Endovascular management of KILT syndrome and COVID-19-related extensive deep vein thrombosis in a pregnant patient: A case report.

We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events.

Focal Minimally Invasive Treatment in Localized Prostate Cancer: Comprehensive Review of Different Possible Strategies.

BACKGROUND: Focal therapy is a promising, minimally invasive method for the treatment of patients with localized prostate cancer. According to the existing literature, there is growing evidence for positive functional outcomes and oncological effectiveness. The aim of this review is to evaluate the technical efficacy of three minimally invasive techniques (cryoablation, electroporation, and microwave ablation) and their impact on quality of life in patients with prostate cancer. METHODS: Studies between January 2020 and July 2023 were selected using PubMed, Embase, and The Cochrane Library and analyzed following PRISMA guidelines; they have not been registered. RESULTS: Twenty-three studies investigating three different sources of energy to deliver focal therapy were found. Thirteen studies evaluated the performance of the cryoablation therapy, seven studies of the irreversible electroporation, and three studies of microwave ablation option. The majority of studies were retrospective cohort studies. Cryoablation showed excellent oncological outcomes for low-grade prostate cancer, whether performed on the lesion, on the hemigland, or on the entire gland, with the best results obtained for patients with intermediate risk. Irreversible electroporation showed promising oncological outcomes with no significant changes in functional outcomes. Microwave ablation showed great early functional outcomes. CONCLUSIONS: The oncological effectiveness of minimally invasive treatment in comparison to standard of care is still under investigation, despite encouraging results in terms of functional outcomes improvement and adverse events reduction. More comprehensive research is needed to fully understand the function of minimally invasive treatment in patients with localized PCa.

Irreversible Electroporation (IRE) for Prostate Cancer (PCa) Treatment: The State of the Art.

We evaluated the most recent research from 2000 to 2023 in order to deeply investigate the applications of PCa IRE, first exploring its usage with primary intent and then salvage intent. Finally, we discuss the differences with other focal PCa treatments. In the case of primary-intent IRE, the in-field recurrence is quite low (ranges from 0% to 33%). Urinary continence after the treatment remains high (>86%). Due to several different patients in the studies, the preserved potency varied quite a lot (59-100%). Regarding complications, the highest occurrence rates are for those of Grades I and II (20-77% and 0-29%, respectively). Grade III complications represent less than 7%. Regarding the specific oncological outcomes, both PCa-specific survival and overall survival are 100%. Metastasis-free survival is 99.6%. In a long-term study, the Kaplan-Meier FFS rates reported are 91% at 3 years, 84% at 5 years, and 69% at 8 years. In the single study with salvage-intent IRE, the in-field recurrence was 7%. Urinary continence was still high (93%), but preserved potency was significantly lower than primary-intent IRE patients (23%). In addition, Grade III complications were slightly higher (10.8%). In conclusion, in males with localized low-intermediate-risk prostate cancer, IRE had an excellent safety profile and might have positive results for sexual and urinary function.

Transoral percutaneous radiofrequency ablation with a steerable needle and cementoplasty under CBCT and infrared augmented reality navigation system guidance for the treatment of a C1 solitary plasmacytoma: A case report.

We report a case of a 40-year-old female with a solitary plasmacytoma of the right transverse apophysis of C1 who underwent combined transoral ablation using a curved steerable needle and cementoplasty under CBCT and infra-red augmented reality navigation system. An imaging work-up revealed an osteolytic lesion determining partial collapse of the right lateral mass of C1 and involving the vertebral foramen. After a biopsy, that revealed a solid tissue consistent with plasmacytoma, it was decided to proceed with radiation therapy. Subsequent PET-CT restaging scans showed residual tumors treated with a transoral percutaneous approach, combining ablation and cementoplasty. This report evaluates the benefits of this combined procedure and the transoral approach, focusing on the advantages of steerable devices and navigation systems.

Percutaneous Cryoablation of Recurrent or Oligometastatic Tumors in Thoracoabdominal Soft Tissues: Safety, Effectiveness, and Technical Aspects.

