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Objevtive(s): Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs.Methods: This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a 68Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18.Results: Forty patients with a mean age of 48.1±15.80 years entered the study. Twenty-one (52.5%) were male and 19 (47.5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47.5%) in pancreas and gastrointestinal tract, 9 (22.5%) in lung, 3 (7.5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The meanSUVmax was 11.62±20.02 and the the mean tumor size was 38.25±31.35 mm. The mean size of the metastasis was 40.55±24.53 mm. The mean percentage of ki-67 was 12.54±18.40. There was no significant correlation between SUVmax of the lesion and age (r=0.063, P=0.701), tumor size (r=-0.63, P=0.067) or Ki-67 (r=0.011, P=0.960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5).Conclusion:68Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs.

Hypersensitivity pneumonitis (HP) is an immune-mediated diffuse parenchymal lung disease induced by inhaled antigens. High-resolution computed tomography (HRCT) is widely used in the diagnosis and follow-up of patients and determining the progression and prognosis of the disease. In this retrospective study, 45 consecutive patients with the final diagnosis of HP, seen at a large tertiary care center during a period of 4 years, were included and their HRCT findings were evaluated. The most common HRCT findings were ground glass opacity and reticulation. Some HRCT patterns were detected more severely in bird fanciers in comparison with other etiologies. There is no “gold standard” for the diagnosis of HP. HRCT findings play an important role in hypersensitivity pneumonitis diagnosis and CT scan also help to define the severity of hypersensitivity pneumonitis injuries. In our study, reticulation and ground glass opacity were the most common findings in HRCT of patients with HP. We also find that patients with avian contacts had a significantly higher rate of fibrosis.

Introduction: Rhinoplasty is one of the most common surgical procedures performed among Iranians. An important issue to be considered by nasal surgeons is anatomical variations between different ethnic groups. Working on Iranians with the existing ethnic variety encourages the need for an analysis of this particular population. Materials and Methods: The present cross-sectional observational study was conducted on Iranian patients who underwent primary open rhinoplasty at a university hospital in Tehran, Iran. The preoperative evaluations included routine aesthetic analysis as well as the measurement of the subcutaneous fat thickness (using ultrasound imaging) and the angle between the anterior nasal spine and the alveolar process of the maxilla. Intraoperative assessments were performed on the alar rim-inferior border of lateral crus distance, maximal width of lateral crus, connection pattern of upper lateral cartilage, and lower lateral cartilage. Alar cartilage thickness was measured with microscopic evaluation. Moreover, the similar studies conducted on other ethnic groups were reviewed as well. Results: In total, 66 cases were included in the study (41 females and 25 males) who were within the age range of 18-38 years old (27.82±5.51). According to the results, nasolabial angles were 93.68°±7.82° and 92.25°±6.98° in females and males, respectively. In addition, a significant correlation was found between the anterior nasal spine-maxilla angle and nasolabial angle (p

Background: In the era of coronavirus disease 2019 (COVID-19) pandemic, many cases may be misdiagnosed based on their semiology, laboratory tests or chest computed tomography (CT) images and further evaluation might be helpful in appropriately selected cases. Methods:We are discussing usefulness of fluorodeoxyglucose (FDG) positron emission tomography PET/CT scan in appropriately selected suspicious cases of COVID-19 infection. We are discussing two interesting cases on how18F-FDG PET/CT scan might be helpful to avoid COVID-19 infection diagnostic error. Both cases had clinical symptoms suggestive for COVID-19 infection with nonspecific chest CT scan findings including lung nodules, ground glass opacities (GGOs), consolidations, and mosaic perfusion patterns. This case series was approved by our institutional review board and informed consent obtained from both patients. Results: In one case,18F-FDG PET/CT images demonstrated hypermetabolic mostly peripheral GGOs and nodules in both lungs with subsequent evaluation confirming COVID-19 infection. The second case demonstrated right perihilar consolidation, not well appreciated on noncontrast chest CT images in addition to GGOs and further evaluation confirmed diagnosis of poorly differentiated squamous cell carcinoma of the lung. Conclusion: During COVID-19 pandemic, many cases might be misdiagnosed by either clinicians or radiologists. In appropriately selected cases, FDG PET/CT scan may be helpful during COVID-19 outbreak to avoid diagnostic errors.

