Extensive F-18 FDG uptake in metastatic spindle cell carcinoma of the lung

A 77-year-old man with stage IIB squamous cell carcinoma of the lung underwent right upper lobectomy. One month later he was examined for right chest pain, dyspnea, cough, and weakness. A roentgenogram showed nondiagnostic diffuse opacification of his right lung cavity. An F-18 FDG positron emission tomographic (PET) study revealed extensive uptake in the right pleural area, left adrenal gland, right axilla, and soft tissues consistent with extensive local recurrence and metastatic disease. Biopsy of a right chest soft tissue lesion showed spindle cell carcinoma, a rare variant of squamous cell carcinoma.

[Chronic lymphoid leukemia complicated with ascites]

Ascites are common in malignancies of the gastrointestinal tract but are rarely associated with chronic lymphoid leukemia. An unusual progression of chronic lymphoid leukemia, rapidly complicated with ascites, is presented, followed by a discussion of the causes and types of ascites found in solid and blood malignancies.

Pigmented adrenal hyperplasia with myelolipomatous changes and bilateral testicular enlargement in an untreated man with 21-hydroxylase deficiency

OBJECTIVE

To report the occurrence of a giant left adrenal tumor and bilateral testicular masses (adenomatous hyperplasia of Leydig cells) in a young man with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

METHODS

The clinical, radiologic, endocrinologic, and pathologic features of this case are correlated with the findings in the literature.

RESULTS

The interesting elements in this case are the rare pathologic features of the left adrenal lesion (pigmented adrenal hyperplasia with myelolipomatous changes) and the association with the infrequent testicular adrenal rest tumors. The absence of enlargement of the right adrenal gland was unexplained.

CONCLUSION

The presence of these two rare complications seemed to be associated with poor adherence to medical treatment recommendations for congenital adrenal hyperplasia.

Preoperative localization of parathyroid lesions in hyperparathyroidism: relationship between technetium-99m-MIBI uptake and oxyphil cell content

The aim of this study was to assess the relationship between parathyroid oxyphil cell content and early or late phases of uptake of 99mTc-MIBI, a radioisotope preferentially retained in mitochondria-rich cells.

METHODS

This study is a retrospective, single-blind analysis of all double-phase 99mTc-MIBI parathyroid scintigraphy studies performed before surgery in our institution between 1990 and 1995. A total of 18 parathyroid lesions in 14 patients were reviewed. This sample included 11 cases of primary hyperparathyroidism (8 adenomas, 1 adenocarcinoma and 2 hyperplasias) and 3 cases of tertiary hyperparathyroidism secondary to chronic renal failure.

RESULTS

Uptake of 99mTc-MIBI in the early phase of scintigraphy was associated with larger parathyroid lesions (1.61 +/- 1.61 ml versus 0.33 +/- 0.27 ml; p < 0.02) and higher serum calcium levels (3.00 +/- 0.41 mM versus 2.67 +/- 0.14 mM; p < 0.02). More importantly, we found that a parathyroid oxyphil cell content greater than 25% was more often associated with a positive uptake of 99mTc-MIBI in the late phase of the test (positive late uptake in 78% of lesions with a high oxyphil cell content versus 33% in lesions with an oxyphil cell content between 1% and 25% and 0% in lesions with no oxyphil cells; p < 0.04).

CONCLUSION

These findings suggest that the late retention of 99mTc-MIBI in double-phase scintigraphy is related to parathyroid oxyphil cell content.

Porous balloon catheters for local delivery: assessment of vascular damage in a rabbit iliac angioplasty model

OBJECTIVES

This experimental study assessed long-term vascular damage induced by the use of porous balloon catheters designed for local delivery.

BACKGROUND

Local drug delivery using porous balloon catheters has emerged as a possible means by which compounds designed to prevent restenosis might be delivered locally at concentrations higher than achievable by systemic administration. There are, nonetheless, some concerns about the possibility of greater arterial trauma induced by the high pressure fluid jets from the delivery catheter itself, a complication that could provide additional stimulus for intimal hyperplasia. Because these concerns are based mainly on in vitro studies and on studies performed after acute experiments, further work is required to assess the long-term effects of this device on the arterial wall.

METHODS

Local delivery of a saline solution was performed in 32 rabbits in one iliac artery, using an inflation pressure of 6 atm and a balloon/artery ratio of 1.3 to 1.5, followed by angioplasty in both iliac arteries. Vascular injury was assessed using tritiated thymidine incorporation at 4 days (12 rabbits) and planimetry at 30 days after the procedure (20 rabbits).

RESULTS

Tritiated thymidine incorporation did not reveal any significant difference between the angioplasty group and the group with local delivery and angioplasty (117,921 +/- 18,853 vs. 140,652 +/- 23,125 cpm/mg protein, p = NS). Planimetry at 30 days was also similar in the two groups (neointimal area 0.11 +/- 0.02 vs. 0.13 +/- 0.02 mm2).

CONCLUSIONS

In this model the use of porous balloon catheters before angioplasty did not lead to greater intimal hyperplasia than angioplasty alone. Further experimental investigation is required to determine whether this strategy could be used to prevent postangioplasty restenosis in humans.

Effect of CpG-rich sequences in transformation and tumorigenesis by polyomavirus

To address the question of the role of CpG-rich sequences in gene expression, we investigated the effect of an HTF island on the activity of the polyomavirus middle T (pmt) oncogene. pmt is less transformant and less tumorigenic when it is introduced into cultured cells or newborn rats in the presence of an HTF island. Transformed cells carrying pmt in the vicinity of the HTF island have a propensity to revert at a relatively high rate of about 2 X 10(-3) per cell per generation by a mechanism probably involving methylation of some CpG sites in the island. Our results suggest that HTF islands can function as transcriptional silencers.

Assessment of the cricoarytenoid joint: high-resolution CT scan study with histo-anatomical correlation

Eight normal larynges from autopsy cases were CT scanned and 1.5 mm contiguous slices in the cricoarytenoid joint region were taken. The larynges were then sectioned and stained for histological correlation. Different degrees of calcification, ossification and bone marrow cavitation of the cricoid and arytenoid cartilages were observed. This explained the variety of presentations of these structures on CT films. For example, the cricoarytenoid articular interspace was not always visible due to the saddle-shaped configuration of the joint superimposing cartilages on axial views. Features of normal CA joints on CT scan are discussed.

Angiosarcoma of the breast

The authors report a case of angiosarcoma of the breast. The patient, a 44-year-old woman, remains free of disease 7 years after biopsy and 6 years after a simple mastectomy. The authors emphasize the benign appearance of the tumour and the importance of early detection and adequate surgical treatment.