PURPOSE: To assess the effectiveness and safety of cryoablation (CRA) for the treatment of recurrent or oligometastatic solid tumors located in the thoracoabdominal soft tissues. MATERIALS AND METHODS: Twenty-two percutaneous CRA procedures performed in 19 patients to treat recurrent or oligometastatic tumors in thoracoabdominal soft tissue were retrospectively examined. All procedures were performed between January 2015 and June 2021 under ultrasound and computed tomography (CT) guidance, and the most complex procedures were performed with CT-based navigation systems. The histology of the primary tumors included colorectal adenocarcinoma, squamous cell lung carcinoma, pancreatic adenocarcinoma, renal cell carcinoma, and hepatocellular carcinoma. Adverse events, technical success, and local tumor control were analyzed. RESULTS: The mean age of the patients was 66.5 years, with a mean tumor size of 24.8 mm. The mean time of the procedures was 68 minutes, with a mean number of 2.5 cryoprobes used. Hydrodissection was performed in 63% of the procedures to protect the surrounding anatomical structures. The mean size of the ice ball, measured on axial CT scans at the end of the procedures, was 43.5 mm. No severe adverse events were observed. Technical success was achieved in all cases. Three patients experienced local tumor progression (2 residual disease and 1 recurrence), which were successfully treated with a second CRA procedure. CONCLUSIONS: Percutaneous CRA is a safe and effective therapy in selected cases of recurrent or oligometastatic tumors in the thoracoabdominal soft tissues.

Percutaneous Cryoablation under Conscious Sedation: A Safe, Effective and Painless Option for the Treatment of Pediatric Osteoid Osteoma.

BACKGROUND: Percutaneous CT-guided cryoablation is an emerging technique for treating bone tumors. However, experience with using this procedure for osteoid osteomas in pediatric patients remains limited. Our study aims to assess its technical feasibility, clinical efficacy, and safety in children treated under conscious anesthesia. METHODS: We conducted a retrospective study of consecutive pediatric patients who underwent CT-guided percutaneous cryoablation for osteoid osteomas at our institution between September 2017 and March 2021. All patients received conscious anesthesia. Data on peri-procedural VAS scores, post-procedural VAS scores, imaging findings, and nonsteroidal anti-inflammatory drug (NSAID) usage rates were collected for each patient. Technical success was defined as proper cryoprobe placement at the nidus center, while clinical success referred to pain relief without NSAID use. Intra- and post-operative complications were also evaluated. RESULTS: Nine patients underwent CT-guided percutaneous cryoablation for osteoid osteomas under conscious sedation, with a 100% overall success rate with low peri-procedural and median VAS scores (p < 0.01). No complications were observed during or after the procedure. CONCLUSIONS: CT-guided percutaneous cryoablation of pediatric osteoid osteomas is an effective and safe minimally invasive procedure feasible under conscious anesthesia, holding promise as a valuable treatment option.

Imaging of knee osteoarthritis: a review of multimodal diagnostic approach.

Knee osteoarthritis (KOA) is a common chronic condition among the elderly population that significantly affects the quality of life. Imaging is crucial in the diagnosis, evaluation, and management of KOA. This manuscript reviews the various imaging modalities available until now, with a little focus on the recent developments with Artificial Intelligence. Currently, radiography is the first-line imaging modality recommended for the diagnosis of KOA, owing to its wide availability, affordability, and ability to provide a clear view of bony components of the knee. Although radiography is useful in assessing joint space narrowing (JSN), osteophytes and subchondral sclerosis, it has limited effectiveness in detecting early cartilage damage, soft tissue abnormalities and synovial inflammation. Ultrasound is a safe and affordable imaging technique that can provide information on cartilage thickness, synovial fluid, JSN and osteophytes, though its ability to evaluate deep structures such as subchondral bone is limited. Magnetic resonance imaging (MRI) represents the optimal imaging modality to assess soft tissue structures. New MRI techniques are able to detect early cartilage damage measuring the T1ρ and T2 relaxation time of knee cartilage. Delayed gadolinium-enhanced MRI of cartilage, by injecting a contrast agent to enhance the visibility of the cartilage on MRI scans, can provide information about its integrity. Despite these techniques can provide valuable information about the biochemical composition of knee cartilage and can help detect early signs of osteoarthritis (OA), they may not be widely available. Computed tomography (CT) has restricted utility in evaluating OA; nonetheless, weight-bearing CT imaging, using the joint space mapping technique, exhibits potential in quantifying knee joint space width and detecting structural joint ailments. PET-MRI is a hybrid imaging technique able to combine morphological information on bone and soft tissue alterations with the biochemical changes, but more research is needed to justify its high cost and time involved. The new tools of artificial intelligence, including machine learning models, can assist in detecting patterns and correlations in KOA that may be useful in the diagnosis, grading, predicting the need for arthroplasty, and improving surgical accuracy.

