Role and usefulness of mr imaging in the assessment of peritoneal carcinomatosis.

BACKGROUND: For many years, peritoneal carcinomatosis (PC) entitled poor prognosis until the development of the cytoreductive surgery technique associated with hyperthermic intraperitoneal chemotherapy. Imaging of peritoneal carcinomatosis plays an essential role in the diagnosis and management of the patients being considered for cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC). MAIN BODY: The key role of imaging in patients with peritoneal malignancy is to aid surgical decision making. A standardized peritoneal magnetic resonance (MR) imaging protocol, including T2-weighted fat suppressed, diffusion-weighted and gadolinium-enhanced sequences, allows to detect small peritoneal tumours that are often missed on other imaging. A systematic approach to MR imaging and a close collaboration between the radiologist and the oncologic surgeon are key elements for an accurate evaluation of candidate patients for CRS and HIPEC. CONCLUSION: MR imaging provides a powerful tool for accurate preoperative imaging in patients considered for curative surgery and assists the surgeon in evaluating patients for CRS and HIPEC.

Wandering spleen, gastric and pancreatic volvulus and right-sided descending and sigmoid colon.

Wandering spleen is a rare condition, characterized by a mobile spleen that is attached only by an elongated vascular pedicle, allowing it to migrate to any part of the abdomen or pelvis. Mesenteroaxial gastric volvulus usually occurs in children and may be associated with wandering spleen. Both entities result from abnormal laxity or absence of the peritoneal attachments due to abnormal fusion of the peritoneal mesenteries. Pancreatic volvulus is a very rare anomaly, with only a few isolated case reports described in association with wandering spleen. Anomalous right sided descending and sigmoid colon is a very rare entity and its association with wandering spleen has not been previously reported. We report a case of wandering spleen associated with mesenteroaxial gastric volvulus, pancreatic volvulus and rightward shift of the splenic flexure of the colon and right sided descending and sigmoid colon in a young female.

Surface primary bone tumors: Systematic approach and differential diagnosis.

Surface primary bone tumors may appear similar to their intramedullary counterpart, but because they are rare, they may pose diagnostic challenges when showing different characteristics compared to their intramedullary counterpart. It is important for radiologists to recognize the imaging findings for various uncommon surface primary bone tumors, which may help to reduce the differential diagnosis or to lead to a specific diagnosis. Radiography is typically used for first-line imaging. If necessary, it is followed by CT or MRI for evaluation and characterization of surface bone tumors. The aim of this article is to review the imaging findings and differential diagnosis for surface primary bone tumors.

[Criticisms to patient selection in active surveillance in prostate cancer]. / Criticas a la selección de pacientes en vigilancia activa en cancer de prostata.

OBJECTIVES: Active treatment in localized prostate cancer, in its various types, is assumed as a valid alternative. The effect of the possible overtreatment has raised that options such as active surveillance are offered as an alternative to active treatments, without evidence about its validity in many points. The objective of this study is to analyze the current controversies to define candidates to this alternative, follow up criteria, impact on quality of life and evidence bases to do it. METHODS: We perform an analysis updating the Medline search with the terms localized prostate cancer and active surveillance, analyzing the articles and their evidence, as well as guidelines recommendations. RESULTS: Selection criteria for candidates to active surveillance are heterogeneous, without evidence of uniformity. Likewise, follow up and its criteria or progression are not well defined. The impact on progression, or delay in decision-making, have not been analyzed and we lack of studies of highest evidence including comparative studies for cancer specific or global survival results. CONCLUSIONS: Although AS seems to be a reasonable alternative in many patients with localized prostate cancer, we still need to define many features of inclusion and decision-making. Comparative studies are needed to better define selection and validity of active surveillance.

Críticas a la selección de pacientes en vigilancia activa en cáncer de próstata / Criticisms to patient selection in active surveillance in prostate cancer

