Synchronous adrenal metastasis and an inferior vena cava tumor thrombus from an ovarian carcinoma

A 60-year-old woman presented with synchronous adrenal metastasis and an inferior vena cava tumor thrombus in the adrenal vein that developed from an ovarian carcinoma. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and right adrenalectomy with caval tumor thrombectomy for treatment. Microscopic examination revealed a clear cell ovarian carcinoma and a metastatic adrenal tumor. The patient is clinically free of disease after 6 years of follow-up. There have been no reports of synchronous adrenal metastasis with an inferior vena cava thrombus that developed from an ovarian carcinoma. As several reports have described the long-term survival after adrenalectomy for the treatment of isolated adrenal metastasis, clinicians should be aware of this potential occurrence so that patients can be appropriately treated

Incidental discovery of circle contact lens by MRI: you can’t scan my poker face, circle contact lens as a potential MRI hazard

BACKGROUND: Circle contact lenses, also known as color contact lenses and big eye contact lenses, are a type of cosmetic contact lens. It is not generally known that a circle contact lens usually contains iron oxide and other metals, which means their use during magnetic resonance imaging (MRI) is a potential hazard. CASE PRESENTATION: We present a rare case of incidental discovery of circle contact lenses by MRI and MRI images of circle lenses in vitro. CONCLUSIONS: Circle contact lenses usually contain iron oxide, which is a known source of susceptibility artifact on MRI. Not only radiologists and radiographers but also referring physicians should be familiar with the imaging findings and potential risk of scanning circle contact lenses by MRI

Advantages of upright position imaging with medium-energy collimator for sentinel node lymphoscintigraphy in breast cancer patients

取得学位 : 博士（保健学）, 学位授与番号 : 医博甲第1950号 , 学位授与年月日 : 平成20年3月22日, 学位授与大学 : 金沢大学, 審査結果の報告日 : 平成20年2月13日, 主査 :高山 輝彦 , 副査 :天野 良平, 小野口 昌

Oral granuloma with chronic graft-vs-host disease

BACKGROUND Oral mucositis is often observed with graft-versus-host disease (GVHD); however, the occurrence of oral granuloma is rare. The rapid increase in granulomatous lesions should be distinguished from malignant tumors in patients with GVHD because malignant diseases can develop in those patients. This case is the youngest pediatric patient with granuloma associated with GVHD. CASE SUMMARY The patient was a 1-year and 5-mo-old girl who presented to our department for the management of oral nodules. At the age of 5 mo, she was diagnosed with primary immunodeficiency disease, cord blood transplant was performed at 11 mo and bone marrow transplant at 1 year of age. After transplantation, GVHD and oral mucositis developed, and tacrolimus was administered. Interestingly, nodules appeared on the lower lip and buccal mucosa, which spontaneously disappeared. Then, a new nodule appeared on the left lateral border of the tongue. Resection was performed and the histopathological diagnosis was granuloma. The origin of these nodules were considered to be the fibroblasts activated under inflammation caused by GVHD because the calcineurin inhibitor tacrolimus acted on their proliferation. CONCLUSION It is very important to distinguish oral granulomatous lesions from malignancies if GVHD is present at the base and if immunosuppressive agents and steroids are being administered

Elimination of scattered gamma rays from injection sites using upper offset energy windows in sentinel lymph node scintigraphy

Objective: The identification of sentinel lymph nodes (SLNs) near injection sites is difficult because of scattered gamma rays. The purpose of this study was to investigate the optimal energy windows for elimination of scattered gamma rays in order to improve the detection of SLNs. Methods: The clinical study group consisted of 56 female patients with breast cancer. While the energy was centred at 140 keV with a 20% window for Tc-99m, this energy window was divided into five subwindows with every 4% in planar imaging. Regions of interest were placed on SLNs and the background, and contrast was calculated using a standard equation. The confidence levels of interpretations were evaluated using a five-grade scale. Results: The contrast provided by 145.6 keV ± 2% was the best, followed by 140 keV ± 2%, 151.2 keV ± 2%, 134.4 keV ± 2% and 128.8 keV ± 2% in that order. When 128.8 keV ± 2% and 134.4 keV ± 2% were eliminated from 140 keV ± 10% (145.6 keV ± 6%), the contrast of SLNs improved significantly. The confidence levels of interpretation and detection rate provided by the planar images with 140 keV ± 10% were 4.74 ± 0.58 and 94.8%, respectively, and those provided by 145.6 keV ± 6% were 4.94 ± 0.20 and 100%. Conclusion: Because lower energy windows contain many scattered gamma rays, upper offset energy windows, which exclude lower energy windows, improve the image contrast of SLNs near injection sites. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

