Prognostic significance and diagnostic value of PTEN and p53 expression in endometrial carcinoma. A retrospective clinicopathological and immunohistochemical study.

PURPOSE: To investigate the PTEN and p53 gene expression in endometrioid and serous papillary endometrial carcinomas and clarify their prognostic significance by studying the PTEN and p53 expression in relation to tumor stage and grade. METHODS: Archival pathological sections of 61 cases with endometrial cancer examined in a 5-year-period (January 2006-December 2010) were retrieved and re-examined. Immunohistochemical investigation was performed by the Ventana system. Anti-PTEN and anti-p53 monoclonal antibodies were used. Disease staging was made according to the FIGO staging system. RESULTS: Forty-nine (80.32%) cases were endometrioid adenocarcinomas. Patient age ranged from 39-75 years (mean 62.5). Grade 1 tumors:19/22 (86.3%) cases had stage Ib, 2/22 (9.09%) stage Ic and 1/22 (4.54%) stage IIIc. Eighteen of 22 (81.8%) cases were PTEN positive and 4/22 (18.2%) p53 positive. Grade 2 tumors: 17/ 23 (73.91%) cases had stage I b, 4/23 (17.39%) stage Ic and 2/23 (8.69%) stage IIIc. Seventeen of 23 (73.91%) cases were PTEN positive and 47sol;23 (17.3%) p53 positive. Grade 3 tumors: 2/4 (50%) cases had stage Ic and 2/4 (50%) stage IIIc. No case was PTEN positive and 2/4 (50%) were p53 positive. Twelve (19.35%) cases were serous papillary carcinomas. Patient age ranged from 63-79 years (mean 76). Five (41.66%) cases had stage Ic and 5 (41.66%) stage IIIc, with nodal metastases and peritoneal involvement. Two (16.66%) cases developed on endometrial polyps with minimal myometrial involvement (stage Ib) and in both cases elements of endometrioid adenocarcinoma were observed as well. Immunohistochemical study showed that 11 (91.66%) cases were p53 positive and 2 (16.66%) PTEN positive. CONCLUSION: PTEN and p53 immunoexpression helps both in accurate diagnosis and proper therapeutic approach of the various endometrial carcinomas. PTEN and p53 are also prognostic markers for these kind of tumors.

Optimization of a contrast medium suitable for conventional enteroclysis, MR enteroclysis, and virtual MR enteroscopy.

BACKGROUND: The purpose of the current study was to optimize a gadolinium-barium sulfate solution suitable for performing conventional and MR enteroclysis examinations in the same session. METHODS: Eighteen vials of 20% barium sulfate and various gadolinium concentrations (lower 0 ml/lt, higher 45 ml/lt) were prepared and placed in the magnet. The imaging protocol was consisted of the following sequences: true FISP, HASTE with fat saturation and 3d FLASH with fat saturation in various flip angles. Ten patients underwent conventional enteroclysis with 1.2 lt of 20% barium sulfate enema and 18 ml of gadolinium. MR enteroclysis was performed afterwards using true FISP, fat suppressed 3d FLASH and fat suppressed HASTE sequences. RESULTS: The lowest gadolinium concentration in the barium sulfate solution generating low intraluminal signal on HASTE and high intraluminal signal on true FISP and 3d FLASH sequences was 15 ml/lt. The presence of gadolinium did not influence the lumen opacification in conventional enteroclysis examination. In all patients the proposed contrast medium acted as positive in 3d FLASH (T1w), true FISP (T2/T1 w) and as a negative in HASTE (T2w). Bowel wall conspicuity, lumen opacification and distention were ranked as very good to excellent on MR enteroclysis images while artifacts level did not downgraded the overall image quality. High quality virtual MR endoluminal views of the small bowel, based on 3d FLASH images, were obtained in all cases. CONCLUSION: A 20% barium sulfate enema with 15 ml/lt gadolinium is appropriate for conventional and MR enteroclysis examinations.

MR enteroclysis imaging of Crohn disease.

Magnetic resonance (MR) enteroclysis imaging is emerging as a technique for evaluation of the small bowel in patients with Crohn disease. Administration of 1.5-2 L of isosmotic water solution through a nasojejunal catheter ensures distention of the bowel and facilitates identification of wall abnormalities. True fast imaging with steady-state precession (FISP), half-Fourier acquisition single-shot turbo spin-echo (HASTE), and postgadolinium T1-weighted three-dimensional fast low-angle shot sequences can be employed in a comprehensive and integrated MR enteroclysis examination protocol to overcome specific disadvantages of each of the sequences involved. Superficial abnormalities that are ideally delineated with conventional enteroclysis are not consistently depicted with MR enteroclysis. The characteristic transmural abnormalities of Crohn disease such as bowel wall thickening, linear ulcers, and cobblestoning are accurately shown with MR enteroclysis imaging, especially with the true FISP sequence. MR enteroclysis is comparable to conventional enteroclysis in the detection of the number and extent of involved small bowel segments and in the disclosure of luminal narrowing or prestenotic intestinal dilatation. The clinical utility of MR enteroclysis in Crohn disease has not been fully established. At present, the method may be used for follow-up studies of known disease, estimation of disease activity, and determination of the extramucosal extent and spread of the disease process.

Role of conventional radiology in the diagnosis and staging of gastrointestinal tract neoplasms.

