RESUMO
Desmoid tumors (DTs) are a rare and biologically heterogeneous group of locally aggressive fibroblastic neoplasm: their biological behavior spectrum ranges from indolent to aggressive tumors. DTs are classified as intra-abdominal, extra-abdominal, and within the abdominal wall lesions.It is well known that abdominal and extra-abdominal DTs are associated with familial adenomatous polyposis (FAP) and Gardner syndrome. Possible risk factors are prior trauma/surgery, pregnancy, and oral contraceptives.There was a real revolution in the management of DT: from aggressive first-line approach (surgery and radiation therapy) to a more conservative one (systemic treatment and "wait-and-see policy").In these clinical settings, radiologists play an important role for assessing lesion resectability, evaluating recurrence, monitoring the biological behavior if an expectant management is chosen, and assessing response to systemic treatment as well as to radiation therapy.Awareness of common locations, risk factors, and imaging features is fundamental for a correct diagnosis and an adequate patient management.
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Chronic lymphocytic leukemia (CLL) clones are characterized by loss of a critical region in 13q14.3, (del(13)(q14)) involving the microRNA (miRNA) cluster miR-15a and miR-16-1. We have investigated the effects of replacement of miR-15a and miR-16-1. CLL cells transfected with these miRNA mimics exhibited a decrease in cell viability in vitro and impaired capacity for engraftment and growth in NOD/Shi-scid,γcnull (NSG) mice. No synergistic effects were observed when the two miRNA mimics were combined. The phenomena were not restricted to CLL with the del(13)(q14) lesion. Similar effects induced by miRNA mimics were seen in cells with additional chromosomal abnormalities with the exception of certain CLL clones harboring TP53 alterations. Administration of miRNA mimics to NSG mice previously engrafted with CLL clones resulted in substantial tumor regression. CLL cell transfection with miR-15a and miR-16-1-specific inhibitors resulted in increased cell viability in vitro and in an enhanced capacity of the engrafted cells to grow in NSG mice generating larger splenic nodules. These data demonstrate that the strong control by miR-15a and miR-16-1 on CLL clonal expansion is exerted also at the level of full-blown leukemia and provide indications for a miRNA-based therapeutic strategy.
Assuntos
Leucemia Linfocítica Crônica de Células B/genética , MicroRNAs/farmacologia , Animais , Linhagem Celular , Proliferação de Células/efeitos dos fármacos , Sobrevivência Celular/efeitos dos fármacos , Deleção Cromossômica , Cromossomos Humanos Par 13 , Xenoenxertos , Humanos , Leucemia Linfocítica Crônica de Células B/etiologia , Leucemia Linfocítica Crônica de Células B/patologia , Camundongos , MicroRNAs/genética , Transfecção , Carga Tumoral/efeitos dos fármacosRESUMO
Unidimensional Response Evaluation Criteria in Solid Tumor (RECIST) has been recently proposed in the attempt to simplify the standardized bidimensional World Health Organization (WHO) criteria. The complete accord between these two measurement systems was established in a large comparative study [J. Natl. Cancer Inst. 92(3) (2000) 205] that demonstrated the validity and the good performance of RECIST criteria. We report four cases of inadequacy of RECIST criteria in the evaluation of response to chemotherapy in patients with malignant pleural mesothelioma. These four patients were enrolled in two consecutive multicenter phase II clinical trials investigating the activity of a novel chemotherapy regimen in advanced pleural mesothelioma. They were judged as having an objective response to chemotherapy according to WHO criteria. Reassessed according to both methods, we found that results obtained with RECIST criteria do not correspond to WHO underestimating response to chemotherapy. Our data raise doubts about the applicability of unidimensional RECIST response criteria to mesothelioma and, possibly, to any tumor involving the chest wall.
