Clinical Nuclear Medicine

18F-FDG PET/CT in Oral Cuniculatum Carcinoma A 69-year-old woman was referred for initial staging of an oral cavity mass. 18F-FDG PET/CT displayed a homogeneous intense uptake of the 50-mm left hemipalatal mass with local extension to the dental arcade and maxillary sinus. Infracentimetric bilateral cervical nodes with faint uptake were also detected, contrasting with the usual presentation of other head and neck squamous cell carcinoma. Biopsy concluded to a rare head and neck squamous cell carcinoma subtype: oral cuniculatum carcinoma (OCC). After radiotherapy, 18F-FDG PET/CT showed metabolic complete response. Our case describing specifically the metabolic characteristics of OCC and radiotherapy evaluation for this rare tumor. Received for publication February 11, 2019; revision accepted May 1, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Sébastien Dejust, MD, Service de Médecine Nucléaire, Institut Jean Godinot, 1 Rue du Général Koenig, 51100 Reims, France. E-mail: sebastien.dejust@reims.unicancer.fr. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Incidental Detection of Ovarian Thecoma by 99mTc-MDP Whole-Body Bone Scan: Contribution of Hybrid SPECT/CT Ovarian thecoma is a benign and rare neoplasm that accounts for 0.5% to 1% of all ovarian tumors. A 55-year-old woman with known breast cancer underwent a metastatic workup before surgery. The 99mTc-MDP whole-body bone scan revealed intense uptake in the left pelvic region. Hybrid SPECT/CT imaging showed that the elevated 99mTc-MDP activity was in a tumor with calcification in the left adnexa. Dynamic enhanced MRI revealed marked enhancement of the tumor. Resection of the tumor was subsequently performed, and pathologic analysis confirmed the diagnosis of an ovarian thecoma. Received for publication February 5, 2019; revision accepted May 5, 2019. L.Z. and Q.H. contributed equally to this work. Conflicts of interest and sources of funding: none declared. Correspondence to: Rusen Zhang, MD, Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong 510095, China. E-mail: zhangrusen2015@163.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

68Ga-PSMA-617 Compared With 68Ga-RM2 and 18F-FCholine PET/CT for the Initial Staging of High-Risk Prostate Cancer 68Ga-labeled prostate-specific membrane antigen inhibitors and 68Ga-labeled gastrin-releasing peptide receptor antagonists showed interesting results for staging biochemically recurrent prostate cancer. In this case, 68Ga–prostate-specific membrane antigen-617 PET/CT, 68Ga-RM2 PET/CT, and 18F-choline PET/CT were performed in a patient (66-year-old man, prostate-specific antigen = 6.7 ng/mL) with biopsy-proven Gleason 9 (5 + 4) prostate cancer, candidate for radical prostatectomy and lymph node dissection. Received for publication January 3, 2019; revision accepted May 3, 2019. Conflict of interest and sources of funding: This study was funded by the University Hospital of Bordeaux under grant AOI 2016 and was achieved within the context of the Laboratory of Excellence TRAIL ANR-10-LABX-57. None declared to all authors. Correspondence to: Clément Morgat, PharmD, PhD, Nuclear Medicine Department, University Hospital of Bordeaux, Place Amélie Raba Léon, 33076 Bordeaux, France. E-mail: clement.morgat@u-bordeaux.fr. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Low 68Ga–PSMA PET/CT Uptake in Chronic Intramuscular Nodular Fasciitis Nodular fasciitis is an uncommon benign mass-forming myofibroblastic proliferation, most frequently found in the upper limbs, with only rare intramuscular cases. We describe herein a case of chronic nodular fasciitis of the left triceps muscle with a low 68Ga-labeled prostate-specific membrane antigen (PSMA) ligand uptake on PET/CT. 68Ga-PSMA ligands bind to PSMA-expressing prostate cancer cells, but uptake has also been demonstrated in other solid neoplasms and various benign lesions. Nodular fasciitis should be included in the differential diagnosis of soft tissue lesions with variable 68Ga-PSMA uptake. Received for publication April 15, 2019; revision accepted May 4, 2019. Conflicts of interest and sources of funding: none declared. Author Contributions: N.P. followed up on the PET/CT, reviewed the patient's medical records, and drafted the manuscript. C.A. acted as an expert consultant for the case and revised the manuscript. I.K. initially reported the PSMA PET/CT and revised the manuscript. P.F. revised the manuscript for important intellectual content. Correspondence to: Nicolas Plouznikoff, MD, PhD, FRCPC, Service de Médecine Nucléaire, Centre Hospitalier de l'Université de Montréal (CHUM), 1051 rue Sanguinet, Montréal, Quebec, Canada H2X 0C1. E-mail: nicolas.plouznikoff@umontreal.ca. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

