Prostate cancer with metastasis to the omentum and massive ascites: a rare manifestation of a common disease.

BACKGROUND: The most common sites of metastasis in prostate cancer include bone and regional lymph nodes followed by lung, liver, and brain. Peritoneal metastasis without skeletal involvement is extremely rare. CASE REPORT: We present herein a patient with hormone refractory prostate cancer with peritoneal metastasis accompanied by ascites but without bone metastasis. The patient initially experienced an excellent response to docetaxel-based chemotherapy. CONCLUSIONS: Prostate cancer can present with distant metastasis in unexpected sites. The lack of skeletal involvement does not exclude the possibility of distant metastases. The presence of ascites may indicate peritoneal disease which could be responsive to current standard chemotherapy.

CT in appendicitis.

Appendicitis is the most common abdominal emergency occurring in 7%-12% of the population. The aim of this article was to pictorially present the spectrum of appendix and acute appendicitis appearances on computed tomography (CT). The various appearances on CT of the normal appendix are shown as well as the CT criteria for the differentiation of perforated and non-perforated appendicitis.

Lower limb veins color and spectral Doppler ultrasonography examination. An examination protocol.

Lower extremity's venous pathology was traditionally investigated by intravenous venography. Nowadays Color Doppler flow imaging is widely accepted as a well established, noninvasive method for the evaluation of deep pelvic and lower extremity's venous system. The vast majority of authors conclude that the method can safely replace diagnostic venography in all patients with venous thrombosis, thrombophlebitis and valve or communicating veins insuffciency. Optimal performance of Color Doppler flow imaging as a diagnostic tool for the whole lower limb veins requires: Proper equipment specifications and settings. Knowledge of regional venous anatomy. Established examination protocols. Evaluation of morphological and functional findings. Documentation of the findings. All these steps are described as a sequence of guidelines, photographs and multiple ultrasonographic images. Our paper can be useful to all physicians or sonographers involved with color Doppler studies for the evaluation of lower limb venous diseases and abnormalities.

Lower gastrointestinal bleeding treated with transcatheter arterial embolization. Case report and review of the literature.

Acute lower gastrointestinal bleeding, is often a dramatic situation, associated with mortality rate up to 28%. Currently transcatheter alternatives have found their place in the therapeutic spectrum of this situation. An interesting question is when should this procedure be performed and which are the difficulties when performing it. We present the case of a 75-year old woman with acute massive lower gastrointestinal bleeding on the tenth post-operative day of a colic and partial ileal resection. Superselective angiography of the superior mesenteric artery was obtained that disclosed marked contrast extravasation of distal branches of the left colic artery as well as from a small branch feeding the distal enteric anastomoses. Clinical success was achieved after superselective embolization which was accomplished by using polyvinyl alcohol particles. The patient was discharged 5 days later and there were no procedure-related complications during 6-month follow-up period. So, especially in post-operative patients who are considered to be poor candidates for surgical treatment, arterial embolotherapy should be established not only as treatment option, but also as first line therapy for LGI bleeding.

Ultrasound-guided interventional procedures. How we do it.

Ultrasound-guided fine needle aspiration biopsy (FNAB) is currently used as an alternative combined modality, which enables accurate detection and evaluation of solid and cystic abnormal lesions. It's easily performed, with low cost and most effective as it decreases the number of unnecessary operational procedures; that take place to rule-out malignancy. The aim of this paper is to suggest the schedule of an effective protocol, easily approached by residents and physicians with minimal, or no experience on ultrasound interventional procedures. Our tutorial is based on more than 350 fine needle aspiration biopsies that were carried-out in our Institution during the last two years. It includes images and graphics of patients preparation, needle selection, sampling and aspiration technique. On-site cytologic preparation and brief references on possible complications and common piifalls are also described.

Intracranial hemorrhage in a HIV patient. Case report and review of the literature.

The authors report on a case of a hemophilic male patient, aged 43, HIV positive, HCV positive, who had an episode of intracerebral hemorrhage after a car accident. Intracranial hemorrhage is the most feared complication of hemophilia, especially among HIV positive, who now are considered to be a group at high risk for bleeding. In this report, it is reviewed available data on clinical and imaging features of ICH and the association between ICH and HIV.

First sternocostal degenerative arthritis with intrarticular fluid collection. A case report.

A rare case with clinical condition of first sternocostal degenerative arthritis with intra-articular fluid collection that developed after long-lasting intense exercise (weight-lifting) for twenty years is reported. Imaging findings and differential diagnoses of the case are presented.

Osteoid osteoma of the patella. Case report and review of the literature.

