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ENFERMEDAD DE PAGET VERTEBRAL DETECTADA POR CINTIGRAMA OSEO MDP-TC99M: SIGNO DEL "RATON MICKEY"
Ladrón de Guevara H,David; Lobo,Gabriel; Cortés,Esteban; Martínez,Virginia; Jiménez,César; Pérez,Andrés;
Revista chilena de radiología , 2003, DOI: 10.4067/S0717-93082003000400007
Abstract: paget disease (pd) is a benign bone disease affecting 3% of the population over 40 years of age. this disease produces thikening and deformity of bone caused for excessive and abnormal remodeling, mainly in axial skeleton. because to the pathologic characteristics and hypervascularity of lesions, bone scan shows generally intense tracer uptake wherever it localizes. scintigraphic lesion can have a very particular shape in some cases of skull, jaw and spine involvement. we report the clinical case of a 70 years old man with prolonged back pain and a l1 lesion characteristic of pd in bone scan ("mickey mouse" sign). radiography and ct were compatible, and biopsy confirmed pd diagnosis. this scintigraphic sign was reported for first time by estrada et al in 1993, and shows high specificity for vertebral pd diagnosis.
Comparison of 99mTc-MDP and 99mTc-MIBI whole body scans for diagnosis of widespread skeletal metastases
Ansari M,Hoshiari M,Mortazavi SH
Iranian Journal of Nuclear Medicine , 2002,
Abstract: Skeletal metastasis is one of the most important disabling complications of the malignant diseases. As in general, the survival of patients with osteometastatic lesions is relatively long, an early diagnosis can lead to improve the patient’s life, both quantitatively and qualitatively, and prevent exacerbation of the disease and disabling complications. In this study, 22 patients with established diagnosis of malignant disease and clinical manifestations of skeletal metastasis were evaluated both with 99mTc-MIBI and 99mTc-MDP whole body scans, in two separate phases. Patients’ diagnoses were as following: Small Round Cell Tumor, Breast carcinoma, Nasopharynx carcinoma and Multiple Myeloma. In the first phase of the study a whole body bone scan was performed by IV injection of 740MBq 99mTc-MDP. After a period of 1 week a whole body scan was carried out by 99mTc-MIBI for all the patients. No treatment such as radiation therapy or chemotherapy was done in this 1 week interval. The number and intensity of the scan findings were compared visually, according to the three-phase staging, subsequently. Whole body survey with 99mTc-MIBI in 14 out of 22 patients were positive, demonstrating only 44.4% of bony lesions established on whole body bone scan with 99mTc-MDP. The mean value of intensity of radiotracer uptake, was around 1.5+ (Mild to moderate). On the other hand in 7 patients with positive 99mTc-MIBI scan some hidden soft tissue lesions (Mostly lymph nodes) were detected with intensity of 2+. So this study shows that whole body bone scan is preferable for detection of widespread metastasis comparing with 99mTc-MIBI whole body scan. The singnificance of 99mTc-MIBI scan is mainly limited to some equivocal of soft tissue lesions.
"Widespread Hydatidosis of Sacroiliac Bones and Retroperitoneum: A Case Report "
"M. Zhianpour,R. Basiratnia "
Iranian Journal of Radiology , 2004,
Abstract: Hydatid disease is one of the oldest diseases known to humankind. In 85-95% of the cases, the liver and/or the lungs are involved and only 5-15% of other organs. The case presented here is a 38-year-old man with hydatid disease of lower lumbar vertebrae, sacrum, lumbosacral spinal canal, and left iliac bone; with extension to retroperitoneum and piriformis, sacrospi-nalis, iliacus, iliopsoas, and quadratus lumbarum muscles; without involvement of liver or lung, as diagnosed by MRI and CT scan and confirmed by surgery.
Efecto de una sola dosis de ácido zoledrónico en un caso de enfermedad de Paget ósea
Sabán,Melina; Fidalgo,Silvina; Díaz,Carlos A.; Lutfi,Rubén J.;
Medicina (Buenos Aires) , 2010,
Abstract: paget's disease is a chronic disorder of bone remodeling characterized by increase of bone resorption by atypical osteoclasts, followed by rapid increase in bone formation resulting in a disorganized mosaic bone. the biochemical marker for early diagnosis and monitoring is serum alkaline phosphatase (alp). we report the case of a 90 year old male, with diagnose of paget's disease. pamidronate treatment was started orally with partial response, so it was switched to intravenous pamidronate. pain intensity and fal levels diminished. the scyntigraphic scan, however, though improved, persisted abnormal. after several years of treatment, with adequate calcium and vitamin d support, the patient presents pain and increase of fal. we administered intravenous zoledronic acid (4 mg) in a single dose. after this treatment we observed clinical and biochemical remission during four years and a significantly improvement in the scintigraphy. we report a case of paget′s disease, resistant to pamidronate treatment in whom a single dose of zoledronic acid produced clinical and biochemical remission during 4 years and a significant improvement in the scintigraphic scan.
