Evaluation of the relationships between computed tomography features, pathological findings, and rrognostic risk assessment in gastrointestinal stromal tumors

Objectives The aim of this study was to correlate computed tomography (CT) findings with pathology in gastrointestinal stromal tumors (GISTs). Methods A retrospective evaluation of CT images of 44 patients with GISTs was performed. Computed tomography findings analyzed were location, size, margins, degree and pattern of contrast enhancement, angiogenesis, necrosis, signs of invasion, peritoneal effusion, peritoneal implants, surface ulceration, and calcifications. Associations between CT features and mitotic rate, Miettinen classes of risk, lesions size, and among CT features were investigated. χ 2 Test and Fisher test were performed. Results Mitotic rate was associated with margins (P = 0.016) and with adjacent organ invasion (P = 0.043). Pattern of contrast enhancement (P = 0.002), angiogenesis (P = 0.006), necrosis (P = 0.006), invasion of adjacent organs (P = 0.011), and margins (P = 0.006) were associated with classes of risk. Several associations (P < 0.05) between lesion size and CT features and among all the investigated CT features were found. Conclusions Computed tomography features could reflect GIST biology being associated with the mitotic rate and with classes of risk

Impact of sarcopenia on outcomes after pancreatectomy for malignancy

Background: Sarcopenia, which is a subclinical loss of skeletal muscle mass as measured by cross-sectional imaging, is commonly observed in patients with malignancy. Few studies have examined the association between the presence of sarcopenia and outcome following surgery. The aim of this study is to evaluate the prevalence of sarcopenia and to investigate its impact on short- and long-term outcomes in patients who underwent pancreatectomy for malignancy. Materials and Methods: A retrospective review of a pancreatectomy database was performed. Skeletal muscle index (SMI) was measured on preoperative cross-sectional imaging in 144 patients undergoing pancreatectomy for cancer between 2007 and 2014. Sarcopenia was defined, according to the international consensus, as an SMI <52.4 cm2 /m2 and <38.9 cm2 /m2 for men and women respectively. The prevalence and impact of sarcopenia on morbidity, mortality, disease-free and overall survivals was assessed relative to other clinicopathological factors. Results: Mean age was 67.15 years and 51% was female. Pancreatic adenocarcinoma represents 66.7% of all cases. Pancreaticoduodenectomy was performed in 114 cases (79.2%). Margin status was R0 in 76.9%. Mean BMI was 24.85 Kg/m2 and mean SMI was 35,43 cm2 /m2 . One hundred and eight (74.5%) were sarcopenic, 37 (43.5%) were overweight/ obese and 43 (29.7%) were both (p = 0.041). Sarcopenia was significantly related to histology, sex, BMI and albumin. Overall morbidity and 90-days mortality were 50.7% and 9.1% respectively. The median follow up was 21 months. Overall and disease-free survival rate were 25,44 months and 11,84 months respectively. Sarcopenia was associated to a not statistically significant increased risk of overall morbidity, mortality and shorter disease- free and overall survivals after pancreatic surgery for cancer. Conclusions: Sarcopenia was found in 74.5% of cancer patients underwent pancreatectomy. It is an occult condition in overweight/obese patients but can be identified using CT scans. This condition, as defined by international consensus, is not associated with worse short-term and long-term outcomes after surgery

Development and validation of artificial-intelligence-based radiomics model using computed tomography features for preoperative risk stratification of gastrointestinal stromal tumors

Background: preoperative risk assessment of gastrointestinal stromal tumors (GISTS) is required for optimal and personalized treatment planning. Radiomics features are promising tools to predict risk assessment. The purpose of this study is to develop and validate an artificial intelligence classification algorithm, based on CT features, to define GIST's prognosis as determined by the Miettinen classification. Methods: patients with histological diagnosis of GIST and CT studies were retrospectively enrolled. Eight morphologic and 30 texture CT features were extracted from each tumor and combined to obtain three models (morphologic, texture and combined). Data were analyzed using a machine learning classification (WEKA). For each classification process, sensitivity, specificity, accuracy and area under the curve were evaluated. Inter- and intra-reader agreement were also calculated. Results: 52 patients were evaluated. In the validation population, highest performances were obtained by the combined model (SE 85.7%, SP 90.9%, ACC 88.8%, and AUC 0.954) followed by the morphologic (SE 66.6%, SP 81.8%, ACC 76.4%, and AUC 0.742) and texture (SE 50%, SP 72.7%, ACC 64.7%, and AUC 0.613) models. Reproducibility was high of all manual evaluations. Conclusions: the AI-based radiomics model using a CT feature demonstrates good predictive performance for preoperative risk stratification of GISTs

Italie: La réglementation italienne des ventes à crédit

Carbonetti Francesco. Italie: La réglementation italienne des ventes à crédit. In: Revue internationale de droit comparé. Vol. 25 N°3, Juillet-septembre 1973. pp. 661-676

A Case of Postsurgical Necrotizing Fasciitis Invading the Rectus Abdominis Muscle and Review of the Literature

Necrotizing fasciitis is a life-threatening, soft tissue infection and an early diagnosis is needed to permit a prompt surgical and medical intervention. Due to the high fatal potential of the disease complications, the radiologist should distinguish necrotizing fasciitis from the most common soft tissue infections, in order to permit a prompt surgical and medical treatment. We present a case of a wide necrotizing fasciitis who presented at our emergency department and we also provide the basic tools, through a review of the literature, for the general radiologist to distinguish, with computed tomography and magnetic resonance imaging, necrotizing fasciitis from the most common infections that could present during our routine practice

