Cases reported "Bone Neoplasms"

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1/15. Enhanced localization of osteoid osteoma with radiolabeling and intraoperative gamma counter guidance: a case report.

    Osteoid osteoma is a benign bone tumor that can be removed by marginal excision. Excessive removal of reactive bone may result in significant morbidity. We made use of the highly specific radioactive technetium uptake characteristic of osteoid osteoma for its localization. Radioactive technetium (25 mCi) was injected intravenously 2 hours before surgery to a 21-year-old male patient with an osteoid osteoma over the left distal radius. Tumor tissue was localized intraoperatively by a portable hand-held radioactive gamma counter to detect a focal high intensity of radioactivity. Complete tumor removal was shown by reduction of radioactivity to background level. This was confirmed by bone scintigraphy of the specimen and the forearm immediately after surgery. The defect was packed with cancellous bone graft taken from the ipsilateral distal radius through the same wound. Postoperative recovery was very satisfactory. We found this approach useful in limiting resection margin and surgical site morbidity in resection of osteoid osteoma.
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2/15. Uptake of [131I]thiouracil in tumours of patients with disseminated malignant melanoma. A pilot study.

    Previous studies on mice carrying melanoma have shown that 5-iodo-2-thiouracil (ITU) is accumulated in the tumours due to its specific incorporation into melanin during its synthesis. ITU is also selectively localized in murine melanoma metastases and in cultured human melanoma cells. Progressive formation of melanin is, however, a prerequisite for the incorporation. Four patients with disseminated melanoma were injected intravenously with 39-62 MBq [131I]TU. blood and urine samples were gradually collected, and 3-7 days postinjection tumours were biopsied and examined by impulse counting. The patients were scanned with a gamma camera over the total body daily for 3-4 days. The radioactivity was rapidly excreted. Poor melanin pigmentation of the tumours and low proliferation rate (possibly induced by chemotherapy) decreased the uptake of radioactivity by the tumors, and no imaging was possible. One of the patients, however, had clearly progressive disease with darkly pigmented metastases which contained considerably higher levels of radioactivity than the surrounding skin. Calculations indicated that a doubling of the radioiodine dose would probably make visualization of the tumours possible.
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3/15. Disseminated, lethal prostate cancer during human immunodeficiency virus infection presenting with non-specific features. Open questions for urologists, oncologists, and infectious disease specialists.

    INTRODUCTION: prostate cancer is a very infrequent occurrence in persons aged 55 years or less, and it has been rarely reported in hiv-infected patients (10 overall cases so far); therefore, an increased incidence compared with the general population has not been established, although a younger age seems more frequent among population with hiv disease. CASE REPORT: We report a case of metastatic prostate cancer occurred in a 53-year-old hiv-infected man, admitted due to non-specific signs, and symptoms: impaired general conditions, fever, weight loss, fatigue, and exertional dyspnea. A remarkable anemia and an aortic systolic murmur were the prominent initial findings, while AIDS-related conditions were not suspected due to a sustained CD4 count and a contained viremia, which never required antiretroviral therapy. Repeated red blood cell transfusions and an empiric, combined antimicrobial therapy were promptly carried out, under the suspicion of infectious endocarditis, but no appreciable improvement of clinical conditions was achieved. Subsequently, our patient complained not only of an increasingly severe pain at the root of his left thigh, together with overcoming dysuria and urgency, but also urinary tract infection that was rapidly ruled out. During the diagnostic workup for an hiv-associated fever of undetermined origin, a bone marrow biopsy disclosed a metastatic prostatic cancer, with elevated prostate specific antigen (PSA) and acid phosphate levels. An abdominal-pelvic ultrasonography and computerized tomographic scan allowed to detect a dyshomogeneous endopelvic expansive mass with extrinsic compression of the urinary bladder, and involvement of the last lumbar vertebra, large portions of pelvis, and the proximal epiphysis of the right femur. A skeleton scintigraphy pointed out multiple hypercaptation (areas of concentrated traces of radioactivity) areas with involvement of cranial, cervical, dorsal, lumbar, and sacral vertebrae, as well as the pelvis and upper portions of both femurs. Despite therapeutic attempts, our patient deceased after seven weeks due to an overwhelming disseminated intravascular coagulation (DIC). CONCLUSIONS: The non-specific clinical presentation of our case (mimicking other generalized or focal illnesses), and the final, lethal complication (DIC) pose striking problems related to the differential diagnosis during hiv disease, while the rapid evolution into an advanced, complicated, and widely metastatic disease with extensive bone marrow invasion which preceded the appearance of local signs-symptoms, and the lethal overwhelming DIC, deserves attention by specialists who care for hiv-infected subjects.
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4/15. C-choline positron emission tomography in bladder cancer: report of four cases.