Insuficiencia suprarrenal causada por un linfoma no-Hodgking B primario suprarrenal: presentación de un caso y revisión de la literatura
Hernández Marín,B.; Díaz Mu?oz de la Espada,V.M.; álvarez álvarez,R.; Encinas García,S.; Khosravi Shahi,P.; Pérez Fernández,R.; Pérez Manga,G.;
Anales de Medicina Interna , 2008, DOI: 10.4321/S0212-71992008000300007
Abstract: we report a case of 78-year old man who presented with symptoms of adrenal insufficiency. the computed tomography (ct) scan showed the presence of bilateral adrenal masses. a ct-scan guided needle biopsy revealed diffuse large- b cell lymphoma. the absence of pathological findings in clinical, bone marrow and ct scan examinations supported the diagnosis of primary non- hodgkin lymphoma of the adrenal glands. the patient was treated with four cycles of r-chop chemotherapy with rituximab, liposomal doxorubicin, cyclophosphamide, vincristine and prednisolone. at the end of fourth cycle there was radiological improvement but the chemotherapy was stopped because of iv grade toxicity. he completed treatment with radiotherapy of right adrenal mass. few days after finishing radiation therapy the pacient died due to a disseminated infection. no progressive disease was founded.
A rare case of synchronous renal cell carcinoma of the bladder presenting with gross hematuria  [cached]
Stephan Kruck,Marcus Scharpf,Arnulf Stenzl,Jens Bedke
Rare Tumors , 2013, DOI: 10.4081/rt.2013.e19
Abstract: A 57-year old man was referred to the Urology Department due to gross hematuria; abdominal ultrasound revealed an unspecific solid tumor of the left bladder wall. Ultrasound, transurethral resection of the bladder mass with subsequent histological analysis, thoracic and abdominal computed tomography-scan and brain magnetic resonance imaging were performed. He was diagnosed with a bladder metastasis of clear cell renal cell carcinoma (RCC) with concomitant bone, pulmonary, and cerebral metastatic disease of a primary RCC of the right kidney. Management: Transurethral resection of the bladder mass, cerebral and bone radiotherapy, removal of the primary tumor, targeted systemic therapy with mTOR followed by tyrosine kinase inhibition.
Sarcoidosis of the spleen – rare indications for splenectomy. Own experience  [cached]
Marcin Bednarek,Piotr Budzyński,Andrzej Budzyński,Sergiusz Demczuk
Videosurgery and Other Miniinvasive Techniques , 2010,
Abstract: The article presents two patients who underwent laparoscopic splenectomy because of splenic sarcoidosis. In onepatient sarcoidosis was diagnosed based on the chest X-ray and computed tomography (CT) scans. Further imagingallowed for the diagnosis of systemic spread of the disease with bone marrow and splenic involvement. The latterlocation was confirmed by pathological examination after the operation. The indication for splenectomy was hypersplenismwith concurrent thrombocytopenia. In the second patient, an abdominal ultrasound scan (US) showed suspiciousfocal lesions in the spleen. Histological examination proved it to be a rare isolated splenic form of sarcoidosis.
External auditory canal osteoma  [PDF]
Sente Marko
Srpski Arhiv za Celokupno Lekarstvo , 2009, DOI: 10.2298/sarh0902073s
Abstract: Introduction. Osteomas are a slow growing benign neoplasm of unknown etiology very rarely involving the temporal bone. They develop in the external auditory canal on squamous sections, in the mastoid, middle and inner ear. By bone composition they are divided into spongious (osteoma spongiosum) and compact osteomas (osteoma eburnum); by growth direction, into outward-growing (exosteoma) and in inwardgrowing (endosteoma); into unilateral and bilateral; by size, into small and gigantic; by surface structure, into smooth and multilobular; by number, into solitary and multiple; into symmetrical and asymmetrical. The symptoms of intracanalicular osteomas are the result of auditory canal obstruction. Diagnosis is made based on case history, clinical examination, audiological processing and radiography (temporal bone CT scan), and confirmed by histopathological examination of the bone. In terms of differential diagnosis, they must be distinguished from exostoses, bone tissue proliferation and osteoid osteomata. The progress of the disease is prolonged, as they are slow growing, asymptomatic and benign tumours. Therapy is surgical only. Case Outline. The report presents the case of a 70-year old patient with the osteoma of the right external auditory canal. In our patient, the osteoma arose in the auditory canal, the most frequent localization; it was unilateral, solitary, multilobular and compact. It was discovered accidentally, during otoscopic examination. The clinical diagnosis was confirmed by CT scan of the temporal bone. We applied surgical therapy by retroauricular approach. The removed bone change was about 12 mm high, 13-14 mm deep and about 8 mm wide. Histopathological findings confirmed osteoma. Conclusion. Due to their slow growth, the rate of auditory canal osteomas develop asymptomatically for a long time without the characteristic clinical features. In most cases, they are discovered accidentally during otoscopic or radiographic examination. The method of choice in diagnosis is temporal bone CT scan. Therapy is surgical.
