Adjacent Organ Involvement Research Articles

Comparison of Imaging Findings between Granulomatosis with Polyangiitis and Eosinophilic Granulomatosis with Polyangiitis on Sinus CT: Importance of High-Density Opacification of the Paranasal Sinuses.

Granulomatosis with polyangiitis (GPA) and eosinophilic granulomatosis with polyangiitis (EGPA) are the most common causes of chronic sinusitis from systemic granulomatous diseases. While both are small- to medium-sized vasculitis with necrotizing granulomas, they have different clinical courses and prognoses. High-density sinus opacification has been reported in allergic fungal sinusitis with eosinophilic infiltrates. Given that EGPA also has eosinophilic tissue infiltrates, we evaluated the differences in sinus CT findings, focusing on the sinus secretion attenuation between patients with GPA and EGPA, along with other previously described findings. This study included 31 patients with GPA and 22 patients with EGPA who underwent sinus CT. The attenuation of secretions within the paranasal sinuses was visually assessed, and the Hounsfield unit (HU) of the highest-density portions within each sinus was measured. Lund-Mackay scores (LMS), bony destruction, sclerotic wall changes, adjacent organ involvement, and nasal polyps were evaluated and compared between patients with GPA and EGPA. Multiple logistic regression analyses were conducted to determine which factors independently discriminated GPA from EGPA, and the diagnostic ability to differentiate between these 2 diseases was evaluated by using a receiver operating characteristic curve analysis. More patients in the GPA group showed bony destructions, bone sclerosis, and involvement of organs adjacent to paranasal sinuses than in the EGPA group (P = .006, 0.048, and 0.035, respectively). The EGPA group had higher LMS and more nasal polyps than the GPA group (P = .078 and 0.333, respectively). More patients in the EGPA group showed internal high-density opacification than in the GPA group, and patients with EGPA had higher mean HUs (both P < .0001). The presence of high-density opacification or mean HUs independently distinguished GPA from EGPA (OR, 53.67 and 1.07; 95% CI, 4.07-708.03 and 1.02-1.13, respectively) and showed a greater ability to discriminate between these diseases compared with other findings. Patients with EGPA had more high-density sinus opacification and higher mean HU on sinus CT than the patients with GPA. In addition to the previously reported CT findings, such as bony destruction, bone sclerosis, and adjacent organ involvement, evaluating secretion attenuation can assist in distinguishing between GPA and EGPA.

The Role of CT in Differentiating the Non Pediatric Renal and Adrenal Region Fatty Masses

Abstract Background CT is indicated in many abdominal conditions because of its excellent morphological resolution and its ability to image many different structures, such as abdominal viscera, pelvic organs, lungs and bones, with a single examination. Aim of the Work The aim of this study is to highlight the accuracy of multi-detector computed tomography scan in diagnosing the different fatty lesions of the renal and adrenal regions by comparing the CT study of the benign lesions with their follow up CT scan and comparing the CT study of the malignant cases with their histo-pathological results. Patients and Methods The study was conducted on 34 patients most of them had unrelated complaints(incidental findings) and were referred to Radiology department, Theodor Bilharz Research Institute. Their age ranged from 20 years to 81 years old (mean age 56.35 years±13.61). Most of the patients were males 21cases while female were 13 cases. The patients were referred from oncology, general surgery, and urology departments of Theodor Bilharz Research Institute hospital as well as the outpatient clinics to perform MDCT in the period from September 2021 to June 2022. Results MDCT examinations were done for 34 patients and concluded that MDCT should be used in the first place in the course of diagnostic procedures of patients with renal and adrenal region fatty lesions and this was justified by an overall diagnostic accuracy of 100% for benign lesions and 82% for malignant lesions, where MDCT could correctly diagnose (33/34) cases and only 1 case was misdiagnosed, confirming the ability of MDCT to show up the accurate diagnosis, the exact location, extent of tumor, along with involvement of adjacent organs and vessels. Conclusion It also has a high accuracy in differentiation of malignant from benign lesions and detection of lymph node involvement &amp; metastasis. There by improving the prognosis.

