Pancytopenia refers to the simultaneous reduction of all peripheral blood cell lines and is a hematologic finding often indicative of severe and potentially life-threatening disease. Although usually not associated, hypocalcemia and pancytopenia may co-occur, suggesting a common etiology. We report a case of a caucasian woman in her late 50s with asthenia, paraesthesia and nausea. Laboratory results showed severe hypocalcemia, anemia, elevated alkaline phosphatase and lactate dehydrogenase. A computed tomography scan revealed extensive osteosclerosis, suggesting osteoblastic metastasis. Progression to pancytopenia prompted bone marrow evaluation, ultimately leading to the diagnosis of signet-ring cell gastric adenocarcinoma. Unfortunately, the patient died shortly after diagnosis. This case illustrates a rare presentation of gastric adenocarcinoma, featuring hypocalcemia due to osteoblastic metastases and pancytopenia from bone marrow infiltration - an association infrequently reported in the literature - and emphasizes that this unusual constellation of findings may be the first clue to an otherwise unsuspected solid malignancy.

A 72-year-old man with castration-resistant prostate adenocarcinoma underwent 68Ga-PSMA-11 PET/CT for restaging due to significantly increased PSA levels during chemotherapy. Imaging revealed high 68Ga-PSMA-11 uptake in bilateral adrenal uptake, with additional uptake in the prostate and few sclerotic bone lesions. MRI and afterwards adrenal gland biopsy confirmed adrenal metastases, an uncommon metastatic site. As the patient was oligometastatic, refractory to previous systemic therapies, and ineligible for surgery or radiotherapy, 177Lu-PSMA-617 radioligand therapy was initiated. After four treatment cycles, PSA levels progressively decreased, and post-therapeutic follow-up SPECT/CT demonstrated a near-complete response in adrenal and bone metastases without treatment-related adverse effects.

A 65-year-old woman with a 10-year history of right breast cancer underwent mastectomy and chemoradiotherapy. Five years later, left supraclavicular lymph node metastases prompted further chemoradiotherapy. She recently developed new right cervical lymph node metastases and left supraclavicular ulcer, referred for 99mTc-FAPI-46 imaging in a clinical trial. The whole body imaging demonstrated a focal uptake at the left thoracic inlet corresponded on CT to geographic osteolysis with irregular sclerotic margins at the medial end of the left clavicle, consistent with postradiotherapy osteonecrosis. This case emphasizes recognizing nonmalignant 99mTc-FAPI uptake, to avoid misinterpretation as metastatic disease.

A 3-year-old quarter horse cross mare was presented to the Atlantic Veterinary College (Charlottetown, Prince Edward Island) for evaluation of a persistent draining tract on the ventral aspect of the left mandible, associated with a previous fracture. Radiography and ultrasonography confirmed the presence of a chronic sequestrum separated from the parent bone. Sequestrectomy and surgical debridement of the mandible were carried out, and the horse was discharged. Three months later, the mare was presented again to the Atlantic Veterinary College, as the draining tract had not resolved. A CT scan of the mare's skull revealed infection of Tooth 310. The tooth was surgically removed. The animal was discharged, and clinical signs were resolved at the 1-month recheck examination. Key clinical message: The importance of CT in diagnosing tooth involvement secondary to a mandibular fracture is described. In addition, the growing prevalence of antibiotic resistance to trimethoprim-sulfamethoxazole due to prolonged use and frequent usage in equine practice is highlighted.

A current methodological challenge in radiation epidemiology is to account for dose uncertainty in risk estimation. An important preliminary step can be to identify the most influential input parameters involved in dose estimation, before modelling and accounting for their related uncertainty in radiation-induced health risk estimates. In this work, a variance-based global sensitivity analysis (GSA) was performed with Shapley effects and, for the first time in radiation dosimetry, to rank by influence the input parameters of a software conventionally used to estimate organ doses arising from computed tomography (CT) scan exposure: NCICT (National Cancer Institute Dosimetry System for CT) (version 1.0). We focused on brain and red bone marrow (RBM) dose estimation in the French CT cohort and our GSA was performed for three types of examination, classified according to the scanned body region: head, chest, and abdominopelvic. Among the eight uncertain input parameters involved in dose estimation, different influential parameters were highlighted depending on both the scan type and the considered organ dose: these are consistent with the underlying dose calculation methodology. For head CT examinations, technical parameters used for image acquisition including x-ray tube current-time product (mAs) and tube potential (kVp), as well as the end of the scanned body area contributed to about 70% of the variance of the brain dose estimate, while mAs, kVp, the start and end of the scanned body area, and age influenced the RBM dose. The brain and RBM doses delivered during chest CT examinations were mainly influenced by mAs, pitch, and kVp. Finally, kVp was the only input parameter with a significant influence on both the RBM and the brain dose for abdominopelvic CT examinations: it explained more than 30% of the variance of these organ doses. From a clinical perspective, our findings may support optimization of pediatric CT protocols.

Adult-onset Still's disease (AOSD) is a rare autoinflammatory disease, the clinical manifestations of which often overlap with other diseases such as lymphoma. This overlap makes differential diagnosis difficult, especially in patients with generalized lymphadenopathy, splenomegaly, and systemic metabolic hyperactivity. In this article, we discuss a 53-year-old East Asian (Chinese) female patient who had a fever, transient rash, generalized lymphadenopathy, and splenomegaly. An 18F-FDG PET/CT scan showed diffuse hypermetabolism in multiple lymph nodes, her spleen, and her bone marrow, and her serum ferritin level was elevated at 15,485 ng/mL, leading to strong suspicion of lymphoma. However, an excisional biopsy of the right inguinal lymph nodes with pathological, immunohistochemical, and T-cell receptor gene rearrangement analyses showed no evidence of clonality or lymphoma. Given the typical clinical presentation and laboratory findings, the patient was diagnosed with AOSD according to the Yamaguchi classification criteria. Glucocorticoid therapy rapidly normalized the patient's temperature, the rash disappeared, her lymph nodes decreased in size, and her ferritin and inflammation levels significantly decreased, suggesting a good therapeutic response. This case illustrates the value of lymph node biopsy in AOSD with "lymphoma-like" imaging features. Moreover, ferritin is a critical biomarker and is crucial for early identification of such difficult cases.