Small Cell Neuroendocrine Carcinoma of the Prostate on 18 F-DCFPyL and 18 F-FDG PET/CT

ABSTRACT

A 51-year-old man with newly diagnosed small cell neuroendocrine carcinoma of the prostate was referred for a staging 18 F-DCFPyL PET/CT, which showed a solitary metastasis in the left acetabulum. Subsequent 18 F-FDG PET/CT showed intense uptake throughout the prostate as well as extensive avid pelvic and thoracic nodal disease and redemonstration of the left acetabular metastasis. Despite initial metabolic response to treatment, subsequent 18 F-FDG PET 8 months later revealed significant progression of nodal disease above and below the diaphragm, as well as multiple new sites of metastases.

Increased 68 Ga-FAPI Activity in Primary Small Cell Neuroendocrine Carcinoma of the Gallbladder

ABSTRACT

Primary small cell neuroendocrine carcinomas are extremely rare heterogeneous neoplasms. We present 68 Ga-FAPI (fibroblast activation protein inhibitor) PET/CT findings of small cell neuroendocrine carcinoma of the gallbladder in a 57-year-old woman. This rare gallbladder small cell neuroendocrine carcinoma demonstrated intense tracer uptake on 68 Ga-FAPI PET/CT. This demonstrates the potential value of 68 Ga-FAPI PET/CT for evaluation of gallbladder small cell neuroendocrine carcinoma.

Metastatic Small Cell Neuroendocrine Carcinoma of Endometrium: Rare Entity, Rare Presentation

ABSTRACT

Primary small cell neuroendocrine carcinoma of endometrium is very rare and aggressive carcinoma. Most patients present with metastases at the time of diagnosis and have very poor prognosis. Only very few cases are reported in literature. Here we present a case of 67-year-old woman, who on evaluation for mild pain abdomen was subsequently diagnosed to have metastatic small cell neuroendocrine carcinoma of endometrium on PET/CT scan and biopsy.

Primary small cell carcinoma of the gallbladder diagnosed by PET/CT combined with tumour markers: A case report

Small cell cancer (SCC) of the gallbladder is a rare and highly aggressive malignancy. We report here a case diagnosed by positron emission tomography/computed tomography (PET-CT) combined with tumour markers. A 51-year-old man presented with pain in his neck, shoulder, back, lumbar and right thigh. Ultrasonography showed an isoechoic mass in the gallbladder, and a magnetic resonance image (MRI) scan showed multiple retroperitoneal occupations and multiple vertebral bone destruction with pathological fractures. Blood analysis showed elevated levels of tumour markers including neuron-specific enolase (NSE) and PET/CT images showed extensive distant metastases. A diagnosis of primary SCC of the gallbladder was made following exclusion of the possibility of metastasis from other organs. The use of biomarkers with immunohistochemical findings and PET/CT imaging, will assist clinicians in the identification and understanding of the pathology of this disease.

Mismatched Lesions on 18F-FDG PET and 18F-Fluciclovine PET Images in a Patient With Metastatic Prostate Small Cell Carcinoma

ABSTRACT

A 65-year-old man with fluciclovine-avid metastatic prostate small cell carcinoma with prostate-specific antigen (PSA) 19.4 ng/mL at diagnosis underwent system therapy and subsequent surgery and achieved hormonal response with PSA <0.1 ng/mL. An 18F-fluciclovine PET/CT scan 3 months after surgery was negative for disease. Although PSA remained <0.1 ng/mL, the rising carcinoembryonic antigen prompted an 18F-FDG PET/CT 6 weeks later. It showed multiple hypermetabolic lesions in the prostatectomy bed, liver, and right iliac bone, suggestive of malignant disease. The FDG-avid prostatectomy lesions were further confirmed on MRI. This case demonstrates that FDG PET/CT has a role in suspected metastatic prostate small cell carcinoma with negative fluciclovine PET examination.

Combined Simultaneous Multiportal Approach via Minimally Invasive Transciliary and Endoscopic Endonasal Approaches for Tumors Invading Both the Skull Base and the Sinonasal Area

BACKGROUND

A combined transcranial and transfacial approach has long been the gold standard for surgical management of large tumors with sinonasal and skull base involvement. The extended endoscopic endonasal approach for such pathologies has its advantages, but it has flaws as well, such as anatomic limitations and more ponderous skull base reconstruction and thus higher risk of postoperative complications. Our primary technique for surgical treatment of these pathologies has been a combination of transfacial and minimally invasive transciliary supraorbital keyhole approaches. With the aim to further minimize invasiveness, potential complications, and unsatisfactory aesthetic outcomes during surgical treatment of large tumors invading both the sinonasal area and the skull base, we abandoned the transfacial approach and simultaneously combined the transciliary supraorbital keyhole approach with the endoscopic endonasal approach.

METHODS

The well-known microscope-assisted minimally invasive approach via a transciliary supraorbital keyhole craniotomy was combined with the endoscopic endonasal approach.

RESULTS

Six patients with different histologic types of tumors affecting the sinonasal area and the skull base were operated on. The mean operative time was 3 hours, there were no unexpected intraoperative or postoperative complications, and total tumor removal was achieved in each patient. None of the patients experienced complications associated with the surgery during follow-up.

CONCLUSIONS

Our combined simultaneous multiportal approach enables total tumor eradication with reduced operative time and is associated with minimal intraoperative and postoperative complications, low mortality rate, and excellent cosmetic results.