International Endometrial Tumor Analysis (IETA) descriptors in the diagnosis of chronic endometritis

Objective: to compare the terms, definitions and measurement methods developed by the IETA group with the ultrasound criteria of chronic endometritis (CE) used in Russia.Material and methods. A retrospective cohort study of 158 reproductive age women with clinical and laboratory diagnosis of CE was carried out. Sonographic examination was performed in the early or middle proliferative phase (cycle day 4–10 days) with the use of Affiniti70 ultrasound system (Philips, the Netherlands) with a multifrequency 3D endocavitary probe. Uterine corpus volume, endometrial thickness and volume were measured, followed by percentage endometrial/uterine volume ratio calculation, the so-called adjusted endometrial volume. Qualitative analysis of grayscale imaging included assessment of endometrial structure and echogenicity; closure or separation of the endometrial layers; contour of endometrial midline; the presence of acoustic artifacts, such as reverberation in the presence of gas or liquid in the uterine cavity, described by a number of authors. Relevant IETA descriptions were searched when assessing all qualitative CE features. In parallel, a qualitative score analysis proposed by the IETA group was carried out.Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.Results. The comparative analysis of endometrium description in CE indicates a similar measurement technique for endometrial and intrauterine lesions thickness, both proposed by the IETA group and used in our country. Most of the IETA descriptors for qualitative ultrasound findings may be used in CE diagnosis. However, there are no some significant ultrasound features for identifying the inflammation, such as marked and partially or completely thickened midline, as well as gas focuses within the endometrium or in the uterine cavity, in IETA description.Conclusion. Terminology standardization allows compare the results and perform multicenter studies followed by meta-analysis for the diagnosis of chronic endometritis, if researchers use the similar descriptors.

Ultrasound image of ovarian endometrioma as an indicator of external genital endometriosis

Timely preoperative diagnosis of endometrioic cyst (endometrioma), as well as deep endometriosis remains relevant. The aim of the study was to assess the diagnostic value of ultrasound in patients with endometriomas and assess the combination of them with other foci of external genital endometriosis. The study based on retrospective analysis of a date of 95 patients with ultrasound signs of ovarian endometriomas, who underwent examination in MedicoProfi LLC – Borisov Medical and Diagnostic Clinic (Krasnoyarsk) during the period from January 2019 to October 2023. All of patients underwent surgery , followed by morphological evaluation. In the vast majority of cases, it was possible to detect a combination of endometriomas with one or more foci of deep endometriosis. Superficial peritoneal endometriosis and adhesions were found on surgery in all cases when endometriomas appeared isolated on ultrasound. The results of the study showed: endometriomas combined with deep endometriosis in 96.8% of cases. Thus, ultrasound detection of endometrioma is a very reliable sign of deep endometriosis presence. The “kissing ovaries” symptom in bilateral endometriomas can be considered as an absolutely reliable sign of the uterosacral ligaments endometriosis with specificity of 100% and positive predictive value of 100%. The presence of the “kissing ovaries” sign should be depicted in the conclusion of the ultrasound protocol, since it highly suggestive to obliteration of the pouch of Douglas and involvement of adjacent organs (fallopian tubes, intestines, ureters, etc.) in the endometrioid infiltrates, which is extremely important for the surgery planning, as well as in patients with infertility. There is an obvious need to introduce the extended pelvic ultrasound protocol to the diagnostic algorithm for patients with suspected endometriosis, which will more accurately describe the disease extension.

When to MRI

MRI is a non-invasive second line tool which can make a valuable contribution to the diagnosis and pre surgical mapping of pelvic endometriosis. It is validated and serves as an adjunct to high quality ultrasound. It has particular strengths in the mapping of complex obliterative deep cul de sac disease and adjacent organ involvement. It has high sensitivity and specificity in diagnosing pelvic endometriosis and can upstage the degree of endometriosis compared to diagnostic laparoscopy. The use of MRI for endometriosis in Australia has significantly increased in the last 5 years and there is growing national and international research occurring in this space. Access has also improved dramatically for patients since the allocation of $25m of funding to make available Medicare funding for MRI imaging of suspected significant endometriosis by the Federal Government in mid-2022. As clinician and community awareness of improved MRI access grows, it is even more important to have a working knowledge of the strengths and weaknesses of MRI for anyone involved in the diagnosis, workup, and management of patients with suspected or proven endometriosis.