Preoperative diagnosis and staging of primary gastrointestinal (GI) neoplasms are challenges for both clinicians and radiologists. Barium studies are very sensitive in disclosing primary malignancies, even at an early stage. Radiologic signs depend on the evolutional stage of the disease and its appearance on gross pathology. A neoplasm may be manifested on barium studies by a wide spectrum of findings, including mucosal abnormalities, mass presence, ulcerative lesions, submucosal infiltration, and lumen stenosis. Advanced disease can be accurately diagnosed, whereas early cancer should be differentiated from other neoplastic or inflammatory disorders by meticulous analysis of radiologic findings. The extent of GI involvement and multiplicity of the lesions can be assessed on barium studies. In the staging of GI neoplasms, barium studies are of little value. Skeletal survey by conventional radiographs and chest plain films can reveal distant metastases in a short time and with low cost, although they are not that sensitive to the detection of early or subtle lesions. The exact role of conventional radiology in the imaging workup of GI malignancies depends on local expertise and availability of other diagnostic techniques and modalities.

MR enteroclysis protocol optimization: comparison between 3D FLASH with fat saturation after intravenous gadolinium injection and true FISP sequences.

The aim of this study was to introduce the true fast imaging with steady-state precession (FISP) sequence for MR enteroclysis and compare it with the already used T1-weighted fast low-angle shot (FLASH) sequence. Twenty-one patients underwent both MR and conventional enteroclysis. The MR enteroclysis examination was performed after administration of an iso-osmotic water solution through a nasojejunal catheter and the following sequences were included: (a) true FISP; and (b) 3D FLASH with fat saturation after intravenous injection of 20 mg Buscopan or 1 mg glucagon and 0.1 mmol/kg gadolinium chelates. The true FISP sequence provided images with significantly fewer motion artifacts, whereas 3D FLASH was less sensitive to susceptibility and chemical shift artifacts. The homogeneity of endoluminal opacification, wall conspicuity, and distention of the small bowel were very good to excellent and the two sequences presented no statistically significant differences here. True FISP provided significantly better overall image quality than did 3D FLASH. The true FISP sequence can provide good anatomic demonstration of the small bowel on T2-like images and could be combined with T1-weighted FLASH images for an integrated protocol of MR enteroclysis.

MR imaging of the small bowel with a true-FISP sequence after enteroclysis with water solution.

RATIONALE AND OBJECTIVES: To evaluate a novel MR enteroclysis technique for small-bowel imaging. METHODS: Twenty-one patients with suspected small-bowel disease underwent both MR and conventional enteroclysis. MR enteroclysis was performed by injecting an iso-osmotic water solution through a nasojejunal catheter with a flow rate of 80 to 150 mL/min. A maximum of 2 L of water solution was administered. A dynamic heavily T2-weighted single-shot turbo spin-echo sequence was applied in coronal orientation to monitor the bowel filling and adequate distention. Twelve 4-mm-thick slices were acquired by using a true fast imaging with steady-state precession (true-FISP) sequence during an 18-second breath-hold interval. Small-bowel distention, wall conspicuity, homogeneity of opacification, and the presence of artifacts were subjectively evaluated by two reviewers using five-point scales. RESULTS: Chemical shift artifacts were low and ghost artifacts were absent. Susceptibility artifacts were more prominent in the ileum; motion artifacts were low in the jejunum, ileum, and ileocecal area. Homogeneity of opacification was very good in the jejunum, good to very good in the ileum, and good in the ileocecal area. Distention was very good to excellent in the jejunum and ileum and very good in the ileocecal area. Wall conspicuity was very good to excellent in the jejunum and ileum. CONCLUSIONS: MR enteroclysis with the true-FISP sequence produced high-quality images of the small bowel. Further clinical studies are required to determine the clinical efficacy of the new technique compared with conventional enteroclysis.

The clinical significance of acquired jejunoileal diverticula.

OBJECTIVE: Because of the relative rarity of acquired jejunoileal diverticulosis, including its symptomatology and complications, diagnosis is often difficult and delayed, resulting in unnecessary morbidity and mortality. The purpose of the present study was to draw attention to jejunoileal diverticula and their complications as a site of gastrointestinal symptoms. METHODS: The records of 10 patients with symptomatic jejunoileal diverticula treated in our departments were reviewed. RESULTS: The clinical presentation was varying and nonspecific. Jejunoileal diverticula were diagnosed peroperatively in four patients operated on successfully for their acute complications. In one case the diagnosis was considered after a radiotargeted erythrocyte bleeding scan and in five other cases enteroclysis for chronic abdominal complaints demonstrated jejunoileal diverticula. The death of one patient operated on for massive hemorrhage from jejunal diverticula was probably related to delayed diagnosis and treatment. CONCLUSIONS: Jejunoileal diverticula should not always be dismissed as asymptomatic findings, as they may be the cause of vague, chronic symptomatology and acute complications, including intestinal obstruction, hemorrhage, and perforation. Awareness of the fact that jejunoileal diverticula may cause chronic nonspecific abdominal symptoms and serious acute complications may lead to earlier diagnosis and timely treatment with lower morbidity and mortality.

Accidental embryo irradiation during barium enema examinations. An estimation of absorbed dose.

RATIONALE AND OBJECTIVES: To investigate the possibility of an embryo to receive a dose of more than 10 cGy, the threshold of malformations induction in embryos reported by the International Commission on Radiological Protection, during barium enema examinations. METHODS: Thermoluminescent dosimeters were placed in a phantom to calculate the depth-to-skin conversion coefficient needed for dose estimation at the average embryo depth in patients. Barium enema examinations were performed in 20 women of childbearing age with diagnostic problems demanding longer fluoroscopy times. Doses at 6 cm, the average embryo depth, were determined by measurements at the patients' skin followed by dose calculation at the site of interest. RESULTS: The range of doses estimated at embryo depth for patients was 1.9 to 8.1 cGy. The dose always exceeded 5 cGy when fluoroscopy time was longer than 7 minutes. CONCLUSION: The dose at the embryo depth never exceeded 10 cGy. This study indicates that fluoroscopy time should not exceed 7 minutes in childbearing-age female patients undergoing barium enema examinations.