The diagnostic accuracy of multiparametric MRI for detection and localization of prostate cancer depends on the affected region.

Objectives: To determine the diagnostic accuracy of 3T multiparametric magnetic resonance imaging (mpMRI) for detecting and locating prostate cancer (PCa) on Dickinson's 27-sector map, using histopathology specimens from radical prostatectomy (RP) as the reference standard. Patients and methods: The authors studied a continuous series of 140 patients who underwent RP over three consecutive years. Prior to RP, all patients had mpMRI for detection and localization of PCa and further assessment by biopsy. To minimize the potential of disease progression, 25 patients were excluded because the interval between mpMRI and RP exceeded 6 months, which left 115 patients eligible for analysis. The mpMRI findings were reported using the Prostate Imaging-Reporting and Data System (PI-RADS) v2, considering PI-RADS ≥ 3 to indicate PCa. The histopathology findings from RP specimens were graded using the Gleason scoring system, considering Gleason ≥ 6 to indicate PCa. The location of the tumors was mapped on Dickinson's 27-sector map for both mpMRI and histopathology and compared by rigid sector-by-sector matching. Results: The cohort of 115 patients eligible for analysis was aged 66.5 ± 6.0 years at RP. Of the 3105 sectors analyzed, there were 412 true positives (13%), 28 false positives (1%), 68 false negatives (2%), and 2597 true negatives (84%). Across the 27 sectors of the prostate, mpMRI sensitivity ranged from 50% to 100% and specificity from 96% to 100%, while PPV ranged from 50% to 100%, and NPV from 91% to 100%. For the anterior prostate, mpMRI had a sensitivity of 80% (CI, 71%-86%), specificity of 99% (CI, 99%-100%), PPV of 91% (CI, 83%-95%), and NPV of 99% (CI, 98%-99%). For the posterior prostate, mpMRI had a sensitivity of 88% (CI, 84%-91%), specificity of 98% (CI, 97%-99%), PPV of 94% (CI, 92%-96%), and NPV of 96% (CI, 94%-97%). Overall, mpMRI had a sensitivity of 86%, specificity of 99%, PPV of 94%, and NPV of 97%. Conclusions: The accuracy of mpMRI in detecting and locating prostate tumors depends on the affected region, but its high NPV across all sectors suggests that negative findings may not need corroboration by other techniques.

Loss of dipeptidylpeptidase IV activity in chronic rhinosinusitis contributes to the neurogenic inflammation induced by substance P in the nasal mucosa.

In this study, we have found that dipeptidylpeptidase IV (DPPIV) plays in vivo an active role in the modulation of the inflammatory response of chronic rhinosinusitis. Human nasal mucosa expresses DPPIV-like immunoreactivity in submucosal seromucus glands, leukocytes, and endothelial cells of blood vessels. DPPIV enzymatic activity in nasal tissue biopsies taken from patients suffering from chronic rhinosinusitis was correlated inversely with the density of inflammatory cells in the nasal mucosa, and the DPPIV activity rose when chronic rhinosinusitis was treated. By using a pig animal model, we have shown that the intranasal administration of recombinant DPPIV decreased the vasodilatation induced by exogenous substance P (SP), a proinflammatory peptide released by sensory nerves. In contrast, an inhibitor of DPPIV enhanced the vasodilatatory effect at low doses of SP. SP5-11 was 100- to 1000-fold less potent than SP as a vasodilator of the nasal mucosa. The vasodilatatory effect of SP was abolished by a NK1 receptor antagonist. In conclusion, these results suggest a new pathophysiological pathway for rhinitis based on clinical observations in humans, indicating the involvement of an enzyme to modulate non-adrenergic and non-cholinergic substrate that occurred during nasal dysfunctions.

Psammomatous Melanotic Schwannoma: A Challenging Histological Diagnosis.

Psammomatous melanotic schwannoma (PMS) is a rare pigmented tumor that can be part of the Carney complex. Here, we describe the case of a 35-year-old female patient presenting an isolated subcutaneous PMS. Histopathological analysis could not formally exclude the malignant nature of the tumor. The challenging histological diagnosis and consequently the management of the patient are described.

Ganglion cyst of the spinal anterior longitudinal ligament presenting as a retropharyngeal mass.

Cervical spinal synovial and/or ganglion cysts can occur at various periarticular sites and should be considered in the differential diagnosis of intraspinal-extradural or paraspinal masses of the cervical spine. The first report of a ganglion cyst of the cervical anterior longitudinal ligament presenting as a retropharyngeal mass, is presented. The histopathology, etiology, and clinical aspects of synovial and ganglion cysts of the cervical spine are briefly reviewed.

Mice transgenic for intracellular interleukin-1 receptor antagonist type 1 are protected from collagen-induced arthritis.

Interleukin-1 receptor antagonist (IL-1Ra) is a natural IL-1 inhibitor, which competitively inhibits binding of IL-1 to its receptors. IL-1Ra is produced as four different isoforms, one secreted (sIL-1Ra) and three intracellular (icIL-1Ra1, 2, 3), derived from the same gene. We previously observed increased production of icIL-1Ra1 in the joints of mice with collagen-induced arthritis (CIA). However, due to its intracellular localization, the biological role of icIL-1Ra1 remains unknown. The aim of the present study was to examine the effect of the icIL-1Ra1 isoform, as compared to that of sIL-1Ra, in the CIA model by comparing transgenic (tg) mice overexpressing icIL-1Ra1 or sIL-1Ra to their wild-type littermates. Serum levels of tg human IL-1Ra were elevated in sIL-1Ra and, to a lesser extent, also in icIL-1Ra1 mice. Clinical scoring indicated that none of the icIL-1Ra1 or siL-1Ra tg mice developed CIA, whereas arthritis was present in, respectively, 60% and 100% of their wild-type littermates. Histological and radiological analyses confirmed the absence of arthritis in icIL-1Ra1 and sIL-1Ra tg mice. Accordingly, circulating levels of the acute-phase protein serum amyloid A tended to be lower in icIL-1Ra1 tg mice than in their wild-type littermates and were significantly lower in sIL-1Ra tg mice than in controls. In contrast, no difference was observed between the groups regarding serum levels of anti-type II collagen antibodies and ex vivo spleen cell proliferative response to collagen. In conclusion, icIL-1Ra1, which is released into the extracellular space when produced in high amounts, has a similar anti-arthritic effect as sIL-1Ra.

Delayed resolution of acute inflammation during zymosan-induced arthritis in leptin-deficient mice.

The severity of antigen-induced arthritis (AIA) is decreased in leptin-deficient ob/ob mice. However, joint inflammation in AIA depends on the immune response, which is impaired in ob/ob mice. In the present study we investigated the effects of leptin deficiency on zymosan-induced arthritis (ZIA), which is independent of adaptive immunity. Arthritis was induced by injection of zymosan into the knee joint. Joint swelling was similar after 6 and 24 hours in ob/ob and control mice. However, it remained elevated in ob/ob animals on day 3 whereas values normalized in controls. Histology revealed similar articular lesions in all animals on day 3, but on days 14 and 21 arthritis tended to be more severe in ob/ob mice. The acute phase response, reflected by circulating levels of IL-6 and serum amyloid A, was also more pronounced in ob/ob mice, although corticosterone was significantly elevated in these animals. Similar results were obtained in leptin receptor-deficient db/db mice. Thus, in contrast to AIA, ZIA is not impaired in leptin-deficient animals. On the contrary, resolution of acute inflammation appears to be delayed in the absence of leptin or leptin signalling, suggesting that chronic leptin deficiency interferes with adequate control of the inflammatory response in ZIA.