Extradigital glomus tumor: dermoscopic description and histopathological correlation

Abstract Glomus tumors are rare benign neoplasms arising from the neuromyoarterial structure called glomus body. They present as angiomatous papules, soft and painful, especially to cold and pressure. In general, they are solitary and affect the extremities, located mainly the subungual bed. Extradigital lesions are rare and can constitute a diagnostic challenge. This is the report of a patient with an extradigital lesion on the left arm, and its dermoscopic aspects, including angiomatous lagoons circumscribed by a pale halo, a structure not previously described in the two reports of extradigital glomus tumor with dermoscopic features, found in the literature.

Uso de PET-CT en el delineado de volumen en la planificación del tratamiento con radiación / Use of PET-CT in the one delineated of volume in the planning of the one radiant treatment

El tratamiento con radioterapia, consiste en irradiar de forma homogénea el tumor, evitando irradiar los órganos cercanos. El desarrollo de la tecnología en el campo de la medicina, ha permitido que se cumpla este principio, con buenos resultados de respuesta objetiva, que se traduce en el control de la enfermedad de los pacientes con cáncer. La Tomografía axial computarizada por emisión de positrones (PET-CT) consigue una mayor precisión en el delineado del volumen blanco o tumoral. El propósito de este estudio fue analizar la influencia del uso del PET-CT en el delineado de volúmenes a tratar en la planificación del tratamiento con radiaciones.Se diseñó un estudio piloto con dos pacientes preparados para radioterapia por neoplasias malignas, a los cuáles se les realizó un TAC simple y un PET-CT y observadores independientes realizaron la delimitación del tumor. Se examinó la consistencia entre los observadores y las mediciones en las imágenes.El uso del PET-CT favoreció la delimitación del volumen a irradiar lo que disminuye el riesgo para los órganos vecinos.

The treatment with radiotherapy consists on irradiating in a homogeneous way the tumor, avoiding to irradiate the near organs. The development of the technology in the field of the medicine, it has allowed that this principle is completed, with good results of objective answer what allows the control of the illness of the patients with cancer. The computerized axial tomography by positrons emission (PET-CT) it gets a bigger precision in the one delineated of the white volume or tumoral. The purpose of this study was to analyze the influence of the use of the PET-CT in the one delineated of volumes to try in the planning of the treatment with radiations.A study pilot was designed with two prepared patients for radiotherapy for malignant diseases, to those which they were carried out a simple TAC and a PET-CT and independent observers carried out the delimitation of the tumor. The consistency was examined between the observers and the mensuration in the images.The use of the PET-CT favors the delimitation of the volume to irradiate what diminishes the risk for the neighboring organs.

Estadificación clínica como factor pronóstico en cáncer de vejiga músculo-invasor / Clinical Staging as Prognostic Factor in Muscle-Invasive Bladder Cancer

El cáncer de vejiga músculo invasor (CV-MI), requiere de una adecuada estadificación clínica y patológica, ya que eso determina las estrategias terapéuticas y el pronóstico de la enfermedad, caracterizada por una alta morbimortalidad. Este articulo tiene como objetivo realizar una revisión de la literatura sobre la exactitud diagnóstica de las técnicas de imagen disponibles para la estadificación clínica de los pacientes con CV-MI y cómo se debería realizar el seguimiento radiológico en los pacientes llevados a cirugía. Para eso se realizó una búsqueda en la base de datos Pubmed de artículos en inglés y en español, se incluyeron artículos de revisión, metanálisis, guías clínicas, estudios retrospectivos y prospectivos de pronóstico y diagnóstico desde el año 1988 hasta el año 2020.

Muscle invasive bladder cancer (CV-MI) requires an adequate clinical and pathological staging, as this determines the therapeutic strategies and prognosis of the disease, characterized by high morbidity and mortality. This article aims to carry out a review of the literature on the diagnostic accuracy of the available imaging techniques for the clinical staging of patients with CV-MI and how the radiological follow up should be made in the patients who underwent surgical management of the disease. For this, a search was carried out in the Pubmed database of articles in English and Spanish; review articles, meta-analyzes, clinical guidelines, retrospective and prospective prognosis and diagnosis studies from 1988 to 2020 were included

Progress in Clinical Research of Amide Proton Transfer Imaging / 中国医疗器械杂志

As a new type of magnetic resonance imaging method, amide proton transfer (APT) imaging can detect the chemical exchange characteristics of free proprotein, peptide amide proton and water proton by water signal changes, reflecting the changes of protein and pH in tissues. In recent years, clinical research on brain tumors, multiple sclerosis, hepatic encephalopathy and cervical cancer have been carried out. It is a radiation-free and non-invasive new magnetic resonance molecular imaging technology. This study briefly reviews the principle of APT technology and its clinical application, and prospects its application prospects in children's abdominal tumors.

