A case of tuberculous peritonitis monitored by gallium-67 scintigraphy

An 18-year-old man was admitted to our hospital for further examination of fever of unknown origin and ascites. Ga-67 scintigraphy revealed diffuse increased uptake throughout the abdomen. He was diagnosed with tuberculous peritonitis and began the treatment for tuberculosis (rifampicin, 450 mg/day orally and isoniazid, 300 mg/day orally, and 0.75 g of streptomycin by intramuscular injection 2 times a week). One year after starting the treatment, Ga-67 scintigraphy revealed accumulation of radioactivity in the upper abdomen, but the diffuse accumulation in the abdomen decreased. A specimen obtained by tumor biopsy under ultrasonic guidance revealed a tuberculous granuloma. Percutaneous injection was performed in the tumor with 1.0 g of streptomycin. On Ga-67 scintigraphy performed 2 weeks after the injection of streptomycin, the accumulation of radioactivity in the upper abdomen had disappeared. These findings suggest that Ga-67 scintigraphy is useful for diagnosis and observation during treatment of tuberculous peritonitis.     

Mesenteric desmoid tumor: De novo occurrence or recurrence following appendectomy?

Desmoid type fibromatosis (DF) is a rare, locally aggressive but benign proliferation of fibrous tissue which produces a fibroblastic mass that can cause a wide range of symptoms secondary to mass effect. When resected, these masses most commonly recur in the first 2 years. We present a case of a 33-year-old male with a history of an appendectomy 2 years prior, though his pathology report did not identify inflammation in the appendix, who presented with gradual onset of abdominal pain, and radiographs that demonstrated a large mass in the right lower abdomen. Given his symptoms the mass was resected and pathologic evaluation revealed a desmoid tumor. This case presents a unique possibility of a recurrent desmoid tumor in which the patient''s surgical history and radiographic findings can contribute to the overall management strategy of the patient given the evolving options for treatment of desmoid fibromatosis.     

Intense accumulation of gallium-67 citrate in pancreatic endocrine tumor

We report intense accumulation of gallium-67 (Ga-67) citrate in a pancreatic endocrine tumor. A 69-year-old woman was admitted because of cough, fever, and weight loss. An abdominal enhanced computed tomography (CT) scan revealed a large tumor located between the liver and pancreas as well as swollen paraaortic lymph nodes. Whole-body scintigraphy with Ga-67 revealed intense accumulation in the upper abdomen corresponding to the mass, as well as in the midabdomen and the mediastinal lesion. Percutaneous needle biopsy was performed, and the diagnosis was adenocarcinoma of the pancreas. The patient's condition deteriorated, and she died 2 months after admission. The pathological examination at autopsy revealed a pancreatic endocrine tumor. No report has described findings of Ga-67 citrate scintigraphy of pancreatic endocrine tumors. Pancreatic endocrine tumor should be included in a differential diagnosis when such scintigraphic findings are encountered.     

Extra-abdominal desmoid mimicking malignant male breast tumor

A rare case of extra-abdominal desmoid tumor is reported. A palpable mass was detected in the right breast of a 47-year-old man. Mammography showed a stellate mass without calcification, and breast ultrasound examination revealed a solid, inhomogeneous, non-calcified lesion. The result of cytological examination of the fine-needle aspiration biopsy specimen was equivocal. Histology of the surgical specimen showed extra-abdominal desmoid tumor. Extra-abdominal presentation of this semimalignant tumor is rare and may mimic malignant breast tumor. Differential diagnosis is difficult and usually based on the result of the histological examination. Received: 2 July 1998; Revision received: 8 September 1998; Accepted: 14 October 1998     

Diffuse abdominal accumulation of Ga-67 citrate in a patient with alpha-chain disease

A middle-aged Latin American with serological and biopsy proven diagnosis of alpha-chain disease involving the small intestine had whole-body imaging with 5 mCi Ga-67 citrate for the staging of possible lymphoma. There was persistent diffuse accumulation of the Ga-67 activity in the abdomen, simulating findings of peritonitis. The causes of diffuse abdominal Ga-67 activity are briefly discussed.     

Hepatic carcinosarcoma demonstrated by Ga-67 scintigraphy

A case of a primary hepatic carcinosarcoma, a very uncommon liver tumor in adults, demonstrated by Ga-67 scintigraphy, was reported. The liver image showed a lesion of low activity in the left lobe of the liver, whereas the Ga-67 image showed a moderate accumulation in the lesion detected by the liver scan and further indicated a high accumulation extending downwards from the hepatic lesion. An autopsy revealed that the huge abdominal tumor was composed of hepatocellular carcinoma and malignant mesenchymoma in the left hepatic lobe and in the lower part of the tumor, respectively. The Ga-67 image demonstrated these two different histological components of the tumor.     

