Hepatocellular adenoma: An unsolved diagnostic enigma

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1\u3b1-mutated HCA, inflammatory HCA, \u3b2-catenin-mutated HCA, and unclassified HCA. \u3b2-catenin-mutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1\u3b1-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization

Bilateral osteoma of the internal auditory canal: Case report and literature review

Osteomas of the external auditory canal tend to be rather common; those of the internal auditory canal (IAC) are much rarer, though, with less than twenty cases reported in literature up to this very day. Bilateral IAC osteomas, as in this case, are extremely unusual.These benign bone tumors grow very slowly and this implies that the patient is very often asymptomatic. The diagnosis is generally made relatively late and it is, in many cases, absolutely incidental, with Computed Thomography (CT) scans of the temporal bones performed for other reasons. The manuscript describe the case of a patient complaining with progressive bilateral hearing impairment, worsening in the course of many years; we would like to point out the benefits brought by CT in the diagnosis and therapeutic choice, which is, still today, not yet subject to unanimous consensus. (C) 2014 The College of Radiographers. Published by Elsevier Ltd. All rights reserved

Analysis of size and shape differences between ancient and present-day Italian crania using metrics and geometric morphometrics based on multislice computed tomography

The Museum of Human Anatomy in Naples houses a collection of ancient Graeco-Roman crania. The aim of this study was to use multislice computed tomography (MSCT) to evaluate and objectively quantify potential differences in cranial dimensions and shapes between ancient Graeco-Roman crania (n = 36) and modern-day southern Italian crania (n = 35) and then to characterize the cranial changes occurring over more than 2000 years, known as secular change. The authors used traditional metric criteria and morphometric geometry to compare shape differences between the sets of crania. Statistically significant differences in size between the ancient and modern crania included shorter facial length, narrower external palate, smaller minimum cranial breadth, shorter right and left mastoid processes, and wider maximum occipital and nasal breadth. The shape changes from the ancient to modern crania included a global coronal enlargement of the face and cranial diameters, with more anterior projection of the face at the anterior nasal spine, but also posterior projection at the glabella and the nasion. It is not possible to determine whether these differences result exclusively from secular changes in the cranium or from other factors, including a mix of secular change and other unknown factors. To the best of our knowledge, this is the first MSCT-based study to compare ancient Graeco-Roman and modern-day southern Italian crania and to characterize shape and size differences

The medical treatment of Cushing's disease: effectiveness of chronic treatment with the dopamine agonist cabergoline in patients unsuccessfully treated by surgery

BACKGROUND: The role of dopamine agonists in the treatment of Cushing's disease (CD) has been previously debated. AIM: The aim of this study was to evaluate the effectiveness of short-term (3 months) and long-term (12-24 months) treatment with cabergoline in patients with CD. Patients and Methods: 20 patients with CD unsuccessfully treated by surgery entered the study. Cabergoline was administered at an initial dose of 1 mg/wk, with a monthly increase of 1 mg, until urinary cortisol levels normalized or the maximal dose of 7 mg/wk was achieved. The responsiveness to treatment was evaluated according to changes in urinary cortisol excretion. A decrease greater than 25% was considered as a partial response, whereas complete normalization was considered as a full response at short-term evaluation; persistence of normal cortisol excretion was the only criterion to evaluate the response at long-term evaluation. RESULTS: After short-term treatment, 15 (75%) patients were responsive to cabergoline treatment. Among these, normalization of cortisol excretion was maintained in 10, whereas treatment escape was observed in five patients after 6-18 months. Among the 10 long-term responsive patients, eight were followed for 24 months, whereas the remaining two were followed for 12-18 months, due to cabergoline withdrawal for intolerance. A sustained control of cortisol secretion for 24 month cabergoline treatment at the maximal dose ranging from 1-7 mg/wk (median: 3.5) without significant side effects, was obtained in eight of 20 (40%) patients. CONCLUSIONS: The results of this study demonstrated that cabergoline treatment is effective in controlling cortisol secretion for at least 1-2 yr in more than one third of a limited population of patients with CD. If this evidence is confirmed by additional studies, this agent may be considered as a useful treatment option in patients with CD who are unsuccessfully treated by neurosurgery

Imaging of metabolic bone disease

Osteoporosis is the most important metabolic bone disease, with a wide distribution among the elderly. It is characterized by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk. Identify bone weakening with an appropriate and accurate use of diagnostic imaging is of critical importance in the diagnosis and follow-up of osteoporotic patients. The aim of this review is to evaluate the detection rates of the different imaging modalities in the evaluation of bone strength, in the assessment of fracture risk and in the management of fragility fractures

Feasibility of stereotactic ablative reirradiation in breast cancer patient undergoing palbociclib: a case report

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Choosing the optimal gated window for defining target volume in lung stereotactic ablative radiotherapy

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