Estado actual y perspectivas de la imagen molecular PET en México / Current status and perspectives of PET molecular imaging in Mexico

Resumen La tomografía por emisión de positrones (PET) es una técnica de diagnóstico médico mediante la cual se obtienen imágenes funcionales a partir de registrar la biodistribución espacio-temporal de radiofármacos específicos dirigidos a blancos moleculares específicos, proveyendo información bioquímica a nivel molecular. A principios de la primera década de este siglo XXI, la Facultad de Medicina de la Universidad Nacional Autónoma de México implementó esta técnica de diagnóstico en México, convirtiéndose en pionera en aplicaciones PET en el país y Latinoamérica. Casi dos décadas después, la PET se ha convertido en una herramienta esencial en la clínica médica. En este artículo se describen los antecedentes, el estado actual, las perspectivas de la imagen molecular PET en México y el impacto que ha tenido en el manejo de pacientes con enfermedades oncológicas, neurológicas y cardiológicas.

Abstract Positron-emission tomography (PET) is a medical diagnostic technique by means of which functional images are obtained by recording the spatio-temporal biodistribution of specific radiopharmaceuticals targeted at specific molecular objectives, which provides biochemical information at the molecular level. Early in the first decade of this 21st century, the Faculty of Medicine of the National Autonomous University of Mexico acquired the technology to implement this diagnostic technique in Mexico, thus becoming a pioneer in PET applications in the country and in Latin America. Almost two decades after its implementation in Mexico, PET has become an essential tool in medical clinics. This article describes the background, current state and perspectives of PET molecular imaging in Mexico, and the impact it has had on the management of patients with oncological, neurological and heart diseases.

Hallazgo de Tumor Maligno/Premaligno Insospechado en Estudios 18 F-FDG PET/TC en Pacientes Oncológicos: Incidental Malignant/Premalignant Tumor Detection in Oncological Patients / 18 f-fdg pet/ct

Objetivo Determinar la frecuencia y el tipo de tumor maligno/premaligno insospechado como hallazgo en estudios 18 F-FDG PET/TC en pacientes oncológicos. Material y Métodos Se revisaron retrospectivamente (de enero de 2014 a marzo de 2017), informes de estudios 18 F-FDG PET/TC de pacientes oncológicos, identificando aquellos pacientes con hallazgo de lesión sospechosa de otro tumor maligno como hallazgo incidental. La información fue obtenida a partir de determinadas "palabras clave" en la base de datos del Centro. Los hallazgos se confirmaron mediante histopatología y/o seguimiento clínico y paraclínico de como mínimo seis meses. Resultados De 4.086 pacientes oncológicos estudiados con 18 F-FDG PET/TC, se encontró lesión sospechosa de otro tumor maligno en 130 (3,2%), de los cuales 72 eran mujeres y 58 hombres, con edad media de 61 años. Los tumores primarios más frecuentes (aquellos que motivaron el pedido del examen PET/CT inicialmente), fueron de mama (n = 27), pulmón (n = 27) y colo-recto (n = 20). Se confirmaron por histopatología 49 (1,2%) nuevos tumores malignos/premalignos y dos lesiones metastásicas. La localización del segundo tumor primario correspondió a: colon (n = 18), pulmón (n = 6), mama (n = 6), linfoma (n = 3), ovario (n = 2), endometrio/cuello uterino (n = 2), tiroides (n = 2) y otros (n = 10). Resultaron 28 hallazgos falsos positivos, 31 pacientes no se estudiaron por progresión lesional y 20 pacientes se perdieron de seguimiento. Discusión La prevalencia de neoplasia primaria maligna múltiple (NPMM) es variable entre 0,7 y 11,7%. En nuestra serie, se encontró lesión sospechosa de segundo tumor en 130 casos (3,2%), de los cuales se confirmaron 49 segundos tumores (1,2%), similar a Conclusiones La tasa de detección de tumor maligno insospechado confirmado histológicamente fue de 1,2%. Todo hallazgo incidental sospechoso de malignidad en 18 F-FDG PET/TC debe ser estudiado, ya que puede corresponder a un segundo tumor maligno no sospechado con posibilidad de tratamiento curativo.

