Evaluation Of Disease Extension Research Articles

Giant Wilms tumor in a child: Safe radical nephrectomy

Abstract Wilms tumor is the second most common intraabdominal malignancy, and the most common malignant renal tumor in the pediatric age group, accounting for more than 95% of all renal tumors in children. In the last few decades, a significant improvement has been reported in the prognosis of patients with Wilms tumors due to adopting a multidisciplinary treatment approach consisting of surgery, chemotherapy and radiotherapy based on results of sequential trials. Regardless the kind of protocol followed to treat children with Wilms tumor, surgery remains an essential and fundamental step in the overall management. Well performed surgeries following rules of safe tumor excision, evaluation of disease extension and lymph nodes sampling will determine the accurate stage of the disease and decide future therapy. Although Wilms tumors can often grow to very large sizes at time of detection, most are resectable and radical nephrectomy should almost be the initial therapeutic option unless there are indications of delayed resection. We present a giant right sided Wilms tumor that developed in a 16 months old female, where surgical excision was attempted as the initial therapeutic option and discuss the preoperative evaluation, intraoperative details and immediate postoperative outcome.

Imaging musculoskeletal soft tissue infections

Musculoskeletal soft tissue infections are not uncommonly encountered in both the clinic and Emergency Department setting. The clinical diagnosis is not always evident as these infections can have variable presentations depending on the duration and depth of disease extension through the soft-tissue layers. Imaging often plays an important role in diagnosing the infection, defining the extent of involvement, directing tissue sampling, and in monitoring treatment response. After initial radiographs, ultrasound (US) is often the next modality utilized to evaluate patients with suspected soft tissue infections given its low cost, availability, portability, and potential for real-time guidance of fluid aspiration. The widespread use of cross-sectional imaging with magnetic resonance imaging (MRI) and computed tomography (CT) has greatly increased the radiological diagnosis in conditions where US may be limited. In addition, CT and MRI allow a thorough evaluation of disease extension, including assessment of joint spaces, tendons, and osseous changes indicative of bone involvement. This review will focus on the radiological findings of soft tissue infections on US, CT, and MRI.

Investigating the small bowel in pediatric Crohn's disease: Prospective comparative study between small intestine contrast ultrasonography and magnetic resonance imaging

Background: Magnetic resonance imaging (MRI) is considered the gold-standard to evaluate SB in pediatric Crohn’s disease (CD). However, MRI is expensive, requires a strong compliance and a considerable amount of oral contrast to distend intestinal lumen. Small intestine contrast ultrasonography (SICUS) is non-invasive, low cost and generally well tolerated by patients. Objectives: To compare the diagnostic accuracy of SICUS and MRI in detecting presence, site and extension of SB disease and in assessing strictures in pediatric CD. Methods: Pediatric pts with suspected or known CD were prospectively enrolled. All underwent SICUS, MRI and ileocolonoscopy, performed by blind different operators. The SB was subdivided into: jejunum, ileum, terminal ileum (TI). The statistic concordance (k) between the two techniques was calculated. For the TI sensitivity (SE) and specificity (SP) were also assessed, with endoscopy as reference standard. The one-way ANOVA was used to compare the disease extension (cm) in the different segments. Results:66 consecutive patientswere included. The overall k for the presence of lesions was=0.94 (ES 0.06; 95%CI 0.8–1. The k for segments was 0.67 (jejunum), 0.91 (ileum) and 0.91 (TI). SE and SP (%) of SICUS andMRI for TI lesions were 98, 100 and 93, 92, respectively. There was no difference (p ns) in the evaluation of disease extension between the two techniques. The k for SB strictures was 0.62. SE and SP (%) of SICUS andMRI for TI strictures were 100, 100 and 92, 87, respectively. MRI provided 7 false positive results. Conclusions: The diagnostic performance of SICUS is comparable to that ofMRI. SICUSmight represent afirst-line tool in pediatric CD, able to reduce costs and to post-pone or even avoid more invasive investigations.

Paget Cells in Endometrial and Endocervical Curettings in a Patient With Recurrent Vulvar Paget’s Disease

Paget's disease of the vulva is a rare malignancy primarily affecting Caucasian women in their seventh to eighth decades. Most patients experience an indolent disease course and undergo surgical excision for disease control. Although progression to invasive adenocarcinoma is rare, recurrence is common because of the difficulty of achieving negative surgical margins. We report a case of a 73-year-old woman with a long-standing history of recurrent vulvar Paget's disease who presented with postmenopausal bleeding. Workup revealed extensive endocervical involvement by Paget's disease, resulting in Paget cells on endocervical curettage, as well as endometrial curettage (because of cervical contamination). Extensive endocervical involvement by vulvar Paget's disease can occur despite multiple reexcisions and topical therapy. The presence of Paget cells on endometrial and endocervical curettings, particularly in patients without visible vulvar or cervical lesions, should raise suspicion of endocervical involvement and prompt further evaluation of disease extension.

HE4 combined with MDCT imaging is a good marker in the evaluation of disease extension in advanced epithelial ovarian carcinoma

The purpose of the study was to evaluate the expression of the biomarkers CA125 and HE4 combined with imaging, in patients with advanced epithelial ovarian cancer (EOC). Forty-six women with EOC were included in the study all affected with peritoneal carcinomatosis. Twenty-two of 46 patients (group I) had peritoneal carcinomatosis with small implants in single or in multiple sites (score 1); 24/46 patients (group II) had macro-nodular implants and omental thickening (score 2). High levels of CA125 (350 ± 11, mean ± SEM) have been observed in 21/22 patients of group I, and a similar value (370 ± 13) has been observed in all patients belonging to group II. HE4 positivity values (350 ± 9) have been observed in all group I patients, whereas all patients belonging to group II showed a higher value of HE4 (600 ± 12). Statistically significant differences were observed between the HE4 levels observed in group I patients in comparison with group II patients (p < 0.0001). In addition, we expressed the extension of lymph nodal disease in three scores: L1-L2-L3, and a statistically significant correlation was observed between high HE4 levels and severity of lymph nodal disease L3 (p < 0.0001). The availability of biomarkers, particularly HE4, together with sophisticated imaging techniques, strengthens the clinical relevance of this study, for the follow-up of patients with peritoneal carcinomatosis.