Publications by authors named "Shamim Ahmed Shamim"

68 Publications

Intraobserver and interobserver variations in cortical transit time measurement in children with pelviureteric junction obstruction.

World J Nucl Med 2021 Jan-Mar;20(1):38-45. Epub 2020 Sep 14.

Department of Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, India.

Cortical transit time (CTT) has recently been shown to be a useful parameter in the management of children with pelviureteric junction obstruction (PUJO). The aim of this study was to assess intraobserver and interobserver variations in the qualitative and quantitative assessment of CTT in children with PUJO. A retrospective study was performed, and Tc-MAG3 renogram images of all children with PUJO performed from January 2016 to December 2017 were retrieved. The images were assessed by three observers at two different time points. CTT was qualified as delayed if CTT was more than 3 min else; it was noted as normal. The intraobserver and interobserver variations in the results of the CTT of the normal kidney and affected kidney both before and after surgery were studied. The kappa statistic was used to compare the interobserver variation of qualitative interpretation of CTT. The Bland-Altman plot was used to evaluate the intraobserver and interobserver variations of the quantitative interpretation of CTT. A total of 57 Tc-MAG3 renal scintigraphies were evaluated. Overall, 114 renal units were evaluated with 51 normal renal units and 63 renal units with PUJO. Of these, 63 renal units with PUJO, 31 renal units had been operated upon, whereas the remaining 32 renal units had no intervention at the time of the study. The kappa statistic in the normal, affected operated, and affected unoperated kidneys was interpreted as almost perfect, substantial to almost perfect, and moderate to substantial level of agreement, respectively. The Bland-Altman plot revealed a large mean difference and wide 95% limits of agreement in affected kidneys (both operated and unoperated). The study concludes that the qualitative CTT interpretation in the affected renal unit which is most commonly used in recent studies is a reliable and reproducible parameter in children with PUJO. The quantitative measurement had wide inter- and intraobserver variation for clinical use.
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http://dx.doi.org/10.4103/wjnm.WJNM_37_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034798PMC
September 2020

Avapritinib in advanced gastrointestinal stromal tumor: case series and review of the literature from a tertiary care center in India.

Future Sci OA 2021 Jan 19;7(4):FSO676. Epub 2021 Jan 19.

Sarcoma Medical Oncology Clinic, Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.

The therapeutic landscape in advanced gastrointestinal stromal tumor has evolved. Avapritinib and ripretinib have now been approved by the US FDA for platelet-derived growth factor alpha D842V-mutant and refractory gastrointestinal stromal tumor patients, respectively. Here we report five patients who have been on avapritinib under an expanded access program. Response assessment was available for four patients - a partial response in two patients and stable disease in one, while one patient had progressive disease. Though preliminary results of the VOYAGER trial have shown less activity of avapritinib and no significant difference in progression-free survival when compared with regorafenib, avapritinib may show some clinical benefit in a subset of patients refractory to approved therapies. We share our experience of five cases, with clinical benefit in three. We believe avapritinib should be further evaluated in clinical trials.
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http://dx.doi.org/10.2144/fsoa-2020-0178DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015663PMC
January 2021

Early clinical and metabolic response to tazemetostat in advanced relapsed INI1 negative epithelioid sarcoma.

Future Sci OA 2021 Jan 12;7(4):FSO675. Epub 2021 Jan 12.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Epithelioid sarcoma (ES) is a rare soft tissue sarcoma with an incidence of 0.05 per 100,000 population in the USA. It is characterized by multiple local recurrences and regional lymph nodes form the commonest site of metastases. The function of Integrase Inhibitor 1 (INI1) protein is lost in more than 90% of cases, which was the basis for the introduction of tazemetostat into the therapeutic armamentarium for management of advanced ES. The efficacy and manageable toxicity profile of tazemetostat have been demonstrated recently, leading to its accelerated approval for treatment of advanced ES. We report one of the first real-world cases of relapsed, metastatic ES treated with tazemetostat. The patient attained partial response with the therapy and is tolerating the drug well without serious toxicities.
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http://dx.doi.org/10.2144/fsoa-2020-0173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8015673PMC
January 2021

Extramedullary Infiltration in Multiple Organs in a Relapsed Case of Acute Lymphoblastic Leukemia on F-Fluorodeoxyglucose Positron Emission Tomography.

Indian J Nucl Med 2020 Oct-Dec;35(4):355-357. Epub 2020 Oct 21.

Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India.

T-cell acute lymphoblastic leukemia (ALL) is hematological malignancy with a propensity to involve extramedullary organs. We present the case of a 7-year-old child who was diagnosed with disease free from ALL for 1 year and then developed fever. F-fluorodeoxyglucose positron emission tomography/computed tomography revealed extramedullary infiltration of ALL in lungs, pancreas, kidneys, bone, muscles, and subcutaneous tissues.
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http://dx.doi.org/10.4103/ijnm.IJNM_47_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905286PMC
October 2020

Response Assessment of Recurrent Extragastrointestinal Stromal Tumor of the Urinary Bladder to Imatinib: Findings on Serial F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans.

Indian J Nucl Med 2020 Oct-Dec;35(4):350-352. Epub 2020 Oct 21.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Extragastrointestinal stromal tumors (EGISTs) are rare mesenchymal tumors occurring outside the gastrointestinal tracts that have similar histological and immunohistochemical characteristics similar to those of gastrointestinal stromal tumors. EGISTs involving the urinary bladder are extremely rare tumors with very few reports mentioned in the literature. We present a case of a 48-year-old man, known case of biopsy-proven EGIST of the urinary bladder that presented with recurrence after partial cystectomy and F-fluorodeoxyglucose positron emission tomography-computed tomography scans documenting the response assessment of the recurrent tumor to imatinib.
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http://dx.doi.org/10.4103/ijnm.IJNM_68_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905292PMC
October 2020

F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography in Response Assessment of Perivascular Epithelioid Cell Tumor of the Pelvic Cavity to Irinotecan and Temozolomide.

Indian J Nucl Med 2020 Oct-Dec;35(4):348-349. Epub 2020 Oct 21.

Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.

Perivascular epithelioid cell tumors (PEComas) are a rare variety of mesenchymal tumors composed of distinctive cells that show a focal association with blood vessel walls and usually express melanocytic and smooth muscle markers. We present a case of 38-year-old male, diagnosed with PEComa of the pelvic cavity who underwent serial F-fluorodeoxyglucose positron emission tomography-computed tomography scans for the assessment of response to the chemotherapeutic combination of irinotecan and temozolomide.
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http://dx.doi.org/10.4103/ijnm.IJNM_29_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905274PMC
October 2020

An Unusual Case of Synovial Sarcoma with Breast Metastasis: Findings on Positron Emission Tomography-Computed Tomography.

Indian J Nucl Med 2020 Oct-Dec;35(4):345-347. Epub 2020 Oct 21.

Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.

Synovial sarcomas are aggressive soft-tissue tumors with the propensity for metastases at presentation or later course of disease. The most common site of metastases is lung, followed by lymph node and bone. It rarely metastasizes to the liver and to the brain. Breast metastases from extramammary tissue are extremely rare, more so from synovial sarcoma. F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) plays a very important role in diagnosing occult metastasis in sarcomas. Histopathological diagnosis and translocation studies are important to confirm the diagnosis. We present a case of synovial sarcoma who underwent FDG PET/CT which showed occult metastasis to the breast.
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http://dx.doi.org/10.4103/ijnm.IJNM_110_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7905283PMC
October 2020

What Is the Comparative Ability of 18F-FDG PET/CT, 99mTc-MDP Skeletal Scintigraphy, and Whole-body MRI as a Staging Investigation to Detect Skeletal Metastases in Patients with Osteosarcoma and Ewing Sarcoma?

Clin Orthop Relat Res 2021 Feb 26. Epub 2021 Feb 26.

A. Aryal, V. S. Kumar, S. A. Khan, Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.

Background: Skeletal metastases of bone sarcomas are indicators of poor prognosis. Various imaging modalities are available for their identification, which include bone scan, positron emission tomography/CT scan, MRI, and bone marrow aspiration/biopsy. However, there is considerable ambiguity regarding the best imaging modality to detect skeletal metastases. To date, we are not sure which of these investigations is best for screening of skeletal metastasis.

Question/purpose: Which staging investigation-18F-fluorodeoxyglucose positron emission tomography/CT (18F-FDG PET/CT), whole-body MRI, or 99mTc-MDP skeletal scintigraphy-is best in terms of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) in detecting skeletal metastases in patients with osteosarcoma and those with Ewing sarcoma?