Laparoscopic Transperitoneal Adrenalectomy for Adrenal Tumors in Children: Technical Considerations and Surgical Experience.

Aims: This study aimed to review our surgical experience of laparoscopic adrenalectomy (LA) for adrenal masses in the pediatric age group. Materials and Methods: The electronic medical records of all patients younger than 18 years of age who underwent LA between 2016 and 2023 were retrospectively reviewed. Children with adrenal tumors localized to the site of origin without evidence of encasement of major vasculature or involvement of adjacent organs were considered for LA. Patients with diagnosis of malignant adrenal tumor on preoperative work-up underwent open adrenalectomy. Data were collected regarding demography, clinical presentation, hormonal workup, imaging, duration of surgery, transfusion requirement, conversion rate, postoperative recovery, duration of intravenous (i.v.) analgesia and hospital stay, pathology, complications, and status at follow-up. Results: Between 2016 and 2023, LA adrenalectomy was performed in 11 patients (6 boys and 5 girls) with a mean age of 46.3 (8-120) months. A functional tumor was detected in 6 (54.5%) children, manifesting clinically with Cushing's syndrome (3), virilization (1), feminization (1), or Conn's syndrome (1). Seven (63.6%) tumors originated from the right adrenal, and 4 (36.4%) from the left adrenal gland. The mean tumor weight and size was 49.1 (10-80) g and 5.6 (3-8) cm, respectively. Histopathology included adrenal adenoma (5), ganglioneuroma (3), ganglioneuroblastoma (1), myelolipoma (1), and intermediate adrenocortical tumor (1). The mean surgery duration was 186.6 (120-265) minutes. Intraoperative blood transfusion was required in 2 (18.2%) patients and none required conversion. Full feeds were resumed at 42.7 (24-60) hours, i.v. analgesia requirement was for 54.5 (36-72) hours and mean hospital stay was 5.1 (3-8) days. All patients were symptom-free with no recurrence at mean follow-up period of 50.6 (3-83) months. Conclusions: In children with well-circumscribed, localized, and noninvasive adrenal tumors, LA is feasible, effective, and safe with all advantages of minimally invasive surgery.

The Role of Multiparametric MRI in the Local Staging of Prostate Cancer.

Prostate cancer ranks as the second most frequently diagnosed cancer globally among men and stands as the fifth leading cause of cancer-related death in males. Hence, an early and precise diagnosis and staging are critical. Traditional staging is based on clinical nomograms but presents a lower performance than prostate multiparametric magnetic resonance imaging (mpMRI). Since tumor staging serves as the basis for risk stratification, prognosis, and treatment decision-making, the primary objective of mpMRI is to distinguish between organ-confined and locally advanced diseases. Therefore, this imaging modality has emerged as the optimal selection for the local staging of prostate cancer, offering incremental value in evaluating pelvic nodal disease and bone involvement, and supplying supplementary insights regarding the precise location and disease extension. As per the Prostate Imaging Reporting & Data System v2.1 guideline, a comprehensive and accurate mpMRI requires several key sequences, which include T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) for morphological assessment, with T2WI serving as the cornerstone for local staging. Additionally, diffusion-weighted imaging (DWI) and dynamic sequences acquired with intravenous administration of paramagnetic contrast medium (DCE) are crucial components. It is worth noting that while MRI exhibits high specificity, its sensitivity in diagnosing extracapsular extension, seminal vesicle invasion, and lymph node metastases is limited. Moreover, mpMRI has its own constraints and is not as effective in detecting distant metastases or evaluating lymph nodes, for which extended pelvic lymph node dissection remains the gold standard. This review aims to highlight the significance of mpMRI in prostate cancer staging and provide a practical approach to assessing extracapsular extension, seminal vesicle invasions, and the involvement of adjacent organs and lymph nodes.

