Advantages of percutaneous abdominal biopsy under PET-CT/ultrasound fusion imaging guidance: a pictorial essay.

Positron emission tomography (PET) is a functional imaging technique that can investigate the metabolic characteristics of tissues. Currently, PET images are acquired and co-registered with a computed tomography (CT) scan (PET-CT), which is employed for correction of attenuation and anatomical localization. In spite of the high negative predictive value of PET, false-positive results may occur; indeed, Fluorine 18 ((18)F)-fluorodeoxyglucose ((18)F-FDG) uptake is not specific to cancer. As (18)F-FDG uptake may also be seen in non-malignant infectious or inflammatory processes, FDG-avid lesions may necessitate biopsy to confirm or rule out malignancy. However, some PET-positive lesions may have little or no correlative ultrasound (US) and/or CT findings (i.e., low conspicuity on morphological imaging). Since it is not possible to perform biopsy under PET guidance alone, owing to intrinsic technical limitations, PET information has to be integrated into a CT- or US-guided biopsy procedure (multimodal US/PET-CT fusion imaging). The purpose of this pictorial essay is to describe the technique of multimodal imaging fusion between real-time US and PET/CT, and to provide an overview of the clinical settings in which this multimodal integration may be useful in guiding biopsy procedures in PET-positive abdominal lesions.

CDKN2A is the main susceptibility gene in Italian pancreatic cancer families.

Background Most familial pancreatic cancer (FPC) remains unexplained. The identification of individuals with a high genetic risk of developing pancreatic adenocarcinoma (PC) is important to elucidate its biological basis and is critical to better define emerging strategies for the detection of early pancreatic neoplasms. Patients and methods A series of 225 consecutively enrolled patients with PC were tested for CDKN2A mutations. After personal and family cancer histories of all the patients had been reviewed, a subset of the patients were classified as FPC and were also tested for mutations in PALLD, PALB2, BRCA1 and BRCA2 as FPC candidate genes. Results The CDKN2A mutation rate in the 225 PC cases was 5.7%. The CDKN2A founder mutations, p.E27X and p.G101W, were predominant, but the mutation spectrum also included p.L65P, p.G67R and two novel, potentially pathogenic variants, promoter variant c.-201ACTC>CTTT and p.R144C. None of the patients with FPC harboured germline mutations in PALLD, PALB2 or BRCA2. One family was positive for the BRCA1 UV variant p.P727L. Strikingly, five of 16 patients with FPC (31%) carried CDKN2A mutations. Conclusion These findings suggest that a sizeable subset of Italian FPC families may carry CDKN2A mutations. This result may be of value for identifying the best candidates for future PC screening trials in Italy.

Diffusion of laparoscopic appendectomies in Italy: a national audit.

A national audit focused on laparoscopic appendectomy was promoted by the Italian Association of Hospital Surgeons (ACOI). Four-hundred and sixty surgical practices received an e-mail questionnaire. Data concerning epidemiology, timetable, surgeon's age, selection of patients, laparotomic conversion, behaviour in the case of a normal appendix, and technical aspects were investigated. The response rate was 51.7%. The median number of appendectomies performed is 50-100 each year in a surgery ward. Laparoscopic operations are very common (93%), but mostly performed in less than 50% of the observed cases. There is no significant difference between the number of operations during the day vs. at night, and they are performed by a limited (<30%) group of surgeons, equally composed of physicians aged above and below 40. The majority of surgeons adopt an "all comers" policy regarding laparoscopic appendectomy, including selected older patients (>70 years old). There are no standard indications for conversion, while the behaviour in the presence of a normal appendix is generally removal. Even if laparoscopic appendectomy is not yet considered a gold standard, it is widely diffused in Italy, and the audit's data show different behaviours between subgroups.

Collision Tumor Composed of an Inflammatory Myofibroblastic Tumor and Adenocarcinoma of the Colon: a Rare Entity.

This report presents the case of an 83-year old man with a collision tumor consisting of an inflammatory myofibroblastic tumor (IMT) and adenocarcinoma of the left colon. As the clinical and radiologic features of IMT are non-specific, only the accurate histopathological examination from the left hemicolectomy specimen was diagnostic. Although the prognosis of a colorectal IMT seemed more favorable than in other sites, four months after surgery the patient developed a tumor relapse. Therefore, malignant behavior of IMT could not be totally excluded. Recent studies have demonstrated that a chromosomal rearrangement involving 2p23, the site of the anaplastic lymphoma kinase (ALK) gene, is present in a subset of these tumors. In our patient, tumor cells did not present ALK-1 perinuclear positivity and it could have indicated a less favorable prognosis. The collision of these different entities is extremely rare and this is the first case reported in literature. Further cases of collision tumors with clinical information including their treatment and prognosis are needed.

Gastrointestinal bleeding due to suspected anisakiasis: challenging differential diagnosis for a rare disease.

As compared with Eastern countries, the incidence of gastrointestinal diseases caused by the ingestion of nematode eggs is very low in Europe, in spite of the fact that the consumption of raw fish has increased in these countries as well in recent years. The authors present here, a rare case of gastrointestinal bleeding due to Anisakis simplex. This is a very uncommon clinical presentation which rise several problems in diagnosis and management.

Assessment of hepatic reserve for the indication of hepatic resection: how I do it.

Despite the careful selection of cirrhotic patients with hepatic neoplasms, liver resection for these patients remains associated with greater risk than in patients without underlying liver disease. The most rational indications for resective surgery in patients with hepatic neoplasms and cirrhosis are nonprogressive cirrhosis and good functional reserve. Therefore, evaluation of hepatic reserve is mandatory for hepatectomy candidates. Because of the complexity of hepatic function, a single, reliable liver function test is not yet available. However, a good multifactorial system that combines several elements (clinical, laboratory, functional, and volumetric evaluation) does provide sufficient data for determining the safe limits of hepatectomy.