Methods: A prospective diagnostic study was performed among 54 of a total 66 consecutive osteosarcoma and Ewing sarcoma patients who presented between March 2018 and June 2019. The institutional review board approved the use of all three imaging modalities on each patient recruited for the study. Informed consent as obtained after thoroughly explaining the study to the patient or the patient's parent/guardian. The patients were aged between 4 and 37 years, and their diagnoses were proven by histopathology. All patients underwent 99mTc-MDP skeletal scintigraphy, 18F-FDG PET/CT, and whole-body MRI for the initial staging of skeletal metastases. The number and location of bone and bone marrow lesions diagnosed with each imaging modality were determined and compared with each other. Multidisciplinary team meetings were held to reach a consensus about the total number of metastases present in each patient, and this was considered the gold standard. The sensitivity, specificity, PPV, and NPV of each imaging modality, along with their 95% confidence intervals, were generated by the software Stata SE v 15.1. Six of 24 patients in the osteosarcoma group had skeletal metastases, as did 8 of 30 patients in the Ewing sarcoma group. The median (range) follow-up for the study was 17 months (12 to 27 months). Although seven patients died before completing the minimum follow-up, no patients who survived were lost to follow-up.

Results: With the number of patients available, we found no differences in terms of sensitivity, specificity, PPV, and NPV among the three staging investigations in patients with osteosarcoma and in patients with Ewing sarcoma. Sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 67% (4 of 6 [95% CI 22% to 96%]) and specificities were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 78% (14 of 18 [95% CI 52% to 94%]), respectively, in patients with osteosarcoma. In patients with Ewing sarcoma, sensitivities to detect bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 88% (7 of 8 [95% CI 47% to 100%]), 88% (7 of 8 [95% CI 47% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and specificities were 100% (22 of 22 [95% CI 85% to 100%]), 95% (21 of 22 [95% CI 77% to 100%]), and 95% (21 of 22 [95% CI 77% to 100%]), respectively. Further, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (6 of 6 [95% CI 54% to 100%]), 83% (5 of 6 [95% CI 36% to 100%]), and 50% (4 of 8 [95% CI 16% to 84%]) and the NPVs were 100% (18 of 18 [95% CI 82% to 100%]), 94% (17 of 18 [95% CI 73% to 100%]), and 88% (14 of 16 [95% CI 62% to 98%]), respectively, in patients with osteosarcoma. Similarly, the PPVs for detecting bone metastases for 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy were 100% (7 of 7 [95% CI 59% to 100%]), 88% (7 of 8 [95% CI 50% to 98%]), and 80% (4 of 5 [95% CI 28% to 100%]), and the NPVs were 96% (22 of 23 [95% CI 78% to 100%]), 95% (21 of 22 [95% CI 77% to 99%]), and 84% (21 of 25 [95% CI 64% to 96%]), respectively, in patients with Ewing sarcoma. The confidence intervals around these values overlapped with each other, thus indicating no difference between them.

Conclusion: Based on these results, we could not demonstrate a difference in the sensitivity, specificity, PPV, and NPV between 18F-FDG PET/CT, whole-body MRI, and 99mTc-MDP skeletal scintigraphy for detecting skeletal metastases in patients with osteosarcoma and Ewing sarcoma. For proper prognostication, a thorough metastatic workup is essential, which should include a highly sensitive investigation tool to detect skeletal metastases. However, our study findings suggest that there is no difference between these three imaging tools. Since this is a small group of patients in whom it is difficult to make broad recommendations, these findings may be confirmed by larger studies in the future.

Level Of Evidence: Level II, diagnostic study.
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http://dx.doi.org/10.1097/CORR.0000000000001681DOI Listing
February 2021

Immune Checkpoint Inhibitors in Alveolar Soft Part Sarcoma: New Standard of Care?

J Adolesc Young Adult Oncol 2020 Dec 16. Epub 2020 Dec 16.

Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1089/jayao.2020.0167DOI Listing
December 2020

Partial response to erlotinib in a patient with imatinib-refractory sacral chordoma.

Clin Sarcoma Res 2020 Dec 12;10(1):28. Epub 2020 Dec 12.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Background: Chordoma is a rare, slow growing and locally aggressive mesenchymal neoplasm with uncommon distant metastases. It is a chemo-resistant disease with surgery and radiotherapy being the mainstay in treatment of localized disease. In advanced disease imatinib has a role. We report a case of metastatic sacral chordoma with symptomatic and radiological response to erlotinib post-progression on imatinib.

