The aim of this study was to evaluate the diagnostic performance and the utility of F-18fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET/CT) in the clinical management of patients presenting with lymph node metastasis of undefined primary origin (CUP). A total of 53 patients (34 males, 19 females) with a diagnosis of lymph node metastasis according to the histopathology and/or conventional imaging were enrolled in this retrospective study. Patients were divided into four groups according to the initial location of their metastasisgroup 1, cervical lymph nodes (n = 39), group 2, axillary lymph nodes (n = 6), group 3, mediastinal lymph nodes (n = 2) and group 4, abdominal and pelvic lymph nodes (n = 6). The site of a probable primary malignancy suggested by PET/CT was confirmed by biopsy/further investigations or follow-up. 18F-FDG PET/CT accurately detected the primary carcinoma in 19 of 53 patients (36%), with head and neck cancer and lung carcinoma being the most common primary locations. The PET-CT scan results were negative for primary site localization in 13% of patients (false-negative), while 45% had true negative results, and 6% displayed false-positive results. Additional distant metastatic foci were identified in 21 of all patients (40%). The overall sensitivity, specificity, and accuracy rates of the study were identified as 73%, 89%, and 81%, respectively; in the group with cervical lymph node metastasis sensitivity 70% and specificity 84%. To conclude, 18F-FDG PET/CT is a sensitive and selective procedure for detecting unknown primary tumors, especially in the clinical setting of cervical lymph node metastasis and its use should be encouraged earlier in pre-treatment phase of CUP-patients, leading to higher detection of probable primary sites, guiding subsequent biopsy, and more accurate detection of distant metastases in a single examination.

A case of occult carcinoma of the ureteral stump is reported. A 67-year-old man presented with pain syndrome due to multiple bone metastases from unknown primary origin detected by previous imaging studies as magnetic resonance imaging, whole body contrast-enhanced computed tomography (CT), and technetium-99m methyldiphosphonate bone scan. He had undergone a right nephrectomy for a benign disease previously. He was referred to our department for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to help localize possible primary tumor. Our observations in this case show that the use of 18F-FDG PET/CT successfully and more accurately evaluated the overall tumor burden and led to a rapid decision of an adequate therapeutic approach.

Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.

Accurate imaging of the morphology in a child with a rare and complex congenital heart disease (CHD) is crucial for the surgical planning and, if possible – the minimization of operative risk. We present a case of a 3-month-old child with a rare variant of Total Anomalous Pulmonary Venous Return (TAPVR) – mixed type – which illustrates the benefi t of additional imaging modalities and techniques for the operative planning. The patient’s anomalous drainage of the pulmonary veins (PV) is as follows: left and right lower PVs drained in the coronary venous sinus, left upper PV drained via a vertical vein into the innominate vein and the right upper PV drained into the superior vena cava (SVC). Clinical fi ndings consist of heart failure (HF), pulmonary venous congestion and mild hypoxemia developing within the fi rst days after birth. Transthoracic echocardiography (TTE) demonstrates the features of TAPVR, but the modality is unable to differentiate all of the described anatomic details. Accurate morphological diagnosis is obtained via contrast Computed Tomography (CT). The. additional techniques of 3D modelling and 3D printing of a patient-specifi c model, based on the acquired CT, contributed to the planning of the surgical strategy. The patient underwent a radical operation at age of 3 months. The unique aspect of the case is the application of all possible operative techniques for correction of TAPVR – coronary sinus deroofi ng, anastomosis of a draining vessel into the left atrial appendage and Warden procedure which involves tunnelling of the right upper PVs from the SVC into the left atrium. Feedback from the surgical team shows that the additional imaging methods and the printed 3D model represent the pathology in detail that completely corresponds to the intra-operative fi ndings