The Predictive Value of Urinary Trypsinogen-2 Dipstick for Early Diagnosis of Acute Pancreatitis in Intensive Care

Abstract Background Acute pancreatitis is a sudden inflammation in the pancreas, with potential and variable involvement of adjacent organs or other organ systems. Aim of the Work to evaluate the rule of urinary trypsinogen-2 using dipstick test in the diagnosis of acute pancreatitis. Patients and Methods This cross-sectional study was carried out in surgical intensive care unit, Ain Shams University hospitals, during a period of 6 months. Forty five patients were included in our study, thirty patients were diagnosed as acute pancreatitis and fifteen patients weren’t diagnosed as acute pancreatitis through cross sectional study. All patients were subjected to full history taking, full clinical examination, laboratory investigations including serum levels of renal function tests, CBC, total and direct bilirubin, liver enzymes, alkaline phosphatase, INR, amylase and lipase. Urinary trypsinogen-2 dipstick test was done. Also, radiological examinations were done using ultrasonography of abdomen and pelvis, computed tomography of the abdomen. Results The most common cause of acute pancreatitis was gall stone obstructive pancreatitis (70%) and we found that serum amylase and lipase were elevated in (83.3% and 86.7% respectively) in acute pancreatitis patients. While the sensitivity of urinary trypsinogen-2 dipstick test was 93.3% in acute pancreatitis patients. The specificity of serum amylase, serum lipase was 73.3% for both of them, while the specificity of urinary trypsinogen-2 was 100% in diagnosis of acute pancreatitis. Conclusion In-conclusion urinary trypsinogen-2 dipstick test is a promising low cost, bed side and easy test to be done in the diagnosis of acute pancreatitis.

Isolated Duodenal Perforation at D3 Following Blunt Abdominal Trauma, a Challenging Diagnosis and Management: A Case Report

Introduction: Isolated duodenal rupture following blunt abdominal trauma is rare. We here report a case of isolated duodenal perforation treated by suture, pyloric exclusion and side-to-side gastrojejunostomy in order to discuss its diagnostic, therapeutic, and evolutionary features. Observation: A 46-year-old man, victim of a physical aggression, consulted ten hours after the trauma for diffuse abdominal pain associated with vomiting. The physical examination revealed a febrile patient at 38.2°C, hemodynamically stable with generalized abdominal defense. The abdominal CT revealed parietal defect of the 3rd duodenum (D3), pneumoperitoneum, intra and retroperitoneal fluid effusion without adjacent organ involvement. The patient underwent emergency surgery. Intraoperatively, a centimetric perforation of D3 on the anterior wall was found. The lacerated edges were repaired with interrupted sutures. A pyloric exclusion and side- to-side gastrojejunostomy are performed. Postoperative course of patient was unremarkable. Isolated duodenal injuries are rares in blunt abdominal trauma because the duodenum is located in a deep anatomical position. Duodenal injuries secondary to blunt trauma can range in severity from intramural hematoma to a complete transection and devascularization of the duodenum. There is no consensus on the surgical procedure. Options range from primary suture to complex duodenopancreatic resections based on the severity of the lesions. Conclusion: Isolated duodenal trauma is unusual following blunt trauma. Prompt diagnosis and management is the key to prevent morbidity and mortality.

Retroperitoneal Liposarcoma: Rational Extent of Surgery Tailored to Grade of Malignancy.

This study was aimed at determining the indications for combined and organ-preserving operations. The study included 190 patients with retroperitoneal liposarcoma (RLPS). The influence of the following factors on the overall survival (OS) and recurrence-free survival (RFS) were studied: involvement of adjacent organs in the tumor, volume of surgical intervention. OS and RFS were worse in pathologically confirmed visceral invasion in the both RLPS low grade and high grade (p = 0.000). In RLPS low grade, there was no significant difference in OS and RFS between the group of patients who underwent combined surgery without confirmed visceral invasion and the group of patients who underwent organ-preserving surgery (p > 0.080). In RLPS high grade, OS and RFS were higher in the group of patients who underwent combined surgery without confirmed visceral invasion than in the group of patients who underwent organ-preserving surgery (p < 0.050). In RLPS low grade, it is advisable to perform organ-preserving operations, including nephrosaving operations. In RLPS high grade, the organ-preserving operations worsen long-term results and prognosis. Combined operations including nephrectomy are justified in RLPS high grade.