Long-term follow-up of residual mediastinal-hilar Ga-67 uptake after treatment for Hodgkin's and non-Hodgkin's lymphomas: what degree of Ga-67 uptake is significant?

PURPOSE: Ga-67 planar and SPECT images of 85 patients after treatment for mediastinal-hilar (M-H) lymphoma were reviewed retrospectively. Forty-seven patients had Hodgkin's disease and 38 patients had non-Hodgkin's lymphoma. The entire period was 7 years after diagnosis. The main goal was visual assessment of the significance of mild (grades 1 or 2) Ga-67 uptake in the M-H area as compared with Ga-67 uptake in bone marrow. METHODS: Residual Ga-67 mediastinal uptake after a complete course of chemotherapy or other treatments was defined as normal (no residual) M-H uptake, borderline (M-H residual uptake with intensity less than that or equal to the sternum, spine, or both), and abnormal (M-H residual uptake with intensity greater than that of the sternum or spine). RESULTS: Among the 38 patients (45%) with no residual M-H uptake, four (one Hodgkin's disease and three non-Hodgkin's lymphoma) experienced recurrence: two in the mediastinum and two in the abdomen. Among the 45 patients (53%) with borderline M-H uptake, five experienced recurrence: two in the mediastinum and three in other sites. The two patients (2%) with abnormal (M-H) uptake never responded to treatment. No significant statistical difference in tumor recurrence was found between no residual and borderline uptake (P = 0.21). CONCLUSIONS: Visual assessment of M-H Ga-67 uptake (without quantification) could be useful to differentiate active residual tumor from nonactive residual uptake.     

A transferrin-mediated uptake of gallium-67 by EMT-6 sarcoma. II. Studies in vivo (BALB/c mice): concise communication

The EMT-6 sarcoma-like tumor of BALB/c mice can be grown as a solid subcutaneous transplantable tumor in vivo or as a monolayer culture in vitro. We have studied the uptake of gallium-67 by this tumor growing subcutaneously on the backs of 6-week-old BALB/c mice. After i.v. administration of Ga-67 citrate, tumor uptakes were as high as any others reported for mouse tumors. Also, for unknown reasons, there was appreciable reduction in tumor uptake with increasing amounts of Ga-67 citrate, even in the microcurie range. Furthermore, when mouse serum is prelabeled with Ga-67 and then injected, the EMT-6 uptake is greater than with Ga-67 administered as citrate (p less than 0.02). We believe that the finding of avid Ga-67 uptake in vivo helps to establish this unique in vivo/in vitro tumor system as a valid experimental model for studies regarding the mechanism of Ga-67 accumulation by neoplastic tissue.     

The influence of ferric metabolism on Ga-67 distribution in the human body

This investigation was undertaken to make clear the influence of ferric metabolism on Ga-67 distribution in human body. Count ratios for each organ to femoral soft tissue (i.e. relative Ga-67 uptake) were calculated in 125 scintigrams obtained 48 hours following injection, and the relation between the relative Ga-67 uptake in each organ and serum Fe, or UIBC were investigated. The relative Ga-67 uptake in the liver and the lumbar vertebra had negative correlation to serum Fe, and had positive correlation to UIBC. However, there was no significant difference in the relative Ga-67 uptake in the lumbar vertebra between normal and high serum Fe group. Only in group with exceedingly low serum Fe, each vertebral body was visualized separately in posterior view of the abdomen. These findings indicated that in group with exceedingly low serum Fe, Ga-67 accumulated mainly in the bone marrow, and in group with high serum Fe, Ga-67 accumulated mainly in the bone. The urinary bladder was visualized only in group with high serum Fe, which suggested that the excretion of Ga-67 to the urine was continued yet at 48 hours after injection. Ferric metabolism affected remarkably on the relative Ga-67 uptake in the liver, the bone marrow and the bone, and also the excretion of Ga-67 to the urine.     

67Ga scintigraphic study of a case of recurrent extra-abdominal desmoid tumor]

A case of extra-abdominal desmoid tumor was studied with 67Ga scintigraphy. Extra-abdominal desmoid tumors show an aggressive clinical course with tendency of recurrence in high percentage. On 67Ga scintigraphy, our case revealed a hot spot which is useful of recurrence. 67Ga scintigraphic study was useful in searching for local and recurrence after surgery.     

