Rationale:Differentiated thyroid cancer is the most common endocrine malignancy with concomitant hematological malignancy in 7%.Patient concerns:We present a case of a synchronous papillary thyroid cancer and a follicular variant of non-Hodgkin lymphoma and discuss the possible diagnostic and treatment dilemmas.Diagnosis:A 48-year-old female was reffered to our hospital with diagnosis „thyroid cancer“. Due to a history compatable of synchronous lymphoproliferative disease we performed a computed tomography, which revealed multiple enlarged lymph nodes in the neck, mediastinum, axilla and abdomen.Interventions:A total thyroidectomy with dissection of the central compartment was performed. The microscopic examination of thyroid gland revealed multifocal papilary thyroid cancer and metastaes from the same cancer plus aggressive follicular B-cell non-Hodgkin lymphoma in the lymph nodes. Despite the classic approach „solid cancer first“, due to the advanced stage of lymphoma we first started the chemotherapy of NHL. She received 8 cycles of CHOP and I131 therapy with 129 mCi. Because of incomplete response 4 cycles Mabthera plus Bendamustin were added. The follow-up PET scan revealed complete remission of lymphoma and bilaterally enlarged single cervical lymph nodes, previously known to be iodine positive on I131-SPECT/CT. She was sheduled for bilateral radical neck LND.Outcomes:Complete remission of NHL and residual single metastatic cervical lymph nodes requiring bilateral radical neck LND.Lessons:The synchronous DTC and NHL is rare. To date, there is no standardized approach due to lack of experience. We suggest lymphoma first approach with synchronized and tailored multidisciplinary efforts. The molecular mechanisms of this link are poorly understood and yet remain to be elucidated.
BACKGROUND: Sarcomas comprise 1% of malignant tumors in adults but represent a significant diagnostic and therapeutic challenge. Molecular imaging with
Background: Despite the extensive use of FDG-PET/ CT its role in brain tumor assessment remains controversial mostly because of the physiologically high brain uptake which easily obscures pathological processes. The wide availability of FDG, however, maintains the interest in FDG neuro-oncological applications.Objective: to evaluate the use of a late registration at 180min in patients with brain tumors, studied with FDG-PET/CT based on visual and semiquantitative analysis.Materials and methods: 38 patients with brain neoplasms and non-tumor structural lesions underwent a selective brain 18F-FDG PET/CT at two time points at 60 and 180 minutes after administration. Visual assessment was made by two readers with interobserver agreement calculation. Region ratio comparison with three different reference regions -the contralateral one, the white matter, and the cerebellum was used as a base for semiquantitative analysis.Results: Visual analysis showed better delineation of malignant lesion on late registrations with higher inter/ intraobserver agreement as compared to the early images. Semiquantitative analysis demonstrated significant differences in early and late indices of metastases and gliomas, but failed in distinguishing gliomas from metastatic lesions and benign lesions.Conclusion: Delayed brain images with FDG-PET/CT at 180 min after injection provide better tumor delineation, higher accuracy, lower interobserver variations. The use of semiquantitative indices, irrespective of the reference region used, is of limited value.
Extranodal lymphoma, secondary to or accompanying nodal disease is uncommon, but not unusual finding. 18-Fluorodeoxyglucose positron emission tomography (
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