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Splenic hamartoma, also known as splenoma, splenic adenoma or nodular hyperplasia, is a rare benign splenic tumor. It is composed of disordered vascular channels with abnormal mixture of red or white splenic pulp. Mostly it is asymptomatic and encountered incidentally at imaging, surgery or autopsy. Radiologically hamartomas are almost identical to hemangioma. In such circumstances radiolabelled blood pool imaging and radiocolloid scintigraphy helps to differentiate the two entities. We present a case of asymptomatic splenic lesion on hybrid radionuclide imaging with SPECT-CT, findings suggestive of hamartoma. Key Words: Splenic hamartoma, SPECT-CT, Radiocolloid scintigraphy

Detection of primary tumor site in patients with carcinoma of unknown primary (CUP) syndrome has always been a diagnostic dilemma, necessitating extensive workup. Early detection of primary tumor site coupled with specific therapy improves prognosis. The low detection rate of the primary tumor site can be attributed to the biological behavior or the small size of the primary tumor to be detected by conventional imaging. The objective of this study was to evaluate the diagnostic accuracy of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting CUP.A retrospective, cross-sectional analysis of 100 PET-CT scans of patients with CUP syndrome between November 2009 and December 2013 was performed. Eighteen patients whose final histopathology results could not be obtained for correlation were excluded from analysis. The hypermetabolic sites were assessed in correlation with histopathology. The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive values were assessed for PET-CT.Out of the 82 patients, primary tumor was correctly identified in 57.3% patients by 18F-FDG PET-CT (true positive). The PET-CT scan results were negative for primary site localization in 15% of patients (false negative). While 21% had true negative results, 7.3% displayed false positive results. PET-CT scan upstaged the disease in 27% cases. Overall, the diagnostic accuracy was found to be 78%, sensitivity 80%, specificity 74%, positive predictive value 88.7% and negative predictive value 59%.Our data supports the utility of 18F-FDG PET-CT scan in the localization and staging of CUP syndrome.Amaç: Primeri bilinmeyen karsinom (PBK) sendromu olan hastalarda primer tümör yerleşiminin bulunması tanısal bir zorluk oluşturmuş ve detaylı incelemeyi gerektirmiştir. Primer tümör yerleşiminin bulunması ile spesifik tedavinin birleşimi prognozu iyileştirir. Primer tümör yerinin bulunmasındaki düşük oranlar primer tümörün biyolojik davranışına veya konvansiyonel görüntüleme ile saptanamayacak kadar küçük çapta olmasına bağlanabilir. Bu çalışmanın amacı PBK’nın değerlendirilmesinde F-18 florodeoksiglükoz ( 18 F-FDG) pozitron emisyon tomografisi/bilgisayarlı tomografinin (PET-BT) tanısal doğruluğunu değerlendirmektir. Yöntem: Kasım 2009 ve Aralık 2013 tarihleri arasında PBK nedeniyle PET-BT uygulanmış 100 hasta retrospektif, kesitsel olarak analiz edildi. Histopatolojik değerlendirme sonuçlarına ulaşılamayan 18 hasta çalışma dışı bırakıldı. Hipermetabolik alanlar histopatoloji ile karşılaştırıldı. PET-BT için tanısal doğruluk, duyarlılık, özgüllük, pozitif öngörü değeri ve negatif öngörü değeri belirlendi. Bulgular: Seksen iki hastadan %57,3’ünde primer tümör 18 F-FDG PET-BT ile doğru olarak tespit edildi (gerçek pozitif). PET- BT sonuçları primer tümör lokalizasyonunu belirlemede %15 hastada negatif idi (yanlış negatif). Hastaların %21’inde gerçek negatif sonuç, %7,3’ünde yanlış pozitif sonuç saptandı. PET-BT ile %27 hastada evre daha ileri olarak bulundu. Genel olarak, tanısal doğruluk %78, duyarlılık %80, özgüllük %74, pozitif öngörü değeri %88,7 ve negatif öngörü değeri %59 olarak saptandı. Sonuç: Sonuçlarımız 18 F-FDG PET-BT görüntülemenin PBK sendromunda lokalizasyon ve evreleme amacıyla kullanılabilirliğini desteklemektedir.

