progressive pain and swelling of the left wrist for 6 months. Physical examination revealed a firm, tender, oval swelling over the left wrist. X-rays showed a pressure effect on the distal radius and ulna. Magnetic Resonance Imaging (MRI) revealed a well-defined, asymmetrical, dumbbell-shaped soft-tissue lesion involving the interosseous region of the distal forearm and extending until the distal radioulnar joint (DRUJ). Core needle biopsy confirmed the diagnosis of desmoid tumour. Marginal excision of the tumour was done. At the 2-year follow-up, the patient was doing well and had painless and improved left wrist motion. Desmoid tumour involving the DRUJ has not been previously reported. We, through this case, report new observation and discuss the epidemiology, investigation of choice, treatment modalities, and the need for a regular follow-up for appendicular desmoid tumours.

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