Background: A few studies have evaluated the predictive value of fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) in patients with head-and-neck squamous cell carcinoma (HNSCC). Methods: We performed a retrospective study on 32 HNSCC patients, undergoing PET/CT after completion of planned treatment. The PET/CT volumetric parameters measured separately for primary tumor site and nodal or distant metastases. The primary outcome measure of the study was overall survival. Results: There was significant difference between alive and dead patients regarding some of volumetric parameters. Univariate and multivariate Cox regression analyses demonstrated association between metabolic tumor burdens with survival outcome. There was also significant difference in time to survival between patients with metastatic metabolic tumor burden and metastatic total lesion glycolysis (TLG) above and below 50th percentile. Conclusion: PET/CT volumetric parameters including metabolic tumor burden and TLG are significant prognostic markers for overall survival of patients with primary HNSCC after treatment.

Synovial sarcoma is an uncommon soft tissue tumor occurring mainly in the periarticular region of the extremities in young adults. It happens less frequently in the head and neck, mediastinum, lungs, heart, and digestive tract. A 28-year-old man two months after total esophagectomy with final diagnosis of esophageal synovial sarcoma was referred to our Positron Emission Tomography (PET-CT) department for the evaluation of treatment response and further treatment planning. To our knowledge this case is the 11th case of esophageal synovial sarcoma, being reported in the literature. We presented the 11th case of esophageal synovial sarcoma. Synovial sarcomas are very rare tumor entities, particularly in the gastrointestinal tract and are likely to be mistaken with other more common tumors such as gastrointestinal stromal tumors.

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP) as an appropriate imaging tool in early phase of initial standard work up.Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated.Results: Sixty-two patients with mean age of 62 (30 men, 32 women), PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway.Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation.

"nNeurofibromatosis is a benign neurogenic tumor, originatig from Schwann cells of the nerve sheath. This tumor forms a round, white mass on the course of the involved nerve. It occurs sporadically or in association with von Recklinghausen's disease. Laryngeal involvement is a rare occasion that affects women more than men (F/M ratio 3:2). The most common symptoms are hoarseness, dyspnea and dysphagia. The most common sites of origin are arytenoids and aryepiglottic folds. Because of benign nature of this tumor, conservative surgery is recommended as the management of choice. Only few cases of laryngeal involvement have been reported in literatures and this article presents two cases of laryngeal neurofibroma with brief review of literatures. Both cases had submucosal, non-ulcerated, endolaryngeal mass with signs and symptoms of airway compromise. In both cases surgical approach was endolaryngeal conservative surgery with CO2 laser.

