Search

Aims: This study investigates to what extent the dose received by lungs from a commercially available treatment planning system, Ir-192 high-dose-rate (HDR), in breast brachytherapy, is accurate, with the emphasis on tissue heterogeneities, and taking into account the presence of ribs, in dose delivery to the lung. Materials and Methods: A computed tomography (CT) scan of a breast was acquired and transferred to the 3-D treatment planning system and was also used to construct a patient-equivalent phantom. An implant involving 13 plastic catheters and 383 programmed source dwell positions were simulated, using the Monte Carlo N-Particle eXtended (MCNPX) code. The Monte Carlo calculations were compared with the corresponding commercial treatment planning system (TPS) in the form of percentage isodose and cumulative dose-volume histogram (DVH) in the breast, lungs, and ribs. Results: The comparison of the Monte Carlo results and the TPS calculations showed that a percentage of isodose greater than 75% in the breast, which was located rather close to the implant or away from the breast curvature surface and lung boundary, were in good agreement. TPS calculations overestimated the dose to the lung for lower isodose contours that were lying near the breast surface and the boundary of breast and lung and were relatively away from the implant. Conclusions: Taking into account the ribs and entering the actual data for breasts, ribs, and lungs, revealed an average overestimation of the dose by a factor of 8% in the lung for TPS calculations. Therefore, the accuracy of the TPS results may be limited to regions near the implants where the treatment is planned, and is a more conservative approach for regions at boundaries with curvatures or tissues with a different material than that in the breast. [ABSTRACT FROM AUTHOR]

Purpose: We performed this study to explore the association of computed tomography (CT) findings with outcomes of patients with non-small-cell lung cancer (NSCLC) treated with tyrosin kinase inhibitor (TKI) such as gefitinib or erlotinib. Materials and Methods: We analyzed outcomes for 240 patients according to primary tumor (T), regional nodal (N) staging and diffuse small pulmonary metastases (DSPM) at the initial presentation. Tests for epidermal growth factor receptor (EGFR) mutation were performed in 92 patients. Results: On multivariate analysis for tumor response, the N3 stage was predictive of a poor response (P < 0.001), whereas DSPM was a favorable factor (P = 0.007). Multivariate analysis for progression-free survival showed that the T3-4 stage (hazard ratio [HR]: 2.5, P < 0.001), in addition to the N3 stage (HR: 2.1, P < 0.001), was predictive of a poor outcome, whereas DSPM (HR: 0.6, P = 0.006) was a favorable factor. Notably, the multivariate model that included the EGFR mutational status revealed that the T3-4 stage predicted poor progression-free survival (HR: 2.2, P = 0.017) and poor overall survival (HR: 4.1, P < 0.001). Conclusion: Our data suggest that, in addition to EGFR mutational status, T-stage based on CT is predictive of outcomes of TKI-treated NSCLC patients. [ABSTRACT FROM AUTHOR]

Objective: To investigate the correlation between cellular proliferation and the fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT) imaging by comparing 50 cases of different subtypes of lymphoma. Materials and Methods: Fifty cases of lymphomas were collected. Each case was labeled with Ki-67 stain, a marker of cellular proliferation, and a PET/CT examination was performed. All lymphoma cases were sorted according to the World Health Organization's classification, and the International Non-Hodgkin's Lymphoma Working Formulation was used to differentiate groups of large and small cell non-Hodgkin's lymphoma. The Ki-67 staining was described as slight, mild, middle, or strong according to the nuclear staining of positive cells. FDG uptake by lesions in PET/CT images was semi-quantitatively analyzed to calculate the average standard uptake value. The statistics software SPSS13.0 was used to calculate the mean and standard deviation of the FDG uptake value of the lymphoma subtypes, the difference between the large and small cell lymphoma group with a Student's t-test, and the correlation between the Ki-67 level and FDG uptake of lesion with a Spearman's analysis. Results: The FDG uptake value of large cell origin lymphoma was significantly higher than that of small cell origin lymphoma (t = 6.19, P < 0.01). The correlation coefficients between the Ki-67 level and FDG uptake value in lymph nodal and extranodal lesions was 0.750 and 0.843, respectively. Conclusions: Ki-67 staining, a reflection of tumor-proliferation activity, was significantly related to the FDG uptake value in lymphoma lesions. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the role of positron emission tomography (PET) for predicting the clinical outcome of patients with recurrent cervical carcinoma following definitive radiation therapy (RT). Materials and Methods: Twenty two patients of post irradiated recurrent cervical carcinoma (PIRCC) were enrolled in this prospective study. 18-fluorodeoxyglucose (FDG) PET imaging was performed in each patient before the salvage therapy. The maximum standardized uptake value (SUVmax) and metabolic tumor volume (MTV) were measured and correlated with cumulative progression free survival (PFS). Results: Median age of patients was 42 years. Majority of patients had stage III disease at the initial presentation and all 22 patients had received prior definitive RT. The median recurrence free period was 11 months. Salvage therapy consisted of surgical resection or re-irradiation depending upon the various clinical and radiological factors. Median SUVmax was 5.8 (range 1.8-50.6) and median MTV was 43 cm3(range 5.8-243). The cumulative PFS for all patients was 20% at 30 months. The one-year PFS was 28% for patients with SUVmax value of >5.8 versus 42% for those with SUVmax value of <5.8 (P value 0.01). The one-year PFS was 43% for patients with MTV value of >43 cm3 versus 45% for those with MTV value of <43 cm3 (P value 0.8). Conclusion: Our preliminary experience has suggested that FDG uptake on PET scan can predict the clinical outcome of PIRCC patients. Further randomized studies may be conducted with large sample size and longer follow up to establish its definite predictive value. [ABSTRACT FROM AUTHOR]

Carcinoma cervix is one of the most common cancers amongst Indian women. Though treatment strategies continue to evolve, there are no established predictive biomarkers of prognosis or therapeutic response. Novel imaging techniques using magnetic resonance (MR) and positron emission tomography (PET) can facilitate time resolved spatial evaluation of biological characteristics (perfusion, permeability, cellularity, proliferation, oxygenation, and apoptosis) thereby serving as early surrogate biomarkers for prognosis and therapeutic response. Several of these imaging modalities such as dynamic contrast-enhanced MRI (DCE-MRI), diffusion-weighted MRI (DW-MRI), MR spectroscopy (MRS) and fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) are now being evaluated for gynecological oncology, with the majority of work being performed on cervical tumors. PUBMED database was searched for this review from January 1966 till February 2011. This review examines the basic principles of functional MR imaging for cervical cancer and its current status as a diagnostic and predictive biomarker for cervical cancer. [ABSTRACT FROM AUTHOR]

Background and Objectives: One of the important factors in the pretreatment evaluation of patients with squamous cell carcinoma is the detection of the presence and extent of bone invasion by the tumor, which is significant for planning the therapy and determining the prognosis. Therefore, a study was undertaken with an objective to compare the accuracy and predictability of an Orthopantamograph (OPG), conventional Computed Tomography (CT), and Single Positron Emission Computed Tomography (SPECT) in the detection of bone invasion in squamous cell carcinoma patients scheduled to undergo surgery. Materials and Methods: A descriptive study was carried out on 15 patients with clinically and histopathologically diagnosed squamous cell carcinoma. OPG, conventional CT, and SPECT were carried out on all patients. Subsequently, the bone adjacent to the tumor was assessed histopathologically and served as a gold standard. The various imaging modalities were compared with the gold standard. Results: The study revealed that the tumor infiltration into the bone was positive in eight out of fifteen cases and seven were negative for bone invasion. OPG and conventional CT showed the presence of bone invasion in six out of eight cases with a sensitivity of 75% and a specificity of 100%. The positive predictive value for OPG was 100% and the negative predictive value was 78%. SPECT showed the presence of bone invasion in eight out of eight cases with a sensitivity of 100% and a specificity of 14.3%. The positive predictive value for SPECT was 57% and the negative predictive value was 100%. Conclusion: The present study showed that SPECT was highly sensitive, but with a very low specificity due to an increase in false positive values. However, OPG and conventional CT showed an acceptable degree of sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Sarcomatoid hepatocellular carcinoma is a rare disease with a poor prognosis. A 62-year-old man presented with 1-month history of middle-grade fever and fatigue in the background of loss of weight and a history of hepatitis B for 10 years. Dynamic contrast enhanced computed tomography showed two distinct irregular hypodense masses on precontrast scan located in hepatic segment VI and VII with size 6.7×4.7×4.5 cm and 1.9×1.3×1.6 cm. The patient underwent the right hepatectomy. Microscopic examination revealed that the large tumor was sarcomatoid hepatocellular carcinoma and the small tumor was early hepatocellular carcinoma. [ABSTRACT FROM AUTHOR]

Lung cancer combined with eczema is a rare disease. We report a case of 58-year-old man with eczema as the first manifestation of a lung cancer. Skin examination revealed diffuse erythema, dander, itchy rash, and scratch. Chest contrast-enhanced computed tomography showed a heterogeneously enhanced irregular mass in the right lung. Punch biopsy of the tumor confirms squamous cell lung cancer. Eczema vanished nearly completely after one cycle of chemotherapy. [ABSTRACT FROM AUTHOR]