Self-Distinguishing and Stimulus-Responsive Carrier-Free Theranostic Nanoagents for Imaging-Guided Chemo-Photothermal Therapy in Small-Cell Lung Cancer

Lack of tumor targeting and low drug payload severely impedes various nanoagents further employed in small-cell lung cancer (SCLC). Therefore, how to develop a new targeting ligand and enhance drug payload has been an urgent need for SCLC therapy. Herein, we first sift and verify that capreomycin (Cm) has a high affinity toward CD56 receptors overexpressed on SCLC cells. Motivated by the concept of self-targeted drug delivery, Cm is selected as the specific targeting ligand toward CD56 receptors and chemodrug doxorubicin (Dox) is adopted to be covalently linked via the redox-responsive disulfide linkage. The synthesized self-distinguishing prodrug (Dox-ss-Cm) and FDA-approved photosensitizer indocyanine green (ICG) as structural motifs can be self-assembled into theranostic nanoagents (ICG@Dox-ss-Cm NPs) within an aqueous solution. Such carrier-free nanoagents with high drug payload can exert targeted on-demand drug release under multiple stimuli of intracellular lysosomal acidity, glutathione (GSH), and an external near-infrared (NIR) laser. Besides, our nanoagents can be specifically self-targeted to SCLC sites in vivo and self-distinguishing via SCLC cells in vitro; thus, they decrease the undesirable effects on normal tissues and organs. Further in vitro and in vivo studies uniformly confirm that such nanoagents show highly synergistic effects for SCLC chemo-photothermal therapy (PTT) under the precise guidance of NIR fluorescence (NIRF)/photoacoustic (PA) imaging. Taken together, our work can provide a novel and promising strategy for the targeted treatment of SCLC.

Extrapulmonary small cell carcinoma of the external auditory canal: a case report and review of the literature

Extrapulmonary small cell carcinoma (EPSCC) affecting the external auditory canal (EAC) is uncommon. We herein report a case involving a 56-year-old man with EPSCC of the EAC who had a 48-year history of recurrent purulent discharge in both ears and a 20-day history of right ear pain and hemorrhage followed by incomplete right eyelid closure and an askew mouth. He underwent surgical removal of middle ear granulation tissue, residual ossicles, and a right EAC mass. Postoperatively, pathomorphological examination combined with immunohistochemical staining supported a diagnosis of small cell carcinoma. Radiation therapy at a dose of 60.06 Gy in 33 daily fractions was completed 1 month after surgery, and synchronous etoposide-cisplatin regimen chemotherapy was performed for two cycles and four sequential cycles. One year postoperatively, magnetic resonance imaging showed no tumor in the ear; however, computed tomography showed multiple liver space-occupying lesions that were considered to indicate liver metastasis. Further chemotherapy was performed, but the patient died 15 months postoperatively. This case indicates that timely and accurate chemoradiotherapy is likely the most reasonable approach to EPSCC of the EAC given the aggressiveness of this tumor.

Small cell carcinoma of gall bladder: An uncommon histologic entity

&lt;b&gt;Introduction:&lt;/b&gt; Gall bladder (GB) small cell carcinoma (SCC) comprises 0.5% of all gall bladder cancers. It carries a poor prognosis in view of its aggressive nature. &lt;br&gt;&lt;b&gt;Case report:&lt;/b&gt; We here report a case of small cell carcinoma of GB in a female who presented with obstructive jaundice. Examination revealed a hard lump in the right upper abdomen. Tumour markers showed raised CA 19-9. Staging CECT of the thorax and abdomen reported polypoidal enhancing wall thickening of the gall bladder with multiple metastatic deposits close to the pancreatic head encasing the main portal vein and common bile duct. Histopathology report was suggestive of small cell carcinoma, which was confirmed by immunohistochemistry. Patient was referred to the Oncology Department for palliative chemotherapy.

Rare Hereditary Burden associated with a Hypercalcemic Small-Cell Carcinoma of Cervix in a Young Female Patient

BACKGROUND

Oncological diseases have, in most cases, a multifactorial etiology, composed of a combination of external and internal environmental factors. Hereditary tumorous syndromes are mostly autosomal dominant diseases with incomplete but very high penetrance.

OBSERVATION

The patient, an 18-year-old virgin female, consulted a gynecologist in June 2018 because of metrorrhagia. Magnetic resonance imaging revealed a cervical tumor with the dimensions 80 × 90 × 80 mm. Histological analysis confirmed the presence of a very rare hypercalcemic type of small-cell carcinoma of the cervix. Further investigation of the germinal exom of the patient showed pathological variations in genes PALB2 and BRCA2, presented with recommendation of detailed examination by medical genetics.

CONCLUSION

Clinical experience with this type of tumor is very limited, but it still comes with some useful outcome. Small cell carcinomas of the gynecologic tract are very rare, aggressive diseases, with very poor prognosis, affecting mainly young women. Their origin is most often the ovaries, based on most clinical data, but these tumor also localize to the endometrium, cervix, vagina and vulva. It is an extremely rare type of cancer, for which clinical data is scant due to the extremely low number of reported cases. In this patient, the carcinoma had an unusual genetical mutation burden, which she inherited from her parents. In the light of these findings, we recommend that patients suspected of having a small-cell of the gynecologic tract provide a detailed family history, and that genetic testing be considered in similar cases. This work was supported by MH CR grant 16-33209A and research program of Charles University Progress Q40/06. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 10. 6. 2019 Accepted: 9. 9. 2019.