Case Presentation: A 48-year-old male with a sacral chordoma underwent partial sacrectomy followed by post-operative radiotherapy. Upon recurrence he received palliative radiotherapy to hemipelvis and was offered therapy with imatinib. However, the disease was refractory to imatinib and he was started on treatment with erlotinib-showing a partial response on imaging at two months. He is currently doing well at 13 months since start of erlotinib.

Conclusions: As seen in previously reported cases, erlotinib is a therapeutic option in advanced chordoma, even in imatinib refractory cases and thus warrants exploration of its therapeutic role in prospective clinical trials.
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http://dx.doi.org/10.1186/s13569-020-00149-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7733273PMC
December 2020

Evaluation of the Graft Kidney in the Early Postoperative Period: Performance of Contrast-Enhanced Ultrasound and Additional Ultrasound Parameters.

J Ultrasound Med 2020 Nov 12. Epub 2020 Nov 12.

Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India.

Objectives: To evaluate the various quantitative parameters of Doppler ultrasound, contrast-enhanced ultrasound (CEUS), and shear wave elastography (SWE) of graft kidneys in the early postoperative period and to explore their utility in the diagnosis of parenchymal causes of graft dysfunction.

Methods: In this ethically approved study, consecutive patients who underwent renal transplantation from March 2017 to August 2018 were recruited, and those with urologic or vascular complications and those who denied consent were excluded. All patients underwent ultrasound with Doppler, SWE, CEUS (using sulfur hexafluoride), and renal scintigraphic examinations 3 to 10 days after transplantation. A composite reference standard was used, including the clinical course, renal function test results, urine output, and histopathologic results for graft dysfunction. Cortical SWE values, quantitative CEUS parameters (generated from a time-intensity curve), and their ratios were analyzed to identify graft dysfunction and differentiate acute tubular necrosis (ATN) from acute rejection (AR).

Results: Of the 105 patients included, 19 developed graft dysfunction (18.1%; 12 ATN, 5 AR, and 2 drug toxicity) in the early postoperative period. The peak systolic velocity in the interpolar artery showed a significant difference between control and graft dysfunction groups (P < .001) as well as between ATN and AR (P = .019). Resistive indices and SWE did not show significant differences. Ratios of the time to peak showed a significant difference between control and graft dysfunction groups (P < .05). The rise time and fall time of the large subcapsular region of interest and the rise time ratio were significantly different between ATN and AR (P = .03).

Conclusions: Contrast-enhanced ultrasound can be used to diagnose parenchymal causes of early graft dysfunction with reasonable diagnostic accuracy.
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http://dx.doi.org/10.1002/jum.15557DOI Listing
November 2020

Posterior Pharyngeal Wall Tuberculosis-A Forgotten Entity Mimicking Malignancy.

Ear Nose Throat J 2020 Nov 11:145561320973781. Epub 2020 Nov 11.

Department of Pathology, 28730All India Institute of Medical Sciences, New Delhi, India.

Background: Tuberculosis (TB) of posterior pharyngeal wall (PPW), either primary or secondary, is extremely rare and can mimic malignancy in elderly patients.

Case Report: A 36-year-old female patient presented with complains of nonhealing ulcer at the back of her throat for 4 months. On examination, there was an ulceroproliferative growth covered with slough over PPW. Positron emission tomography scan showed uptake in PPW. There was no uptake in any other part of body. A biopsy from PPW lesion showed epithelioid cell granulomas with Langhans type giant cells. Auramine-rhodamine staining showed few beaded bacilli consistent with TB.

Conclusion: Tuberculosis of PPW is an extremely uncommon entity and can mimic malignancy. It should be kept as one of the differential diagnosis as it can be cured solely by giving anti-tubercular therapy.
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http://dx.doi.org/10.1177/0145561320973781DOI Listing
November 2020

Recurrent Cavitary Pulmonary Metastasis from Osteosarcoma: Findings on F-Fluorodeoxyglucose Positron Emission Tomography.

Indian J Nucl Med 2020 Jul-Sep;35(3):262-263. Epub 2020 Jul 1.

Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India.