Purpose To determine the frequency and type of unexpected malignant/ premalignant tumor as a finding in 18 F-FDG PET/CT studies in oncological patients. Material and Methods Reports of 18 F-FDG PET/CT studies of oncological patients were reviewed retrospectively (from January 2014 to March 2017), with the finding of suspicious lesion of another malignant tumor. The information was obtained from certain "keywords" in the Center's database. The findings were confirmed by histopathology when possible and with clinical and paraclinical follow-up for at least six months. Results Of 4086 oncological patients, studied with 18 F-FDG PET/CT, a suspicious lesion of another malignant tumor was found in 130 (3.2%), 72 female and 58 male sex, average age 61 years. The most frequent primary tumors were: breast (n = 27), lung (n = 27) and colo-rectum (n = 20). 49 (1.2%) new malignant/premalignant tumors and two metastatic lesions were confirmed by histopathology. The location of the second primary tumor was: colon (n = 18), lung (n = 6), breast (n = 6), lymphoma (n = 3), ovary (n = 2), endometrium/cervix (n = 2), thyroid (n = 2) and others (n = 10). There were 28 false positive findings, 31 patients were not studied for progression and 20 patients were lost to follow-up. Discussion The prevalence of multiple malignant primary neoplasia (MMPN) is variable between 0.7 and 11.7%. In our series, a suspicious second tumor lesion was found in 130 cases (3.2%), of which 49 second tumors (1.2%) were confirmed, similar to that reported by other authors. Conclusions The detection rate of unsuspected malignant tumor was 1.2%, coincident with the literature. Any incidental finding suspicious of malignancy in 18 F-FDG PET/CT should be studied since in most cases it corresponds to early diagnosis with the possibility of curative treatment.

Positron emission tomography/magnetic resonance imaging (PET/MRI): An update and initial experience at HC-FMUSP / Tomografia por emissão de pósitrons/ressonância magnética (PET/RM): atualização e experiência inicial do HC-FMUSP

Summary The new technology of PET/MRI is a prototype of hybrid imaging, allowing for the combination of molecular data from PET scanning and morphofunctional information derived from MRI scanning. Recent advances regarding the technical aspects of this device, especially after the development of MRI-compatible silicon photomultipliers of PET, permitted an increase in the diagnostic performance of PET/MRI translated into dose reduction and higher imaging quality. Among several clinical applications, PET/MRI gains ground initially in oncology, where MRI per se plays an essential role in the assessment of primary tumors (which is limited in the case of PET/CT), including prostate, rectal and gynecological tumors. On the other hand, the evaluation of the lungs remains an enigma although new MRI sequences are being designed to overcome this. More clinical indications of PET/MRI are seen in the fields of neurology, cardiology and inflammatory processes, and the use of PET/MRI also opens perspectives for pediatric populations as it involves very low radiation exposure. Our review aimed to highlight the current indications of PET/MRI and discuss the challenges and perspectives of PET/MRI at HC-FMUSP.

Resumo A nova tecnologia PET/RM é o protótipo de diagnóstico por imagem híbrido e permite combinar dados moleculares obtidos da tomografia PET e informações morfofuncionais derivadas da ressonância magnética. Avanços recentes relativos a aspectos técnicos desse dispositivo, principalmente após o desenvolvimento de fotomultiplicadores de silício compatíveis com RM, permitiram uma melhora do desempenho diagnóstico da PET/RM traduzida em redução da dose e qualidade superior das imagens. Entre diversas aplicações clínicas, a PET/RM ganha espaço inicialmente no campo da oncologia, onde a RM tem papel essencial na avaliação de tumores primários (limitado no caso da PET/TC), incluindo tumores de próstata, reto e ginecológicos. Por outro lado, a avaliação dos pulmões ainda é um enigma, a despeito de novas sequências de RM que estão sendo criadas para tentar resolver essa questão. Outras indicações clínicas da PET/RM são encontradas no âmbito da neurologia, cardiologia e de processos inflamatórios, nos quais a técnica também abre perspectivas para pacientes pediátricos, já que envolve uma exposição baixíssima à radiação. Nossa revisão teve como objetivo destacar as indicações atuais da PET/RM e discutir os desafios e perspectivas da aplicação dessa técnica no Hospital das Clínicas da FMUSP.

