Clinical application of SPECT-CT with 99mTc-Tektrotyd in bronchial and thymic neuroendocrine tumors (NETs)

Neuroendocrine tumors (NETs) of the thorax including bronchial and thymic tumors belong to foregut NETs. Limited loco-regional thoracic NETs can be resected with surgery, but in extensive metastatic disease the treatment is mainly palliative. A high incidence and density of somatostatin receptors (SSTR2, SSTR3, and SSTR5) are found in thoracic NETs. The purpose of this study was to evaluate the role of SPECT-CT somatostatin receptor scintigraphy (SRS) with 99mTc-Tektrotyd for imaging, staging and follow up of patients with bronchial and thymic neuroendocrine tumors. Forty-one patients with thoracic tumors with neuroendocrine differentiation were studied. Sixty-eight examinations including SPECT-CT studies of the neck and chest and/or abdomen and pelvis were carried out 2–4 hrs. post i.v. administration of aver­age 740 MBq activity dose of 99mTc-EDDA/HYNIC-TOC (Tektrotyd, Polatom). In all 41 investigated patients we obtained 81.25% (13/16), 88% (22/25) and 85.36% (35/41) of sensitivity, specificity and accuracy of this diagnostic approach, respectively. Somatostatin-receptor scintigraphy correctly identified all primary NETs located in the lungs and thymus. SPECT-CT studies with 99mTc-EDDA/HYNIC-TOC resulted in exact pre-surgical and pre-treatment N/M staging of bronchial and thymic NETs, except 2 cases with multiple hepatic metastases and 1 with massive suprarenal metastasis. It can be concluded that SPECT-CT with 99mTc-EDDA/HYNIC-TOC is a valuable tool for staging and follow-up of patients with thoracic NETs

First record of Psorergatoides Fain, 1959 (Acari, Cheyletoidea, Psorergatidae) for the Balkan Peninsula with description of the cutaneous lesions on the wing membrane of its hosts Myotis myotis (Borkhausen, 1797) and Myotis blythii (Tomes, 1857) (Chiroptera, Vespertilionidae)

Healthy wing membranes are essential for bats. They are critical for maintaining the water balance and, during hibernation, they protect the bat’s body from dehydration. Assessing the state of the membrane visually is an easy and effective way to monitor a bat’s health and discover abnormal structures and infections in wild bat populations. During pre- and post-hibernation surveys of bats’ wings, we identified the presence of skin mites, Psorergatoides kerivoulae (Fain, 1959). The parasite causes cutaneous lesions on the wing membranes of the greater moused-eared bat, Myotis myotis (Borkhausen, 1797) and the lesser moused-eared bat, Myotis blythii (Tomes, 1857). The lesser mouse-eared bat is a new host for this parasite. Our study is the first to describe the histopathology of the infection on the wings of the greater and lesser mouse-eared bats. To our knowledge, this is the southernmost record of this parasite and the first mention of the genus Psorergatoides for the Balkans

Fulminate anaerobic bacteremia after chemotherapy for metastatic breast cancer despite the prophylactic use of GCSF

Mila Petrova1, Zhasmina Mihaylova1, Albena Fakirova21Clinic of Hematology and Oncology, Department of Medical Oncology; 2Department of Pathology, Medical Military Academy, Sofia, BulgariaAbstract: Chemotherapy-induced neutropenia often occurs in our routine work and presents an obstacle for adequate (dose and continuance) treatment, which may affect patients’ outcome. Granulocyte colony-stimulating factors (GCSFs) effectively prevent myelosuppression and thus improve the standard treatment. Through their application cases of chemotherapyinduced neutropenia have been reduced. Still these factors cannot remove entirely the danger of encountering neutropenia, which can cause dangerous complications. We present a case of a fulminate anaerobic infection with unknown origin in a patient with metastatic breast cancer after standard treatment with chemotherapy supported by GCSFs.Keywords: neutropenia, granulocyte colony-stimulating factors, anaerobic infection, phlegmo