Replantation of solitary kidney in a patient with giant primary retroperitoneal sarcoma

Background. Surgery for non-organ malignant retroperitoneal tumors poses a serious challenge. Long-term asymptomatic course of the disease leads to a delayed diagnosis, when tumors can reach massive size with potential involvement of adjacent organs and critical structures. In most cases, nephrectomy is often required during resection of retroperitoneal sarcomas. Recently, there has been growing interest in nephronsaving surgery for large retroperitoneal tumors.Description of the clinical case. A 70-year-old patient was admitted to Irkutsk Regional Cancer Center with right-sided giant primary retroperitoneal tumor and grade 1 hydronephrosis of solitary right kidney. The patient underwent extended resection of primary retroperitoneal tumor with right-sided hemicolectomy and nephradrenalectomy. Extracorporeal resection of the solitary kidney was then performed. After obtaining negative kidney smears (imprints), the kidney was replanted in the pool of right iliac vessels. No complications were observed in the postoperative period. Histopathology examination revealed was welldifferentiated liposarcoma. On follow-up examination 38 months after surgery, there were no signs of local tumor recurrence, and renal function was satisfactory.Conclusion. Extracorporeal resection of the kidney with heterotopic replantation is an effective nephron-saving method in surgery for primary retroperitoneal sarcomas. The patient’s solitary kidney with primary retroperitoneal sarcoma is an absolute indication for kidney’s saving, including the use of transplant technologies.

CT and MR imaging features of mixed neuroendocrine–non-neuroendocrine neoplasm of the pancreas compared with pancreatic ductal adenocarcinoma and neuroendocrine tumor

ObjectiveThis study aimed to assess the computed tomography (CT) and magnetic resonance imaging (MRI) features of pancreatic mixed neuroendocrine–non-neuroendocrine neoplasm (MiNEN) and compare them with those of pancreatic ductal adenocarcinoma (PDAC) and neuroendocrine tumor (NET).MethodsTwelve patients with pancreatic MiNEN, 24 patients with PDAC, and 24 patients with NET, who underwent both contrast-enhanced CT and MRI, were included. Clinical data and the key imaging features were retrospectively evaluated by two independent readers and compared between MiNEN and PDAC or NET. Univariate and multivariable logistic regression analyses were performed to obtain predictors for pancreatic MiNEN.ResultsPatients with pancreatic MiNEN more frequently presented with large size and heterogeneous and cystic components compared with PDAC (p < 0.031) and ill-defined irregular margins, progressive enhancement, and adjacent organ involvement compared with NET (p < 0.036). However, vascular invasion was less commonly seen in MiNEN than PDAC (p = 0.010). Moderate enhancement was observed more frequently in MiNEN than in PDAC or NET (p < 0.001). Multivariate logistic analyses demonstrated that moderate enhancement and ill-defined irregular margin were the most valuable features for the prediction of pancreatic MiNEN (p ≤ 0.044). The combination of the two features resulted in a specificity of 93.8%, sensitivity of 83.3%, and accuracy of 91.7%.ConclusionsWe have mainly described the radiological findings of pancreatic MiNEN with ill-defined irregular margin and moderate enhancement compared with PDAC and NET. The combination of imaging features could improve diagnostic efficiency and help in the selection of the correct treatment method.