Spontaneous cavitation in primary lung malignancies although common, but is rare in secondary metastatic lung tumors. We present a case of 20-year-old male who presented with cavitary left lung lesion 1-year postexcision of the left tibia osteosarcoma on F-fluorodeoxyglucose positron emission tomography-computed tomography which on histopathology confirmed as metastatic lesion secondary to the sarcomatous primary.
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http://dx.doi.org/10.4103/ijnm.IJNM_20_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537912PMC
July 2020

Coexisting Somatostatin Receptor Expressing Gastric Neuroendocrine Tumor Primary and Lymph Nodal Tuberculosis on Ga-DOTANOC Positron Emission Tomography/Computed Tomography.

Indian J Nucl Med 2020 Jul-Sep;35(3):241-243. Epub 2020 Jul 1.

Department of Paediatric Surgery, Dr. Ram Manohar Lohia Hospital and Post Graduate Institute of Medical Sciences, New Delhi, India.

Gastric neuroendocrine tumors (G-NETs) express somatostatin receptors (SSTR), which can be imaged using radiolabeled somatostatin analogs, including Ga-DOTA octreotide analogs. SSTR expression is also seen in activated lymphocytes and macrophages, which might result in false-positive results on SSTR imaging, in patients with coexistent granulomatous pathologies including tuberculosis, sarcoidosis, and Wegener's granulomatosis. We present a case where Ga-DOTANOC positron emission tomography/computed tomography (PET/CT) showed primary G-NET, with SSTR expressing nonregional lymph nodes which on histopathology showed necrotizing granulomas with Langhans histiocytes. Antitubercular therapy was started, and a decrease in size and SSTR expression in involved lymph nodes was noted on follow-up Ga-DOTANOC PET/CT.
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http://dx.doi.org/10.4103/ijnm.IJNM_33_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7537921PMC
July 2020

Multiple endocrine neoplasia type 2A with cutaneous lichen amyloidosis.

BMJ Case Rep 2020 Aug 26;13(8). Epub 2020 Aug 26.

Endocrinology and Metabolism, Army Hospital Research & Referral, New Delhi, Delhi, India.

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http://dx.doi.org/10.1136/bcr-2020-238423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7451451PMC
August 2020

Role of 18F-FDG PET/computed tomography in prognostication and management of malignant peripheral nerve sheath tumors.

Nucl Med Commun 2020 Sep;41(9):924-932

Department of Nuclear Medicine.

Aim: Malignant peripheral nerve sheath tumors (MPNSTs) are rare tumors arising from a peripheral nerve or in extraneural soft tissue which shows high metastatic potential and poor prognosis. They can arise de-novo or through malignant transformation in neurofibromatosis (NF-1). The purpose of our study is to evaluate potential role of fluorodeoxyglucose (FDG) PET/computed tomography (CT) in prognostication and management of MPNSTs.

Materials And Methods: We have performed a retrospective analysis in patients of MPNSTs who underwent F-FDG PET/CT imaging for staging and restaging. Standardized uptake values (SUVmax and SUVmean) and texture parameters (calculated using radiomics package version 0.1.3) were measured for primary/recurrent lesions and were compared between two groups based on presence of event (recurrence/progression). Student t-test was applied for comparative analyses using the SPSS software package (version 23.0; IBM), with a significance level of 0.05.

Results: Thirty patients (17 male, 13 female; mean age 42.7 ± 15.66 years) were included, who underwent F-FDG PET/CT for staging (n = 10) and restaging (n = 20). Change in management was observed in four patients at baseline and in three patients in follow-up imaging for response assessment, who had progressive disease which prompted treatment intensification. SUVmax of primary/recurrent lesion showed correlation with histopathologic grade (r = 0.712, P = 0.034). Textural analysis showed more heterogeneity in lesions in the high-risk group with recurrence and progression.

Conclusion: F-FDG PET/CT can be used for staging and restaging in MPNSTs leading to change in management. Texture analysis and quantitative F-FDG PET/CT parameters can help in prognostication at both baseline and relapse.
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http://dx.doi.org/10.1097/MNM.0000000000001237DOI Listing
September 2020

RET gene mutation analysis and long-term clinical outcomes of medullary thyroid cancer patients.

Nucl Med Commun 2020 Nov;41(11):1136-1142

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi.

Objective: Medullary thyroid carcinoma is a rare, potentially aggressive tumour, with relatively worse prognosis than well-differentiated thyroid cancer. We evaluated the long-term outcomes and prognosis of medullary thyroid carcinoma patients at a single institution in India and compared outcomes based on results of RET protooncogene mutation analysis.

