Transcatheter aortic valve implantation (TAVI) is an alternative method of treatment for severe symptomatic aortic stenosis in patients who are at high risk of surgical aortic valve replacement (AVR). In randomised clinical trials TAVI was shown to be superior to standard medical therapy in a cohort of inoperable patients and non-inferior to AVR in high-risk operable patients. Additionally, in a recent trial with self-expandable prosthesis use, TAVI was associated with lower mortality compared with surgery. Usually, femoral arteries are the most common vascular access to deliver the bioprosthesis; however, in some cases (up to 20%) this route may not be applied because of significant peripheral artery disease or tortuosity. In this article, we present the first two TAVI procedures in Poland performed via the left common carotid artery.
Ga DOTATATE PET/CT is very useful in the localization of NEN primary tumors. Ga DOTATATE PET/CT allows for visualizations of bone and lymph node metastases, not detected by any other modalities, which provides better staging and changes the clinical decision in approximately one third of patients.Our study shows that pancreatic NEN presented statistically a significantly lower frequency of bone metastases in comparison to lung and intestinal NEN. No significant frequency of metastases in the liver and lymph nodes based on primary tumors was observed.
Radioguided surgery using 68-gallium labelled somatostatin analogues is a promising method for detection of small, intra-abdominal, neuroendocrine neoplasm (NEN). However, due to high background activity (physiological uptake in e.g. spleen, adrenal glands and kidneys) tumours of the tail and body of pancreas might be impossible to detect with hand-held gamma probe. Therefore a new concept of intraoperative PET/CT scan of the resected tissue can be helpful in determining whether the tumour has been excised within the margins of healthy tissue. A 71-year-old woman with primary, non-metastatic NEN of the tail of pancreas is described. The tumour was diagnosed using MRI and PET/CT scan. Before operation patient was administered intravenously 80 MBq of ⁶⁸Ga-DOTATATE. The surgery procedure was performed 60-180 minutes post injection. During the procedure pancreas was visualized, but the tumour could not be localized neither with palpation nor gamma probe. The tail of the pancreas was resected en bloc with spleen and adjacent lymph nodes. PET/CT scan of the tissue specimen was performed immediately followed by pathological examination. PET/CT scan of the resected tissue showed moderate activity in the tail of pancreas, and a small focus of high activity in the tail. Area of high SSTR expression in the tail corresponded with preoperative findings in MRI and whole-body PET/CT. Histopathological examination of the specimen confirmed the presence of neuroendocrine tumour grade 1. Immediate PET/CT scan of the surgical specimen can bring new quality to intraoperative assessment of completeness of resection of neuroendocrine tumours.
Case presentation: a 75-year-old man with a 10-year history of nodular goitre was referred for clinical evaluation. The ultrasound scan revealed enlarged thyroid right lobe almost fully filled with a heterogeneous nodule with numerous calcifications. Fine-needle aspiration biopsy suggested medullary thyroid carcinoma (MTC). Before the surgery the patient was referred to the nuclear medicine department and somatostatin receptor imaging (SRS; 68Ga-DOTATATE) with PET/CT was performed. The scan demonstrated an increased uptake within the right thyroid mass. Subsequent PET/CT with 68 Ga-gastrin analogue (MG48) revealed the same indications as the SRS: an increased alveolar uptake in the right thyroid mass without the signs of lymph node metastases. The patient underwent total thyroidectomy and central lymph nodes dissection. Histopathology examination confirmed the presence of MTC with vascular invasion, but without lymph node metastases (pT3NoMx according to the 7 th edition of the AJCC Cancer Staging Manual). Immunohistochemical staining revealed positive reaction to calcitonin and CD56, whereas the reaction to thyroglobulin remained negative. The Ki-67 was 1%. Staining for SSTR2 and CCK2 showed high cytoplasmic expression in both cases. Knowledge of the presence of CCK2 receptor in MTC patients may be an important indication for the choice of diagnostic and therapeutic procedures. The presence of both the receptor types, cholecystokinin-2/gastrin and somatostatin, is possibly an interesting combination as far as the therapeutic target is concerned. StreszczenieW pracy przedstawiono opis 75-letniego mężczyzny z dziesięcioletnią historią wola guzkowego skierowanego do Kliniki w celu badań kontrolnych. W badaniu USG stwierdzono powiększenie prawego płata tarczycy, wypełnionego prawie całkowicie niejednorodnym guzkiem z licznymi zwapnieniami. W biopsji aspiracyjnej cienkoigłowej wysunięto podejrzenie raka rdzeniastego tarczycy (MTC). Przed zabiegiem pacjenta skierowano do Zakładu Medycyny Nuklearnej w celu scyntygrafii receptorów somatostatynowych (SRS; 68 Ga-DOTATATE) wykonanej techniką PET/CT. W badaniu stwierdzono zwiększone gromadzenie znacznika w zmianie prawego płata tarczycy. Następnie wykonano badanie PET/CT z 68 Ga-analogiem gastryny(MG48), stwierdzając podobnie jak w SRS, zwiększone gromadzenie znacznika w guzku prawego płata tarczycy, nie stwierdzono przerzutów do węzłów chłonnych. Wykonano całkowite wycięcie tarczycy i centralnych węzłów chłonnych. Badanie histopatologiczne potwierdziło obecność MTC z cechami inwazji naczyniowej, ale bez przerzutów do węzłów chłonnych (pT3NoMx według 7. edycji AJCC stopnia złośliwości). Barwienie immunohistochemiczne ujawniło pozytywną reakcję na kalcytoninę i CD56, podczas gdy reakcja Tg była negatywna. Ki-67 wynosiło 1%. Barwienie na obecność receptorów SSTR2 oraz CCK2 wykazało wysokie poziomy ekspresji cytoplazmatycznej, w obu przypadkach. Znajomość obecności receptora CCK2 u pacjentów z MTC może być ważna w trakcie wyboru procedur diagnostycznych i terapeutycz...
SummaryBackgroundOne of the most common cardiac tumors is myxoma. Despite its predominantly benign course, diverse cardiological, systemic as well as neurological complications have been reported.Case ReportWe are the first from Poland to present the case of a patient with multiple central nervous system metastases associated with the left atrial myxoma. Various diagnostic, neuroradiological and histopathological procedures were described. The patient underwent cardiac surgery.ConclusionsFollow-up studies excluded the recurrence of the heart tumor and confirmed partial resolution of brain metastases. Nevertheless, subsequent neurological assessment was advised according to the literature data and possible late relapses mainly due to cerebral emboli.
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