[A Case of Small Cell Carcinoma of the Pancreas]

A 55-year-old man was admitted to our hospital for jaundice. Magnetic resonance cholangiopancreatography showed a mass in the pancreatic head as well as biliary obstruction. We strongly suspected invasive ductal carcinoma of the pancreas. We performed pancreaticoduodenectomy with partial resection of the portal vein. The histopathological diagnosis was small cell carcinoma of the pancreas. We detected metastasis of the right hilar lymph node in PET-CT scan performed 2 months after the surgery and started chemotherapy with cisplatin(CDDP)plus irinotecan(CPT-11). However, we observed recurrent metastasis of the right hilar lymph node 12 months after the surgery. We started second-line chemotherapy with amrubicin( AMR)and radiotherapy. Unfortunately, the patient died from multiple metastases of the left adrenal gland and brain 26 months after the surgery. The prognosis of small cell carcinoma of the pancreas is extremely poor. Multimodal treatment such as chemotherapy, radiotherapy, and curative operation are required for long-term survival.

Multimodality imaging of naturally active melanin nanoparticles targeting somatostatin receptor subtype 2 in human small-cell lung cancer

Somatostatin receptor subtype 2 (SSTR2) is highly expressed in pulmonary neuroendocrine tumors, which account for approximately 25% of all lung cancers including small-cell lung cancer (SCLC). It is possible to establish SCLC-specific imaging agents for multimodal imaging to obtain tumor integrity information. Herein, we constructed novel multifunctional organic melanin nanoparticles (MNPs) as a carrier and surface-loaded somatostatin analog octreotide to produce a human small-cell lung cancer-targeted nanoprobe OCT-PEG-MNPs. MNPs have an excellent photoacoustic imaging (PAI) function and can be directly chelated with the magnetic resonance contrast agent Mn2+, and N-bromo succinimide (NBS) can be used as an oxidant to label the nanoparticles with the long half-life radionuclide 124I by an electrophilic substitution reaction. Therefore, (124I, Mn) OCT-PEG-MNPs can not only be used for PAI but also be used for positron emission tomography (PET) and magnetic resonance imaging (MRI). The NCI-H69 SCLC tumor xenograft model with high SSTR2 expression was constructed to evaluate the multimodal imaging ability of (124I, Mn) OCT-PEG-MNPs. This nanoprobe showed good imaging abilities in PAI, MRI and PET. The PA images showed that the photoacoustic signal in the NCI-H69 tumor site gradually increased with time, and the NCI-H69 xenograft showed a clear increase in the T1-weighted signal intensity after injection of Mn-OCT-PEG-MNPs at 24 h compared to that in the prescan. MicroPET and biodistribution studies showed that the uptake of NCI-H69 tumors (8.03 ± 0.37% ID g-1) was significantly higher than that in the control A549 model (3.35 ± 0.54% ID g-1) after injection of (124I, Mn) OCT-PEG-MNPs at 24 h. The (124I, Mn) OCT-PEG-MNPs were successfully applied to multimodal imaging in a small-cell lung cancer model with high SSTR2 expression. This nanoprobe may be considered for clinical trials since it combines the numerous advantages of organic nanoparticles.

Primary mixed adenocarcinoma and small-cell carcinoma of appendix: A case report (CARE-compliant)

RATIONALE

Primary extrapulmonary small-cell carcinoma (SCC) of appendix is reported very rarely. We report herein a case of mixed SCC and adenocarcinoma of appendix.

PATIENT'S CONCERN

A 70-year-old female was consulted to our Emergency Department with the right lower abdominal pain and low-grade fever for 2 days.

DIAGNOSIS

Abdominal ultrasonography revealed the perforated appendicitis with periappendiceal abscess. Postoperative histology confirmed the diagnosis of mixed SCC and adenocarcinoma.

INTERVENTIONS

After laparoscopic appendectomy, she underwent right hemicolectomy for radical surgery.

OUTCOMES

Laparoscopic appendectomy was performed and histological examination showed mixed SCC and adenocarcinoma. After confirming that there was no other organ metastasis, right hemicolectomy was performed for radical surgery. Five months after surgery, the patient expired due to multiple organ metastases.

LESSONS

Further studies are required for better understanding of disease entities, and clinical trials are needed to define adequate treatment strategies for extrapulmonary SCC.

Primary small cell carcinoma of the vagina: a rare instance of prolonged survival

Small cell carcinoma (SmCC) of the vagina is a rare and aggressive tumour. It comprises only 1% -2% of all gynaecological malignancies 85% of the patients with SmCC vagina die within a year of diagnosis. Here we report the case of a 65-year-old woman with stage III primary neuroendocrine carcinoma of vagina who was treated with chemoradiotherapy. The patient survived 1 year and 10 months after the initial presentation. SmCC of the vagina is very rare and despite being aggressive, the local disease can be controlled with a chemoradiation regimen.