Can Machine Learning Models Detect and Predict Lymph Node Involvement in Prostate Cancer? A Comprehensive Systematic Review.

(1) Background: Recently, Artificial Intelligence (AI)-based models have been investigated for lymph node involvement (LNI) detection and prediction in Prostate cancer (PCa) patients, in order to reduce surgical risks and improve patient outcomes. This review aims to gather and analyze the few studies available in the literature to examine their initial findings. (2) Methods: Two reviewers conducted independently a search of MEDLINE databases, identifying articles exploring AI's role in PCa LNI. Sixteen studies were selected, and their methodological quality was appraised using the Radiomics Quality Score. (3) Results: AI models in Magnetic Resonance Imaging (MRI)-based studies exhibited comparable LNI prediction accuracy to standard nomograms. Computed Tomography (CT)-based and Positron Emission Tomography (PET)-CT models demonstrated high diagnostic and prognostic results. (4) Conclusions: AI models showed promising results in LN metastasis prediction and detection in PCa patients. Limitations of the reviewed studies encompass retrospective design, non-standardization, manual segmentation, and limited studies and participants. Further research is crucial to enhance AI tools' effectiveness in this area.

Preoperative Embolization of Vertebral Metastasis: Comprehensive Review of the Literature.

The aim of this review is to determine the safety and efficacy of pre-operative spinal metastases embolization procedures. Two reviewers independently conducted the literature search (on MEDLINE databases), including in the review of all the studies that used pre-operative TAE to treat spinal metastases. Twelve articles on pre-operative spinal metastases embolization were selected. Most of the studies demonstrated the low complication rate of pre-operative embolization. The most important study strength is that there are very few reviews in the literature with the setting on pre-operative vertebral metastases embolization. A limitation of the review is that the studies included were predominately retrospective case-control studies, increasing the risk of bias in the primary data. Plus, divergent surgical and embolization procedures were performed in the studies, causing a potential risk of bias in the pooled results. We can conclude that preoperative arterial embolization of vertebral metastases is a safe, well-tolerated technique that reduces surgical blood loss and facilitates surgical tumor resection.

Spontaneous Soft Tissue Hematomas in Patients with Coagulation Impairment: Safety and Efficacy of Transarterial Embolization.

The aim of this study is to report the authors' experience of percutaneous transarterial embolization (TAE) in patients with spontaneous soft tissue hematomas (SSTH) and active bleeding with anticoagulation impairment. The study retrospectively identified 78 patients who received a diagnosis of SSTH by CT scan and underwent TAE between 2010 and 2019 in a single trauma center. The patients were stratified using Popov classification into categories: 2A, 2B, 2C, and 3. The patient's 30-day survival after TAE was considered the primary outcome; immediate technical success, the need for additional TAE, and TAE-related complications were considered secondary outcomes. Immediate technical success, complication rate, and risk factors for death were analyzed. Follow-up stopped on day 30 from TAE. 27 patients (35%) fell into category 2A, 8 (10%) into category 2B, 4 (5%) into category 2C, and 39 (50%) into category 3. Immediate technical success was achieved in 77 patients (98.7%). Complications included damage at the arterial puncture site (2 patients, 2.5%) and acute kidney injury (24 patients, 31%). Only 2 patients (2.5%) had been discharged with a new diagnosis of chronic kidney disease. The 30-day overall mortality rate was 19% (15 patients). The mortality rate was higher in hemodynamically unstable patients, in Popov categories 2B, 2C, and 3, and in patients with an initial eGFR < 30 mL/min × 1.73 m2. The study demonstrated a higher mortality risk for categories 2B, 2C, and 3 compared to category 2A. Nonetheless, TAE has proven effective and safe in type 2A patients. Even though it is unclear whether type 2A patients could benefit from conservative treatment rather than TAE, in the authors' opinion, a TAE endovascular approach should be promptly considered for all patients in ACT with active bleeding demonstrated on CT scans.

Radiomic Machine-Learning Analysis of Multiparametric Magnetic Resonance Imaging in the Diagnosis of Clinically Significant Prostate Cancer: New Combination of Textural and Clinical Features.