Concepções de professores e adolescentes sobre o corpo de adolescente após o tratamento de câncer: um diálogo educativo na escola / School teachers and adolescents conceptions about the adolescent body after cancer treatment: an education dialogue in the school

O aumento progressivo na cura do câncer infanto-juvenil abre vertente para estudos relacionados ao momento pós-tratamento de câncer, incluindo a reinserção plena na escola. Para isso investigaram-se as concepções de adolescentes e professores sobre a inclusão escolar de uma adolescente após o tratamento de câncer; uma abordagem grupal e participativa, como estratégia de problematização da inclusão escolar de adolescente após o tratamento de câncer e as implicações dessa abordagem na promoção da saúde mediada pelas práticas de convivência entre adolescentes. Pesquisa participatória, com abordagem qualitativa e método criativo-sensível, com 10 participantes, sendo quatro professores, cinco alunos adolescentes e o caso-índice. Para a produção de dados foram utilizadas dinâmicas de criatividade e sensibilidade mapa falante, encontros etnográficos e descrição do caso-índice, os dados foram analisados com a análise de conteúdo de Bardin. Respeitaram-se os aspectos éticos, com aprovação dos comitês de ética da instituição proponente e da instituição hospitalar do caso-índice. O processo de conscientização, bem como a teoria sócio- histórica foram as lentes teóricas. O caso-índice foi uma adolescente com alteração da imagem corporal derivada do diagnóstico e tratamento oncológico. As concepções de adolescentes e professores revelaram a expectativa de a adolescente-índice ser estigma "zoada" na chegada à nova escola, as inciativas de acolhimento e de (des)acolhimento por parte dos pares. A ação educativa participativa colaborou no processo de transição do hospital para a escola, mediando o desenvolvimento com o instrumento e signos, conduzindo adolescentes através da zona de desenvolvimento proximal para a transitividade crítica da consciência na promoção da inclusão socioescolar de uma adolescente em pós-tratamento de câncer.

The progressive increase of cure of child-youth cancer opens strand for studies related to the post-cancer treatment moment, including full reintegration into school. For this, we investigated the adolescents' and teachers' conceptions on school inclusion of an adolescent in post treatment of cancer; a group and participative approach as problematization strategy of school inclusion of the adolescent post treatment of cancer and the implications of this approach on health promotion mediated by practices of interations among adolescents. Participatory research with qualitative approach and creativite and sensitive method with 10 participants, being 4 teachers, 5 students/adolescents and an index case. To produce data, we used creativity and sensitivity dynamics talking map, ethnographic encounters and description of the index case. Data analysis was with Bardin's thematic content. Respecting ethical aspects, there was ethical comittees approval from the proposing institution and the hospital institution of the index case. Awareness process, as well as the socio- historical theory were theoretical lenses. The index case was an adolescent with altered body image derived from oncological diagnosis and treatment; the conceptions of adolescents and teachers revealed the expectation of the adolescent index to be "made fun of" on arrival at the new school, the initiatives of reception and dis- welcoming by peers; the application of participative educational action generated expectations in the index adolescent of being accepted and attitudes compatible with the concreteness of apprehension of the reality in the pairs. The participative educational action collaborated in the process of transition from hospital to school, mediating development with instrument and signs, leading adolescents through the proximal zone of development to the critical transitivity of consciousness in the promotion of the socio-scholar inclusion of an adolescent in post- treatment of cancer.

Relação médico-paciente na oncologia: estudo a partir da perspectiva do paciente / The doctor-patient relationship in oncology: a study from the patient's perspective / Relación médico-paciente en oncología: un estudio desde la perspectiva del paciente

Resumo As peculiaridades do diagnóstico de câncer impõem ao médico abordagem diferenciada, tornando necessário o estudo dos aspectos psicossociais do doente e de técnicas comunicacionais, de modo a não gerar iatrogenias. O objetivo do trabalho foi estudar a relação médico-paciente com câncer em um centro de referência em oncologia do serviço público. Trata-se de estudo exploratório qualitativo e descritivo, envolvendo 17 pacientes diagnosticados com câncer na Fundação Centro de Controle de Oncologia do Estado do Amazonas. Os entrevistados demonstraram diversos sentimentos: desejaram mais sinceridade e clareza dos médicos no diagnóstico; questionaram a dificuldade do acesso ao sistema de saúde; queixaram-se dos efeitos do tratamento e das limitações emocionais e físicas vivenciadas; e, por fim, destacaram a importância da relação médico-paciente. Portanto, foram reconhecidos aspectos importantes do diagnóstico e tratamento de câncer, devidamente contextualizados, de modo a se repensar a prática médica e a relação médico-paciente.