Endoscopic ultrasound-guided fine needle aspiration with liquid-based cytology preparation in the diagnosis of metastatic small-cell carcinoma in the pancreas

Pancreatic metastasis is extremely rare, particularly from small-cell lung cancer (SCLC). Studies on the role of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) with liquid-based cytology (LBC) in the diagnosis of metastatic small-cell carcinoma in the pancreas have been rarely conducted. We report herein a case of pancreatic metastasis from SCLC diagnosed using EUS-FNA with LBC (ThinPrep). A 71-year-old man presented with chief complaints of hemoptysis and jaundice over the past 1 month. Lung & pancreas tumors with multiple liver nodules were detected on computed tomography. The aspirated material from the pancreas using EUS-FNA was prepared as a cytologic specimen with ThinPrep method, which revealed scattered and clustered "small blue cells" with scant cytoplasm and stippled chromatin with frequent apoptotic bodies. Immunocytochemical staining of the cellblock material revealed strong positivity for CD56 and thyroid transcription factor-1. Endobronchial biopsy for lung mass revealed nests of small, round, blue tumor cells with hyperchromatic nuclei showing salt and pepper chromatin, scant cytoplasm, and brisk mitotic activity. Therefore, a diagnosis of metastatic small-cell carcinoma to the pancreas with an extensive stage was finally made.

Complete response to ipilimumab and nivolumab therapy in a patient with extensive extrapulmonary high-grade small cell carcinoma of the pancreas and HIV infection

BACKGROUND

Immune checkpoint inhibitors (CPIs) have shown promising results in many solid tumors. There are limited data on the safety and efficacy of these drugs in HIV infected patients as they have traditionally been excluded from CPIs clinical trials.

CASE PRESENTATION

We present a case of an HIV-positive patient with extensive extrapulmonary high-grade small cell carcinoma who was treated with dual CPIs (nivolumab and ipilimumab) with a complete response to therapy and with a manageable safety profile. We performed a comprehensive literature review identifying 62 total HIV positive cases treated with CPIs showing this to be a potentially safe option in HIV-positive patients.

CONCLUSION

HIV infection is not an absolute contraindication to CPI therapy. Our case and others provide justification for ongoing trials of CPI therapy in patients with HIV infection, a group that has traditionally been excluded from clinical trials.

Phase I Trial of Technetium [Leu13] Bombesin as Cancer Seeking Agent: Possible Scintigraphic Guide for Surgery?

Aims and Background

Bombesin-like neuropeptides work as neurotransmitters and growth factors at the same time. Several human cancers show overexpression of three receptors for mammalian counterparts of amphibian bombesins (ABNs), ie gastrin-releasing peptide (GRP), neuromedin B (NMB) and possibly another peptide. ABNs in turn are able to bind to mammalian and human receptors in vitro, and it is therefore interesting to study radioisotope-labeled bombesin (BN) and BN-like peptides as cancer seeking agents.

Methods and Study Design

Starting from the amino acid sequence of [Leu13] ABN, the Demokritos Institute has synthesized and labeled with technetium a new BN-like peptide that has the same biological characteristics as the amphibian peptide; changes were made only in the N-terminal part of this tetradecapeptide. After having obtained satisfactory results with 99mTc BN in a preclinical study, we started a phase I trial involving cancer patients as well as normal volunteers in Tomsk. Three normal volunteers, one patient with small cell lung cancer and one patient with primary prostate cancer were studied after iv injection of 185 MBq, corresponding to 0.7 micrograms of 99mTc BN. Dynamic images of the tumors were acquired for 20 mins, followed by SPET. Total body images were acquired in patients and normal volunteers 1 and 3 h after 99mTc BN acquisition. In addition, 99mTc sestamibi scintigraphy was performed in the patient with small cell lung carcinoma.

Results

No relevant side effects were observed. Both tumors were well visualized on early 1-2 mins images with planar as well as tomographic imaging. Total body images showed radioactivity in the liver, kidneys and thyroid gland. The stomach and spleen were never imaged. Radioactivity was found in the urinary bladder 4 mins after injection in the patient with prostate cancer. Three-hour total body scans showed radioactivity in the duodenum. In the patient in whom also 99mTc sestamibi scintigraphy was performed, thyroid uptake was much higher with sestamibi than with 99mTc BN, whereas the uptake of small cell lung carcinoma was higher with 99mTc BN than with sestamibi.

Conclusions

99mTc BN is able to clearly image tumors with BN receptor overexpression. Our first impression is that in the future this radiopharmaceutical may serve as a cancer seeking agent and, due to its high tumoral uptake, also as a radiotracer for radioisotope-guided surgery.

Small-Cell Lung Cancer: Importance of Fiberoptic Bronchoscopy in the Evaluation of Complete Remission

The authors report their eight-year experience on the methodical of fiberbronchoscopy in the evaluation of complete remission in 140 patients affected by small-cell lung cancer. The higher reliability of fiberbronchoscopy than of standard chest X-ray is emphasized.

Indium-111-DTPA-octreotide Scintigraphy Modulation by Treatment with Unlabelled Somatostatin Analogue in Smali-Cell Lung Cancer

Aims and background

Small-cell lung cancer (SCLC) tissue expresses somatostatin receptors and can be visualized by means of the indium-111-labelled somatostatin analogue DTPA-D-Pheoctreotide. The aim of the study was to investigate whether treatment with a cold somatostatin analogue can affect the imaging of somatostatin receptor scintigraphy.

Methods

Three patients with SCLC were treated with 200 μg of cold octreotide three times a day subcutaneously for 7 days. Whole body and planar scintigraphy was performed before and after the treatment.

Results

111In-DTPA-octreotide uptake was increased in cancer lesions, whereas fixation in normal tissues (liver, spleen, kidneys) decreased.

Conclusions

This is the first demonstration of an enhancement of SCLC imaging following unlabelled somatostatin analogue administration. Similar results have been described by other authors in a limited number of carcinoid tumors.

