ABSTRACT ABSTRACT Objectives:Although not uniformly accepted, an increased uptake by 18F-FDG PET/... more ABSTRACT ABSTRACT Objectives:Although not uniformly accepted, an increased uptake by 18F-FDG PET/CT in large-vessels is accepted to be a sign of active disease in Takayasu's arteritis (TAK). We aimed to investigate the value of 18F-FDG-PET/CT for clinical assessment in a subset of TAK patients having a persistent acute phase response (APR) without any signs or symptoms of clinical disease activity. Method: We studied 14 patients (mean age: 38.6±13.9 years, Female/Male: 11/3, disease duration: 5.7±5 years). Patients were clinically inactive (according to the definition of activity by Kerr et al), while categorized as having "persistent" disease activity by physician's global assessment due only to APR. 18F-FDG uptake was graded using a four-point scale from grade 0 (no uptake present) to grade III (high-grade: uptake higher than liver). Any uptake in major vessels with a grade ≥2 was accepted to be "active." Results: Mean ESR was 50.8±13.2 mm/hour, mean CRP was 28.5±22.1 mg/L. Active vasculitic lessions were observed by 18F-FDG-PET/CT in 9 of 14 (64.3%) of patients. The median number of active vascular lesions were 2 (1-5). A step-up treatment change was decided in 8 patients according to 18F-FDG-PET/CT results. Conclusion: We observed increased 18F-FDG uptake in the majority of TAK patients with an increased APR, but clinically silent disease. 18F-FDG-PET/CT showed the presence and localisation of active inflammation in the aorta and its branches. Although specificity of observed lesions are not clear, 18F-FDG-PET/CT imaging may influence physician's assessment of clinical activity and treatment choices in TAK.
Introduction: Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representi... more Introduction: Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representing less than 1% of the pituitary tumours, present with elevated thyroid hormones and normal/high TSH concentrations. Case Presentation: A 7-year-old boy with nervousness was referred by his psychiatrist for elevated free T4, T3 and TSH levels. Initial evaluation revealed an elevated -subunit.Pituitary MRI demonstrated a macroadenoma. The patient underwent a trans-sphenoidal tumour resection (TSS) which showed positive immunohistochemical staining for TSH, growth hormone, and prolactin in tumoral tissue. Euthyroidism was achieved for one year after TSS, then, recurrence of tumour with elevated TSH and thyroid hormone levels necessitated a re-operation with TSS followed by gamma-knife radiosurgery. The euthyroid state was achieved and lasted for 2.5 years this time, but, due to the recurrence, medical treatment had been commenced with cabergoline and octreotide. Euthyroidism was maintaine...
Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that ... more Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that mostly affects the nasal cavity and adjacent areas. However, some patients can present with distant nodal or extranodal involvement including the Waldeyer ring, gastrointestinal tract, genitourinary organs, lung, thyroid, skin, or adrenal glands. Herein, we present a unique case of extranodal natural killer/T-cell lymphoma with widespread cutaneous and subcutaneous involvement on 18F-FDG PET/CT.
ABSTRACT ABSTRACT Objectives:Although not uniformly accepted, an increased uptake by 18F-FDG PET/... more ABSTRACT ABSTRACT Objectives:Although not uniformly accepted, an increased uptake by 18F-FDG PET/CT in large-vessels is accepted to be a sign of active disease in Takayasu's arteritis (TAK). We aimed to investigate the value of 18F-FDG-PET/CT for clinical assessment in a subset of TAK patients having a persistent acute phase response (APR) without any signs or symptoms of clinical disease activity. Method: We studied 14 patients (mean age: 38.6±13.9 years, Female/Male: 11/3, disease duration: 5.7±5 years). Patients were clinically inactive (according to the definition of activity by Kerr et al), while categorized as having "persistent" disease activity by physician's global assessment due only to APR. 18F-FDG uptake was graded using a four-point scale from grade 0 (no uptake present) to grade III (high-grade: uptake higher than liver). Any uptake in major vessels with a grade ≥2 was accepted to be "active." Results: Mean ESR was 50.8±13.2 mm/hour, mean CRP was 28.5±22.1 mg/L. Active vasculitic lessions were observed by 18F-FDG-PET/CT in 9 of 14 (64.3%) of patients. The median number of active vascular lesions were 2 (1-5). A step-up treatment change was decided in 8 patients according to 18F-FDG-PET/CT results. Conclusion: We observed increased 18F-FDG uptake in the majority of TAK patients with an increased APR, but clinically silent disease. 18F-FDG-PET/CT showed the presence and localisation of active inflammation in the aorta and its branches. Although specificity of observed lesions are not clear, 18F-FDG-PET/CT imaging may influence physician's assessment of clinical activity and treatment choices in TAK.
Introduction: Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representi... more Introduction: Thyrotropin-producing pituitary adenoma (TSHoma) is a very rare disease, representing less than 1% of the pituitary tumours, present with elevated thyroid hormones and normal/high TSH concentrations. Case Presentation: A 7-year-old boy with nervousness was referred by his psychiatrist for elevated free T4, T3 and TSH levels. Initial evaluation revealed an elevated -subunit.Pituitary MRI demonstrated a macroadenoma. The patient underwent a trans-sphenoidal tumour resection (TSS) which showed positive immunohistochemical staining for TSH, growth hormone, and prolactin in tumoral tissue. Euthyroidism was achieved for one year after TSS, then, recurrence of tumour with elevated TSH and thyroid hormone levels necessitated a re-operation with TSS followed by gamma-knife radiosurgery. The euthyroid state was achieved and lasted for 2.5 years this time, but, due to the recurrence, medical treatment had been commenced with cabergoline and octreotide. Euthyroidism was maintaine...
Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that ... more Nasal-type extranodal natural killer/T-cell lymphoma is an aggressive rare type of lymphoma that mostly affects the nasal cavity and adjacent areas. However, some patients can present with distant nodal or extranodal involvement including the Waldeyer ring, gastrointestinal tract, genitourinary organs, lung, thyroid, skin, or adrenal glands. Herein, we present a unique case of extranodal natural killer/T-cell lymphoma with widespread cutaneous and subcutaneous involvement on 18F-FDG PET/CT.
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