Serous Cystadenocarcinoma of Pancreas: A Rare Find

Abstract Introduction/Objective Pancreatic cystic neoplasms comprise 1-2% of pancreatic lesions and most of these lesions are cystadenomas. Serous cystadenocarcinoma is an extremely rare but known malignant condition described in the literature and the diagnosis is restricted to cases with distant metastasis of tumor beyond the pancreas. Per WHO, cytologic atypia, vascular, perineural, and adjacent organ and lymph node involvement by direct spread are insufficient for the diagnosis of serous cystadenocarcinoma. Methods/Case Report We report an interesting case of serous cystadenocarcinoma of pancreas in a 55-year-old male with medical history of prostate cancer was found to have a 15 cm mass pancreatic tail suspicious for neuroendocrine tumor and 5 small hepatic lesions suspicious for metastasis. The patient underwent subtotal pancreatectomy and splenectomy, and wedge resection of liver lesions. On gross examination, a yellow cystic mass was present in the pancreatic tail measuring 13.2 cm in the maximum dimension. H&amp;E slides from the pancreas and liver demonstrated a neoplasm composed of cystic and solid areas, within a background of fibrosis and focal hemorrhage. Cystic areas showed microcysts composed of cells with clear cytoplasm and round to oval bland nuclei. Solid areas demonstrated almost no microcysts but sheets and clusters of cells with clear to scant cytoplasm, oval to round nuclei, few areas of atypical hyperchromatic cells, and occasional mitosis. Very focal clusters and cords of neuroendocrine cells, constituting less than 5% of the tumor volume were also identified. Immunohistochemical stains demonstrated the neoplastic cells both in cystic and solid areas were positive for CK7, CK19, MUC6, and inhibin. Ki67 demonstrated an overall proliferation index of 3%. Chromogranin and synaptophysin were negative within the solid and cystic components of the tumor, however, showed positive staining within neuroendocrine foci. Neoplastic cells were negative for all other tested markers including beta-catenin, ER, Hep-par 1, HMB45, IMP3, MART-1, PAX-8, and trypsin. RB1 expression was retained within neoplastic cells. Results (if a Case Study enter NA) N/A. Conclusion The differentiation between benign and malignant serous cystadenoma both histologically and clinically may be very difficult as some cases of serous cystadenocarcinoma may not show overt cytologic atypia. The presence of metastasis, which most often occurs in the liver is required for the diagnosis of serous cystadenocarcinoma.

Diagnosis and treatment of splenic torsion in children: preoperative thrombocytosis predicts splenic infarction

BackgroundPediatric splenic torsion is a rare entity, and the most common cause is wandering spleen. This study aimed to summarize our clinical experience in the diagnosis and surgical treatment pediatric patients with splenic torsion, and to use preoperative thrombocytosis as a preoperative predictive factor for splenic infarction.MethodsFrom January 1st, 2016 to December 31st, 2021, 6 children diagnosed as splenic torsion were included. All patients were surgically treated and followed up. The clinical data was collected including clinical presentations, laboratory tests, imaging results, surgical procedures, and prognosis. Clinical experience of diagnosis and surgical treatment were summarized.ResultsThere were 4 females and 2 males, with median age at surgery 102.6 (range 9.4–170.7) months. Abdominal pain and abdominal mass were the most common presentations. The diagnosis of splenic torsion depended on imaging studies, and adjacent organ involvement (gastric and pancreas torsion) was observed on contrast CT in one patient. Five patients were diagnosed as torsion of wandering spleen, and one was torsion of wandering accessory spleen. Emergent laparoscopic or open splenectomy was performed in all patients. Pathology revealed total splenic infarction in 4 patients, partial infarction in 1 patient, and viable spleen with congestion and hemorrhage in 1 patient. Preoperative platelet counts were elevated in all 4 patients with splenic infarction, but normal in the rest 2 with viable spleen. Postoperative transient portal vein branch thromboembolism occurred in one patient.ConclusionsImaging modalities are crucial for the diagnosis of pediatric splenic torsion and adjacent organ involvement. Preoperative thrombocytosis may predict splenic infarction. Spleen preserving surgery should be seriously considered over splenectomy in patients with a viable spleen.

