Coexistence of isolated internal iliac artery aneurysm with uterine cervical carcinoma.

Isolated internal iliac artery aneurysms are rarely described in the available literature. The paper presents a case of a 70-year-old female with idiopathic thrombocytopenia, squamous cell cervical carcinoma, and saccular aneurysm of the left internal iliac artery, detected in magnetic resonance. The review of aneurysm of the common, external and internal iliac arteries is added.

Place of residence does not significantly influence radiological morphology of cervical cancer.

INTRODUCTION AND OBJECTIVE: Cervical squamous cell carcinoma is one of the most common malignancies of women. Its incidence and morphology was analyzed based on the magnetic resonance (MR) data among rural and urban residents. MATERIAL AND METHODS: The study involved 61 Caucasian women (58.26±9.63 years) preliminary diagnosed with a cervical cancer without any previous treatment. Standard MR examination, including diffusion weighted imagining, apparent diffusion coefficient (ADC) value measurement and dynamic contrast enhancement, was performed. RESULTS: The rural residents (n=22) were insignificantly older. Their first and last menstruation were observed later and number of pregnancy was higher than in urban women (n=39). However, the incidence of miscarriage was insignificantly rarer. All the tumour linear diameters as well as its volume were insignificantly higher in rural women. The ADC value of the cervical tumor was insignificantly lower, while ADC of lymphatic nodules was higher in rural women. Insignificant changes in tumour grade between both examined groups were found in histological, clinical and radiological examinations. Place of residence did not influence any clinical symptoms nor tumour volume and its ADC. Colporrhoea and colpodynia were insignificantly more often observed in urban women, while parametrium, urinary bladder and rectal infiltrations were more commonly seen in rural residents. Higher risk of lymphatic spread to the internal iliac and parametral lymphatic nodes was reporte[b]d in the rural community. CONCLUSIONS: Cervical cancer had similar morphology and growth pattern, regardless of the place of residence. However, a insignificantly larger tumour size among rural residents may suggest a higher incidence of lymphatic spread, probably as a result of less aaccess to modern health care.

[Ten years progression-free survival obtained in a patient with mantle cell lymphoma]. / Dziesiecioletnie przezycie wolne od progresji u pacjentki z chloniakiem z komórek plaszcza.

Mantle cell lymphoma is a rare aggressive lymphoma derived from B cells, characterized by rapid progression and subsequent recurrence. It is considered to be an incurable disease, with exception of a certain group of patients treated with an autogenic stem cell transplantation. The mean survival time is three years, after applying the conventional regimen based on COP (cyclophosphamide, vincristine, prednisone) or CHOP chemotherapy (COP + doxorubicin). An addition of rituximab to CHOP regimen significantly prolongs progression-free survival. The present case reports ten years progression-free survival in a female patient with mantle cell lymphoma with baseline clinical stage IVB (MIPI 5), treated with nine courses of CHOP chemotherapy. Rituximab was added from 3 to 8 course. The complete clinical, radiological and histopathological response has been obtained.

[Diagnosis of benign ovarian lesions using imaging techniques]. / Diagnostyka obrazowa zmian lagodnych w jajnikach.

Benign ovarian focal lesions - such cystic, inflammatory, vascular and metaplastic changes - may occur at any age but they are most commonly observed in girls at puberty and in young women. The most important preliminary procedures in case of suspected adnexal pathologies are interview, physical examination and classical female bimanual pelvic examination which together with imaging techniques allow correct diagnosis. The commonly available and inexpensive method of female reproductive organs imaging is an ultrasonography (USG). Magnetic resonance (MR), computed tomography (CT) and in case of malignant lesions also positron emission tomography (PET) may also be performed. In doubtful cases, when the evaluation of lesions using USG method is difficult MR is recommended. Due to high resolution, it facilitates precise evaluation of the type and size of lesions, allows distinguishing simple and complex fluid collections while fat saturation sequences make it possible to distinguish cysts containing blood and fat. Moreover, the patient is not exposed to ionizing radiation, which is especially important in women in reproductive age and in children. Computed tomography is recommended for preoperative staging and monitoring of treatment of malignant adnexal neoplasms as well as localization of small peritoneal metastases.