Synchronous Presentation of an Askin Tumor and a Plasmacytoma in an Adult Patient

Askin tumor, or malignant small round cell tumor of the thoracopulmonary region, is an extremely infrequent entity occurring primarily in children and adolescents. Its histopathologic and cytogenetic features suggest that it belongs to the family of Ewing's sarcoma and primitive neuroectodermal tumors.

We report the case of a 43-year-old woman affected by an Askin tumor with bone metastases at diagnosis, presenting synchronously with a plasmacytoma. This is the first reported case of the simultaneous occurrence of an Askin tumor and a malignant hemopathy. The progression of the former and the remission of the plasmacytoma during chemotherapy were remarkable, since Askin tumor treatment shares drugs used for the treatment of plasma cell tumors. Given the infrequent presentation of these diseases in a young adult and the coexistence of two neoplasias characterized by typical chromosomal abnormalities, we consider the possibility of a genetic cancer susceptibility in our patient.

A Case of Primary Small Cell Carcinoma of the Cervical Esophagus with Long-term Survival following Concurrent Chemoradiotherapy: Case Report and Review of the Literature

The authors describe a case of small cell carcinoma of the esophagus that was treated by concurrent chemoradiotherapy. Both the esophageal tumor and the regional lymph node metastases disappeared after this treatment. The patient is alive and disease free after more than five years.

Primary small cell carcinoma of the esophagus is a rare and aggressive neoplasm with a very poor prognosis, and the treatment modality is controversial. This case illustrates the possibility of treating this tumor type with concurrent chemoradiotherapy.

Clinical Diagnostic Application of111In-DTPA-Octreotide Scintigraphy in Small Cell Lung Cancer

Some years ago it was proved that a good percentage of small cell lung cancers, classified among cancers of the APUD system, produces somatostatin receptors that can be detected in vivo by scintigraphy with 111In-DTPA-octreotide. With the method in the whole body it is possible to identify the principal neoformation and the probable metastases. The authors present a study of 21 patients afflicted with small cell lung cancer diagnosed histologically. The study, carried out between January 1995 and December 1997, compared the radiologic iconography of the CT scan with the scintigraphic map obtained by a planar scintigraphy and in SPECT 1, 4 and 24-hr after iv injection of 110 MBq of 111In-DTPA-octreotide. The comparison was made with reference to the principal neoplasm and probable metastases. A scintigraphic study, a CT of restaging and a follow-up, done after 3 and 6 months of chemotherapy, on 15 patients with cancer that produces somatostatin receptors proved that the neoplasm sometimes regresses and sometimes progresses. In the latter case, it is possible to identify cerebral, mediastinal and hepatic metastases with the administration of 200 microg of octreotide 3 times a day for 7 days before the scintigraphy. In fact, the administration lowers background activity. The authors concluded that scintigraphy with 111In-DTPA-octreotide plays an important part in the study of patients afflicted with small cell lung cancer. Scintigraphy identifies the subgroups of patients who can be cured with somatostatin analogues together with chemotherapy. Scintigraphy presents a good sensibility in the re-staging and in the follow-up of patients who are treated, even though it is difficult to identify subdiaphragmatic metastases where liver, spleen and kidney show an increase in 111In-DTPA-octreotide.

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

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.

Multiple Bilateral Choroidal Metastatic Tumors from a Small-Cell Neuroendocrine Carcinoma of Unknown Primary Site

PURPOSE

To report one case of multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary.

METHODS

The case of a 30-years-old white female who developed multiple and bilateral choroidal tumors from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary is presented.

RESULTS

The patient had a disseminated disease and died 6 months after. The oncologic work-up, including physical examination, laboratory and radiographic study, fails to identify the primary site.

CONCLUSIONS

Intraocular involvement from a poorly differentiated small cell neuroendocrine carcinoma of unknown primary has not yet reported. We describe this case together with a review of the literature.

Report: Small cell neuroendocrine carcinoma (SCNEC) of the tongue: A case report

Small cell neuroendocrine carcinoma (SCNEC) of the tongue is very rare. We here present a SCNEC impatient with distant metastasis. A 74-year-old Chinese male went to hospital to treat a tongue tumor, which was founded at a conventional physical examination in Weifang Stomatology Hospital. The check of positron emission tomography-computer tomography (PET-CT) by Weifang people's hospital revealed a tumor in the right root of tongue, and distant metastasis in the right submandibular area, neck, mediastinum, right hilar, abdominal, retroperitoneal multiple lymph nodes, left thyroid, right lower lung, right scapula and bilateral adrenal. The patient was diagnosed tongue SCNEC by the pathological analysis of the tissue section. Conforming to the diagnosis of tongue SCNEC, the patient received adjuvant chemotherapy for 6 cycles with etoposide and carboplatin, and is alive now 9 months after the diagnosis.

Desmoplastic astrocytoma: new insights into its clinical profile, diagnosis, and treatment

BACKGROUND

Desmoplastic astrocytoma (DA) is a rare intracranial tumor which usually affects pediatric patients. The aim of this study is to describe the clinical features and management of DA based on a joint analysis of the cases reported in the scientific literature.

MATERIAL AND METHODS

A thorough review was carried out, gathering those pathologically proven DAs reported since the first description of this entity. Two new own cases were included in order to illustrate this review. Epidemiological, clinical, radiological, therapeutic, and follow-up data were analyzed with the software SPSS version 20.