Scintigraphic visualization of extraosseous xanthomatosis

A histologically proven case of extraosseous xanthomatosis is presented. Both Ga-67 citrate and Tc-99m-MDP imagings demonstrated tumor uptake of radiotracers. A second Ga-67 imaging taken after excisional biopsy of the left knee lesion revealed disappearance of the lesional uptake of the tracer seen on the preoperative Ga-67 scan. Radiotracer accumulation in extraosseous xanthomatosis has not been reported previously.     

Relationship between Ga-67 uptake and radiotherapeutic response of primary lung cancer (squamous cell carcinoma)]

This investigation was undertaken to evaluate the relationship between Ga-67 uptake and radiotherapeutic response to primary lung cancer (squamous cell carcinoma), Ga-67 uptake of tumor was estimated on 16 patients with untreated primary lung cancer (squamous cell carcinoma). Ga-67 uptake was then compared with the response to radiation therapy (tumor reduction ratio). There was statistically significant inverse correlation between Ga-67 uptake and response to radiation therapy (r = -0.701, p less than 0.01). The fewer the Ga-67 accumulation in the tumor, the more effective radiotherapy in reducing tumor size. In conclusion, Ga-67 scintigraphy appears to be able to predict the response of primary lung cancer (squamous cell carcinoma) to radiation therapy.     

Ga-67 tumor scan in malignant diffuse mesothelioma —Comparison with CT and pathological findings—

Malignant diffuse mesothelioma is characterized by more difficult diagnosis and worse prognosis than other pleural tumors. In the Department of Thoracic Surgery, Hyogo Medical Center for Adults, 11 patients underwent panpleuropneumonectomy for this disease between January, 1988 and March, 1993. In 7 of these cases, Ga-67 scans were obtained before the operation. To clarify the factors affecting Ga-67 uptake in the pleural tumor, we compared Ga-67 uptake on the involved side of the thorax with CT and the pathological findings of the tumor. Regarding the use of Ga-67 scan imaging for the diagnosis of this disease, a number of related findings must be considered, such as an encircled wide Ga-67 uptake in the thickened pleural involvement and a diffuse slight Ga-67 uptake on the affected side with very slight involvement of the pleura. When the involved pleural thickness was over 6 mm, a definite correlation was found between the degree of Ga-67 uptake and the macroscopic thickness of mesothelioma in resected specimens. Thickness of the pleura on CT images demonstrates the real tumor thickness in the case of thickened involvement but in the case of thin involvement the real thickness of active mesothelioma could not be identified. No definite correlation was found between the degree of Ga-67 uptake and the histological type, or among microscopic findings, such as the extent of tumor parenchyma, interstitial volume and tumor vascularity. Our results suggest that the Ga-67 scan is very useful for revealing the extent of pleural involvement, especially when this involvement is more than 6 mm thick.     

Intense Ga-67 uptake in adenosquamous carcinoma of the pancreas

Gallium-67 citrate (Ga-67) scintigraphy was performed in a patient with adenosquamous carcinoma of the pancreas. Intense and homogeneous uptake was observed in the tumor. Few reports have dealt with Ga-67 findings in pancreatic cancers. Ga-67 uptake in the tumor was assumed to be due to accumulation in the component of squamous cell carcinoma. This case suggested that Ga-67 citrate scintigraphy may be useful in detecting adenosquamous carcinoma of the pancreas. To our knowledge, no report has described findings of Ga-67 citrate scintigraphy of adenosquamous carcinoma of the pancreas. Radiologists should remember adenosquamous carcinoma of the pancreas when encountering such scintigraphic findings.     

Pyometra as a lower abdominal doughnut sign on a Ga-67 scan

A 77-year-old woman was referred for Ga-67 scan to evaluate intermittent fever and chills that had lasted more than 20 days. The Ga-67 whole-body scan revealed a doughnut-shaped Ga-67 accumulation in the lower abdominal region. Combined Ga-67 and Tc-99m MDP bone scan confirmed that this activity was in the uterus, because the shape of the urinary bladder on bone scan was different from that of the Ga-67-avid lesion. Pyometra was proved during operation, and pus culture was performed.     

