Caecal leiomyoma detected by whole-body MRI in a patient with Hodgkin lymphoma: first case report.

INTRODUCTION: Hodgkin Lymphoma (HL) is one of the most curable malignant diseases. Modern treatments, like the combined radiochemotherapy and stem cell transplantation, have increased the number of malignant disease survivors. However, HL survivors are at risk of long-term effects, including the development of solid tumors. Secondary neoplasms are a major cause of late morbidity and mortality following treatment for HL. CASE REPORT: We report the case of a male patient, treated for HL by chemotherapy, who developed a large leiomyoma of the cecum one year after the treatment. A whole-body Magnetic Resonance (WBMRI) scan performed during the follow-up allowed the detection of this incidental caecal mass that was absent in a Computed Tomography (CT) scan performed immediately after the treatment. After a CT-guided biopsy, the lesion was surgically removed and the diagnosis of caecal leiomyoma was obtained. DISCUSSION: To our knowledge, this is the first case report, according to the scientific literature, of caecal leiomyoma developing after chemotherapy in a HL survivor. Leiomyoma is a rare benign tumor that usually appears as a solitary small mass with a nodular growth and a benign course. CONCLUSION: This case shows that WB-MRI allows detecting relevant incidental findings during the oncologic follow-up, avoiding both radiation exposure and contrast agent administration. Furthermore, leiomyoma should be considered in the differential diagnosis between the caecal masses with high growth rate.

Treatment of de novo femoro-popliteal lesions with a new Drug Coated Balloon: early experience of a single Center in the first 50 patients.

Angioplasty with drug-coated balloon (DCB) is an emerging and reliable method for the treatment of femoro-popliteal lesions. We report our experience with the Stellarex™ DCB in the first 50 patients. METHODS: From July 2015 to November 2017, 50 patients (41 M, 9F), medium age (64 ± 7.4 year) were subject to 33 angioplasties (PTAs) for femoro-popliteal lesions with a paclitaxel-coated balloon (Stellarex™). Based upon clinical data sixteen patients had severe claudication (56% - Rutherford class 3); ten patients suffered from ischemic rest pain (34% - Rutherford class 4); and five presented minor tissue loss (10% - Rutherford class 5). 42% of patients showed femoro-popliteal lesion TASC-II B, and 58% presented lesions pertaining to TASC-II C. RESULTS: Immediate technical success was 100% without perioperative complications. Primary patency rate was 94% at twelve months. In three cases restenosis (6%) was detected within a year from procedure, and a further PTA DCB was performed with primary assisted patency rates of 100% at twelve months. Two patients underwent major lower limb amputation. Three patients died during follow-up and one patient was lost at follow-up. CONCLUSION: DCB angioplasty with Stellarex™ is a viable alternative to traditional endovascular procedures proving satisfactory primary patency rates at twelve months. Based on our experience, treatment with DCB is a first choice technique for non-complex de novo lesions of the femoro - popliteal tract.

Sonographic diagnosis of hepatic erosion caused by umbilical catheterization.

The use of umbilical venous catheter (UVC) is common practice in neonatal units. The traumatic injury of the hepatic parenchyma is a rare complication. We present a case of a preterm newborn underwent ultrasound examination revealing a hyperechogenic focal lesion at the confluence of the hepatic veins This finding, according to patient's history, was suspected to be a traumatic injury of the liver parenchyma caused by umbilical catheterization. During sonographic follow-up this lesion gradually reduced until complete resolution. Finally, when focal hyperechogenic hepatic lesion is incidentally detected in newborn with history of UVC placement, the radiologists must consider the traumatic etiology.

Role of Whole-Body MR with DWIBS in child's Bartonellosis.

Cat-scratch disease (CSD) is a zoonosis in children, result of infection by Bartonella henselae, a gram-negative bacillus. Infection is generally characterized by regional and self-limited lymphadenopathy after exposure to a scratch or bite from a cat. Rarely, B. henselae is cause of fever of unknown origin (FUO), with dissemination to various organs, most often involving the reticuloendothelial system (liver, spleen, bone marrow), mimicking an inflammatory rather than a lymphoproliferative disease. Whole-body Magnetic Resonance Imaging (WBMRI), in association with diffusion-weighted imaging (DWIBS), allows a comprehensive evaluation of pediatric patients, without the risks inherent to ionizing radiation. It is a rapid and sensitive method for detecting and monitoring multifocal lesions such as proliferative or inflammatory and infectious processes. We report a case of systemic CDS in an immunocompetent young boy with fever of unknown origin, without history of cat contact, investigated by WBMRI.

Chest pain due to Pinch-off syndrome: radiological findings and endovascular rescue.

