B Cell Lymphoma: A Case With Localized Involvement of the Prostate on F-18-FDG Examination

An 80-year-old man had symptoms of urinary retention. Biopsy of the prostate revealed B cell lymphoma. To evaluate the extent of the disease, an F-18 FDG study was performed with positron emission tomography/computed tomography (CT). One hour after intravenous administration of 18.5 mCi F-18 FDG, imaging was carried out from the skull base to the upper thigh. An area of moderately increased activity was noted within the prostate bed. A noncontrast CT, for attenuation correction and anatomic localization, revealed maintenance of fat planes around the prostate, indicating disease localized to that organ. Hence, a B cell lymphoma had been localized to the prostate.

Asymmetric Tongue Muscle Uptake of F-18 FDG

A 58-year-old woman, with nonsmall cell carcinoma, had multiple metastasis on 2-F-18 FDG positron emission tomography imaging. The right hemitongue had increased activity as compared with the left. This was not the result of the presence of a metastasis to the tongue, as shown by a negative computed tomography scan of the region and failure to demonstrate a lesion over a period of weeks. Uptake was likely related to right hemiglossal muscle activity. This was made more apparent by decreased uptake on the opposite side of the tongue (up to the midline) as a result of left cranial nerve XII paralysis.

Supine versus prone injection of Tc-99m MAA: evidence of thoracic compression or fluid shift

After a cesarean section, a woman had sharp left chest pain that radiated to the arm and was worse with inspiration. A chest radiograph revealed minimal left lung base atelectasis. A total of 5 mCi (185 mBq) Tc-99m macroaggregated albumin (MAA) was injected with the patient supine. A posterior oblique perfusion lung image revealed nearly absent perfusion of the left lung base. The patient was then injected with an equal quantity of Tc-99m MAA while prone. Images now demonstrated perfusion of the left lower lung. This might represent redistribution of fluid obscured by the atelectatic area, or the relief of pressure on pulmonary arteries to the left lower lobe by positional change.

Male/female weight of internal organs: examination across multiple populations

For internal organ weights in the 50th percentile, the male/female weight relationship was examined by use of autopsy data in eight populations. Values were closely coupled (P < 0.001), so that male organ weight could be expressed as a linear function of the corresponding female organ. A variant, in a reported population from India, was noted. The concept of "allometric mass exponent" was also applied to relating male/female organ weights, with close agreement. To examine if findings correlated with height and weight of the whole body, male height was expressed as a function of the female value in each population. There was close agreement. Correlation was also noted when male body weight was given as a function of female body weight.

Migration of Tc-99m DTPA from the cerebral ventricle to the subarachnoid space

A 70-year-old woman was examined because of increasing problems with cognition. She had a history of a cerebral shunt placed surgically 10 years previously. Introduction of Tc-99m DTPA directly into the ventricular cavity revealed good ventricular distribution, followed by progression downward, as though into a previous ventriculoperitoneal shunt. However, a chest radiograph revealed what appeared to be a shunt tube in the right atrium. Delayed lateral images showed activity in proximity to the vertebral column, indicating migration of tracer and cerebrospinal fluid into the dorsal and lumbar subarachnoid space.

Pubertal height gain: male-female and interpopulation comparisons

Data are not available as to the exact age of the start of the pubertal growth spurt (or age at its conclusion) in various populations. As an initial approach, contribution of the pubertal gain to overall height was examined, using age 9 as the start of puberty in girls and age 11 in boys. Data were analyzed from 11 reports (single assays on five populations, two studies on a group analyzed 30 years apart, and four studies of a population spread over 31 years. Using the percent contribution to overall height, pubertal growth showed a close agreement between the populations as well as between male and female values (overall p < 0.003). Results for both sexes clustered around a narrow range. Pubertal growth for the 50th percentile, expressed as a percent contribution to overall height, may approach a biologic invariant. The value of percent contribution of pubertal growth to final height, did not show a secular trend.