BACKGROUND: The aim of our study was to develop a radiomic tool for the prediction of clinically significant prostate cancer. METHODS: From September 2020 to December 2021, 91 patients who underwent magnetic resonance imaging prostate fusion biopsy at our institution were selected. Prostate cancer aggressiveness was assessed by combining the three orthogonal planes-Llocal binary pattern the 3Dgray level co-occurrence matrix, and other first order statistical features with clinical (semantic) features. The 487 features were used to predict whether the Gleason score was clinically significant (≥7) in the final pathology. A feature selection algorithm was used to determine the most predictive features, and at the end of the process, nine features were chosen through a 10-fold cross validation. RESULTS: The feature analysis revealed a detection accuracy of 83.5%, with a clinically significant precision of 84.4% and a clinically significant sensitivity of 91.5%. The resulting area under the curve was 80.4%. CONCLUSIONS: Radiomic analysis allowed us to develop a tool that was able to predict a Gleason score of ≥7. This new tool may improve the detection rate of clinically significant prostate cancer and overcome the limitations of the subjective interpretation of magnetic resonance imaging, reducing the number of useless biopsies.

Microwave ablation using two simultaneous antennas for the treatment of liver malignant lesions: a 3 year single-Centre experience.

BACKGROUND: sequential or simultaneous applications of multiple antennas have been proposed to create larger ablation zone; however, there is a lack of data in patients affected by liver tumors, with potentially different results from animal liver models. The purpose of this study was to evaluate efficacy and safety of liver percutaneous microwave ablation using simultaneous activation of two antennas to treat lesions bigger than 2,5 cm; particularly the focus was assessing whether the ratio of ablation zone volume in millimeters to applied energy in kilojoules [R(AZ:E)] differs between hepatocellular carcinoma in a cirrhotic liver and liver metastasis and if it is correlated to complications incidence or recurrence of disease. METHODS: Fifty-five liver microwave ablation performed with two simultaneous antennas from March 2017 to June 2021 were retrospectively reviewed; 9 procedures were excluded due to the association with Chemoembolization. Size, shape, volume of lesions and ablation zones were recorded. Technical success was defined as complete devascularization of the treated area at the post-procedural CT. R(AZ:E) was determined dividing the ablation zone volume in mm3 by the amount of energy in kilojoules applied in each procedure and complications were reported. RESULTS: Technical success was achieved in all the procedures. Mean R(AZ:E) was 0,75 ± 0,58. T-student test for patients with HCC and patients with metastasis about R(AZ:E) was significant (p = 0.03). The incidence of bilomas was lower for HCC (p = 0.022). One-month follow-up showed Complete Response (CR) in 44/46 (95,6%) patients; Three-six months follow-up demonstrated: CR in 43/46 (93.5%) cases and 12 months follow-up highlighted CR in 40/45 (88,9%) cases. CONCLUSIONS: These results provide preliminary evidence of efficacy and safety of simultaneous liver MWA using two antennas, highlighting the importance of procedural indications.

CT, MR, and CEUS imaging features of recurrent GIST of the pre-sacral space: A case report.

We present the case of a 50-year-old woman affected by a rectal gastrointestinal stromal tumor (GIST), with a recurrence in pre-sacral and pre-coccygeal space after surgery and Imatinib therapy. GISTs are the most common mesenchymal tumors of the gastrointestinal tract and rectal GISTs are rare (only 2% of cases); magnetic resonance and computed tomography are the main imaging techniques for diagnosis and follow-up, while ultrasound and contrast-enhanced ultrasound may be useful to perform a percutaneous biopsy, as in the case presented: the imaging features of the lesion in all these imaging methods are displayed.

Easy Intra-Operative Localization of Pulmonary Nodules during Uniportal Video-Assisted Thoracoscopy: Experience with Hydrogel Plugs at Our Institution.