OBJETIVO: El tratamiento activo del cáncer de próstata localizado, en sus diferentes formas, es asumido como una alternativa válida. El efecto del posible sobretratamiento ha planteado que opciones como la vigilancia activa se oferte como alternativa a los tratamientos activos, sin en muchos puntos evidencias importantes sobre su validez. El objetivo de este estudio es analizar las controversias actuales para definir candidatos a esta alternativa, criterios de seguimiento, impacto en calidad de vida y bases de evidencia para ello. MÉTODO: Realizamos un análisis actualizando con la búsqueda en medlinede términos cáncer de próstata localizado y active surveillance-vigilancia activa "VA", analizando los diferentes trabajos y sus evidencias, así como recomendaciones en guías clínicas. RESULTADOS: Los criterios de selección de los pacientes candidatos a seguimiento activo son heterogéneos, sin una evidencia de uniformidad. El seguimiento y criterios del mismo o progresión igualmente están mal definidos. El impacto en la progresión o retraso en la toma de decisiones no está analizado y carecemos de estudios de máxima evidencia sobre estudios comparativos para resultados de supervivencia cáncer específica o global. CONCLUSIONES: Aunque la VA parece una alternativa razonable en muchos pacientes con CPL, la inclusión y toma de decisiones, todavía necesitan de muchas aspectos por definir, siendo necesarios estudios comparativos que puedan definir mejor la selección y validez de seguimiento activo

OBJECTIVES: Active treatment in localized prostate cancer, in its various types, is assumed as a valid alternative. The effect of the possible overtreatment has raised that options such as active surveillance are offered as an alternative to active treatments, without evidence about its validity in many points. The objective of this study is to analyze the current controversies to define candidates to this alternative, follow up criteria, impact on quality of life and evidence bases to do it. METHODS: We perform an analysis updating the Medline search with the terms localized prostate cancer and active surveillance, analyzing the articles and their evidence, as well as guidelines recommendations. RESULTS: Selection criteria for candidates to active surveillance are heterogeneous, without evidence of uniformity. Likewise, follow up and its criteria or progression are not well defined. The impact on progression, or delay in decision-making, have not been analyzed and we lack of studies of highest evidence including comparative studies for cancer specific or global survival results. CONCLUSIONS: Although AS seems to be a reasonable alternative in many patients with localized prostate cancer, we still need to define many features of inclusion and decision-making. Comparative studies are needed to better define selection and validity of active surveillance

Mullerianosis vesical / Mullerianosis of the urinary bladder

La mullerianosis vesical, entidad raramente descrita, fue definida por primera vez en 1996 por Young y Clement como la combinación de al menos 2 tipos de tejido ectópico de origen mulleriano (endometriosis, endocervicosis y endosalpingiosis) en el espesor de la pared vesical. Se ha intentado explicar su origen tanto por un mecanismo de implantación como metaplásico. El carácter cíclico de la sintomatología, que puede aparecer hasta en el 50% de las pacientes, debería hacer sospechar su presencia. Aunque la resección transuretral tiene un valor diagnóstico indudable, el carácter transmural de la lesión aconseja su exéresis completa (cistectomía parcial), como ocurrió en nuestro caso (AU)

Müllerianosis of the urinary bladder, a rare entity, was first defined by Young and Clement in 1996 as the combination of at least two types of ectopic tissue of Müllerian origin (endometriosis, endocervicosis, and endosalpingiosis) in the bladder wall. Theories of implantation or metaplasia have been proposed to explain the origin of this entity. Recurrent or cyclic symptomatology, which is reported in up to 50% of patients, is highly suspicious of müllerianosis of the bladder. Although transurethral resection is useful in diagnosis, complete removal of the lesion (partial cystectomy) is highly advisable, as performed in the patient presented herein (AU)

Síndrome OHVIRA (hemivagina obstruida y anomalía renal ipsilateral) asociado a útero didelfo / Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) associated to uterus didelphys

La asociación de útero didelfo, hemivagina obstruida y aplasia renal ipsilateral es una entidad rara, diagnosticada habitualmente después de la menarquia, que cursa con dismenorrea y dolor pélvico cíclico secundario a hematocolpos. Aunque la ecografía es de elección para la valoración inicial, la resonancia magnética es la técnica que permite clasificar la anomalía. El reconocimiento temprano facilita la exéresis quirúrgica del septo vaginal obstructivo, con alivio rápido de los síntomas y prevención de complicaciones. Dado que la agenesia renal o la displasia multiquística son un diagnóstico prenatal o neonatal frecuentes, sería recomendable buscar una anomalía mulleriana asociada en estos casos (AU)

Uterus didelphys with obstructed hemivagina and ipsilateral renal agenesis is a rare entity that usually presents after menarche with dysmenorrhea and cyclic pelvic pain due to hemihematocolpos. Although ultrasound scanning allows correct diagnosis, magnetic resonance imaging plays a decisive role in characterizing the malformation. Early diagnosis is important so that prompt excision of the vaginal septum can relive pain and prevent further complications. The possibility of an obstructed Müllerian system should be investigated whenever a multicystic dysplastic kidney or the absence of a kidney is diagnosed in a fetus or neonate (AU)