Primary hyperparathyroidism (PHPT) is caused by parathyroid malignant neoplasm in 1% of cases. The risk of the latter is higher in patients with symptomatic PHPT. The prognosis in this group of patients depends on the extent of the process and primary surgical intervention. In these cases, the differential diagnosis between secondary foci in the bones associated with parathyroid cancer and hyperparathyroid osteodystrophy is a challenging problem. This article describes two cases of severe PHPT accompanied by hyperparathyroid osteodystrophy suspected for metastatic parathyroid cancer. Positron emission tomography in combination with computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18F-FDG) and/or 18F-fluorocholine was included in the examination algorithm. In both cases, pronounced bone changes similar to parathyroid metastases were observed. Accumulation of 18F-fluorocholine was also observed only in altered parathyroid gland. Histological examination of postoperative material verified benign parathyroid tumors, and characteristic lesions of bone tissue were regarded as areas of osteodystrophy. Therefore, accumulation of 18F-fluorocholine at the areas of bone destruction does not enable differentiation between hyperparathyroid osteodystrophy and metastatic lesions; further research is required to assess sensitivity and specificity of the method with respect to topical diagnosis of altered parathyroid gland.
Objective: demonstration of possibilities of18F-prostate specific membrane antigen-1007 (18F-PSMA-1007) positron emission tomography/computed tomography (PET/CT) for diagnostic prostate cancer recurrence.The article presents clinical observation of the patient with prostate cancer biochemical recurrence after the multiple treatment.18F-PSMA-1007 PET/CT demonstrates high sensitivity in prostate cancer recurrence diagnostic, in particular with low prostatic specific antigen level.
Background. Breast cancer is the second most common cancer worldwide. Despite significant advances in breast cancer treatment, more than 50 % of patients develop recurrence following completion of treatment. If there is a suspicion of disease progression, the differential diagnosis of metastatic tumor and non-metastatic lesion using the standard imaging methods can be difficult. A modern approach to the detection and assessment of the extension of recurrent disease is individual evaluation of the biological characteristics of the tumor, including determination of the status of estrogen receptors with the goal of adequate treatment. PET/CT with 18F-fluoroestradiol in patients with hormone-dependent breast cancer can be used to determine the expression of estrogen receptors (RE) in tumor tissue and assess the presence of receptor-positive metastases throughout the body in a single study. Case description. We report the cases of 55-year-old and 57-year-old women with hormone-dependent breast cancer after standard treatment (surgery, radiation therapy and hormone therapy). During hormone therapy, lung lesions were detected in both patients. To assess the activity of these lesions, 18F-fluoroestradiol PET/CT was used. In the first case, a low uptake of 18F-FDG was observed. In the other case, no18F-FDG uptake was found. Given that both patients had hormone-dependent breast cancer, it was decided to perform PET/CT with 18F-fluoroestradiol (18F-FES) to evaluate the expression of ER. In the first case, the 18F-FES uptake was detected in all lesions that indicated the evidence of metastases. Histological examination confirmed the evidence of metastatic tumor. In the second case, no uptake of 18FFES was detected in the foci and the patient was followed-up for 6 months. Computed tomography showed decrease in the size of lesions.Conclusion. The use of 18F-FES PET/CT can be an important diagnostic tool for detection of disease progression in patients with hormone-dependent breast cancer. In case of detection of positive foci on 18F-FES PET/CT scans, hormone therapy for breast cancer can be administered without invasive procedures for verifying the diagnosis.
Erdheim–Chester disease (ECD) is a rare and frequently neglected disease, usually with a poor prognosis. The first two cases of ECD were reported by Austrian pathologist: Jakob Erdheim and his apprentice student William Chester in 1930. The etiology and disease incidence are unknown. One of the main components of this disorder is a chronic uncontrollable inflammation. Clinical manifestations of the disease can be very different. ECD affects predominantly adults, usually male population. There is no effective treatment developed yet. In 2016 ECD was classified as histiocytic neoplasm by the World Health Organization and was categorized as “tumors of histiocytes and dendritic cells”. More than half of patients testing positive for the BRAF mutation. There is a Erdheim–Chester Disease Global Alliance (ECDGA), which try to unite and provide with information about diagnostics and treatment of this rare disease both patients and doctors. Today, there are 571 registered patients and only one from Russia. The final diagnosis is made on the basis of histological finding such as infiltration with foamy histiocytes, signs of inflammation and Touton giant cells. Immunohistological analysis is usually CD68 and XIIIa positive. There are radiological finding indicating a possible association with the disease. There is this specific, almost pathognomonic scintigraphic picture of the skeleton, “coated” aorta, “hairy kidney” patterns on computer tomography. We demonstrate a clinical case of a patient with a newly diagnosed ECD with bone and connective tissue involvement, with manifestation of this disease more than 10 years ago. It took four months to make the final diagnosis. There were three biopsies and a wide range of other diagnostic procedures.
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