Intreduction: Melanoma is an extremely aggressive form of skin neoplasia, an important stage in the diagnostic and treatment is identifying the dissemination at the lymphatic level. For a more accurate staging, the sentinel lymph node biopsy technique is performed, which in most of the time addresses one, respectively 2 locations, but cases with sentinel nodes in 3 lymphatic basins have rarely been described. Case report: We present a case of melanoma located in the right lumbar region, which from the point of view of histopathological features has a Breslow index of 4.2 mm, classified in the pT4b stage. After the CT evaluation was performed, it was decided that there is indication for performing the sentinel lymph node technique and excision with a margin of safety. Scintigraphy revealed that sentinel lymph nodes were identified in 3 different regions, respectively the right axilla and bilateral inguinal. Conclusions: Melanoma located on the trunk can present different lymphatic routes for the sentinel lymph nodes, unlike that on the limbs where certain patterns are present. Identifying these lymph nodes in cases like this involves a challenge both from a diagnostic and surgical point of view.

We report a two-month-old male cat weighing 630 grams with congenital hypothyroidism. The main complaints were difficulty defecating for more than three days and prostration. Physical examination revealed a broad, flat face, a short neck, enlarged submandibular lymph nodes, chemosis, mild bilateral mucopurulent ocular discharge, seborrheic coat, with gingival thickening around the upper and lower deciduous incisor teeth with partial eruption. The abdomen was distended due to constipation and right unilateral cryptorchidism. Based on this, feline congenital hypothyroidism was suspected. Hormonal tests (free T4 by equilibrium dialysis of 0.06 ng/dl, total T4 of 0.1 ng/ml and TSH of 4.7 ng/ml) confirmed this. Treatment was started with levothyroxine sodium (5-32.2 µg/kg/day). After 120 days of treatment, there was clinical stabilization. Then the patient underwent orchiectomy of the left and of the right ectopic testicles, and at 380 days of treatment, the thyroid scintigraphy showed intense uptake of the radiopharmaceutical by both thyroid lobes and a significant increase in volume. Clinical evaluation showed weight gain (2.6 kilograms during treatment), improvement in the shape of the skull, and a notable increase in body size. At 17 months of age, hormone values were within the reference limits after administration of levothyroxine sodium (32.2µg/kg/day).
O objetivo deste trabalho foi relatar o caso de hipotireoidismo congênito em um felino, macho, pelo curto brasileiro (PCB), com dois meses de idade, pesando 630 gramas. Apresentava como queixa principal dificuldade para defecar por mais de três dias e prostração. O exame físico geral constatou face larga e plana, pescoço curto, linfonodos submandibulares aumentados, quemose e discreta secreção ocular mucopurulenta bilateral. A pelagem apresentava-se opaca e seborreica, espessamento gengival em torno dos dentes decíduos incisivos superiores e inferiores com parcial erupção. À palpação, o abdômen apresentava-se distendido pela presença de fezes em cólon e criptorquidismo unilateral direito. Diante das alterações supracitadas, suspeitou-se de hipotireoidismo congênito felino. O qual foi confirmado através de exames complementares hormonais específicos (T4 livre por diálise do equilíbrio 0,06 ng/dl, T4 total 0,1 ng/ml e TSH 4,7 ng/ml). Iniciou-se o tratamento com levotiroxina sódica na dose de 5 a 32,2µg/kg/dia. Com 120 dias de tratamento houve estabilização clínica e então o paciente foi submetido à orquiectomia dos testículos esquerdo ectópico e direito. E aos 380 dias de tratamento ao exame de cintilografia de tireoide onde foi evidenciado intensa captação do radiofármaco por ambos os lobos tireoidianos e importante aumento de volume. Na avaliação clínica, foi observado ganho de peso (2,6 quilogramas ao longo do tratamento), melhora na conformação do crânio e notável aumento de tamanho corporal. Aos 17 meses de idade, os valores hormonais se encontravam dentro dos limites de referência, após a administração da dose de lexotiroxina sódica na dose de 32,2µg/kg/dia.

Hourglass bladder is a definition used to describe a particular configuration of the urinary bladder, divided into two compartments, upper and lower, communicating through a narrowed segment resembling an hourglass. It may be due to various conditions, such as bladder diverticula, bladder neck obstruction, neurogenic bladder, or other abnormalities. Congenital hourglass bladder is an extremely rare anomaly. To the best of our knowledge, only 24 cases have been reported. We present the case of a 2-year-old male, probably the youngest patient with congenital hourglass bladder ever recorded. We aim to increase knowledge about the incidence of this likely underdiagnosed condition and its management and stress the importance of long-term follow-up.

A 90-year-old man experienced chest oppressive sensation at 12:30 AM for the first time. Electrocardiography showed a newly developed inversion of the terminal T-wave in the V2-5 leads. A left coronary angiogram showed no significant atherosclerotic stenosis. A myocardial bridge was found in the mid-left anterior descending artery (LAD). Myocardial scintigraphy with 123I beta-methyl 15-para-iodophenyl 3(R,S)-methylpentadecanoic acid revealed a reduced uptake in the apical and septal areas. Based on these findings, we suspected new-onset vasospastic angina complicated by a myocardial bridge in the territory of the LAD. He remained in good condition without recurrent anginal attacks after nifedipine was started before bedtime.

BACKGROUND: Tuberculosis remains a complicated problem. A lack of awareness accompanied by difficulty in diagnosis hinders the management of tuberculosis. Delayed management, particularly in osteoarticular regions, results in unnecessary procedures, including joint-sacrificing surgery.
METHODS: Three cases of subclinical ankle joint tuberculosis without clear signs of tuberculosis were presented. The efficacy of technetium-99m-ethambutol scintigraphy in diagnosing early-stage tuberculous arthritis is reported.
CONCLUSIONS: The reports suggested that scintigraphy is recommended to diagnose subclinical tuberculous arthritis, especially in tuberculosis endemic regions.