Abstract The peculiarities of cancer diagnosis require the doctor to adopt a different approach and make the study of the psychosocial aspects of the patient and communication techniques necessary to avoid iatrogenesis. This paper aims to study the relationship between the doctor and the cancer patient in a public oncology reference center. A qualitative and descriptive exploratory study was performed involving 17 patients diagnosed with cancer at Fundação Centro de Controle de Oncologia do Estado do Amazonas (Amazonas State Oncology Control Center Foundation), Brazil. The patients interviewed expressed a wide variation of feelings; they wanted greater sincerity and clarity from doctors during diagnosis; they questioned the difficulty of access to health care; they complained about the effects of treatment and the emotional and physical limitations experienced during the process; and finally they emphasized the importance of the doctor-patient relationship. In conclusion, it was noted that patients recognized important aspects of the diagnostic process and the treatment of cancer, which, when duly contextualized, serve as a basis for rethinking medical practice and the doctor-patient relationship.

Resumen Las peculiaridades del diagnóstico de cáncer imponen al médico abordajes diferenciados, tornando necesario el estudio de los aspectos psicosociales del enfermo y de las técnicas de comunicación, con el fin de no generar iatrogenias. El objetivo del trabajo fue estudiar la relación médico-paciente con cáncer en un centro de referencia en Oncología del servicio público. Se trata de un estudio exploratorio cualitativo y descriptivo, con 17 pacientes con diagnóstico de cáncer en la Fundación Centro de Control de Oncología del Estado de Amazonas, Brasil. Los entrevistados mostraron diversos sentimientos: desearon mayor sinceridad y claridad de parte de los médicos en el diagnóstico; cuestionaron la dificultad en el acceso al sistema de salud; se quejaron de los efectos del tratamiento y de las limitaciones emocionales y físicas experimentadas; y, finalmente, destacaron la importancia de la relación médico-paciente. Por lo tanto, se reconocieron aspectos importantes del diagnóstico y del tratamiento del cáncer, debidamente contextualizados, de modo tal de poder repensar la práctica médica y la relación médico-paciente.

PET/CT: Técnica, consideraciones e indicaciones en el estudio oncológico de pacientes pediátricos / PET/CT: Technique, considerations and indications in the oncology study of pediatric patients

Resumen El cáncer en la población pediátrica representa la segunda causa de muerte en niños mayores de 5 años en nuestro país, después del trauma. La tomografia por emisión de positrones/tomograña computada (PET/CT) es una técnica hibrida que involucra radiación y que progresivamente se está implementando en niños. Esta técnica permite hacer evaluaciones morfológicas y funcionales del cuerpo con aplicaciones en patología neoplásica y no neoplásica. Su principal rol en la oncología se encuentra en la evaluación y control de linfomas, sarcomas y neuroblastomas, entre otros. La calidad de los resultados depende de la realización de procesos rigurosos para obtener las imágenes. En este artículo se revisan los pasos para la obtención de las imágenes, los aspectos técnicos involucrados, las fuentes de mala interpretación y las principales indicaciones que debe conocer el médico radiólogo y pediatra.

Abstract Pediatric cancer is the second cause of death in children older than 5 years in our country, after trauma. Positron emission tomography/computed tomography (PET/CT) is a hybrid technique that involves radiation, which has been used for some time in adults and is being progressively imple mented in children. This technique allows morphological and functional assessments of the body with applications in neoplastic and non-neoplastic pathology. Its main role in oncology is in the evaluation and control of lymphomas, sarcomas and neuroblastomas, among others. The quality of the results is determined by a number of rigorous processes to obtain the images. In this article we describe the steps in obtaining the images, the technicalities involved, sources of misinterpretation and what the main current indications that must be known by radiologists and pediatricians are.

Patologías benignas y variantes que captan 68Ga-DOTATATE en PET/TC / Benign Pathology And Variants With Uptake In 68ga-Dotatate Pet/Ct Studies

Objetivos: Valorar las variantes fisiológicas, anatómicas y lesiones benignas en estudios por tomografía computada por emisión de positrones (PET/TC) con Galio 68 (68Ga)-DOTATATE. Materiales y métodos: Se revisaron en forma retrospectiva los informes de PET/TC con 68Ga-DOTATATE y se seleccionaron aquellos en los cuales se mencionaran palabras en el reporte relacionadas a variantes anatómicas, fisiológicas y tumores benignos. El grado de captación del 68Ga-DOTATATE fue evaluado de forma cualitativa y cuantitativa mediante la medición del valor estandarizado de captación máximo (SUVmax). Se consignó la localización del hallazgo, el valor de SUVmax y la imagen morfológica por tomografía computada (TC). Todos los casos fueron controlados mediante evolución clínica y hallazgos imagenológicos. Resultados: De un total de 772 informes de PET/TC se obtuvo un total de 28 pacientes con 33 variantes o tumores benignos, 14 mujeres y 14 hombres con edad promedio de 63 años. Las captaciones se clasificaron en cuatro grupos: variantes anatómicas y/o fisiológicas (n = 15), dependientes de la actividad osteoblástica (n=4), dependientes de actividad inflamatoria (n = 10) y tumores benignos no neuro-endócrinos (n = 4). Discusión: Los receptores de somatostatina se localizan no sólo en el sistema neuroendócrino sino también en otros tejidos. Las variantes fisiológicas, anatómicas y tumores benignos que expresan estos receptores pueden inducir a un error diagnóstico. Conclusión: Las variantes fisiológicas y lesiones benignas (tumorales e inflamatorias) pueden captar 68Ga-DOTATATE ya que sus tejidos pueden expresar receptores de somatostatina. El análisis semiológico del componente tomográfico de este método de imágenes híbrido, permite la orientación diagnóstica, optimizando el rendimiento del estudio PET/TC.