Magnetic resonance imaging and endorectal ultrasound for diagnosis of rectal lesions.

Endorectal ultrasonography (ERUS) and magnetic resonance imaging (MRI) allow exploring the morphology of the rectum in detail. Use of such data, especially assessment of the rectal wall, is an important tool for ascertaining the perianal fistula localization as well as stage of the cancer and planning it appropriate treatment, as stage T3 tumors are usually treated with neoadjuvant therapy, whereas T2 tumors are initially managed surgically. The only advantage of ERUS over MRI is the possibility of assessing T1 tumors that could be treated by transanal endoscopic microsurgery. However, MRI is better for visualizing most radiological prognostic features in rectal or anal cancer such as a circumferential resection margin less than 1 mm, T stage at T1-T2 or T3 tumors with extramural extension less than 5 mm, absence of extramural vascular invasion, N stage at N0/N1, and tumors located in the middle or upper third of the rectum. It can also evaluate the intersphincteric space or levator ani muscle involvement. Increased signal on diffusion weighted imaging (DWI) and low apparent diffusion coefficient (ADC) values as well as an irregular contour and heterogeneous internal signal intensity seem to predict the involvement of pelvic lymphatic nodes better than their size alone. Computed tomography as well as other examination techniques, including digital rectal examination, contrast edema, recto- and colonoscopy, are less useful in staging of rectal cancer but still are very important screening tools.

[Dural metastatic infiltration in prostate cancer--case report]. / Przerzuty raka gruczolu krokowego do opon mózgowych--opis przypadku.

Metastatic changes secondary to prostate cancer usually occur in bones, less commonly in pelvic lymph nodes, liver, lungs, urinary balder and brain. Less common localization includes skin, testis and other structures. The current paper reports a rare case of metastatic infiltration of the dura mater in patient with prostate cancer (Gleason 8 (4+4)) with disseminated bone metastasis. Magnetic resonance imaging revealed an advance infiltration of dura mater of anterior and posterior cranial fossa without any neoplasmatic-related changes in brain. Along optic nerves it penetrated to the optic canal and right orbit.

[Evaluation of prostate cancer progression]. / Ocena zaawansowania raka gruczolu krokowego.

Prostate cancer occures in male, especially over 65 year old. It develops usually in the peripheral zone, less commonly in central or transitional ones. The neoplasm screening bases on clinical digital rectal examination and serum level of prostate-specific antigen (PSA). Among patients with increase PSA concentration, transrectal ultrasound usually with multiple core biopsies is performed. The obtained bioptates are histologically evaluated using Gleason's grading system. However, the method of choice to examine the entire pelvis is a magnetic resonance. According to current principles, the obtained images are evaluated using five-step PI-RADS classification based on T2-weithed, diffusion weighted and dynamic contrast enhancement images. Spectroscopy is also suggested especially in case of prostatic carcinoma. Such procedures allow precise evaluation of cancer progression, and is helpful in treatment planning and response monitoring.

Solid-pseudopapillary neoplasm of the pancreas - comparisons between magnetic resonance and histological findings.

Solid-pseudopapillary neoplasm is a rare pancreatic tumor typically observed in young adults. A new case of the tumor was diagnosed in a 22-year-old woman. An abnormal mass connected with the pancreatic body was found on ultrasound and computed tomography. Magnetic resonance revealed weak homogeneous contrast enhancement and a low ADC value (0.824 mm/s2; b1000). Primary radiological diagnosis suggested a solid pancreatic neoplasm, which was confirmed during histopathological assessment after resection of the pancreatic body with preservation of the spleen and normal drainage through the main pancreatic duct. Histological appearance of the solid-pseudopapillary neoplasm corresponded with its radiological morphology.

Incidence of spinal perineurial (Tarlov) cysts among East-European patients.