RESULTS

A total of 52 DAs were recorded. Most cases occurred in the first 2 years of life, although older patients were also reported. Patients mainly presented symptoms and signs of elevated intracranial pressure. According to their radiological features, we were able to classify DAs in four main groups, with distinct differential diagnosis and prognosis. After treatment, 14.2 % of patients presented persistent neurological impairment and the mortality rate was close to 10 %.

CONCLUSION

DAs can be diagnosed at any age from birth to adolescence. These neoplasms can show up a wider range of radiological morphologies than previously thought. Surgery represents the treatment of choice for DAs, although chemotherapy can also be useful in the setting of recurrence or progression of the disease. Those DAs lacking classic radiological features, especially type 4 tumors, were linked with a poorer clinical outcome.

Diagnostic Performance of Whole-Body Diffusion-Weighted Imaging Compared to PET-CT Plus Brain MRI in Staging Clinically Resectable Lung Cancer

BACKGROUND

Precise staging of lung cancer is usually evaluated by PET-CT and brain MRI. Recently, however, whole-body diffusion-weighted magnetic resonance imaging (WB-DWI) has be applied. The aim of this study is to determine whether the diagnostic performance of lung cancer staging by WB-DWI is superior to that of PET-CT+brain MRI.

MATERIALS AND METHODS

PET-CT + brain MRI and WB-DWI were used for lung cancer staging before surgery with 59 adenocarcinomas, 16 squamous cell carcinomas and 6 other carcinomas.

RESULTS

PET-CT + brain MRI correctly identified the pathologic N staging in 67 patients (82.7%), with overstaging in 5 (6.2%) and understaging in 9 (11.1%), giving a staging accuracy of 0.827. WB-DWI correctly identified the pathologic N staging in 72 patients (88.9%), with overstaging in 1 (1.2%) and understaging in 8 patients (9.9%), giving a staging accuracy of 0.889. There were no significant differences in accuracies. PET-CT + brain MRI correctly identified the pathologic stages in 56 patients (69.1%), with overstaging in 7 (8.6%) and understaging in 18 (22.2%), giving a staging accuracy of 0.691. WB-DWI correctly identified the pathologic stages in 61 patients (75.3%), with overstaging in 4 (4.9%) and understagings in16(19.7%), giving a staging accuracy of 0.753. There were no significant difference in accuracies.

CONCLUSIONS

Diagnostic efficacy of WB-DWI for lung cancer staging is equivalent to that of PET-CT + brain MRI.

[Role of multiphasic multidetector CT imaging in differential diagnosis of small renal cell carcinoma]

OBJECTIVE

To explore the possibility of predicting the histopathological types of small renal cell carcinoma (RCC) by analyzing the different ways of enhancement with multiphasic multidetector computed tomography (MDCT) of small renal cell carcinomas (diameter≤4 cm).

METHODS

CT images of 93 cases, diagnosed as RCC by pathology, were analyzed retrospectively, including 70 clear cell renal cell carcinoma (CCRCC), 13 papillary renal cell carcinoma (PRCC) and 10 chromophobe renal cell carcinoma (CRCC). All of the cases were examined by multiphasic multidetector CT scanning.

RESULTS

In plain scans, 46 CCRCCs were homogeneous, 21 CCRCCs were heterogeneous with low-density area and 3 of them had calcification. CCRCCs were enhanced in contrast scan with a presence of "wash in and wash out" enhancement in general. 11 PRCCs were homogeneous and 2 PRCCs had calcification. Slight-homogeneous enhancement and "delayed enhancement" were present in the PRCCs. Six CRCCs were homogeneous and 2 were calcified, 2 CRCCs were heterogeneous with low-density area. The CRCCs presented as slight or moderate enhancement and 5 CRCCs as homogeneous enhancement, while one CRCC was "spoke-wheel-like enhancement", with a trend of "delayed enhancement". Statistically significant differences were revealed among the actual enhanced CT values, the ratio of enhanced CT value to aorta CT value in the corticomedullary phase, nephrographic phase and excretory phase between the CCRCCs and non-CCRCCs (P<0.001). The analysis of receiver operating characteristic curves (ROC) revealed that when the actual enhanced CT value of tumors in CMP larger than 84.2 HU, the ratio of actual enhanced CT value to aorta CT value at the same phase in CMP larger than 0.315 were used as criteria to diagnose CCRCCs and excluded non-CCRCCs, the diagnostic value was best.

CONCLUSIONS

MDCT is of an important significance in the diagnosis and differential diagnosis of small CCRCCs and non-CCRCCs.

[Agressive small cell carcinoma of the ovary, hypercalcemic type, surgery and oncological treatment: case report]

Small cell carcinoma of the ovary (SCCOHT) is a rare tumor typically affecting young women. It is a highly malignant tumor accompanied with poor prognosis, early relapse and low survival rates. The most significant prognostic factor is stage of the disease. Due to above mentioned factors there are no guidelines for therapy of this rare tumor. We present a case of 22-years-old patient initially treated with antibiotics under diagnosis of pelvic inflammatory disease. Due to persistent mass at left adnexa, she was indicated for diagnostic laparoscopy, converted to laparotomy and left adnexectomy with frozen section revealing unspecified malignant tumor of left ovary. A conservative operation was performed and, after diagnosis of SCCOHT was established, the patient was indicated for adjuvant chemotherapy.