Osteoid osteoma is a benign, bone-forming tumor. The diaphyses of the long bones are the sites of predilection (at least 50% of all cases occurring in the femur and the tibia). Also this lesion has a male preponderance and the majority of cases present in the second and third decade. We represent an unusual localization of osteoid osteoma in the patella of a 51-year old woman.

Breast Adenomyoepithelioma: Ultrasonography, Elastography, Digital Mammography, Contrast-Enhanced Digital Mammography, and Pathology Findings of This Rare Type of Breast Tumor.

Breast adenomyoepithelioma is considered as an uncommon breast tumor. It is evaluated as a variant of intraductal papilloma. The treatment of choice is local resection with free margins. It is the first case of breast adenomyoepithelioma reported with conventional ultrasonography, elastography (both free-hand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 35-year-old white woman presented with a painless lump of the left breast. Treatment was local resection with free margins. There has been no recurrence for 6 months. Although breast adenomyoepithelioma is an uncommon breast tumor, its awareness is imperative because the differential diagnosis from other breast tumors is quite extensive.

Breast Elastography: How We Do It.

In recent years, the use of elastography in addition to sonography has become a routine clinical tool for the characterization of breast masses. Studies have investigated the improvement of specificity in differentiating benign from malignant breast masses. Therefore, additional use of elastography could help reduce the number of unnecessary biopsies in benign breast lesions especially in category IV lesions of the ultrasound breast imaging reporting data system. Ultrasound elastography is a cheap, readily available, useful, quick, noninvasive method, but it needs specific training as well as acknowledging technical and pathological factors, which may influence it. Both strain and acoustic radiation force impulse (ARFI) methods have been evaluated in breast lesions. Whereas strain elastography results in qualitative imaging of tissue stiffness due to induced compression, ARFI elastography displays quantitative and qualitative information of tissue displacement. A standardized imaging protocol is essential for an adequate and effective examination, also helping reduce the dependence from operators. Furthermore, knowledge of pitfalls that can be encountered when ultrasound elastography is performed may help avoid erroneous image interpretation. In this article, we describe a practical examination protocol for both strain and ARFI elastography and demonstrate the elastographic imaging findings in benign and malignant breast lesions. Short video clips displaying the technique are included as supplementary material.

Primary Non-Hodgkin Lymphoma of the Breast: Ultrasonography, Elastography, Digital Mammography, Contrast-Enhanced Digital Mammography, and Pathology Findings.

Lymphomas constitute approximately 0.15% of malignant mammary neoplasms. Less than 0.5% of all malignant lymphomas involve the breast primarily. Primary non-Hodgkin breast lymphoma is usually right sided. The combined therapy approach, with chemotherapy and radiotherapy, is the most successful treatment. Mastectomy offers no benefit in the treatment of primary non-Hodgkin breast lymphoma. To the author's knowledge, this is the first published case of primary non-Hodgkin breast lymphoma reported with conventional ultrasonography, elastography (both freehand and acoustic radiation force impulse imaging), digital mammography, contrast-enhanced digital mammography, and pathology findings. A 45-year-old woman presented with a lump in the right breast for 2 months. There was no evidence of systemic lymphoma or leukemia when the breast lesion was detected. Imaging findings were negative for lymphoma. Ipsilateral lymph nodes were not palpable. The mass was resected, and histopathology findings were diagnostic of non-Hodgkin lymphoma. Immunohistochemistry was confirmatory of non-Hodgkin lymphoma, diffuse large cell type of B-cell lineage. Although primary and secondary lymphomas of the breast are rare entities, they should be considered in the differential diagnosis of breast malignancies.

Hughes-Stovin syndrome: a case report and review of the literature.

BACKGROUND: Hughes-Stovin syndrome is a rare entity. The aetiology of Hughes-Stovin syndrome is still unknown and the natural course of the illness is usually fatal; however it is supposed to be a clinical variant manifestation of Behçet disease. CASE PRESENTATION: We report the case of an 18 years old, greek male patient with Hughes-Stovin syndrome, who initially presented with deep vein thrombosis. There were no findings consistent with Behçet disease and the haemoptysis was treated successfully with methylprednisolone. Pathogenesis, imaging investigation and treatment of this syndrome are also briefly discussed. CONCLUSION: In young men presenting with venous thrombosis as revealed on imaging examination, with platelet count and coagulation tests within normal and hemoptysis the eventuality of Hughes-Stovin syndrome is to be considered.

A case of primary isolated non-Hodgkin's lymphoma of the esophagus in an immunocompetent patient.

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non-Hodgkin's lymphoma of the esophagus in a 77-year-old man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.