Monitoring Gastric Filling, Satiety and Gastric Emptying in a Patient with Gastric Balloon Using Functional Magnetic Resonance Imaging–-A Feasibility Report

Backround Intragastric balloons are used for short term weight loss therapy in obese. It is possible to monitor the ballon with sonography, however this method is sometimes insufficient in obese patients. Therefore MRI seems to be a potential therapy-monitoring option. Purpose In this feasibility report we want to demonstrate the potential use of functional MRI in monitoring gastric filling, patient satiation and gastric emptying in a obese patient who previously received intragastric balloon placement. Material and methods We selected one patient (male, 178 cm, 127 kg, BMI = 40,5 kg/m 2 ) who recently received a gastric balloon and visualized gastric motility in presence of the gastric balloon before and after food intake. Fast cross-sectional images in one breathhold spin echo or gradient echo sequences were aquired. Real-time gastric motion was performed with cine mode. Results MRI offers perfect visualisation of gastric balloons in obese patients. Gastric filling and emptying can be monitored in correlation to patient satiety sensation. MRI can visualize the gastric balloon with degree of filling and possible leakages. Cine mode sequences demonstrate gastric motility and gastric wall peristalsis. Conclusion MR is a valuable imaging alternative for patients with intragastric balloon

p16 Expression Differentiates High-Risk Gastrointestinal Stromal Tumor and Predicts Poor Outcome1

Gastrointestinal stromal tumors (GISTs) are characterized by alterations in genes involved in cell cycle regulation. Although p16 (INK4A) have been extensively investigated in GISTs, there are still discrepancies regarding its prognostic value. Therefore, we evaluated the clinical occurrence, diagnostic and prognostic value of p16 staining in GIST. One hundred one patients (54 women and 47 men) with a mean age of 64.1 years (range, 17–94 years) were surgically treated for a GIST within a 10-year period. Of these patients, 28 (28%) were affected by metastases (mean follow-up, 4.5 years). In 36 patients (36%), GIST occurred coincidentally with other malignancies. Expression of c-kit was confirmed in 97 GIST patients (96%). In patients with high-risk GIST, the expression of p16 expression was highly predictive for poor prognosis, i.e., the development of recurrence or metastases (P = .006) and poor survival (P = .004). In addition, the expression of p16 was highly predictive for reduction of the survival in patients who were affected by metastases or recurrence (P = .041). The disease-specific and disease-free 1-, 3-, and 5-year survival rate was 96%, 90%, and 85% and 81%, 77%, and 72%, respectively. Primary tumor state, tumor size, and high-risk classification were confirmed as relevant predictors for unfavorable prognosis in GIST (P < .001). Our results indicate that in high-risk GIST and in patients with recurrence or metastases, the expression of p16 is highly predictive for poor outcome. Thus, in addition to high-risk classification, p16 expression might be an indicator for “very high risk GIST.

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) ≥ 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology

Diagnostic, Structured Classification and Therapeutic Approach in Cystic Pancreatic Lesions: Systematic Findings with Regard to the European Guidelines

Due to the increasing use of cross-sectional imaging techniques and new technical possibilities, the number of incidentally detected cystic lesions of the pancreas is rapidly increasing in everyday radiological routines. Precise and rapid classification, including targeted therapeutic considerations, is of essential importance. The new European guideline should also support this. This review article provides information on the spectrum of cystic pancreatic lesions, their appearance, and a comparison of morphologic and histologic characteristics. This is done in the context of current literature and clinical value. The recommendations of the European guidelines include statements on conservative management as well as relative and absolute indications for surgery in cystic lesions of the pancreas. The guidelines suggest surgical resection for mucinous cystic neoplasm (MCN) &ge; 40 mm; furthermore, for symptomatic MCN or imaging signs of malignancy, this is recommended independent of its size (grade IB recommendation). For main duct IPMNs (intraductal papillary mucinous neoplasms), surgical therapy is always recommended; for branch duct IPMNs, a number of different risk criteria are applicable to evaluate absolute or relative indications for surgery. Based on imaging characteristics of the most common cystic pancreatic lesions, a precise diagnostic classification of the tumor, as well as guidance for further treatment, is possible through radiology

Immunohistochemical staining modalities of the monoclonal antibody (mAb) Em2G11 for metacestodes of <i>Echinococcus multilocularis</i>.

<p><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001877#pntd-0001877-g002" target="_blank">Figure 2A: </a><i>E. multilocularis</i> lesion in human liver tissue. The antigen is detected in the laminated layer (two arrows, right) and in the necrotic area around the lesion (dashed lined area, right). The antibody detects <u>s</u>mall <u>p</u>articles of <i><u>E</u>. <u>m</u>ultilocularis</i> (spems) up two 1.5 mm away from the main lesion in a small liver vessel (small area marked with a dashed line on the left). Insert left highlights this lesion at a higher magnification showing a specific staining of spems. Insert right shows specific staining in lymphoid tissue of a regional lymph node on the surface of cells (arrows; bar =  750 µm; bar insert =  40 µm). B: In contrast, no staining is observed in caseous necrosis of tuberculosis (arrows low) and in bronchial epithelial tissue (arrows high; bar =  50 µm). C: Serial section of an aspirate from the liver. C shows a PAS staining of a strongly positive laminated layer. C′: Staining of the section with mAb Em2G11 reveals a strong positivity of the laminated layer and of the necrotic tissue with spems (dashed lined area; bar =  500 µm). D: PAS staining of brain tissue showing the laminated layer of an <i>E. multilocularis</i> metacestode. D′: The laminated layer is strongly positive for mAb Em2G11 even after 60 years of formalin fixation (bar =  50 µm).</p

Conventional macroscopic and histological diagnostic criteria for the differential diagnosis of AE and CE [5].

<p>Conventional macroscopic and histological diagnostic criteria for the differential diagnosis of AE and CE <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001877#pntd.0001877-Marty1" target="_blank">[5]</a>.</p

Patients' characteristics and localization of probe.

<p>Patients' characteristics and localization of probe.</p

Cases with difficult histological/cytological diagnoses.

<p>Cases with difficult histological/cytological diagnoses.</p

Immunohistochemical staining modalities of the monoclonal antibody (mAb) Em2G11 for metacestodes of <i>Echinococcus multilocularis</i>.

<p><a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0001877#pntd-0001877-g001" target="_blank">Figure 1A:</a> In metacestodes grown in a Mongolian jird, the antibody strongly marks the laminated layer (single arrow left below). The germinal layer and calcareous corpuscles are strongly stained (two arrows and single arrow right) as well as the precipitated cyst fluid. The area oft the rostellum is superimposed with a positive reacting layer (dashed line) while the inner part of the protoscolex did not react with the monoclonal antibody; bar =  50 µm. 1B, C: In human liver, the Em2 antigen is strongly positive in the slender laminated layer of <i>E. multilocularis</i>. The staining reveals a tubular and infiltrative growth pattern (arrows). In contrast, the laminated layer of <i>E. granulosus</i> is much broader (arrows), no staining is detected by mAb Em2G11; bar =  1000 µm.</p