[Application of nephrometry for choice of the treatment tactics in patients, suffering nephrocellular cancer]

Most significant nephrometric parameters, impacting the operative procedure choice, basing on analysis of examination and treatment of 903 patients, suffering localized nephrocellular cancer (NCC), were determined a residual volume of kidney parenchyma, maximal size and localization of tumor. The authors elaborated the estimation system for tumor affection of kidney (NCIU-nephrometry), what give possibility to determine the tactics of operative treatment of NCC. While localization of tumor in the kidney pole or its lateral segment a threshold value of the functioning parenchyma volume, in which the conduction of resection of kidney (RK) is indicated, must be over 55%. While localization of tumor in the kidney medial segment the indication for RK is a maximal size of tumor up to 4 cm. Introduction of the elaborated system into clinical practice would permit to make objective indications for RK and nephrectomy conduction.

Rare sinonasal small cell neuroendocrine carcinoma evaluated by F-18-FDG PET/MRI

Small cell neuroendocrine carcinoma (SCNEC) is an aggressive neuroendocrine tumor with a poor prognosis. Extrapulmonary SCNEC is an uncommon disease. Here we describe a rare case of sinonasal SCNEC evaluated and staged by fused Fluorine-18-Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging.

FDG-PET imaging for the staging and follow-up of small cell lung cancer

The staging procedures for small cell lung cancer do not differ appreciably from those for other forms of lung cancer. For practical purposes, the TNM stages are usually collapsed into a simple binary classification: limited disease and extensive disease. This study was performed to answer the question of whether fluorine-18 labelled 2-deoxy-2-D-glucose positron emission tomography (FDG-PET) imaging permits appropriate work-up (including both primary and follow-up staging) of patients presenting with small cell lung cancer, as compared with currently recommended staging procedures. Thirty-six FDG-PET examinations were performed in 30 patients with histologically proven small cell lung cancer. Twenty-four patients were examined for primary staging while four were imaged for therapy follow-up only. Two patients underwent both primary staging and up to four examinations for therapy follow-up. Static PET imaging was performed according to a standard protocol. Image reconstruction was based on an ordered subset expectation maximization algorithm including post-injection segmented attenuation correction. Results of FDG-PET were compared with those of the sum of other staging procedures. Identical results from FDG-PET and the sum of the other staging procedures were obtained in 23 of 36 examinations (6x limited disease, 12x extensive disease, 5x no evidence of disease). In contrast to the results of conventional staging, FDG-PET indicated extensive disease resulting in an up-staging in seven patients. In one patient in whom there was no evidence for tumour on conventional investigations following treatment, FDG-PET was suggestive of residual viability of the primary tumour. Furthermore, discordant results were observed in five patients with respect to lung, bone, liver and adrenal gland findings, although in these cases the results did not affect staging as limited or extensive disease. Moreover, FDG-PET appeared to be more sensitive for the detection of metastatic mediastinal and hilar lymph nodes and bone metastases. Finally, all findings considered suspicious for tumour involvement on the other staging procedures were also detected by FDG-PET. It is concluded that FDG-PET has potential for use as a simplified staging tool for small cell lung cancer.

Radiology case of the month. Progressive slurring of speech and difficulty reading in a 62-year-old male. Final diagnosis: Metastatic small cell cancer of the prostate gland

A 62-year-old male with controlled hypertension, coronary artery disease, and borderline diabetes presented to the emergency room after experiencing a gradual one-month progression of slurring of speech and difficulty reading. The patient maintained his vital signs throughout his ambulance ride to the hospital and was clinically stable at time of arrival to the emergency department.

Long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by nephrotic syndrome

We experienced a case of nephrotic syndrome (membranous nephropathy) complicated by extensive small cell carcinoma of unknown primary etiology that was diagnosed based on the findings of bilateral cervical and mediastinal lymphadenopathy. A complete cancer response and proteinuria remission following radical chemoradiation therapy were documented. The status of a complete response and nephrosis remission persisted for more than three years. This is the first report to demonstrate the long-term survival of a patient with extensive small cell carcinoma of unknown primary etiology complicated by paraneoplastic nephrotic syndrome.

[Urachal carcinoma: experience of a clinical center within 30 years]

OBJECTIVE

To summarize more than thirty years of experience with urachal carcinoma and to discuss the clinical features of urachal carcinoma.

METHODS

The clinical data of 22 patients with urachal carcinoma, 18 males and 4 females, their median age at diagnosis was 52 years (range: 31-77 years), were analyzed retrospectively.

RESULTS

Twenty-one cases were urachal adenocarcinoma, and 1 was small cell carcinoma. The first common symptom was gross hematuria in the urachal carcinoma patients (20/22, 90.9%), and CT showed calcification in 18.75% of them (3/16). The cystoscopic finding was a mass seen at the dome of the bladder or anterior wall in all. Twenty cases were followed up (90.9%), with the median follow-up 28 months (range: 3-184 months). The overall 5-year cancer-specific survival rate was 49.5%. It was significantly different in survival between T2 and T3 or more in the urachal carcinoma patients by survival analysis (P=0.026).

CONCLUSION

The results indicate that the most important predictor of prognosis is tumor stage, and it is critical for diagnosis of urachal carcinoma by CT scan and cystoscopy. Extended partial cystectomy is the main surgery of patients with urachal carcinoma. Active multimodal treatments may improve the survival of patients with recurrent and metastatic disease.