Purpose: To evaluate the physiological, anatomical variants and benign lesions in positrón emission computed tomography (PET/CT) studies with 68Ga-DOTATATE. Materials and methods: We retrospectively reviewed PET/CT reports scanned with 68Ga-DOTATATE and selected those that contained words in the report related to anatomical, physiological variants and benign tumors. The degree of 68Ga-DOTATATE uptake was evaluated qualitatively and quantitatively by measuring the standarized uptake max value (SUVmax value). The anatomical location, SUVmax value and morphological CT image findings were recorded. All cases had clinical and imaging follow-up. Results: From a total of 772 PET/CT reports, 28 patients were obtained with 33 benign variants or tumors, 14 females and 14 males with a median age of 63 years. Uptake patterns were classified into four groups: anatomic and physiological variants (15), dependent on osteoblastic activity (4), dependent on inflammatory activity (10) and non-neuro-endocrine benign tumors (4). Discussion: Somatostatin receptors are overexpressed not only in the neuroendocrine system but also in other tissues. Physiological, anatomical variants and benign tumors expressing these receptors may be misleading. In the present work the frequency of this finding is 5.1%. Conclusion: Physiological variants and benign lesions (tumor and inflammatory) can accumulate 68Ga-DOTATATE since their tissues can express somatostatin receptors. The semiologic analysis of the tomographic component of this hybrid method enhances the diagnostic efficacy, optimizing PET/CT study performance.

Evaluation of the Spies TM modalities image quality

Introduction The Spies™ system (Karl-Storz®) was introduced into digital ureteroscopy to improve endoscopic vision. To date, there is no data to either indicate which of the Spies modalities is better for improving diagnosis and treatment procedures, nor to compare the modalities in terms of image quality. The aim of this study was to evaluate and compare the image quality of five Spies™ modalities (SM) to the standard white light in an in-vitro model. Materials and Methods Two standardized grids and 3 stones of different composition were recorded in white light and the 5SM (Clara, Chroma, Clara+Chroma), Spectra A and B) using 4 standardized aqueous scenarios. Twelve templates were done in order to simultaneously compare the same objective in the different modalities. Six urologists, five medical students, five urology residents, and five persons not involved with urology evaluated each video on a scale of 1 (very bad) to 5 (very good). Results Comparing white light to SM, subjects scored better the quality of Clara and Clara+Chroma than white light (p=0.0139 and p<0.05) and scored worse Spectra A and B (p=0.0005 and p=0.0023)). When comparing Clara to the other SM, it was ranked equivalent to Clara+Chroma (p=0.67) and obtained a higher rank than Chroma, Spectra A and B (p<0.05, p=0.0001 and p=0.0001). In the multivariate analysis mean scores were higher among urologists. Conclusion In all analyzed scenarios, the subjects ranked Clara and Clara+Chroma as the modalities with better image quality compared to white light.

Targeting personalized medicine in a non-Hodgkin lymphoma patient with 18F-FDG and 18F-choline PET/CT

Summary Early diagnosis and staging of non-Hodgkin lymphoma (NHL) is essential for therapeutic strategy decision. Positron emission tomography/computed tomography (PET/CT) with fluordeoxyglucose (FDG), a glucose analogue, labeled with fluor-18 (18F-FDG) has been used to evaluate staging, therapy response and prognosis in NHL patients. However, in some cases, 18F-FDG has shown false-positive uptake due to inflammatory reaction after chemo and/or radiation therapy. In this case report, we present a NHL patient evaluated with 18F-FDG and 18F-choline PET/CT scan imaging pre- and post-therapy. 18F-FDG and 18F-choline PET/CT were performed for the purpose of tumor staging and have shown intense uptake in infiltrative tissue as well as in the lymph node, but with some mismatching in the tumor. Post-treatment 18F-FDG and 18F-choline PET/ CT scans revealed no signs of radiotracer uptake, suggesting complete remission of the tumor. 18F-choline may be a complimentary tool for staging and assessment of therapeutic response in non-Hodgkin lymphoma, while non-18F-FDG tracer can be used for targeted therapy and patient management.