Port-a-cath is widely used as a route for administration of drugs in hematology and oncology patients and, recently, has been adapted also for hemodialysis patients. Major complications include infection, thrombosis, arrhythmia, and embolization. The Pinch-off-syndrome (POS) means the clavicle and the first rib compress the long-term central venous catheter. The reported incidence rate ranges from 1.4% to 4.1%. This syndrome can be recognized on chest radiography by observing a thinning of the catheter lumen through the passage between the clavicle and the first rib. Catheter fracture is a rare but potentially life-threatening complication that must be recognized and treated promptly. Management of dislodged ports includes percutaneous transcatheter retrieval, open thoracotomy retrieval and oral anticoagulant therapy. Among these techniques, percutaneous transcatheter retrieval is an easy, safe and efficient method. We report the successful percutaneous endovascular retrieval of dislodged intracardiac catheter, separated from its port, in a 58 year-old male patient who presented with chest pain.

Successful endovascular treatment of a 13 cm abdominal aortic aneurysm. Case report.

There is increasing evidence in the literature that endovascular aneurysm repair is the first-line approach for most of abdominal aortic aneurysms (AAAs). Furthermore aortouniiliac stent graft placement is, in high risk patients or during emergency setting, a safe procedure over the mid- and long-term period and compares well with the results of bifurcated stent grafts. We present a case of a 66 -year-old gentleman, with pneumothorax after therapeutic thoracentesis and a giant AAA, successfully treated with an aortomonoiliac stent grafting and femoro-femoral crossover bypass.

Ectopic prolactinoma in the clivus: a case report.

We report the case of an ectopic pituitary adenoma in a 65-year-old man with an empty sella who initially presented with right ptosis and eyelid edema and headache. Neuroimaging studies revealed a large tumoral process at the height of the clivus, with partial destruction of surrounding bone structure. He underwent transphenoidal surgery and histopathologic examination, including immunohistochemical studies, revealed a prolactin-producing pituitary adenoma. A careful review of the literature was done.

Diagnostic and therapeutic management of diabetic mastopathy: a case report.

Sclerosing lymphocytic lobulitis (SLL) is a benign breast lesion, better known as diabetic mastopathy (DMP), since it tipically occurs in diabetic patients. This very uncommon condition is strongly associated with type I diabetes mellitus. We report a case of a 61-year-old woman, with type II insulin-dependent diabetes mellitus, who presented mammography and ultrasonography images suspicious for breast carcinoma. As histopathology surprisingly demonstrated SLL and breast MRI showed benign characteristics, unnecessary surgery was avoided. The aim of this report is to underline that DMP is an uncommon clinicopathological entity which can clinically and radiologically mimic breast cancer but also that breast carcinoma may be hidden within these dense fibrotic lesions. In the light of cases reported in literature, breast MRI can be considered an essential tool in the diagnostic and therapeutic management of DMP.

Recurrent varicose veins of the legs: a single centre experience.

AIM: The aim of our study is to report our experience on the surgery for recurrent varicose veins of the legs over the period 2007-2012. MATERIALS AND METHODS: A series of 480 consecutive surgical procedures for varicose veins of the legs was reviewed; among a total of 480 cases, 65 procedures were for recurrent varicose veins. Data collected included clinical characteristics, surgical techniques, cause of recurrence and surgical outcomes. We analyzed the causes of recurrences in order to determine factors that influence recurrence itself. RESULTS: Sixty-five procedures for recurrent varicose veins were analized. The main causes of recurrence were: persistence of collaterals at the saphenofemoral junction (27.7%), inadequate stripping of the long saphenous vein (18.5%), perforating veins insufficiency (66.1%), sapheno-femoral junction neovascolarisation (12.3%), inguinal or popliteal cavernoma (27.7%), recurrence after short saphenous venous surgery (4.5%). CONCLUSIONS: We concluded that, as is clear from our study, the main cause of recurrence is inadequate surgery. This can only be due to inadequate preoperative assessment (lack of rigorous clinical and US Doppler rigorous evaluation) and not correct surgical technique, as it may occur if the surgery is performed by a surgeon inexperienced in this type of surgery.

Breast core biopsy of a rare case of unknown primary large cell neuroendocrine carcinoma metastatic to the breast.

Metastases to the breast from extramammary neoplasms are very rare. Correct diagnosis of breast malignancy is important for establishing appropriate management. Here we report a 57-year old male patient with breast metastasis from large cell neuroendocrine carcinoma (LCNEC) which was diagnosed with ultrasonography-guided-core-biopsy.

MR imaging of a bilateral ovarian clear cell borderline adenofibromatous tumor.

Borderline clear cell adenofibromatous tumors of the ovary are extremely rare with less than 50 cases reported in the English literature. We report one case of ovarian borderline clear cell adenofibromatous tumor in a 58-year-old woman. The diagnosis, suspected at the MRI, was confirmed histologically. The patient was submitted to hysterosalpingo-oophorectomy. After a period of 12 months, no recurrence had occurred.

Emphysematous cholecystitis: Imaging findings.

We report a case of emphysematous cholecystitis. We also offer a review of the literature, emphasizing the clinical features, pathogenesis, imaging features and treatment of this surgical condition. Early recognition and surgical consultation are vital in these patients. The significance of plain abdominal radiographs, ultrasonography, CT and RM studies is discussed. Diagnostic problems are mentioned to help understand this rare clinical condition.