Cytologically diagnosed metastatic small cell lung carcinoma in the mandibular soft tissue

Metastatic tumors to the oral and maxillofacial region are relatively rare, they constitute 1% of all malignant tumors of the oral cavity. The purpose of this case report is to evaluate the efficiency of fine needle aspiration cytology (FNAC) in the diagnosis of metastatic small cell lung carcinoma. A 50-year-old female patient presenting with a 4x5 cm firm, hemorrhagic, tender swelling on the left mandibular bicuspid gingiva was evaluated. Her past medical history revealed a mass measuring 8x5 cm in the left pulmonary hilar area with pleural effusion, which was diagnosed as small cell lung carcinoma. A FNAC was performed to the oral mucosal swelling, and cytological examination revealed metastatic small cell lung carcinoma. The duration between diagnosis of the primary lung and development of metastasis was 6 months. The FNAC is a rapid, non-invasive, and safe diagnostic method when carried out with a proper technique, and proved to be a valuable adjunct to a careful physical and radiological examination of the oro-maxillofacial lesions.

Neuroendocrine small cell carcinoma of the breast--a case report

Neuroendocrine tumors are very rare tumors that occur most commonly in the gastrointestinal tract. The occurrence of neuroendocrine tumors outside gastrointestinal tract is very rare but not unknown. Thus, neuroendocrine tumors and their primary seat can be found in the bronchi and lungs, as well as in the testicles, ovaries, prostate, etc. The occurrence of neuroendocrine tumors as a primary seat in the breast is extremely rare phenomenon that is described in literature. We present the case of 55-year old female in where routine mammographic examination found suspicious lesions that we recommended for further processing. The patient made a breast ultrasound examination in which tumor formation was found in size 27 x 19 mm and cytological puncture found breast adenocarcinoma. Further pathohystologic and immunohistochemical analysis set the diagnosis of neuroendocrine carcinoma, small cell type, second grade. Tumor formation by ultrasound initially sized 27 x 19 mm and pathohistologic diagnosis showed tumor size 26 x 20 x 20 mm. The axillary lymph node biopsy did not found distant metastases in lymph nodes as well as gatherings in other organs. Neuroendocrine small cell carcinomas are exceedingly rare phenomena in the literature. By the year 2009 in the USA there were described only 50 cases of this extremely rare tumor of the breast.

Peptide Receptor Imaging

Radiolabeled cell-surface peptide receptor-binding molecules are emerging as an important class of radiopharmaceuticals. Their binding to specific cell membrane receptors allows for noninvasive assessment of regional receptor proteomics in vivo. Information thus obtained can be used for diagnostic purposes and for predicting and monitoring response to treatment. This paradigm also applies to pulmonary diseases. In this review, available radiopharmaceuticals of great potential or already in clinical use for imaging of lung cancer, lung inflammation and infection and pulmonary embolism are discussed. In lung cancer, somatostatin receptor imaging by means of technetium-99m (99mTc)-octreotide scintigraphy has proven useful for characterizing malignancy in solitary pulmonary nodules. Additionally, several radiopharmaceuticals targeting tyrosine-kinase, e.g. 99mTc labeled epidermal growth factor and indium-111 (111In)-diethylene triamine penta-acetic acid-trastuzumab, or G-protein coupled receptors, e.g. 99mTc-bombesin, iodine-123-vasoactive intestinal peptide and 111In-tetraazacyclododecane tetra-acetic acid (DOTA)-cholecystokinine-B, are being explored for their diagnostic as well as treatment monitoring potential. With the purpose of better evaluating the source of pulmonary embolism, as well as to differentiate acute from chronic deep venous thrombosis, several radiolabeled peptides targeting the glycoprotein IIb/IIIa fibrinogen receptor found on activated platelets have been developed. Out of these, 99mTc-P280 is now approved by the US Food and Drug Administration for scintigraphic imaging of suspected acute venous thrombosis in the lower extremities of patients. In the field of lung inflammation and infection, non-specific 111In and 99mTc-human polyclonal immunoglobulins have been successfully used to identify the presence and extent of Pneumocystis carinii, cytomegalovirus, Mycobaterium avium and fungal infections in patients with HIV infection. The clinical role of other radiopharmaceuticals such as 99mTc-J001X, a nonpyrogenic acylated polygalactoside isolated from Klebsiella pneumoniae and binding with high affinity to CD11b and CD14 lipopolysaccharide receptors expressed on monocytes/macrophages, and 111In-octreotide, binding to up-regulated somatostatin receptors on activated lymphocytes needs to be further defined.

A rare case of intussusception associated with metastasized small cell carcinoma of lung

Intussusception is common cause of bowel obstruction in the paediatric age group compared to the elderly population. Many times, the diagnosis may be difficult because of asymptomatic nature of this bowel disorder. We hereby describe the case of a 75-year-old male who presented with lethargy, weakness, loss of movement in the joints and was found to be anemic. The haemoglobin level was low so he was transfused with packed cells. On gastrointestinal (GI) endoscopy, upper GI bleed was observed. A mass was observed beyond ampulla at the 2nd and 3rd part of the duodenal junction. Computerized tomography (CT) scan also showed a mass at the head of pancreas and the lesion at the left lung. In view of persistent bleed, 'Whipple's procedure' was performed. Histopathological examination showed small cell carcinoma of the lungs with metastasis to the pancreas and the jejunum. We here discuss the case of intussusception with intestinal metastasis which presented with gastrointestinal bleeding.