Neurolymphomatosis: Unusual Extranodal Involvement Pattern on 18F-FDG PET/CT in a Non-Hodgkin Lymphoma Recurrence

A 37-year-old woman was diagnosed with Stage IVB diffuse large-B cell lymphoma, presenting with bulky mediastinal and bone marrow involvement. She was treated with 8 cycles of R-CHOP and radiotherapy, achieving complete remission on CT. Two months latter, she presented with pain and weakness in the lower limbs. The ENM, MR and the CSF analysis had shown evidence of lymphoma recurrence with initiation of intrathecal chemotherapy. Her disease continued to progress despite treatment. The following PET/CT shows multiple hypermetabolic areas, compatible with extranodal disease and poor response to therapy, allowing change to R-ICE and autologous stem cell treatment

Achados da tomografia computadorizada de alta resolu??o em pacientes pedi?tricos com asma grave

Submitted by PPG Pediatria e Sa?de da Crian?a ([email protected]) on 2018-12-26T18:18:49Z No. of bitstreams: 1 Dissertac?a?o Mestrado TK final.pdf: 1136236 bytes, checksum: 240ef0dfec10be58f404d315687c0173 (MD5)Approved for entry into archive by Sheila Dias ([email protected]) on 2018-12-27T15:54:04Z (GMT) No. of bitstreams: 1 Dissertac?a?o Mestrado TK final.pdf: 1136236 bytes, checksum: 240ef0dfec10be58f404d315687c0173 (MD5)Made available in DSpace on 2018-12-27T16:04:15Z (GMT). No. of bitstreams: 1 Dissertac?a?o Mestrado TK final.pdf: 1136236 bytes, checksum: 240ef0dfec10be58f404d315687c0173 (MD5) Previous issue date: 2018-08-31Introduction: Quantitative computed tomography (CT) findings in adults with asthma have been correlated with clinical features and pulmonary function tests and used as biomarkers to predict disease severity. However, this correlation is still unclear in children with severe asthma. Purpose: To compare chest CT quantitative parameters in children with severe asthma and healthy individuals, correlating with data from pulmonary function tests, laboratory findings, and hospitalizations due to asthma. Methods: We retrospectively analyzed CT data from 19 school-aged children (5-17 years) with severe asthma and 19 control school-aged children with pectus excavatum. The following CT parameters were evaluated: total lung volume (TLV), mean lung density (MLD), CT air trapping index (AT%) (attenuation < ?856 HU), airway wall thickness (AWT), and percentage of airway wall thickness (AWT%). MDCT data were correlated to the following clinical parameters: forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), forced expiratory flow at 25-75% (FEF 25-75%), FEV1/FVC ratio, sputum and bronchoalveolar lavage analysis, serum IgE levels, and previous hospitalizations due to asthma. Results: asthma patients presented higher mean values of AT% (23.8?6.7% vs. controls, 9.7?3.2%), AWT (1.46?0.22mm vs. controls, 0.47?0.15mm), and AWT% (74.1?3.9% vs. controls, 51.7?6.1%), and a lower MLD (-735 ? 28 HU vs. controls, -666?19 HU). Mean AT% was 29.0 ? 4.7% in subjects with previous hospitalization against 19.2 ? 5.0% in those with no prior hospitalization (p<0.001). AT% presented very strong negative correlations with FVC (r=-0.933, p<0.001) and FEV1 (r=-0.841, p<0.001) and a moderate correlation with FEF 25-75% (r=-0.608, p=0.007). AT% correlation with FEV1/FVC ratio and serum IgE was weak (r=-0.184, p=0.452, and r=-0.363, p=0.202). Conclusion: children with severe asthma present differences in quantitative chest CT scans compared to healthy controls with strong correlations with pulmonary function tests and previous hospitalizations due to asthma. Keywords: asthma; children; quantitative computed tomography; pulmonary function tests; biomarkers.Introdu??o: Achados na tomografia computadorizada (TC) quantitativa em adultos com asma t?m sido correlacionados com dados cl?nicos e de testes de fun??o pulmonar, podendo ser utilizados como biomarcadores da doen?a para predizer crit?rios de gravidade da doen?a. Entretanto essa correla??o ainda n?o ? clara em crian?as com asma grave. Objetivos: avaliar a rela??o dos par?metros quantitativos da TC de t?rax entre crian?as com asma grave e indiv?duos saud?veis, correlacionando-os com dados de testes de fun??o pulmonar, achados laboratoriais e hospitaliza??es por asma. M?todos: Foram analisados, retrospectivamente, dados de TC de 19 crian?as em idade escolar (5-17 anos) com asma grave e 19 crian?as controles saud?veis em idade escolar e com TC de t?rax pr?-operat?ria de pectus excavatum. Avaliaram-se os seguintes par?metros tomogr?ficos: volume pulmonar total (VPT), densidade pulmonar m?dia (DPM), ?ndice de aprisionamento a?reo (%AA), espessura de paredes br?nquicas (EPB) e porcentagem da espessura de paredes br?nquicas (%EPB). Os dados da TC foram correlacionados aos seguintes par?metros cl?nicos: volume expirat?rio for?ado no primeiro segundo (VEF1), capacidade vital for?ada (CVF), fluxo expirat?rio for?ado entre 25 e 75% (FEF 25-75%), raz?o VEF1/CVF, escarro e an?lise de lavado broncoalveolar, n?veis s?ricos de IgE e hospitaliza??es pr?vias por asma. Resultados: os pacientes asm?ticos apresentaram valores m?dios maiores de %AA (23,8 ? 6,7% vs. controles, 9,7 ? 3,2%), EPB (1,46 ? 0,22mm vs. controles, 0,47 ? 0,15mm) e %EPB (74,1 ? 3,9% versus controles, 51,7 ? 6,1%) e uma menor DPM (-735 ? 28 HU vs. controles, -666 ? 19 HU). A m?dia de %AA foi de 29,0 ? 4,7% em indiv?duos com hospitaliza??o anterior, contra 19,2 ? 5,0% naqueles sem hospitaliza??o pr?via (p <0,001). A %AA apresentou correla??es negativas muito fortes com a CVF (r = -0,933, p <0,001) e VEF1 (r = -0,841, p <0,001) e uma correla??o moderada com FEF 25-75% (r = -0,608, p = 0,007). As correla??es de %AA com a raz?o VEF1 / CVF e n?vel s?rico de IgE foram fracas (r = -0,184, p = 0,452; r = -0,363, p = 0,202; respectivamente). Conclus?o: crian?as com asma de dif?cil controle apresentam diferen?as na TC quantitativa do t?rax em compara??o com crian?as controles saud?veis, com fortes correla??es com testes de fun??o pulmonar e hospitaliza??es pr?vias por asma. Palavras-chave: asma; crian?as; tomografia computadorizada quantitativa; testes de fun??o pulmonar; biomarcadores