Use of a novel coaxial guide needle-wire (GNW) combination system for computed tomography guided radiofrequency tumor ablation

We developed a novel coaxial system using a fine guide needle wire (GNW) to safely and easily place the radiofrequency needle under CT-guidance. The GNW consists of a fine needle (diameter, 21-gauge; length, 150 mm) and a wire (0.018 inch, 250 mm). An exclusive radiofrequency cannula (14-gauge; 160 mm) was also used. This system was used for the treatment of six hepatocellular carcinomas in six patients. All lesions were located deeper than 10 cm from the needle entry site. This system was useful in performing CT-guided RF ablation for deeply or precariously located liver lesions particularly in patients who are unable to hold their breath

Prospective longitudinal comparative study of health-related quality of life in patients treated with radical prostatectomy or permanent brachytherapy for prostate cancer

To determine health-related quality of life (HRQOL) after radical retropubic prostatectomy (RRP) or permanent prostate brachytherapy (BT), third party-conducted QOL surveys were prospectively compared. Between 2004 and 2005, 37 patients underwent RRP and 36 were treated with BT. A QOL survey consisting of the Medical Outcomes Study 36-Item Short Form (SF-36), the University of California, Los Angeles, Prostate Cancer Index (UCLA-PCI) and the International Prostate Symptoms Score (IPSS) was completed prospectively by a research coordinator at baseline, and at 1, 3, 6 and 12 months after treatment. The RRP patients scored well in general QOL except at 1 month after surgery, with their mental health better than at baseline by 6 months after surgery. Disease-specific QOL in RRP patients received a low score at 1 month for both urinary and sexual function, though urinary function rapidly recovered to baseline levels. BT patient QOL was not affected by the therapy except in the IPSS score. However, general and mental health scores in BT patients were inferior to those in RRP patients. This prospective study revealed differences in QOL after RRP and BT. These results will be helpful in making treatment decisions.</p

Usefulness of medium-Energy Collimator for Sentinel Node Lymphoscintigraphy Imaging in Breast Cancer Patients

金沢大学大学院医学系研究科小野口, 昌久This study was performed to investigate the usefulness of a general-purpose medium-energy (ME) collimator for the accurate localization of the sentinel lymph node (SLN) in breast cancer patients. Methods: We compared phantom images and lymphoscintigraphy images obtained under different conditions for a patient with breast cancer. Comparisons were performed between 2 cameras, between a low-energy high-resolution (LEHR) collimator and a general-purpose ME collimator, and between energy windows centered at 141 keV and at 146 keV. Profile curves and image contrast were evaluated along with the visual interpretation of images. The most suitable imaging time was selected from the relationship between contrast and the data acquisition time. Results: The images obtained with the general-purpose ME collimator and the energy window centered at 141 keV were of poorer quality than those obtained with the LEHR collimator and the same energy window. However, the quality of the images obtained with the general-purpose ME collimator improved when the energy window was centered at 146 keV. The method involving the general-purpose ME collimator and the energy window centered at 146 keV showed excellent image quality similar to that obtained with the LEHR collimator. The enhancement of contrast was confirmed at more than 3 cm away from the center of the injection site. Stable contrast was obtained with a data acquisition time of 5 min, with the general-purpose ME collimator, and with the energy window centered at 146 keV. Conclusion: The method involving the general-purpose ME collimator and the energy window centered at 146 keV has the merit of the lymph node not being concealed by a lead shield. This new method is expected to improve the rate of detection of SLN and has the potential for shortening the acquisition time