Background: Flourine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan is employed for initial staging and restaging of esophageal cancer patients. Objectives: The present study aimed to assess the value of a semi-quantitative parameter of 18F-FDG PET/CT scan, that is, maximum standardized uptake value (SUVmax), to determine its correlation with patient survival in two subtypes of esophageal cancer, including squamous cell carcinoma (SCC) and adenocarcinoma. Patients and Methods: This cross-sectional study was performed on patients with esophageal SCC and adenocarcinoma, undergoing 18F-FDG PET/CT scan for initial staging before any treatment. The 18F-FDG PET/CT semi-quantitative parameter (SUVmax) was determined by reviewing the PET/CT images. The patients were reevaluated using 18F-FDG PET/CT scan for restaging within 12 - 24 months. Results: Nosignificant differencewasobserved in theSUVmax values of the primarytumor, metastaticlymphnodes, or distant metastasis between the adenocarcinoma and SCC groups, regardless of response to treatment. Similarly, no significant association was found between the short-term survival of patients with adenocarcinoma and the SUVmax values of the primary tumor, metastatic lymph nodes, or distant metastasis. Based on the survival curve, one- and two-year survival rates were estimated at 75% and 63.9% in patients with SCC and at 80% and 60% in patients with adenocarcinoma, respectively. In the SCC group, a significantly higher SUVmax was detected in deceased patients with distant metastatic lesions compared to cancer survivors. According to the area under the ROC curve, the SUVmax of metastatic lesions showed high potential for predicting the mortality of SCC patients. Conclusion: The assessment of SUVmax in distant metastatic lesions by 18F-FDG-PET/CT may help predict the survival of patients with esophageal SCC. However, 18F-FDG-PET/CT findings were not associated with the survival of esophageal adenocarcinoma; therefore, further evaluations on a larger sample size and a longer follow-up are required. [ABSTRACT FROM AUTHOR]

Background: Melanoma is one of the most serious types of skin cancer and one of the leading causes of cancer-related mortality worldwide. Objectives: This study aimed to investigate the association between 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/ computed tomography (PET/CT) scan findings and the pathological characteristics of primary tumors in patients with malignant melanoma. Patients and Methods: In this cross-sectional study, the baseline data of 103 patients with cutaneous or mucosal melanoma (stage III or IV) were recorded, and tumor characteristics and PET/CT scan findings were analyzed. The association between each pathological finding and PET/CT results was also investigated. Results: Patients without a free margin had a significantly higher mean standardized uptake value (SUVmax) of lung metastasis compared to patients with a free margin (3.12 vs. 1.69; P = 0.047). Also, patients with ulceration had a significantly higher mean SUVmax of lung metastasis compared to patients without ulceration (3.28 vs. 1.81; P = 0.041). Based on the results, increased primary tumor thickness was associated with a higher SUVmax of lung metastasis. However, there was no significant association between the metastasis type (single vs. multiple) and free margin, ulceration, or Ki-67 protein. The mean SUVmax of lung metastasis was significantly higher in mucosal melanoma compared to cutaneous melanoma. However, the mean SUVmax values of other metastases (bone, liver, and lymph nodes), even the primary lesion itself, were not significantly different between cutaneous melanoma and mucosal melanoma. Conclusion: The primary tumor margin status, ulceration, tumor thickness, primary tumor location (cutaneous vs. mucosal), and the presence of lung metastasis were significantly associated with PET/CT scan findings. [ABSTRACT FROM AUTHOR]

Background & Objective: Various studies showed the use of epidermal growth factor receptors (EGFRs) gene mutations in the therapeutic plan of patients with advanced lung cancer. This study aimed to investigate the frequency and types of EGFR gene mutations among Iranian patients with lung adenocarcinoma referred to a specialized lung diseases hospital from 2014 to 2019. Methods: The data of all patients with lung adenocarcinoma referred to the Molecular Department of Masih Daneshvari Hospital Laboratory (National Research Institute of Tuberculosis and Lung Diseases) from 2014 to 2019 for EGFR mutation tests were collected. Patients' characteristics data and information on the frequency and types of EGFR gene mutations were obtained from the hospital information system (HIS). The collected data were analyzed using SPSS 25. Results: A total of 570 individuals (Mean age of 58.74, 51.6% Male) were included in the study; 113 out of 570 patients (19.8%) were diagnosed with gene mutation. In terms of the type of mutation, 65 participants (57%) showed deletion, 48 patients (42.1%) were diagnosed with replacement, and one (0.9%) case demonstrated both. Notably, the mutation rate detected among the female patients was significantly higher than the male ones (P=0.001); in particular, deletion type of mutation was found more among women, although both genders were the same in terms of the replacement frequency. However, the age had no effect on the mutation in this study (P=0.05). Conclusion: Among Iranian patients with lung adenocarcinoma, 19.8% harbored EGFR gene mutation. This mutation was found in association with lung cancer and could affect the patient's therapeutic plan. [ABSTRACT FROM AUTHOR]