BACKGROUND: The diffusion of lung cancer screening programs has increased the detection of both solid and ground-glass opacity (GGO) sub-centimetric lesions, leading to the necessity for histological diagnoses. A percutaneous CT-guided biopsy may be challenging, thus making surgical excision a valid diagnostic alternative. CT-guided hydrogel plug deployment (BioSentry®) was recently proposed to simplify intraoperative nodule localization. Here, we report our initial experience. METHODS: We evaluated 62 patients with single, small, peripheral, non-subpleural pulmonary GGO that was suspicious for cancer. All lesions were preoperatively marked, using CT-guidance, with a hydrogel plug (BioSentry®). Then, a uniportal video-assisted thoracoscopy (uniVATS) wedge resection was performed. If cancer was confirmed at the frozen section, a major lung resection was then performed. The study's end points were the rates of intraoperative localization and of successful resection. RESULTS: The hydrogel plug was correctly placed in 54 of the 62 cases, leading to an effective resection of the target lesion. In the remaining eight cases, the plug was displaced, and so the identification of pleural erosions due to the previous percutaneous procedure guided the resection. The uniVATS resection success rate was 98.3%. CONCLUSIONS: CT-guided hydrogel plug placement allowed for the successful detection of lung GGOs and resection with the uniVATS approach. This device allowed us to obtain lung cancer diagnoses and successfully treat 85.4% of cases.

Quantib Prostate Compared to an Expert Radiologist for the Diagnosis of Prostate Cancer on mpMRI: A Single-Center Preliminary Study.

Background: To evaluate the clinical utility of an Artificial Intelligence (AI) radiology solution, Quantib Prostate, for prostate cancer (PCa) lesions detection on multiparametric Magnetic Resonance Images (mpMRI). Methods: Prostate mpMRI exams of 108 patients were retrospectively studied. The diagnostic performance of an expert radiologist (>8 years of experience) and of an inexperienced radiologist aided by Quantib software were compared. Three groups of patients were assessed: patients with positive mpMRI, positive target biopsy, and/or at least one positive random biopsy (group A, 73 patients); patients with positive mpMRI and a negative biopsy (group B, 14 patients), and patients with negative mpMRI who did not undergo biopsy (group-C, 21 patients). Results: In group A, the AI-assisted radiologist found new lesions with positive biopsy correlation, increasing the diagnostic PCa performance when compared with the expert radiologist, reaching an SE of 92.3% and a PPV of 90.1% (vs. 71.7% and 84.4%). In group A, the expert radiologist found 96 lesions on 73 mpMRI exams (17.7% PIRADS3, 56.3% PIRADS4, and 26% PIRADS5). The AI-assisted radiologist found 121 lesions (0.8% PIRADS3, 53.7% PIRADS4, and 45.5% PIRADS5). At biopsy, 33.9% of the lesions were ISUP1, 31.4% were ISUP2, 22% were ISUP3, 10.2% were ISUP4, and 2.5% were ISUP5. In group B, where biopsies were negative, the AI-assisted radiologist excluded three lesions but confirmed all the others. In group-C, the AI-assisted radiologist found 37 new lesions, most of them PIRADS 3, with 32.4% localized in the peripherical zone and 67.6% in the transition zone. Conclusions: Quantib software is a very sensitive tool to use specifically in high-risk patients (high PIRADS and high Gleason score).

COVID-19 vaccination simulating lymph node progression in a patient with prostate cancer.

Several cases of cancer patients with 18-fluorodeoxyglucose (18FDG) Positron Emission Tomography/Computed Tomography (PET/CT) evidence of metabolically active axillary lymph nodes after COVID-19 vaccination have been described, creating a diagnostic dilemma and sometimes leading to further unnecessary examinations. A 62-year-old male, diagnosed with prostate cancer, treated with hormone-therapy and radiotherapy of the prostate 2 years before, underwent fluorine-18 choline (F-FCH) PET/CT for restaging purpose, less than 3 weeks after he had received the second dose of the Pfizer BioNTech-BNT162b2 mRNA COVID-19 vaccine. This exam showed an increased F-FCH uptake and an enlargement of the left axillary, paratracheal, para-aortic, subcarinal, and hilar bilateral lymph nodes. Fourteen weeks later, the patient underwent a new F-FCH PET-CT scan, displaying an almost complete regularization of the FCH uptake in all the previously involved regions. The patient was not treated after the first PET-CT scan, thus, the aforementioned PET/CT findings represented inflammatory vaccine-related lymph nodes. This case highlights the significance of knowing vaccination history to correctly interpret imaging findings and to avoid false-positive reports.

A comparative analysis of thermal ablation techniques in the treatment of primary and secondary lung tumors: a single-center experience.

