Ectopic thyroid (ET) is a developmental anomaly of the thyroid gland with the presence of thyroid tissue at sites other than the normal cervical location anterior to second and third tracheal ring due to abnormal migration of the gland. It may be found along the path of descent of the developing thyroid primordium from the foramen caecum to the isthmus of the thyroid and up to the base of the diaphragm. Dual thyroid ectopia, where ET tissue is simultaneously present at two different abnormal locations, is a very rare developmental defect. Only a few cases have been reported worldwide. ET is predominantly seen in females and during puberty when the hormonal demand is high. Patients with ET may remain asymptomatic or present with swelling in the neck, symptoms such as dysphagia, dysphonia, dyspnea, and features of hypothyroidism. The diagnosis is usually made on clinical examination, laboratory tests, imaging studies, and cytology. Careful clinical evaluation is essential as ET may be the only functioning thyroid tissue. Thyroid scintigraphy is an important imaging tool and the gold standard for the diagnosis of ET tissue, as it has high sensitivity and specificity. Early and accurate diagnosis of ET is essential to start hormone replacement and avoid unnecessary surgery. The authors report here a series of four patients with dual ET tissue, diagnosed on thyroid scintigraphy.
Phyllodes tumor (PT) represents a rare type of breast tumor arising from the stromal component rather than the epithelium. Metastatic spread occurs hematogenously, with lung, bone, brain, and liver being the most common sites. We present the 18 F-FDG PET/CT scan of one such case of phyllodes tumor showing cardiac and pancreatic metastases, which are an extremely rare occurrence.
Objectives:
Skeletal scintigraphy is most sensitive modality for detection of bone metastases in prostate cancer (PCa). Bone scintigraphy (BS) is currently not recommended for staging of PCa patients with serum prostate specific antigen (S.PSA) <10 ng/ml or in low-risk group (NCCN 2021, EAU-EANM-2020). This study aims to establish cutoff of S.PSA levels to predict metastatic bone disease in newly diagnosed treatment naive patients with carcinoma Prostate, in Uttarakhand region, India.
Materials and Methods:
We retrospectively reviewed 105 treatment naïve PCa patients referred to Nuclear Medicine Department, All India Institute of Medical Sciences, Rishikesh, for BS. We assessed association between S.PSA levels (performed within 6 weeks of imaging), Gleason Score (GS)/International Society of Urological Pathology (ISUP) grading and metastatic disease diagnosed on BS.
Results:
A total of 105 patients were included in this study with an average age of 69 ± 9.4 years (42–87 years). Out of 105 patients, 62 (59%) were positive and 43 (41%) patients were negative on BS for skeletal metastasis. According to S.PSA levels, patients were divided into five subgroups. On subgroup analysis, most of the patients with S.PSA of >100 were positive for metastasis on BS (83.7%) but a significant number of patients with S.PSA<10 were also positive for skeletal metastasis (46%–7/15) on BS.
Conclusion:
In current patient population, a high incidence of bone metastasis is noted even at low S.PSA levels and in low-risk groups. Hence, BS can be considered in carcinoma prostate patients even with PSA levels <10 ng/ml. Although, other parameters such as GS/ISUP grading, pathological grade and clinical stage should also be considered and individualised risk adapted strategy to be followed for initial staging.
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