Objevtive(s): Neuroendocrine tumors are a heterogeneous group of neoplasms that arise from the peptide-producing cells of the neuroendocrine system. Different functional imaging methods have been suggested to diagnose NETs. There is still not enough evidence to recommend 68Ga-DOTATATE as a standard diagnostic tool in NETs. Therefore, the aim of this study was to assess the value of 68Ga-DOTATATE scan in detecting NETs. Methods: This was a cross-sectional study. All patients with a pathologically confirmed NET tumor referred to Masih Daneshvari Hospital affiliated to Shahid Beheshti University of Medical Sciences entered the study. Patients underwent a 68Ga-DOTATATE PET/CT. All statistical analysis were performed by SPSS software version 18. Results: Forty patients with a mean age of 48.1±15.80 years entered the study. Twenty-one (52.5%) were male and 19 (47.5%) female. In the studied patients, neuroendocrine tumor was present in 19 cases (47.5%) in pancreas and gastrointestinal tract, 9 (22.5%) in lung, 3 (7.5%) in mediastinum and adrenal gland, 6 cases (5%) in liver and 3 other sites. There was no significant association between mean age and gender with primary location of the tumor. The mean SUVmax was 11.62±20.02 and the the mean tumor size was 38.25±31.35 mm. The mean size of the metastasis was 40.55±24.53 mm. The mean percentage of ki-67 was 12.54±18.40. There was no significant correlation between SUVmax of the lesion and age (r=0.063, P=0.701), tumor size (r=-0.63, P=0.067) or Ki-67 (r=0.011, P=0.960). In 20 cases, metastases were reported, of which 14 were (70%) in the liver, 3 in the lungs (15%), 2 in the gastrointestinal and cervical lymph nodes, and 1 in the bones and pancreas(%5). Conclusion:68Ga-DOTA-peptide PET/CT could find the primary or metastasis sites of NETs with good quality images. In general, this modality can enhance the management in patients with NETs. [ABSTRACT FROM AUTHOR]

Background: The use of 68Ga-PSMA PET/CT scan has recently received particular attention in the evaluation of prostate cancer patients. Objectives: The present study aimed to evaluate the relationship between the PSA level, Gleason score, and 68Ga-PSMAPET/CT findings in prostate cancer patients. Patients and Methods: In this cross-sectional study, 80 male patients with a definitive diagnosis of prostate cancer,whowere candidates for 68Ga-PSMA PET/CT scan for both initial staging and restaging, were included. Restaging indicated biochemical recurrence, which refers to a detectable level of PSA after being documented undetectable following a definitive primary treatment. All prostate cancer patients, who were not initially treated with a definitive therapy, were excluded from the study. A cutoff value ≥ 4 was considered significant for SUVmax to differentiate benign from malignant 68Ga-PSMA-avid lesions. Any 68Ga-PSMA uptake outside the prostate bed, especially in the lymph nodes, bones, and visceral organs, was considered metastatic. Results: Comparison of the PSA level between two subgroups with and without metastasis demonstrated a higher PSA level in patients with metastatic abdominal lymph nodes and a slightly higher PSA level in patients with metastatic pelvic lymph nodes. No significant correlation was found between the Gleason score and the total PSA. There was also no significant association between the level of PSA and the type of Lymph node involvement (single or multiple) in different involved areas. Besides, there was no significant correlation between the SUVmax and the level of PSA and the Gleason score in different involved areas. Conclusion: The SUVmax value in 68Ga PSMA PET/CT scan provides a reliable predictor for neither the grade of prostate cancer, nor the metastatic status associated with cancer progression. The measurement of total PSA may predict metastasis to the abdominal and pelvic lymph nodes caused by prostate cancer. [ABSTRACT FROM AUTHOR]