PURPOSE: To evaluate efficacy and safety of radiofrequency ablation (RFA) and microwave ablation (MWA) in unresectable lung malignancies. METHODS: Data regarding patients with primary and secondary lung tumors treated with RFA or MWA from 2008 to 2020 were reviewed retrospectively. Primary study objectives such as technical success, primary and secondary technique efficacy rates, local tumor progression (LTP) rate, LPT-free survival (LPTFS) and overall survival (OS) were assessed. Secondary study objectives were side effects and complications. RFA and MWA were compared using the Chi-square test for continuous variables. Kaplan-Meier curves were calculated for survival statistical analysis. RESULTS: A total of 113 patients with primary or secondary lung tumor underwent 74 RFA (48%) and 81 MWA (52%). Technical success rate was 151/155 (97%); primary and secondary technique efficacy rates were 123/155 (79%) and 129/155 (83%), respectively. During the entire study follow-up, 32 cases experienced disease progression (20%), of which 18 underwent repeat ablation (12%), in 6 cases with success (4%). Residual unablated tumor happened in 4/155 cases (3%). LTP occurred in 28/155 cases (17%). The only factor associated with poorer LTP-FS was lesion diameter ≥ 30 mm (P < 0.05). One-, 3- and 5-years LTP-FS was 83%, 82%, 82%, respectively. One-, 3- and 5-years OS of the entire population was 87%, 74%, 73%, respectively. Minor and major complication rates were 53/155 (34%) and 29/155 (19%), respectively. CONCLUSIONS: In conclusion, this study confirms the appropriateness of RFA and MWA for lung tumors treatment, in terms of safety and efficacy.

Analysis of Risk Factors of Soft Tissue Bleeding in COVID-19 Patients: A Point of View After Two Years of Pandemic.

Background: The aim of the study was to analyze the relationship between patient characteristics, including anagraphic and laboratoristic data and amount of adipose tissue measured in computed tomography (CT) scans in coronavirus disease 2019 (COVID-19) patients, and incidence of soft tissue bleeding requiring medical and/or interventional radiology management. Methods: A total of 132 patients hospitalized for COVID-19 pathology from October 2020 to May 2021 were included in the study and divided into two groups: a bleeding group of 70 cases with soft tissue bleeding occurring during hospitalization, and a control group of 62 hospitalized COVID-19 patients without bleeding events. In the bleeding group, two subgroups were considered: an embolization group including soft tissue bleeding cases requiring interventional radiology with transarterial embolization (TAE) (16/70; 22.9%) and a non-embolization group, clinically managed without TAE (54/70; 77.1%). Demographics and clinical data, visceral adipose tissue (VAT) area and subcutaneous adipose tissue (SAT) area measured on CT images and VAT/SAT ratio were compared between bleeding and control groups and between embolization and non-embolization subgroups. Results: Bleeding and control groups did not significantly differ for sex distribution, COVID-19, platelet (PLT) count, international normalized ratio (INR), SAT area, VAT area, and VAT/SAT ratio. Embolization and non-embolization groups did not significantly differ for age, COVID-19, PLT count, INR, SAT area, and VAT/SAT ratio. Bleeding group had lower body mass index (BMI) than control group as well as embolization group compared to non-embolization group. A statistically significant difference was observed between embolization and non-embolization groups for VAT area, with smaller values in embolization group (mean difference: 64.2 cm2, 95% confidence interval: 8.3 - 120.1; P < 0.05). Conclusion: Soft tissue bleeding in COVID-19 is more frequent and severe in patients with low amount of VAT, demonstrating that fat mass may have a containing function on bleeding, limiting its progression in surrounding structures. There are some other factors that influence the risk of bleeding, such as age, thromboprophylaxis therapy and BMI.

A Case of Secretory Carcinoma in a Patient With a History of Contralateral Medullary Carcinoma.

Background: Secretory and medullary carcinomas of the breast are rare subtypes of infiltrating ductal carcinoma. The different histological behavior of medullary and secretory carcinomas is correlated with different imaging features on mammography, ultrasound, and magnetic resonance imaging. Case Report: We report the case of a Caucasian woman in which both subtypes of tumors were diagnosed in an 8-year time interval and evaluate, in antithesis, histopathological and imaging aspects of medullary and secretory carcinoma. Conclusion: To our knowledge, this is the first case reported in literature of secretory carcinoma with a complete imaging tumor evaluation in a patient with a previous contralateral medullary cancer.