A 63-year-old male who had subtotal gastrectomy for early gastric cancer three months ago underwent Tc-99m bone scintigraphy for the evaluation of skeletal metastases. He had no symptoms such as fever, tenderness, or wound discharge. On physical examination, the surgical scar along the midline of the upper abdomen had keloid formation and there was no radiographic evidence of calcification. Bone scintigraphy (Fig. 1A & 1B) demonstrated an unusual linear increased uptake along the midline of the upper abdomen that corresponded to the skin incision for subtotal gastrectomy. Usually, an incisional scar will not be visualized in Tc-99m methylene diphosphate (MDP) scintigraphy beyond two weeks after surgery.1) Upon reviewing the literature, there were only a few reports where localization of Tc-99m MDP in surgical scars were found two months after surgery.2) It was also reported that a few cases with Tc-99m MDP uptake in the keloid scar developed after surgery. Although there are several potential mechanisms that may explain the uptake of Tc-99m MDP in scar tissue, the primary mechanism in older scars is suggested to be a result of pathological calcification.2) Siddiqui et al3) suggested it could be due to microscopic calcification in small resolving hematomas. However, the primary mechanism in keloid scar is not well-known. We should obtain oblique or lateral views to differentiate the uptake in healing surgical scars from the artifactual uptake.
Abdomen ; Cicatrix ; Fever ; Gastrectomy* ; Hematoma ; Humans ; Keloid* ; Male ; Middle Aged ; Neoplasm Metastasis ; Physical Examination ; Radionuclide Imaging ; Skin ; Stomach Neoplasms ; Technetium Tc 99m Medronate* ; Wounds and Injuries

A 60-year-old male with carcinoma of the prostate and cerebral infarction underwent a Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bone scintigraphy (Fig. 1) showed multiple areas of increased uptake of Tc-99m MDP in the skull, spine, and ribs representing skeletal metastases. Two different patterns of uptake occurred in the skull region (Fig. 1A-C); one represents bony metastasis and the other represents cerebral infarction. The shape, size, location, intensity, and border of the increased uptake differed between the two lesions. An oval-shaped pattern with smaller size, greater intensity and more sharply defined border in the frontal region was consistent with bony metastasis. A rectangular-shaped pattern with larger size, lesser intensity and relatively indistinct border in the temporo-parieto-occipital region was consistent with cerebral infarction. Increased uptake of bone-seeking radiotracers in cerebral infarction has been reported previously.1-4) A suggested mechanism by which bone-seeking radiotracers accumulate in the necrotizing cerebral tissue is an alteration of the blood-brain barrier induced during cerebral infarction, which results in entry of the radiotracers into the extracellular space of the brain.4) Brain CT (Fig. 2) performed 7 days before and one month after the bone scintigraphy revealed lesions on the right temporo-parieto-occipital region consistent with acute hemorrhagic and chronic cerebral infarction, respectively.
Blood-Brain Barrier ; Brain ; Cerebral Infarction* ; Extracellular Space ; Humans ; Male ; Middle Aged ; Neoplasm Metastasis* ; Prostate ; Radionuclide Imaging* ; Ribs ; Skull ; Spine ; Technetium Tc 99m Medronate*

No abstract available.
Lymphoma, T-Cell, Cutaneous*

No abstract available.
Pericardial Effusion* ; Radionuclide Imaging* ; Technetium Tc 99m Medronate*

No abstract available.
Cough* ; Humans ; Hydrogen-Ion Concentration*

A 61-year-old man had a F-18 FDG PET/CT scan for evaluation of a common bile duct cancer identified on CT. The PET/CT image showed a hypermetabolic mass in the common bile duct, and a focal area of increased F-18 FDG uptake in segment IV of the liver, which corresponded to a hypoattenuated lesion on non-enhanced CT, and was consistent with hepatic metastasis. The patient underwent choledochojejunostomy with hepatic resection, and pathologic findings were compatible with an eosinophilic abscess in the liver. This case demonstrates that F-18 FDG uptake by an eosinophilic abscess can mimic hepatic metastasis in a patient with a malignancy.
Abscess ; Choledochostomy ; Common Bile Duct ; Eosinophils ; Humans ; Hydrazines ; Liver ; Liver Abscess ; Middle Aged ; Neoplasm Metastasis