Osteoporosis Syndrome in Thalassaemia Major: An Overview  [PDF]
Meropi Toumba,Nicos Skordis
Journal of Osteoporosis , 2010, DOI: 10.4061/2010/537673
Abstract: Osteoporosis in thalassaemia major (TM) represents a prominent cause of morbidity. The mechanism of pathogenesis of bone disease (BD) in TM is multifactorial and complicated. Peak bone mass is achieved shortly after completion of puberty and normally remains stable until the third decade of life when age-related bone mass begins. Growth hormone (GH) and sex steroids play a crucial role in bone remodeling and in the maintenance of skeletal architecture during adult life. GH and insulin growth factors (IGFs) have anabolic effect in bone formation. Sex steroids act probably by increasing the expression of RANKL by osteoblastic cells and alterations in the RANK/RANKL/OPG system in favor of osteoclasts. Impaired GH secretion and lack of sex steroids in thalassemic patients due to pituitary damage, contribute to failure of achieving optimal peak bone mass. Other endocrine complications such as hypoparathyroidism and vitamin D deficiency have also a detrimental role on bones in TM. It is still questionable whether the international criteria for defining osteopenia and osteoporosis are relevant to patients with TM; also a question arises for the diagnostic methods such as DEXA scan and management of osteoporosis with known treatment protocols, in the thalassaemic patient.
Radiographically Negative, Asymptomatic, Sentinel Lymph Node Positive Cutaneous T-Cell Lymphoma in a 3-Year-Old Male: A Case Report  [PDF]
Jeffrey Carson,Jiri Bedrnicek,Shahab Abdessalam
Case Reports in Pediatrics , 2012, DOI: 10.1155/2012/791602
Abstract: We present a case of a 3-year-old male originally diagnosed with a CD30+ anaplastic cutaneous T-cell lymphoma with no evidence of systemic disease after CT scan, PET scan, and bone marrow aspiration. Sentinel lymph node biopsy (SLNB) was performed as an additional step in the workup and showed microscopic disease. Current management/recommendations for cutaneous T-cell lymphoma do not include SLNB. Medical and surgical management of cutaneous malignancies is dramatically different for local versus advanced disease. Therefore adequate evaluation is necessary to properly stage patients for specific treatment. Such distinction in extent of disease suggests more extensive therapy including locoregional radiation and systemic chemotherapy versus local excision only. Two international case reports have described SLNB in cutaneous T-cell lymphoma with one demonstrating evidence of node positive microscopic disease despite a negative metastatic disease workup. This case is being presented as a novel case in a child with implications including lymphoscintigraphy and SLNB as a routine procedure for evaluation and staging of cutaneous T-cell lymphoma if the patient does not demonstrate evidence of metastatic disease on routine workup. 1. Introduction Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of lymphoproliferative disorders characterized by infiltration of the skin by malignant T cells. Primary cutaneous CD30+ T-cell lymphoma is a rare subtype of CTCLs. Prognosis is favorable with a 5-year survival of 90% [1]. However, for those diagnosed with stage IV disease, median survival is less than three years [2]. Treatment for CTCL is dependent on subtype and extent of disease. Therapies vary from wide local excision with local topical treatment to systemic chemotherapy, radiation therapy, and allogeneic stem cell transplant. Therefore determining disease extent is of critical importance for prognostic value as well as proper management. Systemic evaluation with sonography of lymph node basins, CT scan, PET scan, and bone marrow aspiration has served to evaluate the extent of disease. Sentinel lymph node biopsy (SLNB) has not been used for routine evaluation of CTCLs however it has been used extensively for evaluation of multiple other cutaneous and noncutaneous malignancies. Kr?mer et al. published a case from Germany where they reported negative metastatic workup but microscopic evidence of disease on sentinel lymph node biopsy [3]. This modality is a potential diagnostic method, which if used routinely could identify higher stage disease on
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