array:22 [ "pii" => "S2253808916300672" "issn" => "22538089" "doi" => "10.1016/j.remnie.2016.03.005" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "791" "copyright" => "Elsevier España, S.L.U. y SEMNIM" "copyrightAnyo" => "2016" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2016;35:415-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemAnterior" => array:18 [ "pii" => "S2253808916300684" "issn" => "22538089" "doi" => "10.1016/j.remnie.2016.03.006" "estado" => "S300" "fechaPublicacion" => "2016-11-01" "aid" => "792" "copyright" => "Elsevier España, S.L.U. y SEMNIM" "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Rev Esp Med Nucl Imagen Mol. 2016;35:413-4" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting images</span>" "titulo" => "A rare case of tonsillar metastatic small cell carcinoma originating from the lung assessed by <span class="elsevierStyleSup">18</span>F-FDG PET/CT" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "413" "paginaFinal" => "414" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Un raro caso de carcinoma metastásico de células pequeñas de la amígdala, con origen en el pulmón, y valorado mediante <span class="elsevierStyleSup">18</span>F-FDG PET/TC" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 855 "Ancho" => 1653 "Tamanyo" => 170427 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Coronal magnetic resonance image of the tonsils (A) demonstrated an enlarged left tonsil with high signal intensity on T2-weighted image. Fused FDG PET/CT image (B) simultaneously revealed the left hilar and tonsillar tumors.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "R. Zhang, Z. Hu, J. Tan, J. Shen" "autores" => array:4 [ 0 => array:2 [ "nombre" => "R." "apellidos" => "Zhang" ] 1 => array:2 [ "nombre" => "Z." "apellidos" => "Hu" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Tan" ] 3 => array:2 [ "nombre" => "J." "apellidos" => "Shen" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808916300684?idApp=UINPBA00004N" "url" => "/22538089/0000003500000006/v1_201611020047/S2253808916300684/v1_201611020047/en/main.assets" ] "en" => array:14 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Interesting image</span>" "titulo" => "Carney's triad with synchronous breast cancer: <span class="elsevierStyleSup">18</span>F-FDG PET/CT imaging" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "415" "paginaFinal" => "416" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "B.D. Nguyen" "autores" => array:1 [ 0 => array:3 [ "nombre" => "B.D." "apellidos" => "Nguyen" "email" => array:1 [ 0 => "Nguyen.ba@mayo.edu" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Department of Radiology, Nuclear Medicine Division Mayo Clinic Arizona, Scottsdale, AZ, USA" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "<span class="elsevierStyleSup">18</span>F-FDG PET/TC en Tríada de Carney con cáncer de mama sincrónico" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 809 "Ancho" => 1000 "Tamanyo" => 77043 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole body PET maximum intensity projection images (A: anterior, B: right anterior oblique) showing the gastric GIST (g), duodenal GIST (d), medial perigastric GIST nodal metastasis (n), esophageal leiomyomas (e), left pelvic paraganglioma (p), left breast carcinoma (b) and related left axillary nodal metastasis (a).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 50-year-old woman consulted our institution for an established diagnosis of gastric gastrointestinal stromal tumor (GIST). <span class="elsevierStyleSup">18</span>F-FDG PET/CT staging exam confirmed the large hypermetabolic gastric GIST (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). PET/CT also showed numerous <span class="elsevierStyleSup">18</span>F-FDG-avid lesions of the left breast, left axilla, esophagus, medial perigastric region, proximal duodenum and left pelvis (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). The complete clinical work-up, along with tissue samplings and subsequent surgical resections found (1) a synchronous adenocarcinoma of the left breast with a left axillary nodal metastasis, (2) multiple benign esophageal leiomyomas, (3) an additional GIST of the duodenum with a medial perigastric nodal metastasis, and (4) an extra-adrenal paraganglioma of the left pelvis. In addition, PET/CT exam detected bilateral adrenal gland adenomas (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). All these PET/CT findings are compatible with the diagnosis of Carney's triad.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Carney's triad is a rare clinical syndrome related to genetic disorder and targeting predominantly women of first to fifth decade of life.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> Carney's triad is characterized by the association of either synchronous or metachronous pulmonary chondroma, gastrointestinal stromal tumor and extra-adrenal paraganglioma.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1–3</span></a> At the present time, the pathogenesis of this disease is not well elucidated; however on-going research considers the genetic impairment of the succinate dehydrogenase complex as a potential causal factor of Carney's triad.