1/4. The significance of incidental noncardiac findings in Tc-99m sestamibi myocardial perfusion imaging: illustrated by a case.technetium 99m sestamibi is widely used in the evaluation of myocardial perfusion imaging. Although the aim of such imaging is cardiac evaluation, numerous other organs are included in the imaging field. Failure to identify incidental abnormal findings in these organs delays diagnosis and treatment. In common with other radiopharmaceutical agents, technetium 99m sestamibi is distributed throughout the body and accumulates in multiple tissues. When interpreting studies that involve this radiotracer, the physician must be aware of its physiologic distribution, in order to recognize abnormal uptake. We present an illustrative case in which areas of decreased tracer activity were noted incidentally during the evaluation of unprocessed single photon emission computed tomography data. These findings were due to metastasis of colon cancer to the liver.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. Umbilical metastasis as the presenting symptom of cecal carcinoma.Umbilical metastases were encountered as the initial presentation of cecal adenocarcinoma in a 62-year-old woman. Intravenous infusion of 5-fluorouracil, along with intralesional injections of 10% 5-fluorouracil, resulted in regression of the tumor masses on the abdominal wall. Although umbilical metastasis is rare, its significance in diagnosing an otherwise silent colorectal cancer warrants the physician's awareness.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. adenocarcinoma arising in an ileostomy. Report of two cases and review of the literature.adenocarcinoma arising in an ileostomy is rare. Two cases are reported, one of a 58-year-old woman and the other of a 54-year-old man who had each undergone a colectomy for chronic ulcerative colitis. Seven other cases previously reported in the literature are reviewed. Though the exact pathogenesis is uncertain, several possibilities, particularly with regard to antecedent dysplasia and backwash ileitis, are discussed. Routine yearly follow-up and examination of the stoma by a physician or enterostomal therapist may lead to earlier detection of this rare complication.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. An unusual case of gastric carcinoma initially presenting bone metastasis and later transverse myelopathy.A 44-year-old man with Borrmann type III gastric carcinoma initially presenting bone metastasis and later transverse myelopathy is reported. Chest and skull roentgenograms showed multiple punched-out lesions. A bone scintigram showed multiple abnormal uptake. Histological examinations of biopsy and autopsy materials revealed signet-ring cell carcinoma of the stomach. Disseminated carcinomatosis of the bone marrow was ruled out histologically and neither microangiopathic hemolytic anemia nor disseminated intravascular coagulopathy was observed. Because this patient with bone metastasis did not have metastasis to the liver and lungs we propose that a nonportal route through the vertebral venous plexus might be an alternative to the portal route of bone metastasis from gastric carcinoma. During the last 20 years, only 10 such cases including this one have been reported in japan. Their prognosis was quite poor and in most of them the malignancy was either undifferentiated adenocarcinoma or signet-ring cell carcinoma. If a bone metastasis is found as the initial sign, physicians should keep in mind that the primary lesion might be in the stomach, or in the thyroid, kidney, lung or prostate as another point of search.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |