Multifocal epithelioid hemangioendothelioma of the lower limbs detected by 18F-FDG PET/MRI.

A 38-year-old man underwent surgical excision of a 1.5-cm subcutaneous nodule of the left leg. Histologic evaluation demonstrated the presence of an epithelioid hemangioendothelioma (EHE). The patient underwent 18F-FDG PET/MRI for staging. This examination demonstrated the presence of several soft tissue and bone lesions in the left lower limb without evidence of distant metastatic disease. The final diagnosis was multifocal EHE of the left lower limb. In this case, 18F-FDG PET/MRI has been very useful in the correct staging of this rare presentation of EHE of the lower limbs.

Chemoendocrine compared with endocrine adjuvant therapies for node-negative breast cancer: predictive value of centrally reviewed expression of estrogen and progesterone receptors--International Breast Cancer Study Group.

PURPOSE: To centrally assess estrogen receptor (ER) and progesterone receptor (PgR) levels by immunohistochemistry and investigate their predictive value for benefit of chemo-endocrine compared with endocrine adjuvant therapy alone in two randomized clinical trials for node-negative breast cancer. PATIENTS AND METHODS: International Breast Cancer Study Group Trial VIII compared cyclophosphamide, methotrexate, and fluorouracil (CMF) chemotherapy for 6 cycles followed by endocrine therapy with goserelin with either modality alone in pre- and perimenopausal patients. Trial IX compared three cycles of CMF followed by tamoxifen for 5 years versus tamoxifen alone in postmenopausal patients. Central Pathology Office reviewed 883 (83%) of 1,063 patients on Trial VIII and 1,365 (82%) of 1,669 on Trial IX and determined ER and PgR by immunohistochemistry. Disease-free survival (DFS) was compared across the spectrum of expression of each receptor using the Subpopulation Treatment Effect Pattern Plot methodology. RESULTS: Both receptors displayed a bimodal distribution, with substantial proportions showing no staining (receptor absent) and most of the remainder showing a high percentage of stained cells. Chemo-endocrine therapy yielded DFS superior to endocrine therapy alone for patients with receptor-absent tumors, and in some cases also for those with low levels of receptor expression. Among patients with ER-expressing tumors, additional prediction of benefit was suggested in absent or low PgR in Trial VIII but not in Trial IX. CONCLUSION: Low levels of ER and PgR are predictive of the benefit of adding chemotherapy to endocrine therapy. Low PgR may add further prediction among pre- and perimenopausal but not postmenopausal patients whose tumors express ER.

Severe large bowel obstruction secondary to infection with Actinomyces israelii.

Abdomino-pelvic actinomycosis is a rare disease, which usually follows a chronic course. However, bowel obstruction may reveal an acute clinical picture. We report on a 38-y-old female with abdomino-pelvic actinomycosis, characterized by a 10 cm long filiform stenosis of the sigmoid colon and bilateral ovarian abscesses. She developed acute ileus that required emergency surgery.