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Guias como Assunto , Mesotelioma/tratamento farmacológico , Mesotelioma/patologia , Neoplasias Pleurais/tratamento farmacológico , Neoplasias Pleurais/patologia , Idoso , Ensaios Clínicos Fase II como Assunto , Feminino , Humanos , Masculino , Mesotelioma/diagnóstico por imagem , Pessoa de Meia-Idade , Neoplasias Pleurais/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Resultado do Tratamento , Organização Mundial da SaúdeRESUMO
The sonographic findings observed in four patients with spontaneous rupture of a renal angiomyolipoma and perinephric haemorrhage are presented. In all cases, a hyperechoic renal mass surrounded by a large hypoechoic haematoma was identified. Furthermore, the actual site of rupture of the tumour could be seen in one case as a wedge-shaped hypoechoic structure extending from the periphery to the centre of the mass. CT has been suggested as the method of choice in the assessment of both the presence and extent of haemorrhagic complications of angiomyolipomas. However, since such lesions can be demonstrated and identified by ultrasound, which is often used as the first imaging procedure in abdominal complaints, the technique may also prove of value in planning further diagnostic tests and in choosing the appropriate therapeutic approach to these patients.
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Hemangioma/patologia , Hemorragia/patologia , Neoplasias Renais/patologia , Lipoma/patologia , Ultrassonografia , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Ruptura EspontâneaRESUMO
In 32 patients with known gastric cancer involving different segments of the stomach, an attempt was made to image the tumour by ultrasonography. Identification of the lesion was possible in 31/32 cases. The tumour always appeared as a focal or diffuse thickening of the gastric wall, with irregular outer margins and luminal echoes; in many cases, a "target" pattern was seen. Although ultrasonography cannot be considered a sensitive test in the diagnosis of gastric cancer, knowledge of the possible appearances of tumours in all different portions of the stomach is important, since this method is often used as the first imaging procedure in a large variety of abdominal complaints, and clinically unsuspected gastric carcinomas may be imaged first by it.
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Neoplasias Gástricas/diagnóstico , Ultrassonografia , Adolescente , Adulto , Junção Esofagogástrica , Fundo Gástrico , Humanos , Antro PilóricoRESUMO
We have recently examined a patient in whom sonographic visualization of the most lateral part of the right lobe of the liver was impossible due to the presence of subcutaneous emphysema of the right flank. To our knowledge, this is the first ultrasonic report of this condition.
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Enfisema/diagnóstico , Enfisema Subcutâneo/diagnóstico , Ultrassonografia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Primitive neoplasms of proximal extrahepatic bile ducts keep their peculiar morphological and spreading patterns, as firstly described by J. Klatskin. Diagnostic and therapeutic approach were modified in the last year, on the basis of technological progress in imaging and more aggressive surgical attitude. Authors reviewed their clinical experience from 1970 to 1995 concerning proximal extrahepatic bile ducts tumors management, mainly evaluating the evolution of diagnostic work-up and the role of resection. Preoperative work-up is now trimed to non invasive techniques, in order to evaluate the intra and extra biliary diffusion; PTC-PTBD performed preoperatively give a clear biliary map, and could be the first step of a palliative definitive treatment in case of non operable patients. Radical resection remains the gold standard of therapy, with the best long-term results. Palliation must be obtained by the easiest comfortable method for the patient (i.e. self-blocking percutaneously inserted endoprosthesis).
Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/terapia , Ducto Hepático Comum , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/cirurgia , Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Diagnóstico Diferencial , Drenagem , Feminino , Ducto Hepático Comum/patologia , Ducto Hepático Comum/cirurgia , Humanos , Tumor de Klatskin/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Ultrassonografia DopplerRESUMO
The authors analyse which therapeutic strategy to adopt on the basis of prognostic factors and staging of hepatic and pulmonary metastases from colorectal cancer. They underline the effectiveness of combined multimodal therapy in the treatment of very advanced metastatic stages. 218 patients with metastases from colorectal cancer (12 pulmonary and 206 hepatic metastases) were treated from January 1980 to October 2000. Among these patients, 159 underwent surgery (4 pulmonary and 155 hepatic resections), 16 were reoperated on for metastatic relapse, 14 with multiple metastases underwent locoregional therapy and 29, deemed unresectable initially, were treated with neoadjuvant chemo- and radiotherapy. In the operated patient group the 5-year actuarial survival rate was 22% with an operative mortality of 3.8% and a morbidity of 17.5%. The 16 patients reoperated on for metastatic relapse had a 5-year actuarial survival of 21% with an operative mortality of 6.2% and a morbidity of 15.8%. The 14 patients treated with locoregional therapy had a median survival of 6 months whereas the 29 patients treated in two different periods with combined multimodal treatment had a response rate of 59.2%. Five patients had a complete response and 4 are currently disease-free. Surgical resection is at present the best known treatment for metastatic disease. In very advanced, as yet undisseminated stages, in which there is no surgical indication for metastases a neoadjuvant treatment is proposed if the primary tumour has already been completely resected. The aim of this therapeutic strategy, called combined multimodal therapy, is to obtain the disease regression with the aid of systemic chemo- and radiotherapy and to offer a chance of re-staging the disease.