Methods: Data were retrieved through a prospectively maintained thyroid cancer database from 1998 to June 2019, and medullary thyroid carcinoma patients were recruited. RET gene mutation status (exon 10-16) was assessed. Patient with a minimum follow-up of 12 months was eligible to be part of the long-term outcome analysis.

Results: Out of 149 peripheral blood samples, 42 were positive for RET gene mutation (prevalence of 28.1%). The median follow-up duration was 48 months, ranging from 12 to 240 months. Long-term clinical outcomes of 113 patients were assessed. Two deaths were noted in this series. Both 5- and 10-year survival was cent per cent. Overall survival was 98.2% (97.3% in RET positive and 98.7% in RET negative group). Progression-free survival was 55.4% in total (60% in RET positive and 53.3% in RET negative group). No statistically significant difference was found between RET positive and RET negative groups concerning overall survival (P = 0.6011) and progression-free survival (P = 0.5140). Univariate analysis revealed high calcitonin (>10 pg/mL), stage IV disease, and presence of lymph nodal metastasis to be significant predictors of disease recurrence, however, multivariate analysis demonstrated the presence of lymph node metastases as the only significant predictor of recurrence (P = 0.0005).

Conclusions: Medullary thyroid carcinoma patients had relatively favourable long-term outcomes. Long-term survival was similar irrespective of RET mutation status. Presence of lymph node metastases appeared to be the strongest predictor of overall and progression-free survival, followed by Calcitonin level and stage of the disease.
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http://dx.doi.org/10.1097/MNM.0000000000001264DOI Listing
November 2020

3P's of Wermer/MEN1 Syndrome on 68Ga-DOTANOC PET/CT Scan.

Clin Nucl Med 2020 Dec;45(12):e516-e517

From the Department of Nuclear Medicine and PET/CT, All India Institute of Medical Sciences, New Delhi, India.

Wermer/MEN1 syndrome is composed of the triad of pancreatic, pituitary, and parathyroid (3P's) tumors. We describe the Ga-DOTANOC PET/CT findings of a 43-year-old man, which revealed the classic 3P's of MEN1 syndrome with somatostatin receptor expression. The patient further underwent surgery for parathyroid lesions, which were suggestive of adenomas.
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http://dx.doi.org/10.1097/RLU.0000000000003232DOI Listing
December 2020

Good and sustained response to pembrolizumab and pazopanib in advanced undifferentiated pleomorphic sarcoma: a case report.

Clin Sarcoma Res 2020 9;10:10. Epub 2020 Jul 9.

Department of Ophthalmology, Lady Hardinge Medical College, New Delhi, India.

Background: Conventional cytotoxic agents and pazopanib are approved for advanced soft tissue sarcomas but have low response rates and modest survival benefits. Recently, immune checkpoint inhibitors have shown clinically meaningful activity. The combination of pazopanib and immunotherapy has shown synergism in various other malignancies but has not been fully explored in advanced soft tissue sarcomas.

Case Presentation: A 63 year old woman with metastatic undifferentiated pleomorphic sarcoma progressed after two lines of palliative combination chemotherapy-doxorubicin with olaratumab, and gemcitabine with docetaxel. In view of significant symptoms, she was treated with pazopanib in combination with pembrolizumab. She had remarkable radiological and clinical improvement, with a manageable toxicity profile and an ongoing response at ten months of therapy.

Conclusions: Undifferentiated pleomorphic sarcoma is an immunologically active subtype of soft tissue sarcoma, which is particularly amenable to immune checkpoint inhibitors. Pazopanib with immune checkpoint inhibitors is a well-tolerated, yet hitherto underexplored combination that may offer significant clinical benefit in advanced sarcomas-this finding warrants further evaluation in clinical trials.
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http://dx.doi.org/10.1186/s13569-020-00133-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7346343PMC
July 2020

Isolated Lymph Node Amyloidosis: Response Assessment to Chemotherapy on Serial 18F-FDG PET/CT Scans.

Clin Nucl Med 2020 Sep;45(9):705-706

From the Departments of Nuclear Medicine and PET/CT.