Diagnostic problems of abdominal desmoid tumors in various locations

BACKGROUND: Abdominal desmoid tumor is one of the forms of deep (musculoaponeurotic) fibromatosis. It occurs more often as a desmoid tumor in the abdominal wall, less often in various intra-abdominal locations. In this work, we performed retrospective study concerning diagnostic problems of this disease with the use of imaging techniques. METHOD: Four patients (three females and one male) were examined by postcontrast CT (computed tomography) and one of them also by MR (magnetic resonance). All findings were correlated with the operational findings and histologic examination. RESULTS: The findings were typical only in the case with the lesion located in the abdominal wall, three described cases of the intra-abdominal desmoid provided a broad range of differentially diagnostic possibilities (metastases, GIT tumors, lymphomas, etc.). In particular, the findings in infiltrative processes in intra-abdominal location and retroperitoneal involvement were less typical. Ultimately, the histological findings were decisive. CONCLUSION: The possibility of the occurrence of intra-abdominal desmoid tumor must be considered particularly in younger individuals with rapidly growing tumorous process, which does not immediately arise from the surrounding organs (digestive tract, internal genitalia, etc.), and is located in the abdominal wall or in the abdominal cavity.     

Accumulation of Tc-99m MIBI in breast lymphoma: Comparison with Ga-67 citrate

We report 2 cases of malignant lymphoma of the breast which were clearly shown on total body imaging as well as on SPECT with Ga-67 and Tc-99m MIBI. Tumor accumulation of Ga-67 was seen in all cases including a recurrent tumor. Ga-67 scintigraphy is useful for follow up in detecting relapse, as well as in predicting responses to therapy. Tc-99m MIBI was found to accumulate in the malignant lymphoma of the breast, and especially SPECT images of breast lesions provided better contrast than planar images, and Tc-99m MIBI SPECT could diagnose localization of the tumor because there was no uptake by the breast. But the Tc-99m MIBI accumulation of the tumor was lower than Ga-67.     

Accumulation and localization of gallium-67 in various types of primary lung carcinoma

The uptake and location of Ga-67 were investigated in 15 primary pulmonary carcinomas. The accumulation in the tumor was determined by scintigraphy of the patient, grain counts over fields of tumor cells in autoradiographs of tumor-tissue samples, and gamma counts in specimens of the tumor. Good correlation was found between the results obtained with these three methods. The relationship between accumulation of Ga-67 in the tumor and the histologic type of tumor was also studied. Undifferentiated carcinomas, and tumor cells in squamous-cell carcinomas showed significantly more Ga-67 than tumor cells in adenocarcinomas. No correlation was found between the presence of inflammatory infiltrates in or around the tumor and the grade of the scintigraphic images. In the autoradiograms, lymphocytes, plasma cells, granulocytes, and macrophages showed less radioactivity than the tumor cells--or none at all. Collagen fibers appeared to have bound some Ga-67, but necrotic areas showed no uptake.     

Osteoblastic osteosarcoma of the mandible: findings on Tc-99m HMDP bone and Ga-67 citrate scintigraphy

A 25-year-old woman presented with a disturbance in the opening of her mouth 5 months before admission. On admission, painful swelling of the right preauricular region was revealed. Computed tomography (CT) demonstrated a soft tissue density mass around the right condylar process of the mandible. Tc-99m hydroxymethylene diphosphonate (HMDP) bone scintigraphy and Ga-67 citrate scintigraphy showed avid uptake in the mass. The tumor was histologically identified as an osteoblastic osteosarcoma of the right mandible. There are few reports of Ga-67 citrate scintigraphy findings of osteoblastic osteosarcoma of the mandible. The accumulation patterns on Tc-99m HMDP bone scintigraphy and Ga-67 citrate scintigraphy are possibly characteristic of osteoblastic osteosarcoma of the mandible.     

Ga-67 and Fe-59 distributions in mice

Tissue distributions of i.v.-injected Ga-67 citrate and [59Fe] ferric citrate were measured in normal mice and in lymphoid-tumor hosts. The study arose out of previously reported tissue-culture work showing marked transferrin stimulation of Ga-67 and Fe-59 uptakes by cultured cells from mouse lymphoid tumors. In vivo, however, no obvious correlation was found between Ga-67 and Fe-59 tissue distributions; indeed, Ga-67 showed high affinity for tumor tissue and low affinity for hemopoietic tissues, while for Fe-59 the reverse applied. Taken together, these comparisons of kinetics and distributions for Ga-67 and Fe-59 suggest that a tissue's avidity for Ga-67 is strongly influenced by other factors besides the cell population's capacity for transferrin interactions.