Gallium-68-labeled prostate-specific membrane antigen (68Ga-PSMA), as a relatively new positron emission tomography (PET) radio-tracer, can be used to evaluate tumors other than prostate cancer, including renal cell carcinoma and probably non-small cell lung cancer, as discussed in our case. We present the case of a 65-year-old man with a history of lung adenocarcinoma diagnosed in 2015 and a subsequent diagnosis of renal cell carcinoma in 2018, treated with a right lower lobectomy and a left partial nephrectomy, respectively. Both conditions were evaluated using 18F-fluorodeoxyglucose (18F-FDG) PET/computed tomography (CT) scan before surgery. A rise in prostate-specific antigen (PSA)was detected in the follow-up in September 2020, and the patient was referred for a 68Ga-PSMA PET/CT scan following pelvic magnetic resonance imaging (MRI). The 68Ga-PSMA PET/CT scan demonstrated avid lesions in both lung and kidney surgical beds. The 68Ga-PSMA PET/CT scan can be potentially used in patients with recurrent renal cell car- cinoma to detect metastasis. This modality may also detect non-small cell lung cancer lesions; however, further investigation is needed. [ABSTRACT FROM AUTHOR]

Background: An initial evaluation of non-small cell lung cancer (NSCLC) patients with 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) scan can modify treatment planning. We investigated the clinical significance of FDG PET/CT quantitative parameters (QPs) in NSCLC patients. Materials and Methods: We included 125 NSCLC patients for initial staging FDG PET/CT scan. The primary tumor (T), regional lymph node metastases (N), and distant metastases (M) were evaluated on FDG PET/CT images. QPs, including standard uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were calculated separately for each T, N, and M lesion and also for the whole body. Statistical analysis through SPSS version 22 was used to evaluate the clinical significance of PET/CT QPs concerning primary tumor pathology characteristics, initial tumor stage, and patient's prognosis. Results: We followed the patients for 19.28 (±11.42) months. Considering primary tumor pathology, there was a significant difference in FDG PET/CT QPs, including primary tumor SUVmax (p=0.00), metastases SUVmax (p=0.014), whole-body MTV (p=0.045), and whole-body TLG (p=0.002). There was also a significant difference in QPs, including primary tumor SUVmax (p=0.00) and regional lymph node metastases SUVmax (p=0.048) when accounting for tumor initial stage. There was a significant prognostic value for the whole-body TLG (p=0.01) and a cut-off point of 568 was reached to differentiate better versus worse survival outcome. Conclusion: We demonstrated a statistically significant difference in FDG PET/CT QPs when accounting for primary NSCLC pathology characteristics and initial stage, as well as patient's prognosis, and recommend incorporating QP values into clinical PET/CT reports. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To investigate the role of 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET) in localizing epileptogenic focus of patients with refractory focal epilepsy and normal brain magnetic resonance imaging (MRI). MATERIALS AND METHODS: In this cross-sectional study, all patients were evaluated clinically and with in-hospital video electroencephalography monitoring (VEM) to localize epileptogenic focus. All patients had unremarkable brain MRI. FDG-PET of brain performed to localize the epileptogenic focus. We used expert visual analysis method in addition to statistical parametric mapping (SPM) and asymmetry index to evaluate brain cortex metabolic activity. We stratified patients with regard to clinical epileptogenic focus as localized in temporal lobe, frontal lobe or partially localized. Finally, clinical and VEM data were compared with FDG-PET results to determine congruence between clinical/VEM data and FDG-PET. RESULTS: Among patients with temporal lobe epileptogenic focus, 62.5% exact congruency with PET results was documented (p<0.001), contrary to 29.7% incongruence. Patients with frontal lobe epileptogenic focus had only 6.6% exact congruency (p>0.05) and 13.3% partial congruency was documented. Finally, among patients with partially localized seizure focus in one hemisphere, only 6.6% exact congruency (p>0.05) and 53.3% incongruence was demonstrated. CONCLUSION: Overall PET results in frontal lobe or partially localized seizure patients were not promising in our study. Although majority of temporal lobe seizure patients demonstrated exactly congruent PET results, these results may be further enhanced by more precise localization of seizure focus with clinical evaluations and VEM, in addition to utilizing more advanced PET imaging software to better quantify and compare PET image findings. [ABSTRACT FROM AUTHOR]