18F-FDG PET/CT in Lymphomatoid Papulosis Mimicking Primary Cutaneous Anaplastic Large Cell Lymphoma Lymphomatoid papulosis is a benign self-healing condition, presenting as papulonodular skin eruptions and mimicking malignant cutaneous lymphomas histopathologically. 18F-FDG PET/CT findings in this benign condition have not been described in detail in the literature. We present a case of lymphomatoid papulosis mimicking primary cutaneous anaplastic large cell lymphoma histopathologically and demonstrating intensely FDG-avid cutaneous lesions on 18F-FDG PET/CT, which disappear spontaneously in the follow-up scan. Received for publication March 4, 2019; revision accepted May 4, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Raja Senthil, MD, Department of Nuclear Medicine and PET/CT, VPS Lakeshore Hospital, Maradu, Nettoor (PO), Kochi, Kerala 682040, India. E-mail: senthilrajapgi@yahoo.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Multiple Solitary Plasmacytomas With Multifocal Bone Involvement Diagnosed With 68Ga–Prostate-Specific Membrane Antigen PET/CT A 63-year-old man with elevated prostate-specific antigen serum levels and enlarged prostate gland underwent ultrasound-guided transrectal biopsy, which did not reveal any evidence of malignancy. In order to help guidance of repeat biopsy, 68Ga–prostate-specific membrane antigen–targeted ligand PET (PSMA PET/CT) was ordered. PET/CT scan showed no abnormal PSMA expression within the prostate gland. There were, however, multiple PSMA-expressing osteolytic lesions throughout the axial skeleton. Bone lesion biopsy obtained for final workup revealed multiple solitary plasmacytomas with multifocal bone involvement. This rare case highlights the utility of PSMA PET/CT in diagnosing nonprostate malignancies. Received for publication April 22, 2019; revision accepted May 11, 2019. Conflicts of interest and sources of funding: none declared. This article has not been published before or is not under consideration for publication anywhere else and has been approved by the author in the title page. Correspondence to: Yazan Z. Alabed, MD, PhD, Department of Nuclear Medicine, PET/CT Unit, Gulf International Cancer Center, PO Box 5882, Abu Dhabi, United Arab Emirates. E-mail: yazan.alabed@gmail.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pearls in the Wrong Pockets: Idiopathic Scrotal Calcinosis Idiopathic scrotal calcinosis, also called dystrophic scrotal calcinosis, is a rare benign condition that causes superficial intradermal scrotal calcifications. We present one such case of a 40-year-old married man who underwent PET/CT scan for staging workup of lymphoma and revealed this rare entity incidentally without any other testicular pathology. Received for publication February 9, 2019; revision accepted May 11, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Pir Abdul Ahad Aziz Qureshi, MBBS, FCPS, Department of Radiology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, 7-A Block R-3, M.A. Johar Town, Lahore, Punjab, Pakistan 54770. E-mail: abdulahadaziz@skm.org.pk. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Propionibacterium acnes Pacemaker Endocarditis in a Patient With a Redundant Loop of the Ventricular Lead: PET/CT Findings A 59-year-old man with a pacemaker who was admitted for evaluation of fever was found to have a redundant loop of the ventricular lead and a vegetation attached to it. An FDG PET/CT revealed a focus of FDG uptake at the ventricular lead loop. Surgical extraction of the pacemaker device confirmed a Propionibacterium acnes pacemaker endocarditis. We hypothesize that the redundant loop of the ventricular lead induced a chronic mechanical stress both to the tricuspid valve and to the lead itself, facilitating the bacterial colonization of the lead. Received for publication April 25, 2019; revision accepted May 17, 2019. Conflicts of interest and sources of funding: none declared. This has not been submitted or presented elsewhere in any form. Correspondence to: Luis Gorospe, MD, Department of Radiology, Ramón y Cajal University Hospital, Ctra. de Colmenar Viejo Km 9.100, 28034 Madrid, Spain. E-mail: luisgorospe@yahoo.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Diverse Behavior in 18F-Fluorocholine PET/CT of Brain Tumors in Patients With Neurofibromatosis Type 1 Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder that causes CNS tumors in around 20% of patients, being pilocytic astrocytomas (PA), and particularly optic pathway gliomas (OPG), the most common. We present three cases of NF1 patients referred for 18F-fluorocholine PET/CT because of suspected glioma in the setting of ongoing FUMEGA (Functional and Metabolic Glioma Analysis) trial. One case turned out to be a WHO grade I ganglioglioma; the second was a high grade glioma; and the last one (negative in PET) a probable low-grade glioma. Received for publication November 8, 2018; revision accepted April 14, 2019. No disclaimer. All the authors have participated in the writing and revision of this article and take public responsibility for its content. The present publication is approved by all authors and by the responsible authorities where the work was carried out. All the authors confirm the fact that the article is not under consideration for publication elsewhere. Compliance with Ethical Standards. Conflicts of interest and sources of funding: none declared. Research involving Human Participants and/or Animals: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent: Informed consent was obtained from all individual participants included in the study. Correspondence to: Francisco José Pena Pardo, MD, Nuclear Medicine Department, University General Hospital, C/ Obispo Rafael Torija s/n. 13005, Ciudad Real, Spain. E-mail: fjpena@msn.com. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Asymptomatic Bone Marrow Edema Detected by 67Ga Scintigraphy A 46-year-old woman presented with a complaint of fever. CRP was 2.1 mL/L in blood, white blood cell count was 20–29/hpf, and bacterial count was 3418/μL in a urinalysis. 67Ga scan revealed accumulation of 67Ga in the left distal femur, although she had no symptoms around the site. MRI demonstrated diffuse high signal intensity on T2-weighted STIR images. Osteomyelitis was suspected, and biopsy was performed. Bacterial culture of the bone marrow was negative, and histological examination showed no infiltration of inflammatory cells. Two months after the biopsy, disappearance of altered signal intensity of MRI was observed. Received for publication February 15, 2019; revision accepted April 27, 2019. Conflicts of interest and sources of funding: none declared. Correspondence to: Shinji Miwa, MD, PhD, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan. E-mail: smiwa001@yahoo.co.jp. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Alexandros Sfakianakis
Anapafseos 5 . Agios Nikolaos
Crete.Greece.72100
2841026182

6948891480

alsfakia@gmail.com