INTRODUCTION: Mass lesions in the pancreatic tail are increasingly identified upon radiological imaging. However the diagnosis of these lesions can be challenging and impact significantly upon patient management. PRESENTATION OF CASE: We report a case of an intrapancreatic accessory spleen initially diagnosed as a neuroendocrine tumour of the pancreas tail following nuclear scintigraphy. DISCUSSION: The investigation of solitary pancreatic tail lesions and the potential management paradigms are discussed. CONCLUSION: Solitary lesions within the pancreatic tail should have splenunculus included in the differential diagnosis. (C) 2019 Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd.

Introduction: Outcomes with CHOP in the first-line treatment of PTCL are poor and a superior regimen is required. Gemcitabine is not effluxed by the multidrug resistance gene-1/P glycoprotein (expressed in ~60% of PTCLs) and has demonstrated efficacy in relapsed/refractory PTCL both as a single agent and in combination. Methods: We conducted a phase II multicenter randomised trial for previously untreated patients ≥18 years with bulky stage I- IV PTCL of the following subtypes: PTCL not otherwise specified (PTCL NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL) ALK negative, enteropathy-associated T-cell lymphoma (EATL), and hepatosplenic gamma delta T-cell lymphoma. The trial was funded by Bloodwise. Patients were randomised (stratified by subtype and IPI) to receive either 6 cycles of intravenous (IV) cyclophosphamide 750 mg/m2, doxorubicin 50 mg/m2, vincristine 1.4 mg/m2 on D1 and oral (PO) prednisolone 100 mg once daily (OD) D1-5 (CHOP) every 21 days (Arm A) or 4 cycles of gemcitabine 1000 mg/m2 IV D 1, 8 and 15, cisplatin 100 mg/m2 IV on D15 and methylprednisolone 1000 mg (IV/PO) OD on D1-5 (GEM-P) every 28 days (Arm B). The primary endpoint was a comparison of end of treatment (EOT) complete response (CR)/CR unconfirmed (CRu) rates assessed by CT using IWG 1999 criteria. The CR/CRu rate was expected to be 50% in Arm A and increased to 70% in Arm B; 93 patients were required per arm to detect this difference with 80% power and 2-sided alpha of 5%. Results: From March 2012 to November 2016, 87 patients were accrued from 47 sites (U.K. n = 46, Australia n = 1). The trial profile is shown in Figure 1. On 22.11.2016 the independent data monitoring committee recommended the trial should close early as the primary endpoint would not be met. Baseline characteristics are shown in Table 1. EOT response is currently evaluable for n = 72, CR/CRu Arm A = 57.1% and Arm B = 43.2% (p = 0.24). Overall rates of grade ≥ 3 toxicity were similar between arms, 67.0% vs 73.0% (p = 0.64); however more ≥3 grade neutropenia (p = 0.036) and febrile neutropenia (p = 0.03) were seen in Arm A; while Arm B had more ≥3 grade thrombocytopenia (p = 0.03). At a median follow-up of 18.1 months, there was no difference in 2-yr overall survival (Arm A = 53.1%, Arm B = 64.7%, p = 0.56) or progression-free survival (Arm A = 36.0%, Arm B = 39.0%, p = 0.81). Conclusion: The EOT CR/CRu rate in Arm B (GEM-P) was not superior to Arm A (CHOP), and Arm B was associated with higher rates of study withdrawal. CHOP remains the reference regimen in PTCL. Keywords: Chemotherapy; gemcitabine; peripheral T-cell lymphomas (PTCL).

Introduction: The evidence base for positron emission tomography/computed tomography (PET/CT) (PET) in PTCL comes from retrospective studies. Herein, we report the initial results of a PET substudy within a prospective trial for patients with previously untreated PTCL. Methods: The UK NCRI phase II randomised multicenter CHEMO-T trial compared the regimens of cyclophosphamide, doxorubicin, vincristine and prednisolone (CHOP) with gemcitabine, cisplatin and methylprednisolone (GEM-P) in previously untreated patients aged ≥18 years with stage I (bulky)–IV disease of the following subtypes: PTCL not otherwise specified (PTCL NOS), angioimmunoblastic T-cell lymphoma (AITL), anaplastic large cell lymphoma (ALCL) ALK negative, enteropathy-associated T-cell lymphoma (EATL) and hepatosplenic gamma delta T-cell lymphoma. In November 2016, the study closed early to recruitment due to an inferior complete response (CR/CRu) rate at end of treatment (EOT) by CT in the GEM-P arm compared to the CHOP arm. All patients had baseline (BL) and EOT PETs performed in accordance with the study protocol. The primary study endpoint was to compare the CR/CRu rate by contrast-enhanced CT at EOT between arms according to the IWG 1999 criteria. Secondary endpoints included a comparison of EOT response by CT versus PET. All PET scans were centrally reviewed while blinded to the patient's clinical status. The following parameters were assessed at BL and EOT: Deauville score (DS), mean, max and peak standardized uptake values (SUVs) and metabolic tumour volume (MTV). At EOT, a DS of 1–2 by PET was negative, a DS of 3–5 was positive. For patients with biopsy-proven bone marrow (BM) involvement at randomisation, PET at BL was reviewed to assess for BM FDG avidity. In an exploratory analysis, PET scores at BL (DS, max/mean/peak SUVs and MTV) were associated with overall response (ORR) by PET. Results: BL central PET review has been completed for 58 (PTCL NOS n = 23, AITL = 25, ALCL ALK negative n = 10) of the 87 patients accrued at time of study closure. All patients had FDG-avid disease at BL (DS = 3 5.2%, DS = 4 28.6%, DS = 5 67.2%). For patients with BM involvement at BL and an evaluable PET (n = 19), 7 (36.8%) had BM uptake on PET. EOT PET response has been completed for 41/87 patients, with DS as follows: 1–2 = 78.1%, 3 = 7.3% and 4–5 = 14.6%. ORR by PET was 80.4% (CR = 56.9%, PR = 23.5%). The proportion of agreement in determination of CR versus PR/SD/PD between PET and CT is shown in Table 1. MTV at BL was the best predictor of response on EOT PET. Conclusion: All PTCL subtypes evaluated to date were FDG avid at BL. In PTCL, PET does not appear to be a sensitive tool for determination of BM infiltration. In the determination of CR the proportion of agreement between EOT CT and PET was 80.4%. In an exploratory analysis, MTV at BL was the score most associated with ORR by PET. The updated complete analysis (N = 87) including correlation of PET scores at BL and PET response with survival will be presented at the meeting. Keywords: peripheral T-cell lymphomas (PTCL); positron emission tomography (PET).

This study evaluated the ability of 18F-FDG PET/CT imaging to predict early response to 90Y-radioembolization in comparison with contrast-enhanced CT (CECT) using RECIST and lesion density (Choi) criteria. Progression-free survival (PFS) in patients with liver metastases at 2 years and decline in tumour markers were the primary end-points of the study.

Aim The purpose of the present paper was to review the literature over the last 30 years to assess the value of radionuclide imaging, particularly labeled leukocyte scan, as compared to other imaging modalities in the management of abdominal abscesses. Methods A systematic review of the published studies in humans cited in PubMed written in English, French, German, Italian, and Spanish was made. Results Ultrasound (US) has lower sensitivity than leukocyte scan (LS), particularly in patients without localizing signs, while CT has higher sensitivity than US, but less than LS. On the other hand, CT had higher specificity than both LS and US. Discussion LS is the more sensitive method to localize abdominal abscesses and may guide dedicated US and CT investigations to improve their diagnostic potential. Further diagnostic evolution is expected from the routine use of hybrid SPECT/CT systems.