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">1,2</span></a> This entity may be associated with esophageal leiomyoma and non-functioning adrenal gland adenoma.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a> Only about one fourth of this patient population exhibits all the lesion components cited above. Consequently, it is exceptionally rare to demonstrate in one setting with one single imaging modality all or nearly all components of this syndrome as seen in this case presentation. Except for the pulmonary component of the triad, PET/CT depicted all other lesions of this rare clinical entity. PET/CT also provided a comprehensive evaluation of the coexisting left breast cancer with related left axillary nodal metastasis.</p><p id="par0015" class="elsevierStylePara elsevierViewall">PET/CT is useful in providing the most accurate anatomic and functional information in the oncologic evaluation especially in instances of multifocal lesions. The differential diagnosis of multifocal <span class="elsevierStyleSup">18</span>F-FDG-avid lesions includes (1) a primary malignancy with diffuse metastases, (2) multiple co-existing distinct primary malignancies and/or inflammatory lesions related or not related to complex clinical syndromes such as Carney's triad, Carney–Stratakis syndrome (distinct from the triad by a dyad of paragangliomas and gastric stromal sarcomas), multiple endocrine neoplasia (MEN) syndromes, and IgG4-related systemic sclerosis or (3) a combination of (1) and (2). To optimize the patient care and outcome, priority should be made, in case of PET/CT depiction of multiple <span class="elsevierStyleSup">18</span>F-FDG-avid lesions, to investigate every single abnormal finding.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The author has no conflict of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflict of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 809 "Ancho" => 1000 "Tamanyo" => 77043 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole body PET maximum intensity projection images (A: anterior, B: right anterior oblique) showing the gastric GIST (g), duodenal GIST (d), medial perigastric GIST nodal metastasis (n), esophageal leiomyomas (e), left pelvic paraganglioma (p), left breast carcinoma (b) and related left axillary nodal metastasis (a).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1873 "Ancho" => 1600 "Tamanyo" => 517007 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Composite axial PET/CT images showing detailed features of the left breast carcinoma (b), left axillary nodal metastasis (a), esophageal leiomyomas (e), gastric GIST (g), medial perigastric GIST nodal metastasis (n), left pelvic paraganglioma (p), bilateral adrenal gland adenomas (ad), and duodenal GIST (d).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:3 [ 0 => array:3 [ "identificador" => "bib0020" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Carney triad: a syndrome featuring paraganglionic, adrenocortical, and possibly other endocrine tumors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "J.A. Carney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1210/jc.2009-1156" "Revista" => array:6 [ "tituloSerie" => "J Clin Endocrinol Metab" "fecha" => "2009" "volumen" => "94" "paginaInicial" => "3656" "paginaFinal" => "3662" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19723753" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0025" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Gastric stromal tumors in Carney triad are different clinically, pathologically, and behaviorally from sporadic gastric gastrointestinal stromal tumors: findings in 104 cases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "L. Zhang" 1 => "T.C. Smyrk" 2 => "W.F. Young Jr." 3 => "C.A. Stratakis" 4 => "J.A. Carney" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0b013e3181c20f4f" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "53" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19935059" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0030" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Adrenal cortical adenoma: the fourth component of the Carney triad and an association with subclinical Cushing syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "J.A. Carney" 1 => "C.A. Stratakis" 2 => "W.F. Young Jr." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/PAS.0b013e318285f6a2" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2013" "volumen" => "37" "paginaInicial" => "1140" "paginaFinal" => "1149" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23681078" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/22538089/0000003500000006/v1_201611020047/S2253808916300672/v1_201611020047/en/main.assets" "Apartado" => array:4 [ "identificador" => "7927" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Interesting images" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/22538089/0000003500000006/v1_201611020047/S2253808916300672/v1_201611020047/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2253808916300672?idApp=UINPBA00004N" ]
Journal Information
Interesting image
Carney's triad with synchronous breast cancer: 18F-FDG PET/CT imaging
18F-FDG PET/TC en Tríada de Carney con cáncer de mama sincrónico
B.D. Nguyen
Department of Radiology, Nuclear Medicine Division Mayo Clinic Arizona, Scottsdale, AZ, USA