Osseous haemangiomas are benign skeletal tumours, usually identi ed as incidental ndings on different imaging modalities. Bone scan is the most frequent radionuclide procedure performed as metastatic workup in patients with various malignancies. Not every hotspot on a staging bone scan is malignant. Haemangiomas with variable degree of radiotracer uptake on technetium-99m (Tc-99m) bone scintigraphy may be falsely labelled as metastases in background of known malignancy. The addition of single-photon emission computed tomography computed tomography (SPECT-CT) enhances the specificity of bone scan which allows accurate detection and anatomical localisation of scintigraphic findings. We present a case series as pictorial review of osseous haemangiomas identi ed on Tc-99m methylene diphosphonate SPECT CT at our department. Key words: Haemangioma, methylene diphosphonate, bone scan, single-photon emission computed tomography- computed tomography

Objectives: To evaluate the efficacy of ultrasound (US) and US-guided fine-needle aspiration (US-FNA) for axillary nodal staging in breast cancer patients. Methods: A retrospective study of breast cancer patients at our institution from January 2007 to December 2009 revealed 449 cases in which axillary US was performed. The US appearance of the axillary lymph nodes was divided into 4 categories: suspicious, borderline, benign, and not visible. The results were compared with the final pathologic outcome and correlated with the tumor size on US and the pathologic nodal stage (pN). Results: Among the 449 patients, the lymph nodes were: not visualized in 124, suspicious in 180, borderline in 39, and benign in 106 cases. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US alone and combined US/US-FNA was 69.1%, 83.3%, 86.8%, 63%, and 74.6% and 69.1%, 100%, 100%, 67.2%, and 81.1%, respectively. The sensitivity of US increased with increasing tumor size and pN. A negative or benign US (combined n = 230) was associated with the pN0, pN1, pN2, and pN3 stage in 146, 66, 13, and 5 cases, respectively. Conclusions: Axillary staging using US criteria is about 70% sensitive and its sensitivity increases with increasing tumor size and pN stage.

Purpose: The purpose of this study was to assess the sensitivity and diagnostic accuracy of integrated positron emission tomography/computed tomography (PET/CT) in detecting recurrent ovarian cancer in treated patients presenting with rising CA-125 levels during clinical follow-up and compare it with those of CT alone. Materials and Methods: This was a retrospective study. We evaluated 45 patients with pathologically proven ovarian carcinoma who underwent PET/CT during October 2010–November 2013 at our institution for suspected relapse; IRB deemed that approval for this retrospective study was not required. Of these, 35 patients who presented with rising CA-125 levels during clinical follow-up were included in this study. Remaining 10 patients were excluded as they had normal CA-125 levels. At least three previous consecutive CA-125 readings and initial conventional imaging before uorodeoxyglucose-PET/CT were noted. Sensitivity and diagnostic accuracy for tumour detection with PET/CT and CT alone were calculated; histological analysis after biopsy/second look surgery or clinical- radiologic follow-up/response to chemotherapy was taken as reference standard. K statistics (Cohen K) was used for statistical analysis. Results: Of 35 patients with suspected relapse, one patient was lost to follow up. 30 patients were documented to have relapsed, while in four patients, recurrence was not identi ed either on CT or PET-CT and they were proved to be disease free on 2-year follow-up. Amongst these relapsed patients, 10/30 cases were proven histologically, 3 with imaging-guided biopsy and 7 with second-look surgery, whereas 20/30 were con rmed on clinical/radiological follow-up (ranging from 3 to 6 months) or by response to chemotherapy on subsequent imaging. Of 30 patients with relapse, PET-CT highlighted recurrence in 27. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of integrated PET/CT were calculated to be 90%, 75%, 96%, 50%, and 88%, respectively. CT alone detected recurrence in 20 patients. Sensitivity, speci city, positive predictive value, negative predictive value, and diagnostic accuracy of CT were calculated to be 73.3%, 100%, 100%, 33%, and 76%, respectively. Conclusion: PET/CT is a highly sensitive and accurate post-therapy surveillance modality for the detection of recurrent ovarian cancer in patients with rising tumour markers as compared to CT alone. Key words: CA125, uorodeoxyglucose, ovarian cancer, positron emission tomo graphy/computed tomography, recurrence

Household poisons can cause serious damage to the health of children. Turpentine oil, used chiefly as a solvent in paints, varnishes, and waxes; is often placed within easy reach of children during polishing or painting work. It is capable of causing serious toxicity, whether ingested or inhaled. Pulmonary aspiration can lead to lung parenchymal damage and turpentine-associated pneumonia. We report a case of exploratory ingestion and inhalation of turpentine oil in an 18-month-old boy, leading to extensive lung parenchymal damage, formation of multiple abscess cavities, and necrosis treated with decortication and segmental resection.

Endoscopic ultrasound (EUS) now has an established role in the diagnosis, staging and management of cancers of the oesophagus, stomach, pancreato-biliary system, and rectum. Recently, a role for EUS in the staging of lung cancers has been proposed. Linear EUS allows fine needle aspiration (FNA), core biopsies and therapeutic manoeuvres such as coeliac plexus block to be performed. We present here the first reported EUS-guided biopsy from Pakistan. A patient with probable bronchogenic carcinoma was referred for assessment of operability. A thoracic CT scan showed subcarinal and aorto-pulmonary recess lymphadenopathy. An EUS-guided FNA was performed, confirming metastatic non-small cell lung cancer and rendering the patient inoperable.