Leiomyosarcoma of the inferior vena cava in a patient with Budd-Chiari syndrome.

A 65-year-old man with no history of cardiovascular disease was admitted because of abdominal pain, nausea and lower limb edema. At clinical examination he presented hepatomegaly, ascites and laboratory evidence of liver failure. The echocardiogram (Figure 1A) showed preserved biventricular function, but a large irregular mass was visible in the right atrium (arrow; Supplementary data, Movie 1 and 2). Computed tomography (Figure 1B) showed patchy contrast uptake and positron emission tomography (Figure 1C) showed pathological uptake of 18-fluoro-deoxyglucose in the mass (arrow), extending along the inferior vena cava (arrowheads), suggesting a neoplastic nature. At cardiovascular magnetic resonance (Figure 1D and E; Supplementary data, Movie 3 and 4) the mass involved the right atrium (arrow) and extended into the inferior vena cava (arrowheads); moreover, it presented irregular contours and signal characteristics typical of a neoplastic mass

Preoperative rectal cancer staging with phased-array MR

<p>Abstract</p> <p>Background</p> <p>We retrospectively reviewed magnetic resonance (MR) images of 96 patients with diagnosis of rectal cancer to evaluate tumour stage (T stage), involvement of mesorectal fascia (MRF), and nodal metastasis (N stage).</p> <p>Our gold standard was histopathology.</p> <p>Methods</p> <p>All studies were performed with 1.5-T MR system (Symphony; Siemens Medical System, Erlangen, Germany) by using a phased-array coil. Our population was subdivided into two groups: the first one, formed by patients at T1-T2-T3, N0, M0 stage, whose underwent MR before surgery; the second group included patients at Tx N1 M0 and T3-T4 Nx M0 stage, whose underwent preoperative MR before neoadjuvant chemoradiation therapy and again 4-6 wks after the end of the treatment for the re-staging of disease.</p> <p>Our gold standard was histopathology.</p> <p>Results</p> <p>MR showed 81% overall agreement with histological findings for T and N stage prediction; for T stage, this rate increased up to 95% for pts of group I (48/96), while for group II (48/96) it decreased to 75%.</p> <p>Preoperative MR prediction of histologically involved MRF resulted very accurate (sensitivity 100%; specificity 100%) also after chemoradiation (sensitivity 100%; specificity 67%).</p> <p>Conclusions</p> <p>Phased-array MRI was able to clearly estimate the entire mesorectal fat and surrounding pelvic structures resulting the ideal technique for local preoperative rectal cancer staging.</p

ESPRESSIONE DI AKT NEI MENINGIOMI AGGRESSIVI

I meningiomi rappresentano il 20% dei tumori primitivi intracranici, con un’incidenza stimata di 2.3 x 100.000. Si classificano in benigni (WHO grado I), atipici (WHO grado II) e anaplastici (WHO grado III). Il trattamento elettivo è quello chirurgico. I tumori non completamente resecabili o recidivanti vengono sottoposti a radioterapia, ma attualmente non è disponibile nessun trattamento farmacologico risolutivo. La serin-treonin protein chinasi AKT è fondamentale in numerosi processi cellulari, come l’uptake del glucosio, la progressione del ciclo cellulare e l’apoptosi. Ad oggi sono note tre isoforme espresse in misura variabile in tutti i tessuti umani. La mutazione AKT1(E17K), identificata in molte neoplasie, determina un’attivazione costitutiva dell’isoforma Akt1 a cui segue una trasformazione cellulare. Dopo revisione di 363 meningiomi archiviati nel Brain Tumour Registry (Imperial College London), abbiamo selezionato ventiquattro tumori atipici, quindici mitoticamente attivi e quindici recidive. Sono stati usati come controlli dieci meningiomi sopratentoriali non recidivati dopo un follow-up di almeno dieci anni. Lo scopo di questo lavoro è dimostrare con metodo immunoistochimico l’espressione di AKT nei meningiomi e verificare se esiste una correlazione tra grado istologico e intensità di colorazione. I risultati potranno contribuire allo sviluppo di un trial clinico volto allo studio dell’efficacia degli inibitori di PI3K/AKT/mTOR nel trattamento dei meningiomi aggressivi

Studio immunoistochimico dello sviluppo corticale umano normale e patologico

Negli ultimi anni l’attenzione dei clinici, in particolare dei neurologi, neuropsichiatri infantili, neuroradiologi, neurochirurghi e anatomo-patologi si è particolarmente focalizzata sulle displasie della corteccia cerebrale, associate ad epilessia farmacoresistente (Guerrini et al.1996). Resta, tuttavia, da chiarire se alcune malformazioni della corteccia cerebrale siano causate esclusivamente da mutazioni genetiche o se la loro eziologia debba ricondursi piuttosto ad una genesi miltifattoriale a cui concorrono cause tossiche o ischemiche prodottesi durante le prime settimane di sviluppo embrionale (Guerrini et al.2001). La resistenza al trattamento farmacologico di tali lesioni è legata all’iperespressione, da parte delle cellule displastiche, della proteina di membrana P-gp che, estrudendo il farmaco dalle cellule, ne impederebbe un’adeguata concentrazione all’interno delle lesioni (Aronica et al.2003). Sono stati analizzati 60 tessuti cerebrali prelevati da autopsie fetali appartenenti ad epoche gestazionali comprese tra la 13° e la 39°settimana di gestazione. E’ stato utilizzato un anticorpo monoclonale (MM 4.17) specificamente reattivo con il dominio di espressione della P-gp nel cervello fetale umano nei diversi stadi di maturazione. Particolare attenzione è rivolta allo studio dell’espressione della P-gp nelle cellule displastiche delle malformazioni corticali

MRI tumor volume reduction rate vs tumor regression grade in the pre-operative re-staging of locally advanced rectal cancer after chemo-radiotherapy

OBJECTIVE: To compare tumor volume reduction rate (TVRR) measured by MR volumetry after preoperative chemoradiotherapy (CRT) and pathological tumor regression grade (TRG) in locally advanced rectal cancer (LARC). MATERIAL AND METHODS: In total, 20 patients with LARC (cT3-T4) treated with CRT followed by Total Mesorectal Excision (TME) between April 2011 and April 2013 were analyzed retrospectively. Pre- and post- CRT tumor volumes (MR volumetry) were measured on 3D MR sequences. TVRR was determined using the equation TVRR (%)=(pre-CRT tumor volume-post-CRT tumor volume)×100/pre-CRT tumor volume. The downstaging (defined as ypT0-T2) of tumor mass was evaluated and the correlation between TVRR and TRG was calculated with the method proposed by Dworak using the Spearman rank test. RESULTS: The median TVRR was 77.3% (range, 26.4-99.3%); TVRR was >60% in 18 cases (90%) and in 8 of these patients (44.4 %) it was >80%. Downstaging of tumor lesions was obtained in 15 patients (75%). In 4 cases there was a complete tumor regression (TRG4) at histological examination and in the same patients there was also a TVRR>80% measured by MR volumetry. A statistically significant correlation between TVRR and TRG (rs=0.5466, p=0.0126) was observed. CONCLUSION: TVRR after preoperative CRT correlates with TRG in LARC. The MR volumetry is a prognostic factor to estimate the tumor response after preoperative CRT. TVRR data may be an useful biomarker for tailoring surgery and postoperative adjuvant chemotherapy. Copyright © 2015. Published by Elsevier Ireland Ltd