Carcinoma de los ductos colectores de bellini: presentación de un caso clínico y revisión del diagnóstico diferencial / Collecting (bellini) duct carcinoma: a case presentation

Collecting (Bellini) duct carcinoma (CDC) is a rare and very aggressive variant of renal cell carcinoma. Objectives: To describe the radiological findings of a CDC case and to determine its differential diagnosis. Basic procedures: Review the published works regarding this tumor and compare the radiological findings of our case with those of other described cases. Most important findings: CDCs are well-defined tumors with a high hemorrhagic component, limited internal enhancement and nodal metastases. In the differential diagnosis, if the lesion presents an exophytic growth it should include papillary carcinoma, mainly the sarcomatoid variant and the complex benign lesions (complex cysts or hydatids). However, if the lesion combines an infiltrating pattern, other lesions such as medullary carcinoma or lymphoma will be taken into account. Main conclusions: In the presence of solid-cystic hypovascular lesions and regional lymphadenopathy, CDC must be included in the differential diagnosis.

El carcinoma de las células colectoras de Bellini (CCB), es una variante rara y muy agresiva del carcinoma de células renales. Objetivos: Describir los hallazgos radiológicos de un caso de CCB y determinar su diagnóstico diferencial. Procedimientos básicos: Revisión de los trabajos publicados sobre este tumor y comparar los hallazgos radiológicos de nuestro caso con los de otros casos descritos. Hallazgos más importantes: Los CCB son tumores bien delimitados con alto componente hemorrágico, escaso realce interno y metástasis ganglionares. En el diagnóstico diferencial si la lesión presenta un crecimiento exofítico debería incluirse el carcinoma papilar, fundamentalmente la variante sarcomatoide y las lesiones benignas complejas (quistes complejos o hidatídicos). En cambio, si la lesión asocia un patrón infiltrante se tendrán en cuenta otras lesiones como el carcinoma medular o el linfoma. Conclusiones principales: En presencia de lesiones sólido-quísticas hipovasculares y adenopatías regionales debe incluirse el CCB en el diagnóstico diferencial.

Tumor fibroso solitario meníngeo / Meningeal fibrous solitary tumor

Se presenta caso de paciente masculino de 28 años, sin antecedentes médicos de importancia, con síndrome convulsivo primer evento. Se le realiza estudio de imagen donde se documenta lesión ocupativa extraaxial temporo ­ occipito ­ cerebelar derecha. Paciente es llevado a resección de tumor. Se obtiene hallazgo histopatológico de tumor fibroso solitario meningeo. Además se documenta foco irritativo cortical a este mismo nivel. El tumor fibroso solitario meningeo representa un espectro de tumores mesenquimales, agrupado actualmente por la Clasificación de la OMS como Tumor fibroso solitario/ Hemangiopericitoma grado 1. El tratamiento se basa en resección quirúrgica amplia y vigilancia a largo plazo...(AU)

O mundo do adolescente após a revelação do diagnóstico de câncer / The world of the adolescent after being diagnosed with cancer / El mundo del adolescente después de la revelación del diagnóstico de cáncer

Objetivou-se conhecer o mundo do adolescente após a revelação do diagnóstico de câncer. Trata-se de estudo descritivo de natureza qualitativa, desenvolvido no Instituto de Oncologia Pediátrica, no município de São Paulo entre fevereiro e abril de 2011. Participaram oito adolescentes entre 10 e 14 anos. Os dados foram coletados por meio de sessões de "brinquedo terapêutico" e revelaram que os adolescentes têm mudanças significativas em suas vidas, decorrentes das hospitalizações, da doença e do tratamento. Diante disso, evidencia o quanto a disponibilidade de uma rede de apoio é fundamental para o enfrentamento, sendo a mesma representada pela família, amigos, instituição de saúde e o animal de estimação. Assim, abre-se para a equipe de saúde a necessidade de uma assistência humanizada ao adolescente com câncer, atendendo às suas necessidades particulares, não só físicas como também psicológicas e sociais, incluindo-se a participação da família.

This study aimed at understanding the world of the adolescent after a cancer diagnosis. It is a descriptive qualitative study carried out at the Institute of Paediatric Oncology, São Paulo between February and April 2011. Participants were eight adolescents between 10 and 14 years of age. Data were collected during play therapy sessions. It revealed that adolescents' life is significant changed after illness, hospitalizations, and treatment. A support network is crucial for helping in the coping process. This network comprises family, friends, health institution and pets. Health care team should deliver a humanized care, striving to meet the adolescents'physical, psychological and social needs, as well as encouragefamily participation.

