Incidental findings in traditional nuclear medicine practice
Published on: 28th July, 2018
OCLC Number/Unique Identifier: 7802611730
The presence of an incidental finding, defined as an abnormality which is unrelated to the initial scanning indication, is widely increases due to the access to new devices and imaging modalities. This growing number of incidental findings can lead to additional medical care including unnecessary tests nevertheless, in a minority of patients, can lead to diagnosis of an important and unexpected condition that could be crucial for the patient. We reported three cases in which nuclear medicine imaging, performed for different reasons and showed a relevant and unexpected pathology. In the case 1, a bone scan, performed in a 66 aged woman for breast cancer staging, allowed the diagnosis of a uterine fibroma. In the case 2, a HMPAO labeled-WBC scintigraphy performed because of a suspect of osteomyelitis, showed a remarkable heart-shaped photopenic area, highly suggestive of cardiac global dilatation. In the case 3, a 62 aged man referred to bone scintigraphy for the staging of recent diagnosed lung cancer. The bone scan allowed the diagnosis of a meningioma. Therefore, the occurrence of incidental findings could lead to reveal relevant abnormalities for the diagnostic pathway.
PET/MRI, aiming to improve the target for Fractionated Stereotactic Radiotherapy (FSRT) in recurrence of resected skull base meningioma after 2 years: Case report
Published on: 12th January, 2021
OCLC Number/Unique Identifier: 8899343514
The increasing use of highly conformal radiation deliberates a higher accurate targeting. Contouring and clinical judgment are presumably the crucial point, thus positron emission tomography/magnetic resonance imaging PET/MRI with somatostatin analogs appears to be useful in radiotherapy target definition. A case report of a 43-year-old woman presented with a recurrence of a meningioma (World Health Organization group I classification) in skull base, 2 years after resection. Magnetic resonance imaging (MRI) revealed a left sided skull base mass on sphenoid wing, anterior clinoid and with a soft tissue component in the lateral portion of the orbit.
Contrast-enhanced MRI and a computed tomography (CT) dedicated were used to the radiotherapy planning. Aiming an improvement on target volume delineation, 68Ga-DOTATOC-PET/MRI was also performed due the difficult localization of the tumor in skull base. Was treated using intensity-modulated radiotherapy (IMRT) to a total dose of 54 Gy in 28 fractions. It was prescribed to the planning target volume (PTV), defined based of both imaging modalities. In our case PET/MRI helped to define the target, which volume becomes bigger than that based exclusively on MRI and CT.
Pituitary adenoma and meningioma simulating a single selar and paraseal injury
Published on: 24th August, 2021
OCLC Number/Unique Identifier: 9244744986
To analyze the importance of including axial cuts in studies of any brain region, including the selar. Remember the possibility of the existence of two different tumors simultaneously, in the same anatomical region.
Intrasellar psammomatous meningioma: a case report and review of the literature
Published on: 18th January, 2022
OCLC Number/Unique Identifier: 9396189210
Intrasellar meningioma (IM) is a rare occurrence that is difficult to distinguish preoperatively from the most common non-functioning pituitary adenoma. Here we describe a case of psammomatous IM occurring in a 68-year-old woman, presented with visual defects. On magnetic resonance imaging (MRI) she was found to have an intrasellar mass with suprasellar extension that was approached with transsphenoidal surgery. Subtle radiological hints, namely dural tail sign, intralesional calcifications and a marked and homogenous early enhancement of IM on MRI after gadolinium administration, may aid clinicians in achieving an accurate pre-operative diagnosis and choosing the proper surgical approach. The clinical and neuroradiological features of IM described in the literature has been reviewed.