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Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Idoso , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVE: The purpose of our study was to determine whether a three-dimensional (3D) isotropic resolution fast spin echo sequence (FSE-cube) has similar image quality and diagnostic performance to a routine MRI protocol for brachial plexus evaluation in volunteers and symptomatic patients at 3.0 T. Institutional review board approval and written informed consent were guaranteed. METHODS: In this prospective study FSE-cube was added to the standard brachial plexus examination protocol in eight patients (mean age, 50.2 years) with brachial plexus pathologies and in six volunteers (mean age, 54 years). Nerve visibility, tissue contrast, edge sharpness, image blurring, motion artefact and acquisition time were calculated for FSE-cube sequences and for the standard protocol on a standardised five-point scale. The visibility of brachial plexus nerve and surrounding tissues at four levels (roots, interscalene area, costoclavicular space and axillary level) was assessed. RESULTS: Image quality and nerve visibility did not significantly differ between FSE-cube and the standard protocol (p>0.05). Acquisition time was statistically and clinically significantly shorter with FSE-cube (p<0.05). Pathological findings were seen equally well with FSE-cube and the standard protocol. CONCLUSION: 3D FSE-cube provided similar image quality in a shorter acquisition time and enabled excellent visualisation of brachial plexus anatomy and pathology in any orientation, regardless of the original scanning plane.
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Neuropatias do Plexo Braquial/diagnóstico , Plexo Braquial , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Adulto , Idoso , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Adulto JovemRESUMO
PURPOSE: To evaluate the correlation of absolute attenuation values of unenhanced computed tomography (CT) with signal intensity (SI) quantitative analysis on chemical shift (CS) magnetic resonance (MR) imaging in differentiating adrenal adenomas from metastases. MATERIAL AND METHODS: Forty-one adrenal masses (27 adenomas, 14 metastases) were studied with CS MR imaging and unenhanced CT. MR included T1-weighted breathhold gradient-echo in-phase (IP) and opposed-phase (OP) sequences. The SI index (SI-i) [(SIIP-SIOP/SIIP)] x 100% and chemical-shift ratio (CS-r) relative to the spleen [(SIlesion/ SIspleen)OP/(SIlesion/SIspleen)IP] were calculated for each lesion. CT absolute attenuation values were also determined. RESULTS: The mean attenuation value of metastases was significantly greater than that of adenomas (< 0.0001). On MR, the mean SI-i of adenomas was significantly greater than that of metastases (P < 0.0001) and no overlaps were evident. The CS-r of malignant and benign lesions overlapped considerably, and five adenomas (all with indeterminate Hounsfield Unit values at CT) were misclassified as potentially malignant. CT attenuation values were significantly correlated with both MR quantitative analyses. CONCLUSION: Since CS MR imaging and CT both depict the presence of lipids within adrenal lesions, absolute attenuation values are highly correlated with MR quantitative analysis. SI-i is the most reliable tool for differentiating adrenal adenomas from metastases, showing better accuracy than lesion-to-spleen CS-r, in particular for adenomas with indeterminate absolute attenuation values.