CT and MRI diagnostics of desmoid fibroids in familial colon adenomatosis

Objective: to study the features of CT and MRI diagnostics of desmoid fibroids (DF) in familial colon adenomatosis (SATC). Patients and methods: the study included 35 patients with desmoid fibroids (DF) in familial colon adenomatosis (SATC). All patients were examined using computed tomography (CT) and magnetic resonance imaging (MRI) with intravenous contrast. Localization, size, growth pattern, prevalence of DF, features of contrast and intensity of the MR signal on T2-VI and post-contrast T1-VI were evaluated. Twenty-five (71.4%) patients were observed in dynamics, including during systemic therapy. Results: in 21 (60.0 %) patients, a lesion of only one anatomical area was detected, and in 14 (40.0%) cases, a combined lesion of different anatomical zones was noted. In the majority of observations (33/35, 94.4 %) desmoid fibroids were detected in the mesentery and mesentery root of the small intestine, including with a combined lesion. The majority of patients (24/35, 68.6%) were diagnosed with a diffuse nodular form of growth; 13 (37.1%) had a nodular form and 6 (17.1%) had a diffuse form. Twenty-five patients (25/35, 71.4%) were repeatedly re-examined using CT (13/35, 37.1%) and MRI (12/35, 34.3%), in particular during systemic therapy. Conclusion: CT and MRI are the basic methods for detecting DF in SATC, allowing to determine the nature of tumor growth, to assess the prevalence of the tumor process and the degree of involvement of adjacent organs and structures. In dynamic observation and evaluation of the response of a desmoid tumor to systemic therapy, MRI has greater diagnostic capabilities compared to CT, since it takes into account not only the size of the desmoid, but also the intensity of the MR signal on T2-VI and the nature of the accumulation of contrast agent on post-contrast T1-VI with fat suppression.

Giant retroperitoneal well-differentiated liposarcoma presenting in emergency with intestinal occlusion: Case report and review of the literature.

Introduction and importanceLiposarcoma (LPS) represents the most common type of retroperitoneal sarcoma (RPS) and can be classified into four subtypes. Preoperative diagnosis of retroperitoneal liposarcoma (RLPS) is a challenge because of its late and nonspecific clinical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery represents a potentially curative treatment of RLPS.Case presentationA 55-year-old Caucasian female presented to the Emergency Department with a two-day history of abdominal pain, abdominal distension, inability to pass gas or stool, nausea, vomiting and lipothymia. Abdominal examination revealed abdominal distention, abdominal pain without obvious muscle guarding and a giant non-tender mass. Laboratory tests reported neutrophilic leukocytosis and anemia. Abdominal contrast-enhanced computed tomography (CECT) showed a heterogeneous and hypodense giant retroperitoneal mass compressing and displacing the surrounding organs and vessels. The patient underwent excision of a giant retroperitoneal mass. The postoperative course of the patient was uneventful.Clinical discussionRLPS is a malignant neoplasm that can slowly grow to enormous size with possible involvement of adjacent organs and vessels; it may recur locally and has a minimal capacity to metastasize. Preoperative diagnosis and staging of RLPS are important to establish appropriate management and prognosis. Surgery represents the gold standard for non-metastatic RLPS treatment.ConclusionRLPS is a rare malignant neoplasm generally difficult to detect early due to its late and nonspecific clinical presentation. CECT represents the most commonly used modality for diagnosis, staging and preoperative evaluation. Surgery represents the appropriate treatment of non-metastatic RLPS.

Colorectal cancer in an Eastern Caribbean nation: are we missing an opportunity for secondary prevention?

ABSTRACTObjective.To establish whether there was any difference in disease stage in patients with screening-detected colorectal cancer (CRC) in a Caribbean country.Methods.The mode of presentation (elective vs. emergent), method of diagnosis (screening vs. symptomatic), and disease stage were retrospectively compared in all consecutive patients who had resections for CRC over a five-year period. Early CRC was defined as disease that could be completely resected with no involvement of adjacent organs, lymph nodes, or distant sites. Locally advanced CRC was disease that involved contiguous organs without distant metastases that was still amenable to curative resection.Results.There were 97 patients at a mean age of 64.9 ± 12.2 years treated for CRC, and only 21 (21.6%) had their diagnoses made through screening. Significantly more screening-detected lesions were early-stage CRCs (21.7% vs. 9.3%; p < 0.001). At the time of diagnosis, patients who did not have screening-detected lesions had a greater proportion of locally advanced (42.3% vs. 0) and metastatic (26.8% vs. 0) CRC. Those who did not have screening-detected lesions had a greater incidence of emergency presentations at diagnosis (26.8% vs. 0).Conclusions.The incidence of screening-detected CRC in this Caribbean nation was low. Consequently, most patients presented with locally advanced or metastatic CRC, for which there is less opportunity to achieve a cure. Significantly more screening-detected lesions were early-stage CRCs. It is time for policymakers to develop a national CRC screening program.