Amyloidosis is a disorder resulting from the deposition of fibrillary protein in the extracellular tissue and can be classified into primary, secondary, familial, and senile types. Isolated lymph node amyloidosis without any other organ involvement is very rarely seen in clinical parlance, and diagnosis remains very challenging owing to nonspecific imaging findings. We present a case of 50-year-old man with lymphadenopathy, which was later confirmed to be amyloidosis on biopsy and serum-free light chain assay with efficacious use of F-FDG PET/CT for response assessment to bortezomib, cyclophosphamide, and dexamethasone.
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http://dx.doi.org/10.1097/RLU.0000000000003156DOI Listing
September 2020

Isolated Pancreatic Metastasis From Choroidal Melanoma After 10 Years of Enucleation Mimicking Neuroendocine Tumor on 68Ga-DOTANOC PET/CT.

Clin Nucl Med 2021 Jan;46(1):e21-e22

From the Departments of Nuclear Medicine.

Isolated pancreatic metastasis from choroidal melanoma is a rare phenomenon. We describe a case of a 38-year-old woman who underwent enucleation surgery for right choroidal melanoma and subsequently developed lesions in the pancreas 10 years after enucleation, which were depicted on Ga-DOTANOC PET/CT and confirmed to be metastasis from choroidal melanoma on surgical histopathology.
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http://dx.doi.org/10.1097/RLU.0000000000003112DOI Listing
January 2021

Metabolic Resolution of Lytic Lesions in Erdheim-Chester Disease on 18F-FDG PET/CT.

Clin Nucl Med 2020 Dec;45(12):e514-e515

From the Departments of Nuclear Medicine.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytic disorder with variable clinical presentation most commonly involving the skeletal system. The long bones are the most common site of involvement giving a characteristic bone scintigraphy pattern of increased bilateral symmetric uptake in metadiaphyseal regions. We describe the findings of serial F-FDG PET/CT in a 16-year-old adolescent girl with ECD, emphasizing the role of F-FDG PET/CT in response assessment of ECD.
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http://dx.doi.org/10.1097/RLU.0000000000003118DOI Listing
December 2020

Scrotal Sac Metastasis in Adenocarcinoma Prostate: Findings on 68Ga-PSMA PET/CT.

Clin Nucl Med 2020 Oct;45(10):e451-e452

From the Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Metastasis to the scrotal sac is a very rare phenomenon. We present a case of a 45-year-old man diagnosed with locally advanced acinar adenocarcinoma prostate, post bilateral orchidectomy and radiotherapy treatment, who showed a rising trend of serum PSA levels with discovery of scrotal sac metastasis on serial Ga-prostate-specific membrane antigen PET/CT scans.
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http://dx.doi.org/10.1097/RLU.0000000000003103DOI Listing
October 2020

Multiple Endocrine Neoplasia Type 2B Syndrome (Clinical image).

QJM 2020 Jun 1. Epub 2020 Jun 1.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

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http://dx.doi.org/10.1093/qjmed/hcaa184DOI Listing
June 2020

Pelvic Leiomyosarcoma With Splenic Metastasis and Response Assessment by 18F-FDG PET/CT.

Clin Nucl Med 2020 Jul;45(7):547-548

From the Departments of Nuclear Medicine.

The pelvis is a rare site for the origin of soft tissue sarcomas, and leiomyosarcoma remains the most common soft tissue sarcoma arising in the pelvis. Pelvic leiomyosarcomas are frequently aggressive tumors, and metastatic recurrence rates are high, with the lung, peritoneum, bone, and liver being the most frequent sites. We describe the findings of serial F-FDG PET/CT in a 53-year-old woman having pelvic leiomyosarcoma with uncommon site of metastasis, emphasizing the role of F-FDG PET/CT in response assessment.
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http://dx.doi.org/10.1097/RLU.0000000000003048DOI Listing
July 2020

Comparison of Lutetium-177 tin colloid and Rhenium-188 tin colloid radiosynovectomy in chronic knee arthritis.

Nucl Med Commun 2020 Aug;41(8):721-726

Departments of Nuclear Medicine.

Objective: To assess the role of Lutetium-177(Lu-177) tin colloid for radiosynovectomy and compare it with Rhenium-188 (Re-188) tin colloid radiosynovectomy for alleviation of pain in patients with chronic inflammatory arthritis of knee.

Methods: Patients of chronic inflammatory arthritis of the knee underwent pretherapeutic evaluation in a form of knee ultrasonogram, bone scan and clinical evaluation. Fifty-seven recruited patients were allocated at random to receive either intraarticular injections of Lu-177 tin colloid or Re-188 tin colloid. Eventually, 27 patients received Re-188 tin colloid and 30 patients received Lu-177 tin colloid. The joint was then immobilized for 2 days. Response evaluation was done using knee ultrasound, bone scan and clinical findings.