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Adenoma/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Imageamento por Ressonância Magnética/métodos , Tomografia Computadorizada por Raios X/métodos , Neoplasias das Glândulas Suprarrenais/patologia , Neoplasias das Glândulas Suprarrenais/secundário , Glândulas Suprarrenais/diagnóstico por imagem , Glândulas Suprarrenais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos TestesRESUMO
OBJECT: Demonstrating the feasibility of magnetic resonance imaging (MRI) at 1.5 T of ultrasmall particle iron oxide (USPIO)-antibody bound to tumor cells in vitro and in a murine xenotransplant model. METHODS: Human D430B cells or Raji Burkitt lymphoma cells were incubated in vitro with different amounts of commercially available USPIO-anti-CD20 antibodies and cell pellets were stratified in a test tube. For in vivo studies, D430B cells and Raji lymphoma cells were inoculated subcutaneously in immunodeficient mice. MRI at 1.5 T was performed with T1-weighted three-dimensional fast field echo sequences (17/4.6/13 degrees ) and T2-weighted three-dimensional fast-field echo sequences (50/12/7 degrees ). For in vivo studies MRI was performed before and 24 h after USPIO-anti-CD20 administration. RESULTS: USPIO-anti-CD20-treated D430B cells, showed a dose-dependent decrease in signal intensity (SI) on T2*-weighted images and SI enhancement on T1-weighted images in vitro. Raji cells showed lower SI changes, in accordance to the fivefold lower expression of CD20 on Raji with respect to D430B cells. In vivo 24 h after USPIO-anti-CD20 administration, both tumors showed an inhomogeneous decrease of SI on T2*-weighted images and SI enhancement on T1-weighted images. CONCLUSIONS: MRI at 1.5 T is able to detect USPIO-antibody conjugates targeting a tumor-associated antigen in vitro and in vivo.
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Anticorpos Monoclonais , Modelos Animais de Doenças , Aumento da Imagem/métodos , Ferro , Linfoma/patologia , Imageamento por Ressonância Magnética/métodos , Óxidos , Animais , Anticorpos Monoclonais/imunologia , Anticorpos Monoclonais Murinos , Antígenos CD20/imunologia , Linhagem Celular Tumoral , Meios de Contraste , Dextranos , Sistemas de Liberação de Medicamentos/métodos , Óxido Ferroso-Férrico , Linfoma/imunologia , Nanopartículas de Magnetita , Camundongos , Rituximab , Transplante HeterólogoRESUMO
This article reviews the capabilities and limits of ultrasonography (US) in the staging of gastrointestinal neoplasms. US is a well-established tool in the investigation of abdominal diseases. Its role is very important in the first approach to liver, gallbladder, biliary, and pancreatic diseases, but its abilities for accurate staging may be limited by various factors, which will be discussed. In the evaluation of the stomach and intestine, US is rarely utilized, but it can occasionally demonstrate an unsuspected gastrointestinal mass that usually must be evaluated further with specific techniques (endoscopy and barium studies) to confirm the diagnosis and to perform an accurate staging (with endosonography and computed tomography).
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Endossonografia , Neoplasias Gastrointestinais/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Ultrassonografia Doppler em Cores , Diagnóstico Diferencial , Neoplasias Gastrointestinais/patologia , Humanos , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios XRESUMO
During a 15-year period, 34 patients with renal cell carcinoma extending into the inferior vena cava were submitted to radical ablative surgery at our institution. 8 patients had caval tumor thrombus (TT) extension at the level of the renal veins, 17 had infrahepatic, 8 retrohepatic and 1 atrial TT extension. Cavography, computerized tomography (CT) and ultrasonography (US) were performed preoperatively on 34, 24 and 16 of these 34 patients, respectively. The sensitivity of the techniques used in diagnosing caval involvement was 100, 97 and 87.5% for US, cavography and CT, respectively. The upper limits of TT were clearly detected by US, CT and cavography in 100, 95 and 76% of diagnosed cases, respectively. From this study it appears that US and CT have a sensitivity comparable to cavography in the detection of caval TT. However, US and CT allow a more precise delineation of the upper limits of TT if compared to cavography. This implies that the role of cavography in diagnosing caval TT and its upper limits must be reappraised in light of the progress of noninvasive outpatient procedures.
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Carcinoma de Células Renais/diagnóstico , Neoplasias Renais/patologia , Tomografia Computadorizada por Raios X , Ultrassonografia , Veia Cava Inferior/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/patologia , Reações Falso-Negativas , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Veia Cava Inferior/diagnóstico por imagemRESUMO
Neurofibrosarcomas are rare neoplasms usually associated with von Recklinghausen's disease. In this paper we describe ultrasound (US), computed tomography (CT) and magnetic resonance (MR) appearances of an unusual isolated neurofibrosarcoma of the liver.
