The incidence of ureteric calculus as a cause for severe abdominal pain in children is mounting, especiallyin the tropical country. The course of illness may be non-specific but a swift detection via non-invasiveimaging modalities singly or in combination may avert unnecessary radiation hazard and futile surgery ina young child. In this paper, we discussed a case of an 11 year-old boy who was presented with a suddenonset of the right side severe abdominal colic whose a bedside ultrasound was positive for hydronephrosisfor which localisation of stone was further confirmed via a low dose limited intravenous urography (IVU).It is important to note that data available on the value of a combined ultrasound and the limited IVU inan emergency setting when urolithiais is being suspected in children with abdominal pain are particularlyscarce. Hence, this case documented the potential value of a combined ultrasound and a limited IVUstudy as a unique combined armamentarium used in a suspected childhood urolithiasis in the tropics.
The presence of calcification in a particular FDG-avid soft tissue lesion may at times present uncertainty
regarding the clinical course of the disease pathology. Calcific deposits are not specific for either benign
or malignant aetiologies (Brant et al., 2010). Altered glucose metabolism with associated calcification
may underpin underlying aggressive pathophysiology with necrosis as sequelae. Mantle Cell Lymphoma
(MCL) is a subtype of non-Hodgkin’s lymphoma. It is a rare B-cell NHL that is prevalent in men over
the age of 60. The disease may be aggressive but it can also behave in a more indolent fashion in some
patients. MCL comprises about 5% of all NHLs. The disease is called Mantle Cell Lymphoma because the
tumour cells originally come from the ‘mantle zone’ of the lymph node (Zhou et al., 2004). Pretreatment
Hodgkin’s lymphoma with calcification may masquerade as other second primary pathologies, e.g.
extraosseous osteosarcoma or myositis ossificans (Apter et al., 2002; Korek-Amorosa et al., 1974). A
calcified perineural lymphoma prior to treatment is exceedingly rare and calcification usually occurs
one to five years after chemotherapy or radiation therapy with an incidence of 2% (Apter et al., 2002).
This case documents how the manifestation of a rare malignant perineural mantle cell lymphoma may
be indistinguishable from other pathological entities based on its pattern of distribution in a combined
FDG- PET-CT study.
The escalating costs of conventional diagnostic technology in oncology have yet to obviate futile surgery intervention and the spiralling treatment cost. The evolution in engineering technology which looks at the correlation of the anatomy and the function of tumours i.e. Positron Emission Tomography-Computed Tomography (PET-CT) have impacted on the improved diagnostic accuracy and treatment in oncology. Clinical data have demonstrated that the information provided by PET/CT often changes patient management. This review addresses the value of PET-CT as a surrogate molecular marker in tumours and to discuss some issues in adopting PET/CT in routine daily practice as supported by the numbers of literature reviews of its application in oncology since it was first commercialised in 2001. The description of the technology used in multimodality imaging has gained encouraging interest among physicians, policy makers and insurance companies on the importance of the PET-CT, for which roles are not limited to the staging, disease prognostication and treatment monitoring with potential impact on treatment cost and justification of radiation safety for the patient. PET/CT is a useful tool in cancer investigation as evidenced by its role as a surrogate marker in underpinning the cellular reprogramming of different pathological entities.
The aim of this study was to evaluate the value of MRI spectroscopy and association with the altered glucose metabolism on 18-FDG PET/CT in patients with suspicious breast cancer. Eight selected breast cancer patients with BIRADS 4 or 5 on mammogram were recruited and patients underwent 18F-FDG PET/CT MRI (spectroscopy). The standardise uptake value (SUVmax) was analysed to determine the degree of the altered glucose metabolism on the PET. The metabolites of tumor lesions were measured using in vivo proton MR spectroscopy (MRS) of the breast. There were eight females with a mean age of 55.3±12.2 years with a biopsy result of invasive ductal carcinoma (2), lobular carcinoma (1) and benign lesion (5). There was a significant difference between the mean of the malignant tumour (SUVmax 4.28±3.74 g/ml) and the mean of the benign tumour (SUVmax: 2.33±0.9 g/ml). On the per-lesional basis of the MRS correlate with SUVmax, the suspicious breast tissue exhibited raised creatinine metabolites (mean: 3.39±0.54u) with significant correlation SUVmax mean 3.06±2.34 as compared to N-acetyl Aspartate (NAA), (mean: 2.84±0.99u) and choline (mean: 2.46± 0.70 u). This study showed that high SUVmax was associated with malignant cancer and the high creatinine metabolite that correlated with the SUVmax could potentially be utilised as a surrogate marker in detecting breast cancer.
Colo-colic intussusception is a rare manifestation of a primary tumour in an adult patient. This article
aims to document the rarity of colo-colic intussusception features on the 18 FDG- PET-CT in a patient
with primary colonic carcinoma. An 18 FDG-PET-CT was performed for the purpose of pretreatment
staging of a colonic carcinoma in a 61-year-old man following a diagnostic colosnoscopic biopsy. He
presented with abdominal distension and peri-rectal bleeding for a month. The fused 18 F-FDG PET-CT
image revealed an FDG-avid mass in the left hemicolon showing a rim of FDG avidity denoting the head
of intussusceptum. There are also multiple FDG-avid nodules seen along the anti-mesenteric colonic fat
suspicious for lymph nodes metastasis. Debulking of tumour revealed a mucinous adenocarcinoma of
colon with a metastatic lymph node. 18 FDG PET-CT features of intussusception in colonic carcinoma
have never been described before. It can potentially become a preferred diagnostic tool in delineating a
potential tumour mass within the intussusceptions that help improve prognosis in patients with malignancy.