Result: Of 30, 20 patients responded to radiosynovectomy in the Lu-177 tin colloid group compared to 21/27 patients in the Re-188 tin colloid group.

Conclusion: Lu-177 tin colloid is an effective alternative to Re-188 tin colloid for radiosynovectomy in patients with chronic inflammatory knee arthritis.
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http://dx.doi.org/10.1097/MNM.0000000000001210DOI Listing
August 2020

A Case of Metachronous Triple Carcinoma with Synchronous Double Primary Carcinoma on F-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography.

Indian J Nucl Med 2020 Apr-Jun;35(2):174-175. Epub 2020 Mar 12.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Multiple primary malignancies in a single patient are exceedingly rare, but their prevalence has increased in recent decades due to prolonged survival rates supported by the advent of newer and better generation of chemotherapeutic agents as well as advances in cancer detectability facilitated by sophisticated modalities such as positron emission tomography-computed tomography. Here, we discuss a case of a 66-year-old male who recovered completely from lung carcinoma but subsequently developed synchronous gall bladder and gastric carcinoma after 1 year.
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http://dx.doi.org/10.4103/ijnm.IJNM_19_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182320PMC
March 2020

Inflammatory Myofibroblastic Tumor: Findings on Ga-DOTA-NOC Positron-emission Tomography-Computed Tomography.

Indian J Nucl Med 2020 Apr-Jun;35(2):170-171. Epub 2020 Mar 12.

Department of Nuclear Medicine and PET-CT, All India Institute of Medical Sciences, New Delhi, India.

Inflammatory myofibroblastic tumor (IMT) or inflammatory pseudotumors are a rare group of tumors usually affecting children and young adults. They occur in various anatomic locations, with most common being the lung accounting for almost 95% of the cases. We present a case of a 4-year-old girl who presented with fever and dull abdominal pain for 6 months with a clinically palpable left hypochondrium mass. On suspicion of mesenteric/gastric neuroendocrine tumor, Ga-DOTA-NOC positron-emission tomography-computed tomography was done; however, the biopsy revealed IMT.
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http://dx.doi.org/10.4103/ijnm.IJNM_195_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182314PMC
March 2020

A Rare Case of Sinonasal Malignant Melanoma - Local, Regional, and Distant Spread Accurately Detected by 18F Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography.

Indian J Nucl Med 2020 Apr-Jun;35(2):160-161. Epub 2020 Mar 12.

Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India.

Melanomas are usually cutaneous in origin but rarely can also arise from the mucosal linings in the body. Sinonasal melanomas arise from the mucosa of the nasal cavity and paranasal sinuses, which account for approximately 50% of mucosal melanomas in the body. 18F fluorodeoxyglucose positron emission tomography-computed tomography (F-FDG PET/CT) has proven its role in malignant melanoma in staging especially in stage III and IV disease, restaging, assessing response to therapy and had affected in treatment change in significant number of cases. We present a case of sinonasal melanoma who underwent FDG PET/CT for staging and showed cervical lymph node and marrow metastases.
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http://dx.doi.org/10.4103/ijnm.IJNM_20_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182322PMC
March 2020

Unusual Gastric Metastasis in Triple-Negative (Estrogen Receptor/Progesterone Receptor/HER2neu Negative) GATA-Binding Protein 3-Positive Breast Cancer.

Indian J Nucl Med 2020 Jan-Mar;35(1):82-83. Epub 2019 Dec 31.

Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi, India.

Triple-negative breast cancer (TNBC) accounts for 20%-25% of breast cancer cases. Around 10%-15% of patients with breast cancer present with upfront metastasis. Lymph node, bone, and liver are common sites of metastasis in hormone-positive breast cancer while brain, lungs, and liver in TNBC. Although visceral metastasis is common in TNBC, metastasis to stomach is unusual. Morphological similarity of primary gastric carcinoma and lobular invasive breast carcinoma often leads to misdiagnosis. Meticulous review of histopathology and immunohistochemistry is essential for diagnosis. We present a case of carcinoma breast with unusual gastric nodular metastasis detected on F-fluorodeoxyglucose positron emission tomography-computed tomography.
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http://dx.doi.org/10.4103/ijnm.IJNM_156_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6958957PMC
December 2019