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Neoplasias Hepáticas/diagnóstico , Neurofibrossarcoma/diagnóstico , Adulto , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Neurofibrossarcoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
The introduction of high frequency transducers has considerably improved the application of US in the study of musculo-tendinous diseases. We report a rare case of tendinous metastasis from malignant melanoma. The tumour (high karyokinetic index, Clark level IV) arose 4 years earlier in the dorsal region. The patient was admitted for pain in the left knee. A nodular hypoechoic lesion, 0.8 cm in diameter, poorly marginated, located in the subcutaneous tissue and involving the patellar tendon was identified with ultrasound. Histological examination confirmed the diagnosis.
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Melanoma/secundário , Neoplasias Cutâneas/patologia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/secundário , Tendões/diagnóstico por imagem , Adulto , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Melanoma/diagnóstico por imagem , UltrassonografiaRESUMO
We describe a case of inferior glenohumeral subluxation or drooping shoulder secondary to acute calcific tendinitis of the rotator cuff. The various etiologies of drooping shoulder and the specific causes determining glenohumeral widening in our report are discussed. The importance in recognizing this uncommon complication of a common abnormal finding and correction by aspiration is stressed.
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Calcinose/diagnóstico , Calcinose/fisiopatologia , Articulação do Ombro/fisiopatologia , Tendinopatia/diagnóstico , Tendinopatia/fisiopatologia , Calcinose/diagnóstico por imagem , Calcinose/reabilitação , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Modalidades de Fisioterapia , Radiografia , Amplitude de Movimento Articular , Articulação do Ombro/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tendinopatia/reabilitaçãoRESUMO
The preoperative assessment of the extent of biliary and vascular involvement by hilar cholangiocarcinoma is clinically important because resectability may be limited by tumor extension along the bile ducts into the hepatic parenchyma or to the adjacent hilar vessels. Thirty-five patients with hilar cholangiocarcinoma were studied with ultrasound, and the results were compared with operative findings and other diagnostic modalities. The level of intrahepatic biliary obstruction was determined in 100% of patients with ductal ectasia, and a tumor mass was shown in 37.1%. Imaging and Doppler ultrasound proved accurate in detecting the neoplastic involvement of the portal vein. Both correctly diagnosed portal occlusion and wall infiltration in 4 of 4 and 15 of 18 (83%) patients, respectively, without any false-positives. On the contrary, imaging ultrasound had poor sensitivity in detecting infiltration of the hepatic artery (43%) and metastases in regional lymph nodes (37%), liver (66%), and peritoneum (33%). In conclusion, ultrasound may be valuable in the preoperative staging of hilar cholangiocarcinoma, specially in predicting ductal and portal involvement.
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Neoplasias dos Ductos Biliares/diagnóstico por imagem , Ductos Biliares Intra-Hepáticos/diagnóstico por imagem , Colangiocarcinoma/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Colangiocarcinoma/patologia , Colangiocarcinoma/secundário , Colangiocarcinoma/cirurgia , Colestase Intra-Hepática/diagnóstico por imagem , Dilatação Patológica/diagnóstico por imagem , Feminino , Artéria Hepática/diagnóstico por imagem , Artéria Hepática/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Metástase Linfática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/secundário , Veia Porta/diagnóstico por imagem , Veia Porta/patologia , Ultrassonografia Doppler , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/patologiaRESUMO
PURPOSE: To evaluate the vascular anatomy of the prostate gland with transrectal color Doppler ultrasound (US). MATERIALS AND METHODS: Thirty-five normal prostate glands were studied. Imaging findings were interpreted on the basis of findings from previous anatomic studies. RESULTS: Distribution of flow signals within the gland was differentiated into two parenchymal groups of arteries, urethral and capsular. The urethral group entered the prostate at the bladder neck and sent forth branches to supply the periurethral zone and the inner portion of the gland. The capsular group coursed along the anterolateral surface of the prostate and sent forth perforating branches to the outer portion of the gland. Intraprostatic venous signals were seen mainly within the periurethral zone. CONCLUSION: Transrectal color Doppler US can depict the vascular anatomy of the prostate gland. Knowledge of the normal vascular appearance of the gland should aid in the differentiation of normal from abnormal findings.