Necrotic stercoral colitis:Importance of computed tomography findings

AIM: To study the computed tomography (CT) signs in facilitating early diagnosis of necrotic stercoral colitis (NSC). METHODS: Ten patients with surgically and pathologically confirmed NSC were recruited from the Clinico-Pathologic-Radiologic conference at Chang Gung Memorial Hospital, Taoyuan, Taiwan. Their CT images and medical records were reviewed retrospectively to correlate CT findings with clinical presentation. RESULTS: All these ten elderly patients with a mean age of 77.1 years presented with acute abdomen at our Emergency Room. Nine of them were with systemic medical disease and 8 with chronic constipation. Seven were with leukocytosis, two with low-grade fever, two with peritoneal sign, and three with hypotensive shock. Only one patient was with radiographic detected abnormal gas. Except the crux of fecal impaction, the frequency of the CT signs of NSC were, proximal colon dilatation (20%), colon wall thickening (60%), dense mucosa (62.5%), mucosal sloughing (10%), perfusion defect (70%), pericolonic stranding (80%), abnormal gas (50%) with pneumo-mesocolon (40%) in them, pericolonic abscess (20%). The most sensitive signs in decreasing order were pericolonic stranding, perfusion defect, dense mucosal, detecting about 80%, 70%, and 62.5% of the cases, respectively. CONCLUSION: Awareness of NSC and familiarity with the CT diagnostic signs enable the differential diagnosis between NSC and benign stool impaction.

Primary lung cancer with radioiodine avidity: A thyroid cancer cohort study

BACKGROUND A proportion of lung cancers show sodium/iodide symporter(NIS)expression.Lung cancers with NIS expression may uptake radioiodine(RAI)and show RAIavid lesions on RAI scan for differentiated thyroid cancer(DTC)surveillance.AIM To investigate the possibility of RAI uptake by lung cancer in a cohort with thyroid cancer.METHODS RAI-avid lung cancers were analyzed using a prospectively maintained database of patients with thyroid cancer who were registered at a medical center between December 1,1976 and May 28,2018.NIS expression in lung cancer was assessed using immunohistochemical staining.RESULTS Of the 5000 patients with thyroid cancer from the studied dataset,4602 had DTC.During follow-up,33 patients developed primary lung cancer.Of these patients,nine received an iodine-131(131I)scan within 1 year before the diagnosis of lung cancer.One of these nine lung cancers was RAI-avid.NIS expression was evaluated,and three of the eight available lung cancers revealed NIS expression.The proportions of lung cancer cells with NIS expression were 60%,15%,and 10%.The RAI-avid lung cancer had the highest level of expression(60%).The RAI-avid lung cancer had a spiculated border upon single-photon emission computed tomography/computed tomography,which led to an accurate diagnosis.CONCLUSION A proportion of lung cancer demonstrates NIS expression and is RAI-avid.Clinicians should be aware of this possibility in the interpretation of RAI scintigraphy.