The spinal perineurial cyst (Tarlov) is a dilatation between the perineurium and endoneurium of spinal nerve roots, located at level of the spinal ganglion and filled with cerebrospinal fluid but without communication with the perineurial subarachnoid space. The aim of the study was to evaluate it incidence among East-European patients. The retrospective data collected during various magnetic resonance spinal examinations and stored on the picture archiving and communication system was analyzed for an incidence of perineurial cysts. From among 842 patients that underwent examination, 75 cases perineurial cysts were revealed. In 22 cases single anomalies were found. In remaining 53 cases, multiple uni- or less frequently bilateral changes were noted. The most common position was the sacral canal, particularly the level of S2 and S3. Occasionally, cysts were also visible on the cervical, thoracic and lumbar level. Incidence of sacral perineurial cysts was significantly higher in females than in males. Similar data was found for single and multiple changes despite of their localization. Insignificant changes were seen for patient age and cyst size. Perineurial spinal cysts were the most frequently observed on the sacral level and such changes were more common in females.

[Lymphoedema--diagnosis and treatment]. / Obrzeki limfatyczne--diagnostyka i leczenie.

Lymphoedema is a common complication of oncological treatment. Various methods of imaging are used in its diagnosing and monitoring. However, presently lymphoscintigraphy has become the golden standard. A physical examination and detailed medical history also play a very important role. There are still no effective methods of prevention and treatment of lymphoedema in spite of medical progress. The treatment requires a multidisciplinary approach with the use of various methods of physiotherapy (pressure therapy, pneumatic pumps and electric high-voltage treatment), pharmacology and surgery. Patient's education and suitable physical exercises are also significant.

[Chemotherapy induced peripheral neuropathy]. / Neuropatia obwodowa wywolana chemioterapia.

Modern cancer therapy prolongs patients life but commonly increases incidence of treatment-related complications. One of such adverse effect is a neurotoxicity, which usually manifestates as peripheral neuropathies (CIPN), characterised by various sensory (tingling, numbness, pain), motor (foot and hands drop, fastening buttons difficulties) and autonomic (constipation, arythmia) abnormalities as well as pain. Despite of intensive epidemiological and clinical studies, standardized diagnostic criteria and methods of the neuropathy prevention and treatment have not been fully established. The most commonly used form of treatment is symptomatic therapy, including anticonvulsant and antidepressant drugs. Proper education of patients and their families of symptoms and neuropathy consequences is desirable to reduce anxiety and stress.

[Epidemiology and risk factors of the prostate cancer]. / Epldemiologia oraz crynniki ryzyka rozwoju raka gruczolu krokowego.

Prostate cancer is the most common malignancy of male genital organs. The etiology of the disease is complex and remains mainly unclear. The only established risk factors are advancing age, ethnicity and genetics, including changing in expression of ELAC2, RNASEL, MSR1 and HOXB13 genes as well as low number of CAG repeats in the androgen receptor gene. There are number of coexisting environmental risk factors, such as eating habits mostly diet reach in animal fats. An early sexual initiation and sexually transmitted infections, both viral (HSV-2, HPV-18 and -16, CMV) and bacterial (Neisseria gonorrhoea, Treponema pallidum, Chlamydia trachomatis) were also included. The etiology of prostate cancer also involves the influence of hormones - androgens and estrogens, as well as chronic inflammation of the prostate. In contrast to the incidence rate, which varies significantly depending on the geographic region, the incidence of the malignancy at autopsy is similar.

[Epidemiology and risk factors of the cervical squamous cell carcinoma]. / Epidemiologia i czynniki ryzyka rozwoju raka plaskonablonkowego szyjki macicy.