    Little work has been done with positive emission tomography (PET) in bladder tumors because high urinary excretion of (18)F-FDG makes visualization of the bladder tumor difficult. (11)C-choline has recently been reported as a new tracer which lacks urinary radioactivity. We report the result of (11)C-choline PET in four patients with invasive bladder tumors. In one case, (11)C-choline PET could detect bladder tumor effectively without urinary activity and bone metastasis despite negative bone scintigraphy. On the other hand, an intense accumulation of the tracer in the bladder hampered the interpretation on PET scanning in three patients. The mechanisms of the (11)C-choline accumulation in the bladder were reported to be due to inflammatory and proliferative changes in the mucosa of the bladder from previous catheterization or other factors. Further study is necessary to prove the value of (11)C-choline PET for detecting primary bladder cancer and bone metastasis.
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5/15. Bone scintigraphy in children.

    Bone scintigraphy with 99mTc-polyphosphate or 99mTc-pyrophosphate was carried out in 54 children suspected of bone disease. Signs of skeletal metastases were recognized in 13 children by scintigraphy whereas X-ray examination showed lesions in only 10 of these. In 5 children with primary osteosarcoma, three cases of fibrous dysplasia, and 4 cases of osteomyelitis, the lesions were clearly demonstrated by scintigraphy. Abnormal accumulation of radioactivity in soft tissue lesions was observed in primary adrenal neuroblastoma, Hodgkin's granuloma, and metastatic Burkitt's lymphoma. Several cases are reported, and the value of bone scintigraphy in children is discussed.
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6/15. F-18 fluorodeoxyglucose: its potential in differentiating between stress fracture and neoplasia.

    F-18 fluorodeoxyglucose (FDG) accumulates into regions of enhanced glucose uptake and metabolism such as the brain, heart, and malignant tumors. The clinical usefulness of this positron-emitting radiopharmaceutical is illustrated in a case where the clinical picture and CT indicated a malignant bone lesion in the clavicle. Histologically a stress fracture was found secondary to chronic strain on the clavicle. On follow-up the lesion's course was benign. Planar imaging with F-18 FDG was performed twice during follow-up, and on both occasions there was no accumulation of radioactivity over the suspicious area, indicating normal glucose consumption. This case demonstrates the differential diagnostic potential of F-18 FDG and shows that clinically useful information may be obtained without a position emission tomograph.
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7/15. Paget's disease mimicing skeletal metastases in a patient with coexisting prostatic carcinoma.

    We present a 93-year-old man with prostatic carcinoma whose 99mTc-HMDP skeletal images showed multiple areas of abnormally increased radioactivity in the bone and virtual absence of renal activity. These findings were interpreted as representing multiple skeletal metastases. When correlated with concurrent radiographs, the abnormalities were found to be due to Paget's disease. Multiple areas of bone involvement are not rare in Paget's disease. We reemphasize that an abnormal bone scintigram should always be correlated with regional radiographs to rule out conditions other than malignancy.
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8/15. Ring-like uptake pattern of a skeletal imaging agent in a huge renal cell carcinoma.

    A case of huge renal cell carcinoma with localization of a skeletal imaging agent is presented. Two unusual scintigraphic findings of bone agent localization in the tumor were observed: a ring-like configuration, and low-intensity uptake. The large ring-like appearance of the extraosseous radioactivity may reflect a bulky tumor with central necrosis and a less active calcification process.
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9/15. Scintigraphic findings of multiple osteochondromas.

    Multiple osteochondromas (hereditary multiple exostoses, diaphyseal aclasis, cartilagenous exostoses) are anomalies of bone development in which multiple cartilagenous exostoses grow out from the cortical surface, mainly involving ends of the long bones. While radiographic characteristics of multiple osteochondromas have been well documented, there is little information concerning the place of bone imaging in this disease. A patient with multiple osteochondromas whose skeletal scintigrams correlate with the concurrent radiographs is presented. Although there is no specific pattern scintigraphically, the abnormal, irregular increase in radioactivity at the end of the long bones may raise a possibility of this disease entity.
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10/15. Photopenia of a hemithorax on technetium-99m HMDP bone scintigraphy resulting from massive pleural effusion.

    Accumulation of Tc-99m labeled phosphonate bone scanning agent in a pleural effusion usually shows a mild and diffuse increase in radioactivity of the involved thorax. A malignant neoplasm was thought to account for this accumulation. The photon deficiency of the hemithorax on Tc-99m HMDP bone scintigraphy was shown in a case of massive pleural effusion, which was proved by autopsy to be due to metastatic breast carcinoma in the pleura. Two factors caused these scintigraphic findings: 1) a large amount of fluid in the pleural cavity caused photon attenuation; 2) the higher body background in the noninvolved hemithorax and other areas of the body was due to renal dysfunction resulting from chronic pyelonephritis. Whether the accumulation of the radiopharmaceutical agent in the pleural effusion was malignant or benign could not readily be distinguished.
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