Sorafenib in metastatic MTC – a case report and minireview of the literature

Mila Petrova1, Zhasmina Mihaylova1, Albena Fakirova21Hematology and Oncology Department, 2Pathology Department, Medical Military Academy, Sofia, BulgariaAbstract: Medullary thyroid cancer (MTC) is a rare and only surgically treatable disease with early development of metastases and bad prognosis. Due to the lack of efficient systemic treatment, new strategies and approaches are needed to better the patients’ outcome. One of the most promising treatment options is the use of tyrosine multikinase inhibitors, which appear to have some effect on the disease progression with tolerable toxicity. Most of them affect many key pathways in the cancer genesis and have proven their effect in different malignancies. We report a case of a young patient with metastatic MTC treated successfully for two months with sorafenib.Keywords: medullary thyroid cancer, tumor response, cardiotoxicity, TKI

LEIOMYOSARCOMA OF INFERIOR VENA CAVA

Sarcomas are very rare tumors and in 10-30% of the cases are located in the retroperitoneum. Leiomyosarcomas of inferior vena cava accounts for less than 1% of all sarcomas. Despite the poor prognosis as a whole, some cases with R0 resection might have excellent outcome. So, all attempts for R0 resection should be undertaken. Herein we present a case with tumor located at the border of lower and middle third of the IVC managed by excision, primary suture and preservation of both renal veins. A short review of the basic surgical options and risk factors is given

L3 rootlet recurrent melanocytic schwannoma – case report and literature review

First described by Miller in 1932, melanocytic schwannoma (MS) (melanotic schwannoma, pigmented schwannoma) is a rare variation of peripheral nerve sheet tumours with ectodermal origin occurring predominantly in somatic, but also in the autonomic peripheral system with around two hundred cases in the literature. Predominantly benign tumours, MS are still imaging and pathological challenge and can be easily misdiagnosed with more aggressive peripheral nerve tumours.We report a case of melanocytic schwannoma on L3 sensory rootlet with systematic literature review of nearly 200 cases presented in intracranial, paraspinal region, thoracic, abdominal or pelvic cavities and skin. Two-thirds of cases are part of Carney complex.We present a case of a 61-year-old male with a 3-month history of low back pain, progressive numbness and stiffness in the right thigh, shin and knee, tibial and peroneal paresis causing gait disturbance and neurological claudication. MRI findings present “sand clock” type intradural extramedullary tumour formation with extension to the L3 rootlet through right L3-L4 foramen, hypointense on T2 and hyperintense on T1. Pathological diagnosis of sporadic type melanocytic schwannoma was made via immunohistological and ultrastructural analysis. Thirteen months after total resection there was clinical and MRI evidence of recurrence of the tumour. Total resection and radiosurgery was performed with a recurrence free period of 14 months.A gold standard for melanocytic schwannoma treatment is gross total surgical resection. Despite being considered benign tumours, MS have a local or metastatic recurrence of around 13%. MRI imaging in most of the cases is insufficient and only exhaustive pathological and immunohistological examination is the key to diagnosis. Need of postoperative radiation therapy is still controversial. For the first time, a criterion for postoperative adjuvant therapy was established

Non-small cell lung cancer in countries of Central and Southeastern Europe : diagnostic procedures and treatment reimbursement surveyed by the Central European Cooperative Oncology Group

This article analyzes the availability of different diagnostic procedures of non-small cell lung cancer (NSCLC) and the reimbursement landscape of drugs for NSCLC in countries of central and southeastern Europe (CEE). A survey was conducted by the Central European Cooperative Oncology Group. Results of the survey show that both availability and reimbursement of diagnoses of molecular alterations in NSCLC, the detection of which is essential for therapeutic decisions, varies widely between countries of CEE. Not only is "reflex" testing often substituted by analyses performed only "on demand," but reimbursement of such assessments varies widely between unavailability and payments by the health care system or even pharmaceutical companies. It was concluded that a structured access to testing and reimbursement should be the aim in order to provide patients with appropriate therapeutic options. Implications for Practice. This article provides an overview of the limitations in lung cancer treatment in countries of central and southeastern Europe, as well as the reimbursement status of various lung cancer treatment regimens in these countries, which directly impacts treatment options