Inflammatory myofibroblastic tumour (IMT) is a rare neoplasm, occurring most often in children and young adults. IMTs have intermediate biological behaviour with the chance of local invasion, recurrence and even distant metastasis. Wide range of clinical presentations makes the precise diagnosis of IMT more challenging. The best method for definitive diagnosis is tissue biopsy and newer imaging modalities including fleurodeoxyglucose (FDG) positron emission tomography (PET)/CT are useful tools in detection of disease recurrence or distant metastasis. Complete surgical resection is the best-known treatment for this tumour. Here we are presenting an IMT case in a 12-year-old girl in which her recurrent pulmonary IMT was diagnosed based on FDG PET/ CT findings and referred for further salvage treatment. Overall imaging modalities are not specific, but PET/CT scan can be useful tool for evaluation of IMT regarding initial staging and restaging to assess treatment response and recurrence. [ABSTRACT FROM AUTHOR]

Background: The effect of various environmental and intrinsic stimulators on the development of brown adipose tissue (BAT) has been widely investigated by PET-based researches. However, evidence regarding the influencing factors on the level of BAT metabolic activity is scarce. Objectives: The aim of the present study was to evaluate the frequency of cancer-related characteristics in addition to anthropometrics and demographics in BAT-bearing cancer patients at 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan and any correlation between the level of BAT metabolic activity and the influencing factors. Patients and Methods: Reports from a total of 3762 F-18 FDG PET/CT scans were retrospectively reviewed to identify BAT-bearing cancer population. Demographic, anthropometric and cancer related characteristics were recorded. Maximum standardized uptake values (SUVmax) was measured separately for each anatomical region. Descriptive quantitative variables were expressed as either frequency or mean. Independent T test, Mann-Withney U test, Pearson correlation coefficients, one-way analysis of variance and linear regression test (IBM SPSS version 23) were used as appropriate (P value <0.05) Results: Sixty-two F-18 FDG PET/CT studies demonstrated BAT related 18-F FDG uptake (1.6%, 32% male, 68% female, P = 0.007, mean age 22.9). Lymphoma(43.5%) and treatment response evaluation (54.54%) were the most frequent type of cancer and reason for referral, respectively. Most patients were in status partial or complete metabolic response to treatment. Fifty-four point eight percent of patients had at least one metabolically active cancer-related lesion. BAT detection rate was higher in females in all adult age groups, younger age (< 40 years old), body mass index (BMI) and body fat (BF) below the obesity cut off and autumn/winter seasons. The dominant distribution pattern of BAT depots was neck, mediastinum, paravertebral (33.87%) with the highest level of metabolic activity in the axillary region. SUVmax demonstrated a weak inverse correlation with age (0.015), evidence of active malignant disease and no recent treatment. Linear regression test demonstrated that age (P = 0.021) and recent treatment (P = 0.033) have independent correlation with BAT SUVmax. Conclusion: The present study provided evidence for age and chemotherapeutic agents on the level of BAT metabolism. In addition, there is a suggestion for different pathways involved in BAT development and regulation of the level of metabolic activity. [ABSTRACT FROM AUTHOR]