Neoplasm of the cervix, especially squamous cell cancer, is one of the most common malignancy of female genital organs. It etiology is complex; however, human papilloma virus (mostly HPV type 18, 16 and 45) infection seems to be the most important one. Other risk factors include: early sexual initiation, multiple pregnancies and labors, concomitant infections (Chlamydia trachomatis, Neisseria gonorrhea, HSV2 - herpes simplex virus) of the genital tract, AIDS, immunosuppressive therapy, smoking and low socioeconomic status. The incidence of cervical cancer is particularly high in developing countries, while in countries where government founding for the prevention and health education is high, the diseases is significantly less likely to occur. The incidence and mortality rate of the cervical cancer can be substantially reduced by systematic screening cytological examinations. For such reason a liquid-based cytology is currently preferred. Implementation of HPV vaccines decrease the risk of infection, but effect on rate of the cervical cancer has to be confirmed in long-time prospective clinical and epidemiological studies.

Usefulness of magnetic resonance in evaluation of cervical cancer progression.

Magnetic resonance belongs to a group of modern diagnostic methods which, together with classic gynecological, transvaginal ultrasound and histopathological examinations, should be routinely used in patients with suspicion or diagnosed cervical malignancies. The procedure allows precise localization and staging of the tumor as well as evaluation of the volume of the local lymph nodes. Obtained data are useful in selection of optimal therapy and evaluation of cancer progression. Intravenous injection of the paramagnetic contrast media significantly increases diagnosis accuracy especially of small lesions. It is also helpful in differentiation of post-radiotherapy changes and malignant infiltration. The new applications, such as diffusion weighted imaging, magnetic resonance spectroscopy and fat or water saturation are also widely used to improve final diagnosis. The endovaginal receiver coil allows high spatial resolution imaging of the cervix, which is particularly useful in very small, controversial lesions.

[Diagnostic imaging of the prostate cancer]. / Diagnostyka obrazowa raka gruczolu krokowego.

Diagnosis of the prostate cancer is based on clinical, biochemical and histological examinations, as well as various imaging techniques. From the last listed group, magnetic resonance imaging (MRI) provides precise identification of focal areas and local staging of the cancer. It improves evaluation of the local extracapsular extension and involvement of regional lymph nodes, which has significant implications for a patient management. MRI, supplemented by dynamic contrast enhanced and diffusion-weighted imaging (DWI), is especially useful in detection of small focal lesions. MRI also plays an important role in the evaluation of a local recurrence and monitoring of the early and late response to treatment. Whole-body MRI should be performed in patients with a disseminated disease. In patients with an increased level of prostate specific antigen (PSA), small lesions, local recurrence and distant metastases, not detected by other imaging techniques, a positron emission tomography (PET) should be also performed. Computed tomography (CT) does not play a significant role in the diagnosis of the primary prostate cancer, however new CT scanners improve the accuracy of prostate cancer staging. Diagnostic imaging is also widely used in the screening process. Transrectal ultrasound (TRUS) examination of the organ is applied to obtain systematic core biopsies for a histological examination.

[Contemporary methods of treatment in local advanced prostate cancer]. / Wspólczesne metody leczenia miejscowo zaawansowanego raka gruczolu krokowego.

The prostate cancer is one of the most often cancers amongst males. Its frequency is increasing with age. Thanks to widespread of screening denomination of specific prostate specific antigen (PSA), ultrasonography including the one in transrectal (TRUS), computed tomography, magnetic resonance and especially the awareness of society, the number of patients with low local advance of illness is increasing. The basic method of treatment in such cases is still the surgical removal of prostate with seminal bladder or radiotherapy. To this purpose tele-(IMRT, VMAT) or brachytherapy (J125, Ir192, Pa103) is used. In patients with higher risk of progression the radiotherapy may be associated with hormonotherapy (total androgen blockage-LH-RH analog and androgen). Despite numerous clinical researches conducted there is still no selection of optimal sequence of particular methods. Moreover, no explicit effectiveness was determined. The general rule of treatment in patients suffering from prostate cancer still remains individual selection of therapeutic treatment depending on the age of a patient, general condition and especially patient's general preferences. In case of elderly patients and patients with low risk of progression, recommendation of direct observation including systematical PSA denomination, clinical transrectal examination, TRUS, MR of smaller pelvis or scintigraphy of the whole skeleton may be considered.