MRI CORRELATION WITH CLINICAL STAGING AND HISTOPATHOLOGY FINDINGS IN CERVICAL CANCER

AIM AND OBJECTIVES:To correlate MRI findings with clinical findings based on FIGO staging and to evaluate the role of MRI in assessing extension of uterine cervical malignancy in reference to post surgery/staging laparoscopy histopathologic examination where ever available. MATERIAL AND METHODS: This retrospective observational study included 35 patients of histopathologically confirmed carcinoma cervix attending the SRMS Institute of Medical Sciences,Bareilly,UP,who underwent clinical staging and preoperative MRI for evaluation of disease extension between November 2019 to February 2022. RESULTS:the mean age observed was 57.43 ±11.03 years.There is strong percentage agreement between clinical and MRI findings for parametrial invasion, vaginal invasion, hydronephrosis, adjacent pelvic organ involvement and distant metastases with fair to moderate agreement with kappa coefficient except for pelvic side wall involvement in which there was only slight agreement. MRI shows high sensitivity, specificity, PPV and NPV of MRI in diagnosing disease extension in comparison to the histopathology findings. CONCLUSION: Carcinoma cervix is primarily staged clinically as per FIGO guidelines but MRI can modify clinical staging and treatment options. MRI is a reliable diagnostic tool for cervical cancer as it correlates strongly with histopathology

Comparative Study of Clinicopathological Features and Outcome of Standard Extended Cholecystectomy in Gall Bladder Cancer (GBC) with or without Adjacent Organ Involvement

Background: Curative surgery is the only treatment to increase the survival in GBC. Standard surgical procedure in resectable GBC is extended cholecystectomy. This study was done to compare the clinicopathological features and the outcome among patients who underwent standard extended cholecystectomy (EC) alone and those with EC and enbloc excision of surrounding structure (ECP) .

Triphase contrast-enhanced CT to evaluate indications for autologous liver transplantation\xa0in patients with end-stage hepatic alveolar echinococcosis

Autologous liver transplantation (ALT) to cure end-stage hepatic alveolar echinococcosis (HAE) requires that hepatobiliary surgeons understand the invasion of intrahepatic structure and adjacent tissues or organs. Triphase contrast-enhanced CT of the liver has been widely used for diagnosis and preoperative evaluation of HAE. Three-dimensional (3D) reconstruction allows for accurate measurement of remnant liver volume (RLV). The objective of the study was to evaluate value of triphase contrast-enhanced CT together with 3D reconstruction in preoperative evaluation of indications for ALT in patients with end-stage HAE. This cohort include twenty-one consecutive patients with end-stage HAE, who preoperatively underwent triphase enhanced CT together with 3D reconstruction for ALT. To depict the indications, the 2D image data were reviewed statistically focusing on porta hepatis invasion, retrohepatic vena cava (RHVC) involvement and degrees of intrahepatic vessel invasion, and the 3D reconstruction was performed to obtain ratio of RLV to standard liver volume (SLV). The results showed that 95.24% patients (20/21) had porta hepatis invasion. When lesions located in right liver lobe, porta hepatis invasion occurred most commonly in the second and third porta hepatis (7/10), whereas the first, second and third porta hepatis were most commonly invaded by lesions in the right and caudate / left medial liver lobes (7/11) (P < 0.05). The mean value of longitudinal invasion of RHVC was 8.0 cm, and 95.2% (20/21) of patients had RHVC invasion with ≥ 180° circumferential invasion. As for the important vascular events, moderate and severe invasion occurred most commonly in the right hepatic vein, right branch of portal vein and RHVC each in 95.2% (20/21) patients (P < 0.05). We also found that preoperative CT had a good agreement with intraoperative findings in assessing intrahepatic vascular involvement by HAE (kappa index = 0.77). The estimated average ratio of RLV to SLV was 0.95 (range, 0.43–1.62). In conclusion, the 2D contrast-enhanced CT could well depict anatomic location and size of HAE, and invasion of porta hepatis and vascular by this disease, and involvement of other adjacent organs and tissues. Above all, 3D reconstruction could accurately measure RLV in patients with end-stage HAE for ALT.