Assessment of response to chemoradiation therapy in rectal cancer using MR volumetry based on diffusion-weighted data sets: a preliminary report.

PURPOSE: This study evaluated the feasibility of magnetic resonance (MR) volumetry using a diffusion-weighted data set (V(DWI)) and compared it with conventional T2-weighted volumetry (V(C)) in patients affected by rectal cancer treated with chemoradiation therapy (CHRT). MATERIALS AND METHODS: Fourteen patients with a biopsy diagnosis of rectal cancer underwent MR examination before and after CHRT. T2-weighted images were used to extrapolate V(C). A diffusion-weighted (DW) sequence was acquired [spin-echo diffusion-weighted echo-planar imaging (SE-DW-EPI)] with a b-value of 800 s/mm(2) and volume (V(DWI)) was calculated by semiautomatic segmentation of tumour hyperintensity. Two radiologists independently assessed volumes and analysed data in order to establish interobserver agreement and compare and correlate volumes to tumour regression grade (TRG), as evaluable at pathological examination of the surgical specimen. RESULTS: Interobserver agreement was 0.977 [(95% confidence interval (CI) 0.954-0.989) and 0.956 (95% CI 0.905-0.980) for V(C) and V(DWI) and 0.964 (95% CI 0.896-0.988) and 0.271 (95% CI-0.267 to 0.686) between V(C) and V(DWI) before and after CHRT. The correlation between TRG and V(C) and V(DWI) was, respectively, rho = 0.597 (p<0.05) and r(2)=0.156 (p=0.162) and rho=0.847 (p<0.001). CONCLUSIONS: V(DWI) seems to be a promising tool for assessing response to CHRT in rectal cancer. Further studies on large series of patients are needed to refine the technique and evaluate its potential predictive value.

Therapeutic strategy of late cerebral radionecrosis. A retrospective study of 21 cases.

AIM: Late cerebral radiation necrosis (LCR) is a serious complication of radiation treatment for brain tumors. This study investigates the diagnosis and management of patients with late clinical and neuroradiological cerebral radionecrosis after primary removal of brain neoplasm. The authors discuss the clinical features and long-term outcome of 21 patients with late cerebral radionecrosis and emphasize the importance of surgical and medical therapy. METHODS: Twenty-one patients with brain tumor treated by surgical resection or brain biopsy alone after radiotherapy during follow-up developed radionecrosis. The magnetic resonance imaging (MRI), surgical and clinical findings of these patients with radionecrosis are reviewed. RESULTS: MRI showed radionecrosis in 21 patients, 9 of which had undergone craniotomy for lesion removal. CONCLUSION: Late radionecrosis is infrequent following radiation therapy and may simulate tumor recurrence on MRI scans. From the authors' experience it is evident that, once begun, radiation treatment of neoplastic lesions can lead to complications such as late cerebral radionecrosis which often require surgical treatment. As correct diagnosis is necessary for appropriate treatment, a fair balance needs to be struck when considering ionizing radiation, medical therapy, surgery and diagnostic imaging.

Benign ulcer of the right colon clinically misdiagnosed as carcinoma: an additional case.

Benign solitary ulcer of the colon is an uncommon lesion that was originally described by Cruveilhier in 1832. Its aetiology remains unknown, and there are no pathognomonic lesions or symptoms. Diagnosis is made by exclusion; in fact, diseases such as specific infections (cytomegalovirus, campylobacter jejuni, entamoeba histolytica), common clinical conditions (acute appendicitis, diverticulitis, intestinal obstruction, inflammatory bowel disease), pharmacotherapy (non-steroidal anti-inflammatory medications, oral contraceptives, dicumarolic agents) and malignancies should be excluded. We describe the case of a 72-year-old patient admitted for acute bloody diarrhoea, originally misdiagnosed as carcinoma by colonscopy. The histological evaluation demonstrated a benign ulcerative lesion.

Melanoma of the nipple. An additional case.

The nipple is an unusual site of cutaneous melanoma with only few cases described in literature. We herein report an additional case of malignant melanoma arising on the nipple of a 47-year old woman. The nodular, ulcerated lesion was removed surgically and the diagnosis was that of a vertical growth phase melanoma. The melanocytic origin of the tumour was confirmed by immunohistochemistry. The case pursued a poor clinical outcome with distant metastases and death of the patient.

Ectopic thyroid of the lung. An additional case.

Thyroid ectopy is a rare phenomenon, which usually occurs in the cervical midline. We, herein, illustrate an unusual location of thyroid tissue, incidentally found at autopsy within the lung of a 77-year old male.

Lymphoepithelioma-like carcinoma of the endometrium.

Only three cases of lymphoepithelioma-like carcinoma of the endometrium have been reported to date. We present a new case in a 67-year-old woman involving an exophytic mass that caused postmenopausal bleeding. Histologically, undifferentiated carcinomatous areas were intermingled with abundant lymphoid tissue. Epstein-Barr virus was not detected in either neoplastic or lymphoid cells.

CD105/endoglin expression in Gorham disease of bone.