A 42-year-old immunocompetent female presented with headache, vomiting and diminished unilateral vision. Computed tomography and magnetic resonance imaging were suggestive of high-grade meningioma. Neurological examination and routine hematological parameters were within normal limits. Craniotomy was performed; the tumor was arising from the dura mater, which was completely resected. Hematoxylin and eosin showed lesion comprising a tumor mass with monomorphic population of tumor cells arranged in sheets and small follicles. The tumor cells were immunoreactive for leukocyte common antigen and CD20 and immunonegative for glial fibrillary acid protein, epithelial membrane antigen, cytokeratin, CD3 and CD30. Rest of the body scan was normal. A diagnosis of primary dural non-Hodgkin's lymphoma was made. We report this exceedingly rare case of primary dural non-Hodgkin's lymphoma, which mimicked clinically and radiologically as meningioma. [ABSTRACT FROM AUTHOR]

Amelanotic melanoma is a rare malignancy and the prognosis is usually poorer than that of pigmented melanomas, because of delay in establishing the correct diagnosis, and in treatment initiation. In our case report, we present a the Flurodeoxyglocose Positron Emission Tomography-Computed Tomography (FDG PET/CT) findings of a patient suffering from malignant amelanotic melanoma and its histopathological confirmation and immunohistochemistry (IHC) correlation In the described case, amelanotic melanoma masqueraded as adenocarcinoma of the rectum in the pathology as well the clinical course. Our case highlights the importance of obtaining a tissue diagnosis and IHC confirmation whenever unusual PET/CT findings are encountered. [ABSTRACT FROM AUTHOR]

Primary non-Hodgkin's lymphoma of tongue is very rare. We report a case of an elderly female who presented with a mass lesion and pain primarily involving the tongue and was diagnosed with diffuse large B cell lymphoma. Computed tomography revealed a 3-cm enhanced mass localized to the right tongue base. The patient was treated with three cycles of combination rituximab and CHOP chemotherapy, followed by external beam radiotherapy. The patient had a complete response after treatment, and three years following treatment, the patient has no signs of recurrence. [ABSTRACT FROM AUTHOR]

Bilateral breast cancer is a rare event accounting for 2-5% of all breast malignancies. A second tumor in contralateral breast may be either synchronous or metachronous lesion. Synchronous bilateral invasive ductal carcinoma is known but medullary carcinoma is rare. The etiology of bilateral breast cancer is uncertain and prognosis in these cases once thought to be poor but recent data suggest a similar survival compared to unilateral disease. We report a case of triple negative synchronous bilateral medullary carcinoma in a 38-year-old female who presented with lump in both the breasts for three months. Multidetector computed tomography breast scan revealed bilateral heterogeneously enhancing well-defined lesion in both the breasts. Fine needle aspiration cytology from both the breast lump was suggestive of malignancy. Patient underwent bilateral modified radical mastectomy with axillary clearance in a single sitting. Histopathology showed synchronous bilateral medullary carcinoma of breast with ER, PR and HER- 2/ neu negativity. Patient was treated with chemoradiation and she is on regular follow up for one year without any recurrence or metastasis. [ABSTRACT FROM AUTHOR]

We report a case documenting fluorodeoxyglucose (FDG) accumulation in cervical, supraclavicular and axillary lymph nodes resulting from acute toxoplasmosis. A 50-year-old Indian female with history of non-Hodgkin's lymphoma (NHL) of left breast, postchemotherapy status, was found to have hypermetabolic right cervical, supraclavicular and axillary lymph nodes on a surveillance FDG positron emission tomography/computed tomography (PET/CT) scan. Her previous two PET/CT scans were unremarkable with no evidence of metabolically active disease. Therefore, a differential diagnosis of relapse of NHL versus infectious/inflammatory pathology was raised in the report. Biopsy of axillary lymph node demonstrated features characteristic of toxoplasmosis. The serological test results were also compatible with acute toxoplasmosis infection. Infective and inflammatory diseases are known to accumulate FDG, resulting in false positives for malignancy. This case demonstrates lymph nodal toxoplasmosis as a potential cause of false positive FDG PET/CT findings in patients with known malignancy and highlights the importance of histopathological and laboratory correlation for the accurate interpretation of FDG PET/CT scans. [ABSTRACT FROM AUTHOR]

