Découverte fortuite d’une masse mésentérique asymptomatique d’évolution rapide : rôle de la TEP/TDM au FDG dans la prise en charge du patient

The purpose of this case report is to illustrate the role of the FDG PET/CT in the diagnosis and management of an atypical form of follicular lymphoma of incidental discovery. We report the clinical case of a 75-year-old patient who was asymptomatic and followed annually by abdominopelvic ultrasonography due to a past history of renal infection. On ultrasonography was discovered incidentally a voluminous mesenteric mass of 23 cm, apparently invading the pancreas and encompassing the mesenteric vessels. FDG PET/CT allowed the characterization of the mass as most probably malignant, the staging of the disease, the elimination of the differential diagnosis of gastrointestinal stromal tumour, and the feasibility of a minimally invasive approach to obtain histologic evidence. A transduodenal fine-needle aspiration by ultrasonography-controlled endoscopy was then performed and resulted in cytological diagnosis of malignant non-Hodgkin's centro-follicular lymphoma, stage IV of Ann Arbor classification. Chemotherapy (R-CHOP rituximab) treatment was started.     

Quid des produits de contraste en TEP/TDM ?

It is important that PET/CT in its current technical form is used to its fullest clinical capability. In order to achieve this, training has to be such that PET/CT readers are capable PET as well as CT readers. Imaging protocols have to be devised such that contrast media enhancement in CT minimizes artefacts since the CT data are also used for attenuation correction. The easiest and most flexible way is to perform a low dose pre-PET/CT scan and add a CE-CT at the end of the examination, if necessary. Necessity is dictated by the clinical question and clinical experience is accumulating telling us that depending on the question asked from the PET/CT examination, CE is mandatory, recommended, optional or unnecessary.     

Quelques données sur la composition du ≪Lait de Pigeon≫

Sommaire Nous avons analysé le lait fraîchement prélevé du jabot des deux parents le matin à jeûn.Le poids sec de ce lait est très variable (de 3,6 à 32,2%). Celui du lait prélevé dans le jabot des jeunes est au contraire presque constant: 26,0%.Le lait de jabot ne contient d'autres hydrates de carbone que la ribose et la désoxyribose des acides nucléiques.La plus grande partie des protéines est formée par une espèce de caséine à faible teneur en phoshore.Il ne semble pas exister de différence entre la quantité de protéines contenue dans le lait des premiers et celui des derniers jours de la période de lactation, ni entre celui secreté par le mâle et celui secreté par la femelle.Les acides aminés libres et ceux contenus dans les hydrolysats ont été déterminés qualitativement.L'indice d'iode des lipides extraits à l'éther (70,65) est de beaucoup supérieur à celui des lipides extraits au méthanol-chloroforme (23,80).La composition du lait total, tel qu'il est fourni aux jeunes, est la suivante: eau 74,00%, cendres 1,37%, protéines 12,40%, autres substances azotées ± 1,32%, lipides 8,61%.

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The composition of pigeon cropmilk

Summary The analyses performed on cropmilk freshly taken from the crop of both parents, lead to the following conclusions:the dry weight of this cropmilk is very variable (between 3.6 and 32.2 %); on the contrary the dry weight of the milk taken from the crop of the squabs is nearly constant (26.0%);the cropmilk doesn't contain any carbohydrates, except the ribose and desoxyribose from the nucleic acids;the bulk of the proteins is formed by a casein with a low phosphor content (Table 1);there seems to exist no difference between the composition of the cropmilk of the first and that of the last days of the lactation period, neither between that secreted by the male or that secreted by the female (Table 2);the free amino acids as well as those contained in the hydrolysates were determined (Table 3);the iodine number of the ether extracted lipids (70.65) is far superior to that of the lipids extracted by methanol-chloroform (23.80);the composition of the milk, as it is given to the squabs, is: water 74.00%, ashes 1.37%, proteins 12.40%, other nitrogen compounds ±1.32%, lipids 8.61%.

     

Apport de la TEP/TDM au FDG en cancérologie de l’intestin grêle

This article focuses on the indication for FDG PET/CT in case of tumours of the small intestine, neuro-endocrine tumours excluded. The adenocarcinomas, lymphomas and sarcomas (including stromal tumours or GIST) are studied. There is no specific recommendation for FDG PET/CT in adenocarcinomas, extremely rare in comparison with colorectal adenocarcinomas. However, the utility of FDG PET/CT has been reported in clinical cases for detection and staging, especially in patients with high risk of developing the disease (Crohn's disease being the most important risk factor). The primary lymphomas of the small gut are also very rare, corresponding in all cases to non-Hodgkin lymphomas, for which the role of FDG PET/CT is recognised in follicular lymphoma, large B-cell lymphoma and Burkitt lymphoma. The stromal tumours correspond to the most frequent sarcomas. Stromal tumours in the small intestine are less frequent in the small intestine than in the stomach. The role of FDG PET/CT is well established in stromal tumours for the staging of the disease and for determining the efficacy of therapy with tyrosine kinase inhibitor. FDG PET is especially effective to evaluate the response since the radiologic criteria are difficult to assess, based not on the decrease of size of the lesions but on the decrease of density and of contrast enhance.     

