Neuroendocrine tumors (NET) are rare neoplasms and commonly metastasize to liver, lymph nodes and less frequently to bones and lungs. Metastases to other organs are extremely rare and we report a case of NET clinically presenting with bilateral proptosis secondary to metastases in orbits. 68Ga-DOTANOC PET/CT demonstrated somatostatin receptor overexpressing lesions in bilateral orbits, small intestine, lymph nodes, lungs, heart and testes in the absence of liver metastases.

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Peritoneal lymphomatosis is relatively uncommon cause of diffuse malignant peritoneal disease, and differentiating it from other causes of diffuse peritoneal disease such as peritoneal carcinomatosis is often difficult on imaging. Common findings observed in peritoneal lymphomatosis in contrast to other etiologies include frequent nodal involvement and splenomegaly. We present a case of diffuse peritoneal disease along with ovarian lesions in the absence of abdominal lymphadenopathy or splenomegaly on fluorodeoxyglucose positron emission tomography–computed tomography in the setting of elevated cancer antigen-125 levels, mimicking primary ovarian malignancy causing peritoneal carcinomatosis, which was finally proven to be lymphoma.

Parasellar extra-axial cavernomas are rare lesions. The authors report a case of extra-axial cavernoma in a 50-year-old male patient, who presented with occipital headache and double vision. The magnetic resonance imaging showed an enhancing extra-axial dural-based mass in the left parasellar region invading cavernous sinus, hyper-intense on T2-weighted images, iso-intense on T1-weighted images and high relative cerebral blood velocity on magnetic resonance perfusion. The patient underwent a left pterional craniotomy and parasellar space occupying lesion was excised. Histopathology was suggestive of cavernous hemangioma. Key words: Extra-axial cavernoma, parasellar cavernoma, meningioma ABSTRACTArticle history:

Hepatocellular carcinoma usually metastasizes to regional abdominal lymph nodes. Distant lymph nodal metastases are relatively rare with most common extra abdominal sites being mediastinum and juxtaphrenic regions. Metastasis to internal mammary lymph nodes is extremely rare, and we present a case of hepatocellular carcinoma with histopathologically proven internal mammary lymph nodal metastasis in the absence of regional abdominal lymph nodal metastases.

Majority of ovarian cancer (OC) patients are usually diagnosed at advanced stage and present with peritoneal spread/ascites. Some patients develop pleural deposits/effusion secondary to transdiaphragmatic spread of peritoneal disease/ascites. However, pleural deposits/effusion from OC in the absence of peritoneal disease/ascites are very rare. We present a case of serous carcinoma of the left ovary with fluorodeoxyglucose (FDG) avid right pleural deposits and effusion in the absence of peritoneal disease/ascites on FDG positron emission tomography (PET)/computed tomography (CT), showing excellent response to chemotherapy in subsequent PET/CT. We also discuss the pathophysiology of pleural abnormalities in patients with ovarian diseases, a characteristic disease spread pattern and recognition of which would help in the imaging interpretation.

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Introduction: An abnormal infiltration of intraepithelial lymphocytes in the intestinal mucosa is described as microscopic enteritis (ME). ME is a heterogeneous condition that can be found in, but not limited to, celiac disease, autoimmune disorders, food protein intolerance, parasitic infections, and NSAID use. Thus, an obvious cause of ME is difficult to elucidate and requires thorough work up. We report a case of a patient who was found to have ME thought to be secondary to infiltrative T-cell promyelocytic leukemia (T-PLL). Case Description/Methods: A 68-year-old male with a history of type II diabetes and hyperlipidemia presented with intermittent fever, abdominal pain, nausea, and emesis. He was found to have small bowel obstruction with severe enteritis of 3/4 of the small bowel (distal jejunum to the ileocecal valve). He had a small bowel resection with pathology revealing necrotizing lymphocytic enteritis. Bidirectional endoscopy revealed mild colonic, ileal and duodenal edema with biopsies revealing increased intraepithelial lymphocytes. He was empirically treated with intravenous methylprednisolone with resolution of fevers. He was discharged home with a follow up with gastroenterology for ME and with hematology for persistent leukocytosis. He continued to have recurrent fevers with persistent lymphocytic leukocytosis (14,200 WBC/microliter). Infectious (acid fast bacteria, fungi, cytomegalovirus, adenovirus, syphilis) and rheumatologic diagnostics were unrevealing. He underwent bone marrow biopsy and peripheral blood examination with immunostains, flow cytometry, and cytogenetic studies and was found to have clonal T-cell receptor gamma gene rearrangement concerning for T-PLL. He was treated with alemtuzumab; however developed worsening disease and disseminating opportunistic infections (cytomegalovirus and aspergillosis). He passed away shortly after his diagnosis. Discussion: ME is a challenging diagnosis as its etiology can be difficult to elucidate. Prompt, timely evaluation should be prioritized to improve outcomes. T-PLL is a rare leukemia due to abnormal growth of T-lymphocytes and typically presents with leukocytosis, weight loss, and infection; however, gastrointestinal symptoms may be a presenting symptom.