El objetivo de la presente investigación es conocer el mundo del adolescente después del diagnóstico de cáncer. Se trata de un estudio descriptivo de naturaleza cualitativa llevado a cabo en el Instituto de Oncología Pediátrica de la ciudad de San Pablo entre febreroy abril de 2011. Participaron ocho adolescentes de 10 a 14 anos. Los datos fueron recogidos mediante sesiones de juego terapêutico y revelaron que en la vida de estos adolescentes hay cambios significativos, producto de las internaciones, de la enfermedad y del tratamiento. Queda evidente cuán importante es poder contar con una red de apoyo formada por la familia, los amigos, los servicios de salud y hasta por sus mascotas. De ese modo el personal de salud muestra la necesidad de brindar atención humanizada al adolescente con cáncer, atendiendo sus necesidades particulares, no sólo físicas sino también psicológicas y sociales, que incluyen la participación de la familia.

Whole-Body MRI in Children: Current Imaging Techniques and Clinical Applications

Whole-body magnetic resonance imaging (MRI) is increasingly used in children to evaluate the extent and distribution of various neoplastic and non-neoplastic diseases. Not using ionizing radiation is a major advantage of pediatric whole-body MRI. Coronal and sagittal short tau inversion recovery imaging is most commonly used as the fundamental whole-body MRI protocol. Diffusion-weighted imaging and Dixon-based imaging, which has been recently incorporated into whole-body MRI, are promising pulse sequences, particularly for pediatric oncology. Other pulse sequences may be added to increase diagnostic capability of whole-body MRI. Of importance, the overall whole-body MRI examination time should be less than 30-60 minutes in children, regardless of the imaging protocol. Established and potentially useful clinical applications of pediatric whole-body MRI are described.

What are the most discriminating two-dimensional and doppler sonographic features in differentiation of benign and malignant adnexal masses?

To determine the two-dimensional and doppler sonographic features that best allow differentiation between malignant and benign adnexal masses, besides develop a new scoring system enable more accurate diagnosis with these features. A cross sectional prospective study was conducted on patients scheduled for surgery due to presence of adnexal masses at Women's Health Hospital, Assiut, Egypt between October 2012 and October 2013. All patients were evaluated by 2D ultrasound for morphological features of the masses aided by doppler examination of their vessels. The final diagnosis was based on histopathological reports used as gold standard. One hundred forty-six patients were recruited, 104 with benign masses, 42 with malignant masses. Features that allowed statistically significant discrimination of benignity from malignancy were; volume of mass, type of mass, presence and thickness of septae, presence and length of papillary projections, location of vessels at colour Doppler and colour score. A scoring formula was supposed combined those features together to develop a new scoring system; Assiut Scoring System [ASS]. The cut-off score with the highest accuracy in detection of malignancy had a sensitivity of 93.5% and specificity of '92.2%. Assiut Scoring System; a multiparameter scoring that use four 2D ultrasound and two doppler features, has a high sensitivity and specificity for prediction of malignancy in adnexal masses

Comparison of the Safety of Seven Iodinated Contrast Media

We aimed to determine the characteristic adverse events (AEs) of iodinated contrast media (IOCM) and to compare the safety profiles of different IOCM. This study used the database of AEs reports submitted by healthcare professionals from 15 Regional Pharmacovigilance Centers between June 24, 2009 and December 31, 2010 in Korea. All reports of IOCM, including iopromide, iohexol, iopamidol, iomeprol, ioversol, iobitridol and iodixanol, were analyzed. Safety profiles were compared between different IOCM at the system organ level using the proportional reporting ratio (PRR) and 95% confidence interval (95% CI). Among a total of 48,261 reports, 6,524 (13.5%) reports were related to the use of IOCM. Iopromide (45.5%), iohexol (16.9%), iopamidol (14.3%) and iomeprol (10.3%) were identified as frequently reported media. 'Platelet, bleeding & clotting disorders' (PRR, 29.6; 95%CI, 1.9-472.6) and 'urinary system disorders' (PRR, 22.3; 95% CI, 17.1-29.1) were more frequently reported for iodixanol than the other IOCM. In conclusion, the frequency of AEs by organ class was significantly different between individual media. These differences among different IOCM should be considered when selecting a medium among various IOCM and when monitoring patients during and after its use to ensure optimum usage and patient safety.