Pneumocystis pneumonia (PCP) is a common opportunistic infection in immunocompromised patients. In general, clinical response to therapy with cotrimoxazole is excellent. However, therapy may be limited by side effects or treatment failure. We present a case of PCP in a 35-year-old male patient with history of heart transplantation and renal failure who was admitted with a 10- day history of fever, nonproductive cough and elevated level of creatinine with a diagnosis of PCP confirmed by chest radiography and in bronchoalveolar lavage specimens. He was treated with trimethoprim-sulphamethoxazole (SMZ/TMP) and primaquine but treatment was completed with reduced dosage of cotrimoxazole, primaquine and with the addition of caspofungin. This therapy was effective and without any adverse effects in a patient with elevated level of creatinine. [ABSTRACT FROM AUTHOR]

We present a middle-aged woman complaining ofweakness, lethargy and weight loss for 6 months. Positron emission tomography (PET )/CT scanrevealed huge bilateral adrenal masses with intense 18F-fluorodeoxyglucose avidity. Biopsy andimmunohistochemical staining were compatible with mantle cell lymphoma (MCL). The patientreceived six cycles of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP )followed by four cycles of intrathechal methotrexate chemotherapy. Bone marrow aspiration biopsy wasperformed for initial staging and also before bone marrow transplantation. Follow-up PET /CT scan aftercompletion of chemotherapy and before bone marrow transplantation demonstrated complete metabolicresponse with no evidence of abnormal metabolic activity in either adrenal gland or bone marrow. MCLhas an aggressive nature and is usually considered incurable; however, there have been a few reports indicating favourable treatment response when MCL is rarely arising from the adrenal glands. Dramatic response of a primary adrenal MCL to R-CHOP is documented in this case. [ABSTRACT FROM AUTHOR]

Introduction. Incidental hypermetabolic thyroid lesions on Positron Emission Tomography have significant clinical value and may harbor malignancy. In this study we evaluated laboratory, radiologic, and pathologic characteristics of incidental hypermetabolic thyroid lesions. Materials and Methods. We evaluated 18 patients prospectively with various malignancies and hypermetabolic thyroid incidentaloma. The thyroid function tests, ultrasound assessment, and guided FNA biopsy were performed on all cases. Results. We included 9 male and 9 female patients with mean age of 51 years. Most common malignancy was colon cancer. Metabolic activity quantification using maximum standard uptake value demonstrated range between 1.4 and 65.4 with mean value of 9.4. We found highest metabolic activity in patients with lung adenocarcinoma, B-cell lymphoma, and colon adenocarcinoma. On ultrasound exam most thyroid lesions were of solid, hypoechoic, noncalcified nature with either normal or peripheral increased vascularity. FNA biopsy report was benign in 15 cases and malignant or highly suggestive for malignancy in 3 other cases. Two of the three malignant cases demonstrated metabolic activity higher than average SUV max. Conclusion. Most thyroid hypermetabolic incidentalomas are benign lesions, while higher values of SUV max are in favor of malignancy. This mandates further evaluation of incidentally found thyroid hypermetabolic lesions on routine PET/CT scans. [ABSTRACT FROM AUTHOR]

Introduction: PET/CT scan has an emerging role in head and neck oncology with a few well-established indications, including: detection of unknown primary tumor site, tumor staging, radiotherapy planning, treatment response assessment and detection of recurrent disease. The purpose of this study is reporting PET/CT findings in head and neck cancer patients to emphasize its role in head and neck oncology. Material and Methods: In a retrospective study, we reviewed our PET/CT database and found 94 patients with primary head and neck cancer. This is a descriptive report of PET/CT scan findings in head and neck cancer patients referred to Masih Daneshvari hospital, Tehran, Iran between 2013 and 2016. Results: The most common primary tumor sites were oral cavity (27%) and nasopharynx (22%). The most common indication for referral was tumor restaging (76%) including treatment response evaluation and differentiation between recurrence and post-treatment fibrosis. In 60% of patients with negative primary tumor site, PET/CT was able to detect evidence of regional or distant metastasis. PET/CT was able to localize the primary tumor site in 66% of patients with unknown primary tumor site. We also had 19 patients with primary head and neck cancer referred for initial staging, demonstrating evidence of metastasis in 66% of all cases. Conclusion: Most patients are referred for restaging and demonstrate evidence of regional or distant metastasis with significant value for further treatment planning. Providing insurance coverage and familiarizing referring physicians about correctindications of this relatively new diagnostic modality will be to the best interest of head and neck cancer patients in the long run. [ABSTRACT FROM AUTHOR]