Cessation of reproduction: an analytic view of menopause

While there is evidence for genetic control of ovarian and follicular development, only recently have reports appeared on genetic components involved in ovarian failure. Unlike predictions of a stable population, age at menarche is decreasing, while female life span is increasing. This leads to examination of genotype-environment interactions. Evolution of the large human brain size has been accompanied by a reduction in size of the gastrointestinal tract. Consequences, in terms of altered diet and effects on menarche/menstruation/menopause were discussed. In the earliest days of human evolution, genotoxic agents and marginal diets could have produced heritable changes in cessation of menstruation. Toxic alterations may still be apparent, such as epidemiological studies on the effects of smoking on age at menopause. Attempts to reconstruct some of the recent past history, from coprolites to findings in frozen human specimens, have to be extended still further into the past.

Bone and In-111 octreotide imaging in oncogenic osteomalacia: a case report

Osteoporosis associated with aging is considered the most common cause of bone mineral loss. Osteomalacia, abnormal bone loss with excess osteoid formation, is another cause. A 46-year-old man was examined for chronic hip and lower extremity pain that had not been relieved by nonsteroidal anti-inflammatory drugs or steroids. A bone scan revealed multiple foci of activity. The serum calcium level was normal, but phosphorus values were low. These results did not correspond with the indications for typical hyperparathyroid disease, so another cause was sought. An In-111 octreotide scan showed a focus in the right humeral head. At surgery, a phosphaturic tumor of mesenchymal origin was partially resected. Oncogenic osteomalacia is related to secretion of a phosphaturic material from a fibroblast growth factor.

Quantifying leukocyte and thrombocyte suppression-recovery after Re-186 HEDP for bone metastases

Using a standard quantity of Re-186 HEDP, for therapy of osseous metastases from carcinoma of the breast, Palmedo and associates reported leukocyte and thrombocyte responses at 4 and 8 weeks. These were analyzed by dividing results into categories, based on the numeric initial values. Thrombocytes at 8 weeks exceeded pretreatment values in 10 of 18 cases. This "over-rebound" was also found in 7 of 19 leukocyte responses. The ability to predict thrombocyte-leukocyte response, in most cases, was linked to the initial hematologic values. If coupled with data on the status of bone marrow, this may allow the quantity of therapeutic radiopharmaceutical used to be increased or decreased without irreversibly compromising hematopoietic responses.

Massive and widely distributed splenosis

A 45-year-old man, seropositive for hepatitis C, was examined because his liver was palpable well below the costal margin. A CT examination revealed multiple nodules within the liver and also several sites of ectopic tissue. The patient had a splenectomy 25 years before. A radiocolloid study showed uptake, consistent with splenosis, in the thorax, abdomen, pelvis, and possibly the left arm. The magnitude of the ectopic tissue, and its multiple locations, indicated the ability of splenic cells to grow in a variety of body sites.

Ureteral leak after renal transplantation

In the course of radionuclide dynamic studies in 187 consecutive patients who had renal transplants, leakage from a ureter was identified in five cases (an incidence of less than 3%). Demonstrated patterns fell into three classes: 1) perirenal collection (n = 2), 2) peribladder activity (n = 2), and 3) downward dissection (n = 1 case). The sensitivity and specificity of the radionuclide study for detecting ureteral escape of urine after renal transplantation is unknown. However, this study suggests that both indices may be high.