TEP/TDM multi-phase : revue de la littérature

This article reviews the literature of studies that have used multiple-time or later PET image acquisitions mainly with 18F-FDG, for the characterization of solid cancers, their staging or as a prognostic tool. The performances of these PET multiphase acquisitions are presented by organ. References from this literature review were searched using Medline and Google Scholar. Only articles in French and English were selected.     

Anomalies postnatales du développement de la spermatogenèse associées aux troubles de la migration testiculaire

Cryptorchidism, a non-descended testis in its physiological intrascrotal location, is one of the most frequent congenital anomalies of the male genital system. The mechanisms of the normal descent of the testis are still unclear. Several etiological hypotheses have been proposed for cryptorchidism. Cryptorchidism is associated with a greater risk of testis cancer, and is also a cause of impairment in sperm parameters and fertility in the adult age. In this article, we review the cellular and hormonal events occurring from birth to puberty in isolated cases of congenital cryptorchidism that will later, in adulthood, alter both spermatogenesis and fertility.     

Évaluation de la cinétique globale et segmentaire du ventricule gauche chez les patients connus ou suspects de cardiopathie ischémique : comparaison des données apportées en scintigraphie de perfusion myocardique et en tomoventriculographie isotopique

Background and aimsThe analysis of the left ventricular contractile function plays a major role in the diagnosis and management of patients with cardiopathies. The aim of our study was to compare gated blood pool SPECT and myocardial perfusion scintigraphy for the assessment of the left ventricular wall contractility at the global and the segmental scales.Material and methodsThe data of 23 ^99mTc-Tetrofosmin perfusion scintigraphies, and 50 ²⁰¹Thallium perfusion scintigraphies were compared to those of gated blood pool SPECT performed at close interval.ResultsThe correlations were good (r = 0.81 to 0.94) concerning the global parameters (left ventricular ejection fraction, end-diastolic and end-systolic volumes) in the two groups. Quite good correlations were also found at the segmental scale (r = 0.49 to 0.62), between the segmental ejection fraction calculated in gated blood pool SPECT and the wall thickening or the wall motion estimated in perfusion scintigraphy. These correlations were significantly lower in the “²⁰¹Thallium perfusion scintigraphy” group than in the “^99mTc-Tetrofosmin perfusion scintigraphy” group, especially for hypokinetic segments.ConclusionAlthough they use very different approaches, GBPS and MPS give data about global and segmental left ventricular wall contraction that are well correlated, but not strictly interchangeable.     

Bilan initial d’imagerie de l’adénocarcinome pancréatique : données de la littérature sur la place actuelle de la tomographie par émission de positons au 18F-fluorodéoxyglucose (TEP FDG)

In pancreatic adenocarcinoma, initial imaging is essential to better select patients for surgery. Recent literature analysis of F18-Fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET) in pancreatic adenocarcinoma is summarized in the present article. Performances of FDG PET in the fields of lymph node involvement, metastatic involvement and therapeutic efficacy assessment are described for its correct use in pancreatic adenocarcinoma.     

Pièges et artéfacts en imagerie TEP/TDM : intérêts des post-traitements

In PET imaging, quantification of the acquired data can be achieved by using a series of correction techniques to minimize the effects inherent in the imaging process of emission tomography. Quantitative images can be reconstructed after correcting the detected emission data for the presence of random and scattered coincidences, attenuation effects, effects associated with the variable detectors sensitivity, effects related to the geometry of the device and the effects of dead-time. All these effects are well accounted for in the PET imaging market. However, other effects can degrade the quality of the PET images, such as the finite spatial resolution generating partial volume effects, or the patient movements including respiratory and cardiac physiological movements. In the thoracic field, the effects of respiratory motion on PET images are characterized by a loss of detection sensitivity due to the associated blur. Several methods have been developed to correct for these effects, but still without a wide acceptance in clinical routine. These research areas are therefore still very active.     

Nouvelles données sur le déroulement de la mycose àNeozygites fumosa sur la cochenille du maniocPhenacoccus manihoti

Résumé Cet article présente les résultats obtenus en 1987 sur des points non encore abordés précédemment dans le cadre de l'étude des circonstances épidémiologiques favorisant le déroulement de l'Entomophthorose àNeozygites fumosa (Speare) Remaudière et Keller, pathogène de la cochenille du maniocPhenacoccus manihoti Matile-Ferrero (Hom.: Pseudococcidae). Il montre notamment que l'évolution de la maladie, très rapide, correspond à la succession de 2 phases: une première phase, d'implantation, fortement liée à la taille et à la structure des colonies et une deuxième phase (épizootique au sens strict) indépendante de leur taille et de leur structure. Son évolution appara?t plus liée à la régularité des pluies qu'à la quantité d'eau. Les conditions sont très favorables quand l'humidité relative est supérieure à 90% pendant au moins 5 heures par jour de fa?on régulière. Le r?le important joué par la durée d'humectation du feuillage est montré ici pour la première fois. La densité des conidies du pathogène dans l'air est proportionnelle aux taux de mycose observés dans les populations deP. manihoti.