Primary Ewing sarcoma (ES) or primitive neuroectodermal tumour (PNET) is a rare tumour in adults and primary renal involvement is extremely rare. Patients with renal ES or PNET respond to and would benefit from conventional ES treatment according to ES study protocols. Here, we report a case of a young woman, presenting with right flank pain and haematuria. After ultrasound and CT evaluation, a right middle pole renal mass was detected. The patient underwent radical right nephrectomy, and a grade 4 ES with peritoneal involvement was documented. Subsequently, the patient underwent adjuvant chemotherapy for 5 months. Follow-up 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT scan demonstrated bilateral cervical, hilar, mediastinal and retroperitoneal FDG-avid adenopathies associated with mild right-sided pleural effusion with no metabolic activity, signifying the role of PET/CT scan in tumour restaging. [ABSTRACT FROM AUTHOR]

Rectal carcinoma with metastasis to skeletal muscle is a rare finding. According to literature review, 17 cases of skeletal muscle metastasis from colorectal carcinoma have been documented where only six cases were rectal carcinomas. We discuss a case of a middle-aged man with a known history of high-grade mucinous adenocarcinoma of the rectum, status post abdominoperineal resection followed by adjuvant radiotherapy and chemotherapy. During the planned chemotherapy course, a right proximal thigh subcutaneous mass was incidentally found which on subsequent biopsy proved to be metastatic from rectal primary site. On subsequent 18F-FDG (Fluorodeoxyglucose) positron emission tomography (PET)/CT scan after completion of chemotherapy for the purpose of treatment response evaluation, only FDGavid lesion was residual right proximal thigh metastatic mass without involvement of other common sites, such as liver and lung. In this case, the 18F-FDG-PET/CT scan was able to exclude additional metastatic sites and also evaluate the patient’s treatment response. [ABSTRACT FROM AUTHOR]

Background: In the era of well-developed site-specific treatment strategies in cancer, identification of occult primary is of paramount importance in CUP patients. Furthermore, exact determination of the extent of the disease may help in optimizing treatment planning. The aim of the present study was to investigate additional value of F-18 FDG PET/CT in patients with cancer of unknown primary (CUP) as an appropriate imaging tool in early phase of initial standard work up. Materials and Methods: Sixty-two newly diagnosed CUP patients with inconclusive diagnostic CT scan of chest, abdomen and pelvis referring for F-18 FDG PET/CT were enrolled in this study. Standard of reference was defined as histopathology, other diagnostic procedures and a 3-month formal clinical follow up. The results of PET/CT were categorized as suggestion for primary site and additional metastasis and classified as true positive, false positive, false negative and true negative. The impact of additional metastasis revealed by F-18 FDG PET/CT on treatment planning and the time contribution of F-18 FDG PET/CT in diagnostic pathway was investigated. Results: Sixty-two patients with mean age of 62 (30 men, 32 women), PET/CT correctly identified primary origin in 32% with false positive rate of 14.8%. No primary lesion was detected after negative PET/CT according to standard of reference. Sensitivity, Specificity and accuracy were 100%, 78% and 85%, respectively. Additional metastatic site was found in 56% with 22% impact on treatment planning. Time contribution for PET/CT was 10% of total diagnostic pathway. Conclusion: Providing higher detection rate of primary origin with excellent diagnostic performance, shortening the diagnostic pathway and improving treatment planning, F-18 FDG PET/CT may play a major role in diagnostic work up of CUP patients and may be recommended as an alternative imaging tool in early phase of investigation. [ABSTRACT FROM AUTHOR]