Aortic calcification contributing to bone densitometry measurement

A 75-yr-old glucocorticoid-dependent asthmatic male had a bone mineral density study to assess possible osteoporosis prior to initiating therapy. A radiograph of the lumbar spine revealed an asymmetrical compression of the second lumbar vertebra, marked scoliosis, vertebral osteopenia, and a highly calcified abdominal aorta. Bone mineral density (dual X-ray absolptiometry [DXA]) revealed low bone mass in L2-L4 and a markedly abnonrnal pattern, with a linear central density representing a calcified aorta. Posterior-anterior measurements of the midlumbar region with and without the overlying aorta indicated that the calcified vessel contributed up to 33% of the measured density. This was a far higher contribution than reported in other studies. Lateral DXA measurements of the L2 vertebra and the overlying aorta were performed to validate this finding. The density of the L2 vertebra was 0.215 g/cm(2), and that of the overlying calcified aorta was 0. 210 g/cm(2). This case suggests that aortic calcifications may contribute sign)ficantly to overall lumbar bone density and, unless recognized, can inadvertently lead to misclassification of osteoporosis.

Early male initiation (time frame shift): a possible contributor to their shortened lifespan

The shorter life expectancy of human males, as compared with females, was analyzed by utilizing the assumption that the specific rate of change of disease occurrence or mortality was a function of the specific rate of change of age. Separate plots were made of log incidence versus log age, for males and females. In several disorders, the line representing males was displaced toward the origin, as compared with the females. This 'time frame shift' suggested an earlier onset of the disorder or its precursors in males ('early male initiation'). While the physiologic/genetic basis for this has to be fully determined, the earlier male 'initiation' of disorders may be a contributing factor to their shorter life expectancy.

Possible feedback control of white blood cells: effect of splenectomy in Felty's syndrome

Feedback control of the white blood cell (WBC) count was analyzed in 20 cases reported by Coon, before and after splenectomy in Felty's syndrome. In only one case did the total white cell count fail to rise postsplenectomy, while in a second case the polymorphonuclear (poly) count did not exceed the preoperative value. Both of these patients had initial poly counts above 1000/mm3. If the preoperative poly count was 35% or greater of total WBC, the postoperative percentage was lower in five out of six cases. A comparison was made between pre- and postoperative poly counts, and three cases were noted to be underresponsive. However, two had a later rise in polys ('late responders'). A non-poly was defined as total WBC minus polys; a relationship was noted between pre- and post-operative non-polys, described by the difference between initial and postoperative counts. Thus, there is evidence for feedback control of the white cell count in Felty's syndrome after splenectomy.

Analysis of growth rate of pediatric kidneys transplanted into juveniles or adults

Estimation of renal length was carried out during radionuclide function studies, in cases of pediatric kidneys transplanted into adolescents or adults. In all 24 cases of single kidney transplants, the kidneys eventually increased in size, but at varying rates. From 5 cases with repeat studies close in time, and shortly after transplantation, an apparent maximal growth rate was estimated. In 3 pairs of dual renal transplants, with both kidneys surviving, marked differences in growth of each member of the pair was noted. The present initial description, of rates of change in size of the transplanted pediatric kidneys, may serve as a baseline from which to sort out the contributions of pre- and post-transplant factors.

Coexistent parathyroid adenomas and Hurthle cell tumors: failure of full detection by subtraction method

Tc-99m sestamibi and I-123 sodium iodide studies were performed on two patients, one with a neck mass and another with suspected hyperparathyroidism. Subtraction images, detected what proved to be Hurthle cell tumors in each case, but coexisting parathyroid adenomas, which were found at surgery, were not visualized. The findings indicate that both types of lesions can occur simultaneously, and that studies are needed to determine whether detailed assays of rate of washout could distinguish between the lesions.

Reticuloendothelial "activation" noted after splenectomy for ITP and presence of a post-poliomyelitis asymmetry

A radiocolloid study was carried out, after splenectomy, in a 75-year-old man who had idiopathic thrombocytopenic purpura. The patient, who did not have an increase in platelet counts after spleen removal or after platelet infusions, showed radiocolloid accumulation in the lungs and in the bone marrow. This suggested some "activation" of reticuloendothelial cells, perhaps by circulating immune complexes. The left femur (site of an episode of poliomyelitis many years previously) had less radiocolloid uptake than the right.