Garanzia SACE e Fondo centrale di garanzia. Coerenze e incoerenze

Nell\u2019articolo viene esaminata la normativa emergenziale relativa alla garanzia Sace e Fondo Centrale di garanzia e vengono espressi dubbi sulla sua concreta applicabilit\ue0 alle imprese in crisi indipendentemente dalla pandemi

A Synchronous Pancreatic Metastasis from Renal Clear Cell Carcinoma, with Unusual CT Characteristics, Completely Regressed after Therapy with Sunitinib

We present a case report of a 75-years-old woman affected by renal clear cell carcinoma with a synchronous pancreatic metastasis and a metachronous lung metastasis. This case has two peculiarities. First the pancreatic metastasis was treated just with medical therapy, that is, Sunitinib, instead of the surgical therapy that is mostly considered. Secondly, the pancreatic lesion showed different characteristics on the computed tomography scan compared to the usual pancreatic metastases from renal clear cell carcinoma. The pancreatic metastasis totally regressed after medical treatment and nowadays, four years after the diagnosis, the patient is disease-free

Sarcopenia predicts reduced survival in patients with hepatocellular carcinoma at first diagnosis.

Abstract: Background. Sarcopenia is a complication and independent risk factor for mortality in patients with liver cirrhosis. Aim. To assess the prevalence and influence of sarcopenia on overall survival in a cohort of cirrhotic patients with hepatocellular carcinoma managed in a tertiary center. Material and methods. Abdominal computed tomography of 92 consecutive hepatocellular carcinoma cirrhotic patients, enrolled and followed from 2004 to 2014, were retrospectively studied with a software analyzing the cross-sectional areas of muscles at third lumbar vertebra level. Data was normalized for height, skeletal muscle index (SMI) calculated and presence of Sarcopenia measured. Sarcopenia was defined by SMI ≤ 41 cm2/m2 for women and ≤ 53 cm2/m2 for men with body mass index (BMI) ≥ 25, and ≤ 43 cm2/m2 for men and women with BMI < 25, respectively. Results. Median age at diagnosis was 71.9 years (30.7-86.4) and BMI 24.7 (17.5-36.7), comparable in women 23.1, (17.5-36.7) and men 24.7 (18.4-36.7). A class of CHILD score and BCLC A prevailed (55.4% and 41.3%, respectively); metastatic disease was found in 12% of cases. Sarcopenia was present in 40.2% of cases, mostly in females (62.9%; p = 0.005). Mean overall survival was reduced in sarcopenic patients, 66 (95% CI 47 to 84) vs. 123 (95% CI 98 to 150) weeks (p = 0.001). At multivariate analysis, sarcopenia was a predictor of reduced overall survival, independent of age (p = 0.0027). Conclusions. This retrospective study shows high prevalence of sarcopenia among cirrhotic patients with hepatocellular carcinoma. Presence of sarcopenia was identified as independent predictor of reduced overall survival. As easily measurable by CT, sarcopenia should be determined for prognostic purposes in this patient population

Gd-EOB-DTPA-Enhanced magnetic resonance findings of a giant inflammatory hepatocellular adenoma. a case report and review of the literature

Hepatocellular adenoma (HCA) is a rare benign tumour mainly found in women who have been receiving oral contraceptives [1]. According to recent studies, HCAs are currently catego- rized in four distinct genetic and pathologic subtypes as fol- lows: inflammatory HCA, hepatocyte-nuclear-factor-1- alpha-(HNF-1α-mutated) HCA, β-catenin-mutated HCA and Bunclassified^ subtype [2, 3]. Inflammatory HCA is also known as telangiectatic HCA and previously referred to as telangiectatic focal nodular hy- perplasia (FNH) [4, 5]. This particular subtype of HCA has specifically been linked to an increased body mass index and a generalized systemic inflammatory condition [4, 6]. Magnetic resonance imaging (MRI) is now established as the method of choice to evaluate focal liver lesions [7, 8]; furthermore, thanks to the introduction of hepatobiliary con- trast agents, the possibility to characterize lesions is really improved [9, 10]. Gadobenate dimeglumine and gadoxetic acid disodium (Gd-EOB-DTPA) are hepatobiliary contrast agents currently available [11]. Gadoxetic acid disodium (gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, Gd-EOB-DTPA, Primovist, Bayer HealthCare, Berlin, Germany) is an hepatobiliary MR contrast agent which offers the combined properties of an extracellular space contrast medium during the vascular-interstitial phases and a liver-specific agent, with an hepatobiliary phase at 20 min after intravenous contrast injection [12]. Recent studies highlight the significant role of Gd-EOB- DTPA-MRI in the diagnosis of hepatocellular carcinoma [13, 14] and suggest that MRI achieves the greatest accuracy in differentiating HCA from FNH with the introduction of liver hepatocyte-targeted contrast agents [15, 16]. However, the inflammatory HCA presents pathological features similar to FNH; in fact, this subtype of HCA can mimic FNH on Gd-EOB-DTPA-MRI [17]. We describe the case of a 22-year-old obese diabetic wom- an, on oral contraceptive therapy, who presents constant and intense upper abdominal pain as the main symptom of a large HCA. This case report was approved by our Institutional Re- view Board and patients’ informed consent was waived

Widespread renal polycystosis induced by crizotinib

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