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies

PURPOSE: To assess the relative frequency of benign and metastatic nodules in patients in whom nodules were resected due to suspected metastasis, and to compare the CT features of these nodules with pathologic findings in resected specimens. MATERIALS AND METHODS: Ninety-four pulmonary nodules resected by pulmonary metastasectomy in 31 patients with extrathoracic malignancies were included in our study. We retrospectively analyzed the CT features of each nodule with regard to size, shape, margin characteristics, the presence or absence of cavity, location and distance from the pleura. RESULTS: Among 94 resected nodules, 67 (71 %) were metastatic, and 27 (29 %), were benign. Among the pathologically benign nodules, involvement was as follows : fibrosis (n=14), intrapulmonary lymph node (n=7), necrosis (n=3), organizing pneumonia (n=2) and xanthogranulomatous inflammation (n=1). The mean diameter of metastatic nodules was 10.9 (range, 1-30) mm, and that of benign nodules 6.0 (range, 1-30) mm. Statistically significant differences in nodule size were found between the two groups (p<0.05), though CT revealed no significant differences in terms of shape, margin, the presence or absence of cavity, location and distance from the pleura. CONCLUSIONS: Twenty-nine percent of surgically resected nodules in patients with extrathoracic malignancies were benign. Although the possibility of metastatic nodule increases with larger nodule size, the correct diagnosis of pulmonary nodules requires histopathologic confirmation or monitoring of serial changes in nodule size.
Diagnosis ; Fibrosis ; Humans ; Inflammation ; Lymph Nodes ; Metastasectomy ; Necrosis ; Neoplasm Metastasis ; Pleura ; Pneumonia ; Retrospective Studies

There was no specific criteria of white cell count to determine the therapy of hyperleukocytosis in chronic myelogenous leukemia (CML). Therapeutic leukapheresis usually indicated in acute myelogenous leukemia with over 100,000/mm3 of white blood cell, leukocyte infiltration and leukostasis with over 100,000/mm3 of white blood cell, and hairy cell leukemia with no response to drug and splenectomy. Leukapheresis can reverse the hyperleukocytic syndrome rapidly, be used immediately without having to wait for the result of allopurinol to reduce the risk of uric acid nephropathy and decrease the tumor cell mass so as to minimize the extent of cytolysis- induced hyperuricemia, hyperkalemia and hyperphosphatemia. We report a case of 56-year-old man presented right lower leg pain, gait disturbance who was diagnosed CML 4 years before. He showed right popliteal artery obstruction in doppler sonogram and immediatly started leukapheresis. After two therapeutic leukapheresis, symptoms were improved and popliteal blood flow was improved by follow-up doppler sonogram. As a result, we consider that leukapheresis without use of anticoagulant or thrombolytic agents is effective therapy in CML associated leukocytosis and vascular obstruction.
Allopurinol ; Arteries* ; Cell Count ; Fibrinolytic Agents ; Follow-Up Studies ; Gait ; Humans ; Hydroxyurea* ; Hyperkalemia ; Hyperphosphatemia ; Hyperuricemia ; Leg* ; Leukapheresis* ; Leukemia, Hairy Cell ; Leukemia, Myelogenous, Chronic, BCR-ABL Positive* ; Leukemia, Myeloid, Acute ; Leukocytes ; Leukocytosis ; Leukostasis ; Middle Aged ; Popliteal Artery ; Splenectomy ; Uric Acid

A 68-year-old man with small cell carcinoma of the lung and adenocarcinoma of the prostate underwent Tc-99m MDP bone scintigraphy for the evaluation of skeletal metastases. Bilateral symmetrical photon defects in both parietal bones of the skull were observed. The radiographs of the skull demonstrates biparietal thinning in the same area of the abnormality identified on bone scintigraphy. Although these findings in cancer patients can be mistaken for skeletal metastases, the symmetry and location of the photon defects are generally indicative of biparietal thinning.
Adenocarcinoma ; Aged ; Carcinoma, Small Cell ; Humans ; Lung ; Neoplasm Metastasis ; Parietal Bone ; Prostate ; Radionuclide Imaging* ; Skull ; Technetium Tc 99m Medronate ; Tomography, Emission-Computed, Single-Photon*