Primary hepatic lymphoma is an uncommon lymphoid tumor with varied clinical presentations and treatment outcomes. The median age of involvement is 50 years (male preponderance) with median survival as 8-16 months. Here we report a 68-years-old female who presented with right hypochondriac pain and anorexia with hepatomegaly on physical examination. Ultrasonography (USG) with subsequent contrast enhanced computed tomography (CECT) of abdomen depicted a hypoechoic mass in the left lobe of liver. CECT of chest and neck showed no abnormality. Liver biopsy proved to be Non-Hodgkin lymphoma (NHL) diffuse large B cell type, CD20 positive. Bone marrow examination showed no infiltration by NHL. The patient was started on three weekly R-CHOP, given a total of 8 cycles. Patient attained a complete remission documented by negative computed tomography (CT) and positron emission tomography (PET) scans. [ABSTRACT FROM AUTHOR]

Primary malignant fibrous histiocytoma (MFH) of the spleen is extremely rare. Since the first description of primary splenic MFH reported by Govoni et al in 1982, to the best of our knowledge, only twelve cases of MFH of the spleen have been reported in the literature. We herein report a rare case of primary splenic MFH in a 30-year-old Indian male who presented with abdominal pain with a history of recurrent hydatid cyst of liver and spleen. A computed tomography (CT) scan was performed and a diagnosis of splenic hydatid cyst was made. Splenectomy was done. On histopathological examination, a diagnosis of malignant mesenchymal tumor, possibly storiform variant of malignant fibrous histiocytoma, was made. On immunohistochemistry, the tumor was positive for vimentin and CD68. The post operative period was uneventful. Compared with the twelve previously cases of MFH of the spleen, our patient is the youngest case reported so far. [ABSTRACT FROM AUTHOR]

T-cell lymphoma (TCL) is a biologically diverse and uncommon group of lymphoid malignant diseases. Compared with its B-cell counterparts, TCL is notably more difficult to diagnose and manage owing to its rarity and biologic heterogeneity. Hepatosplenic TCL is an extremely rare subtype of TCL. A 37-year-old Indian male presented to his physician with swelling and pain in left hypochondrium. Clinical examination revealed pallor, icterus and massive splenomegaly. His blood examination revealed pancytopenia. His bone marrow biopsy was suggestive of lymphoma. Whole body F-18 flourodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) scan revealed diffuse increased metabolic activity in massively enlarged spleen, liver and bone marrow. There was no evidence of metabolically active lymphadenopathy anywhere in the body. Guided by the FDG PET/CT findings, a liver biopsy was advised. Liver histopathology revealed the presence of hepatosplenic TCL. A final diagnosis of hepatosplenic TCL with liver, spleen and bone marrow involvement was made. Even though rare, hepatosplenic TCL should be considered as a possible diagnosis in patients presenting with similar clinical picture and FDG PET/CT scan findings. [ABSTRACT FROM AUTHOR]

Computed Tomography (CT)-guided percutaneous cryoablation was performed in a 43-year-old patient with intractable epigastric abdominal pain caused by advanced adenocarcinoma of the pancreas and extensive celiac trunk involvement. Initial treatment with celiac plexus nerve neurolysis using local ethanol injection was unsuccessful. A 17-gauge 17-cm cryoablation probe (Galil Medical Inc. Plymouth Meeting, PA) was placed into the expected location of the celiac plexus through a left paraspinal approach under CT guidance and two cycles of freeze-thaw were performed. Patient's pain decreased from 10 of 10 (subjective pain scoring using a visual analog scale; VAS; 0-10) to 3. No post-procedure complication was observed. His pain has remained stable after 6 months of follow up. Percutaneous cryoablation appears to be an effective alternative to neurolytic celiac plexus block for palliative treatment of celiac plexus involvement. Further study with larger number of patients is needed to evaluate the safety and efficacy. [ABSTRACT FROM AUTHOR]

Diffuse large lymphomas of B-cell origin (DLBCL) comprise approximately one-third of all non-Hodgkin lymphomas (NHLs) and extranodal involvement is detected in 50% of these cases at initial diagnosis. Primary malignant lymphoma of the adrenal gland is extremely rare. Here we report a 64-year-old male patient with nasopharyngeal lymphoma who had been in remission for 2 years. An adrenal mass was detected on a control abdominal computed tomography (CT) at one of his follow-up visits. The biopsy showed DLBCL. Since the tumor was solitary without any other nodal involvement, a new/de novo primary tumor was considered. Metachronous NHLs develop between 3 months and 15 years after a primary NHLs and VDJ (variable, diversity, joining) rearrangement gene analysis of the tumor tissue is recommended to discriminate recurrence from a metachronous NHLs. VDJ rearrangement gene analysis was consistent with the recurrence of the original neoplasm. [ABSTRACT FROM AUTHOR]