Spinal cord involvement in tuberculous meningitis: a case report and brief review of literature
Published on: 15th March, 2022
Introduction: Tuberculosis (TB) continues to pose a significant public health problem worldwide. Tuberculous meningitis (TBM) is the most devastating form of extrapulmonary TB however other forms of central nervous system (CNS) disease include tuberculoma and spinal arachnoiditis. TBM carries high mortality even for a patient who is already receiving treatment. The difficulty in diagnosis often leads to a delay in treatment and subsequent mortality. The emergence of Xpert ultra has improved the rapid detection of MTB and rifampicin resistance in CSF and is the preferred diagnostic tool in TBM.Case: In this case report we present a 33 years patient of concern who presented with progressive lower limb weakness associated with pain and paresthesia for 4 months, admitted via the Orthopedic unit with a diagnosis of spinal mass (meningioma, neurofibroma, or nerve sheath tumor) for which biopsy was done and revealed a chronic inflammatory process, necrotic bone lesions with no granulomas and no malignancy, he was later diagnosed with tuberculous meningitis and promptly started anti-tuberculous therapy with a dramatic recovery and improvement in neurological function.Conclusion: Tuberculous meningitis conditions have high morbidity and mortality yet diagnosis and start of treatment continue to experience an important delay. Clinicians should keep in mind the limitations of clinical presentation due to pleiotropy and current diagnostics and should employ a combination of diagnostic modalities in addition to a high index of suspicion to prevent morbidity in patients with TBM.
The Accuracy of pHH3 in Meningioma Grading: A Single Institution Study
Published on: 26th March, 2024
Introduction: In the latest WHO classification of central nervous system tumors, Mitotic Index (MI) counted on Phosphohistone-H3 stained slides (pHH3-MI) has been suggested as a valid proliferative marker in various tumors including in the evaluation of meningioma grading.We aim to report our own experience in assessing the efficiency of the anti-pHH3 antibody as a grading tool for meningiomas.Methods: A retrospective study was conducted on a series of 40 meningiomas diagnosed from March 2020 to April 2021 at the Pathology Department of the Military Hospital of Tunis. We attempted immunohistochemistry and compared MI assessed on both pHH3 and HE-stained slides.Results: According to the HE-MI and pHH3-MI, the 40 cases of meningiomas were respectively divided into 35 versus 29 grade 1 cases, four versus eight grade 2 cases, and one versus three grade 3 cases. A highly significant correlation was found between pHH3-MI and HE-MI (p < 0.001). A significantly higher sensitivity in the pHH3 counting method was reported in our study. Discussion: we found, in accordance with the literature, that pHH3-MI is more reliable and accurate in mitotic counting, therefore exhibiting a high sensitivity in tumor grading, reported by an upgrade within 22,5% of the cases.Conclusion: PHH3-MI count facilitated a rapid reliable grading of meningiomas. However, molecular characteristics that could have a potentially significant impact on tumor progression should be the subject of further research.
Exophthalmos Revealing a Spheno Temporo Orbital Meningioma
Published on: 18th June, 2024
Intracranial meningiomas are usually non-cancerous tumors that develop from arachnoid cells in the meningeal envelope. However, there are rare forms called intraosseous meningiomas, which present unique challenges for diagnosis and treatment. In this report, we describe a rare case of a giant sphenotemporal meningioma in a 72-year-old male with diabetes. The patient experienced progressive exophthalmos and visual impairment over a period of five months. Radiological imaging confirmed the diagnosis, showing extensive infiltration into the infra-temporal region. Histopathological examination confirmed a plaque-type meningothelial meningioma. The patient underwent surgical management, which involved maxillofacial surgery. Intraosseous meningiomas are rare but are increasingly being recognized, accounting for about two percent of all meningiomas. The spheno-orbital region is a common site for these tumors. Histologically, there are various subtypes, with meningothelial meningioma being the most common. The differential diagnosis includes Paget’s disease and osteomas. The optimal treatment approach involves extensive surgical resection, followed by adjuvant radiotherapy for any remaining or symptomatic tumors. The prognosis depends on the extent of resection and tumor progression, underscoring the importance of regular monitoring. Early intervention is crucial to preserve visual function and achieve favorable outcomes.
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