UNASSIGNED: Anomalous right coronary artery from pulmonary artery (ARCAPA) is a rare coronary anomaly. Adult patients usually present with few symptoms due to extensive collateral network from left coronary artery, with little/absent symptoms. Few data exist regarding surgical vs. conservative strategy for paucisymptomatic cases. Moreover, consensus is lacking.
UNASSIGNED: We describe the case of a 52-year-old male patient with undiagnosed ARCAPA, who acceded to our emergency department with suspected acute myocardial infarction and was discharged with medical therapy after demonstration of mild ischaemia at myocardial perfusion imaging with dipyridamole and bicycle exercise test.
UNASSIGNED: The patient completed 2-year event-free follow up. After complete imaging assessment and thorough clinical evaluation, medical management could be regarded as valid alternative to surgery for paucisymptomatic ARCAPA patients with evidence of limited ischaemia.

There is only one previous report of canine goitrous hypothyroidism caused by iodine deficiency from 1986. The present case report describes the novel diagnostic methods and long-term outcomes of a dog diagnosed with goitrous hypothyroidism caused by iodine deficiency. A 4-year-old neutered, female Pomeranian dog presented with a cervical mass, lethargy, and inactivity. The dog had a history of eating home-cooked diets sold by a private seller for 1 year. The physical examination and ultrasonography showed two bilaterally symmetric masses in the mid-cervical area (left, 1.8 × 1.4 cm; right, 2.3 × 1.8 cm), and they were suspected to be the thyroid glands. To identify the function of the thyroid gland, the basal concentrations of thyroid hormones [total T4 (tT4) and thyroid-stimulating hormone (TSH)] were measured and a TSH stimulation test was performed: baseline tT4, 0.5 μg/dL (reference interval, 1-4 μg/dL), baseline TSH, 0.81 μg/dL (reference interval, 0.05-0.42 μg/dL), and post-tT4, 1 μg/dL (6 h after the injection of TSH). The values indicated primary hypothyroidism. The urinary iodine concentration was 302 μg/L, which was markedly lower than that of normal dogs (1,289 μg/L). Thyroid scintigraphy with technetium-99m pertechnetate was also performed to quantify the activity of the thyroid gland, and the thyroid-to-salivary ratio was 3.35. Based on the results of these examinations and patient history, the dog was diagnosed with diet-induced (iodine deficiency) goitrous hypothyroidism. The dog was treated with iodine (62.5 μg/day). At 31 days after treatment, clinical signs and thyroid hormones were normalized (tT4, 1.3 μg/dL; TSH, 0.24 μg/dL). One year after treatment, the dog was well with normal concentrations of thyroid hormones (tT4, 1.8 μg/dL; TSH, 0.27 μg/dL) and a partially reduced goiter (left, 1.6 × 1.1 cm; right, 1.2 × 0.9 cm). This is the first case to describe novel diagnostic methods and long-term outcomes of a dog diagnosed with goitrous hypothyroidism caused by iodine deficiency.

Calcinosis of soft tissue is a rare but known complication of dermatomyositis (DM), mostly associated with juvenile DM and rare in adult DM. Bone scan with Tc-99m Methylene diphosphonate is useful in disease mapping and has high sensitivity to know the extent of calcinosis. However, there is scanty literature available on the utility of bone scan in treatment response evaluation in DM. Rituximab has been found useful in adult DM with calcinosis unresponsive to conventional treatment. We describe an interesting case showing partial response to rituximab on bone scan with single-photon emission tomography-computed tomography.

BACKGROUND: Primary hepatic neuroendocrine neoplasm (NEN) is a rare condition, and it is difficult to differentiate between primary and metastatic hepatic NENs. Herein, we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.
METHODS: A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass, suspected to be a hemangioma. Since then, regular follow-up had been carried out. Ten years later, she was referred to our institute due to the tumor (located in segment 4) having increased to 20 mm. Several imaging studies depicted no apparent extrahepatic lesion. Positron emission tomography (PET)/computed tomography exhibited significant accumulation in the mass lesion, which made us consider the possibility of malignancy. Left hepatectomy was performed. The histopathological diagnosis was neuroendocrine tumor grade 2, with somatostatin receptor 2a/5 positivity. Postoperative somatostatin receptor scintigraphy (SRS) showed no other site, leading to the diagnosis of NEN of primary hepatic origin. The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.
CONCLUSIONS: In this case, positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

BACKGROUND: Hypertrophic osteoarthropathy (HOA) is a rare clinical condition including an abnormal periosteal reaction in the long bones that causes painful swelling and tenderness of the extremities, digital clubbing, arthritis, synovitis, and joint effusions. Most cases are associated with tumorous conditions and most commonly with lung cancer. HOA has been rarely reported in association with other cancers.
METHODS: A patient with a history of recurrent renal cell carcinoma was referred to our clinic with bilateral leg pain, knee joint effusion, and arthritis. Simple radiography and bone scintigraphy confirmed a diagnosis of HOA. Oral non-steroidal anti-inflammatory drugs, joint fluid aspiration, and intra-articular injection of pain medications were found to be effective in the management of HOA pain.
CONCLUSIONS: HOA prognosis depends on the underlying disease, therefore, cancer treatment is critical. This case demonstrates the need to consider HOA in patients with various malignancies who present with bone or joint pain of the extremities.