BACKGROUND: Gorham disease is a rare pathological condition characterised by a proliferation of vascular channels of haematic and lymphatic origin in bone and adjacent soft tissues, which results in a progressive destruction of the involved bone segment. AIM: To evaluate expression of the vascular endothelial cell marker CD105/endoglin in Gorham disease of bone. METHODS: An immunohistochemical analysis was conducted on four cases of Gorham disease of bone, and for comparison on eight cases of conventional haemangioma of bone and on normal fetal and adult bone tissue specimens. RESULTS: Diffuse and intense immunostaining of endothelial cells for CD105 was observed in the specimens of fetal bone in areas undergoing ossification and in the growth plate of young adults. In medullary bone, CD105 positivity was limited to sinusoids of haemopoietic marrow, while endothelial cells of capillaries and small arterioles and venules within fatty marrow were either negative or showed weak immunostaining. The mean percentage of positive vessels in Gorham disease was significantly higher than in osseous haemangioma (58.9 (SEM 14.9) vs 17.2 (SEM 12.0); p = 0.03, Mann-Whitney U test). A significant direct correlation was observed between the proliferative activity assessed by MIB-1 immunostaining, and the percentage of CD105 positive vessels in the entire series (r = 0.681; p = 0.01). CONCLUSIONS: Data indicate that the phenotype of proliferating endothelial cells of Gorham disease is similar to that of the endothelial lining of vessels of metabolically active bone characterised by high expression of CD105, while that of conventional haemangioma is more similar to that of metabolically quiescent bone tissue, such as fatty marrow, with low levels of expression of CD105. This may have potential therapeutic and diagnostic applications.

Undifferentiated gastric carcinoma with lymphoid stroma (lymphoepithelioma-like carcinoma/medullary carcinoma).

Undifferentiated gastric carcinoma with lymphoid stroma is a histological type of gastric cancer with favourable prognosis, microscopically characterised by nests of neoplastic epithelial cells intermingled with a dense lymphoid proliferation. Various studies have shown a close relationship between undifferentiated gastric carcinoma with lymphoid stroma and Epstein-Barr virus infection; the presence of viral DNA in tumour cell nuclei has been demonstrated using polymerase chain reaction and Epstein-Barr virus-encoded small RNA in neoplastic cell nuclei have been found using in situ hybridization. We describe two cases of undifferentiated gastric carcinoma with lymphoid stroma, one infiltrating the submucosa of the gastric body and the other invading the muscularis propria of the antrum. No lymph node neoplastic invasion was documented in either case. Epstein-Barr virus was detected in the neoplastic cell nuclei in both cases with in situ hybridization.

Primary linitis plastica of the right colon.

A case of primary linitis plastica of the colon is presented. This case is of interest for three reasons: the site of origin in the right colon (80% of cases reported develop distally to the splenic flexure), a biopsy previously taken from the mucosa demonstrated the presence of a signet ring cell carcinoma (endoscopic biopsies do not provide a conclusive diagnosis in the majority of cases reported) and hyaline with sparse amyloid nodules were detected in the extensive, dense fibrous tissue intermingled with tumour cells.

A rare case of primitive neuroectodermal tumor in the soft tissues of the hand.

Primitive neuroectodermal tumors of the hand are extremely rare, and only 5 cases have been described to date. Here, we report a case of a 35 year-old male who presented a progressive swelling on the palm of his right hand. Clinical examination showed a solid mass and X-ray revealed a soft tissue mass. Magnetic resonance imaging (MRI) revealed infiltrated interosseous muscles, metacarpal bones and tendons. The patient underwent surgery and the lesion was removed. On the basis of morphological, immunohistochemical and molecular biology findings, a diagnosis of primitive neuroctodermal tumor was made.

Bronchial fibrolipomatous hamartoma associated with peculiar unusual bronchial lesions of the peripheral lung.

Multiple hamartomas of the lung are uncommon. The few cases described to date are multiple parenchymal hamartomas or multiple endobronchial and parenchymal hamartomas. Herein, an original case is described which is characterized by the association between an endobronchial hamartoma and multiple, unusual, bronchial lesions of the peripheral lung.

Report of two cases of Rosai-Dorfman disease with only skin involvement.

Although cutaneous localization associated with lymphadenopathy is a common phenomenon in Rosai-Dorfman disease, cutaneous and subcutaneous involvement alone occurs only rarely. We herein report two cases of cutaneous lesions in the absence of lymph node localization and systemic symptoms or signs. Characteristic features of the disease, such as emperipolesis, were evident in both cases.

Evaluation of tumour-infiltrating CD4+CD25+FOXP3+ regulatory T cells in human cutaneous benign and atypical naevi, melanomas and melanoma metastases.

BACKGROUND: CD4+CD25+FOXP3+ regulatory T cells (Tregs) are thought to induce immunotolerance in melanoma. They have not yet been investigated in the entire spectrum of melanocytic cutaneous lesions within a tumour site. OBJECTIVES: To evaluate CD4+CD25+FOXP3+ Tregs among tumour-infiltrating lymphocytes in cutaneous melanocytic lesions. METHODS: We analysed 128 lesions (10 benign junctional common naevi, 10 benign compound common naevi, 10 compound Spitz naevi, 10 junctional atypical naevi, 20 compound atypical naevi, 20 radial growth phase melanomas, 30 vertical growth phase melanomas and 18 melanoma metastases). Tregs were identified by CD25-FOXP3 double immunostains. RESULTS: This study indicates that CD4+/CD25+FOXP3+ Tregs are present in all groups of lesions. Junctional atypical naevi, compound atypical naevi and radial growth phase melanomas showed the highest percentages of CD4+CD25+FOXP3+ Tregs (junctional atypical naevi vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0.0001; junctional atypical naevi vs. vertical growth phase melanomas: P = 0.001; compound atypical naevi vs. junctional common naevi, compound common naevi: P < 0.0001; compound atypical naevi vs. compound Spitz naevi, melanoma metastases: P = 0.002; compound atypical naevi vs. vertical growth phase melanomas: P = 0.02; radial growth phase melanomas vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0.0001; radial growth phase melanomas vs. vertical growth phase melanomas: P = 0.008). CONCLUSIONS: The strong prevalence of CD25+FOXP3+ Tregs both in junctional and compound atypical naevi and radial growth phase melanomas, suggests that they induce immunotolerance early during melanoma genesis, favouring melanoma growth. Their evaluation within a tumour site could be useful for prognostic and therapeutic purposes.