Focal Nodular Hyperplasia After Treatment With Oxaliplatin: A Multiinstitutional Series of Cases Diagnosed at MRI.

OBJECTIVE: Benign hepatic lesions may occur after chemotherapy treatment and may mimic metastases at imaging. We describe focal nodular hyperplasia (FNH) lesions diagnosed at MRI that occurred de novo after treatment with oxaliplatin. MATERIALS AND METHODS: This is a multiinstitutional case series. We report 14 adult patients with cancer (eight men and six women) with a history of treatment with oxaliplatin and development of new hepatic lesions diagnosed as FNH at pathologic analysis or MRI or both. Imaging and pathology features of the included lesions, the interval since chemotherapy, and the temporal evolution were reviewed. RESULTS: The mean interval between the completion of oxaliplatin treatment and the identification of new hepatic FNH at imaging was 47.6 months. In seven of 14 (50%) patients, the index lesion was diagnosed at pathologic analysis (biopsy or resection) as FNH. In the remaining seven cases, the diagnosis was based on highly accurate MRI features (e.g., hyper- or isointensity of the lesion on hepatobiliary phase images). Lesion growth or occurrence of new lesions was present in 75% of patients at imaging follow-up. CONCLUSION: FNH lesions can occur de novo after treatment with oxaliplatin. Recognizing the typical MRI appearance of these lesions may avoid unnecessary biopsy or surgery and reduce patients' anxiety.

Renal biopsies for small renal masses. For whom, when and how.

Objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives in kidney biopsies in small renal masses (BSRM). A PubMed search has been performed for all relevant urological literature regarding BSRM. A literature research of English, French and Spanish languages was performed using the Pubmed database from 2000 to February 2012 using the terms renal mass biopsy and renal tumor biopsy. Manuscripts providing a highest level of evidence were selected for the review.Clinical experience from author's Institutions is also reflected in the manuscript. Considerable technical advances have been made in imaging over the last decade. The latter allow for a comprehensive sharp diagnosis of small renal masses (SRM). Therapeutic decision for SRM's is supported by objective knowledge of histological features and renal biopsy represents an accurate and safe option to particularize treatment in renal incidentalomas. Furthermore, renal biopsies are incorporated in the application and follow-up of patients undergoing ablative therapies. An important number of clinical reports have been published in the subject but there is lack of technical standardization. The available experience is limited to referral centers and there are still up to 30% of biopsies that fail to provide clear diagnosis. Renal biopsies have significantly improved in its diagnostic accuracy and it is indicated when tissue diagnosis can change the therapeutic approach of SRM's. Meantime, the role of renal biopsies keeps on growing and limitations of the procedure are less when compared to the benefits it provides.

Biopsia de las masas renales pequeñas. Quien debe realizarlas, cuándo y cómo / Renal biopsies for small renal masses. For whom, when and how

El objetivo del presente manuscrito es ofrecer un análisis basado en la evidencia del estado actual y perspectivas futuras de las biopsias renales en pequeñas masas renales. Se ha realizado una búsqueda en PubMed de toda la literatura relevante sobre pequeñas masas renales. Se realizó una búsqueda de la literatura en lengua inglesa, francesa y española en la base de datos PubMed entre el 2000 y febrero del 2012 utilizando los términos biopsia de masa renal y biopsia de tumor renal. Se seleccionaron para revisión los manuscritos que ofrecían el mayor nivel de evidencia. El manuscrito también recoge en la experiencia clínica de las Instituciones de los autores. Durante la última década se han realizado considerable avances técnicos en pruebas de imagen. Esto permite un diagnostico completo y preciso de las masas renales pequeñas. La decisión terapéutica se apoya en el conocimiento objetivo de las características histológicas, y la biopsia renal representa una opción precisa y segura para el tratamiento particularizado de los incidentalomas renales. Además, las biopsias renales están incorporadas en la aplicación y el seguimiento de los pacientes sometidos a terapias ablativas. Se ha publicado un número importante de artículos clínicos sobre el tema pero falta una estandarización técnica. La experiencia disponible está limitada a centros de referencia, y todavía hay hasta un 30% de biopsias que no consiguen dar un diagnostico claro. Las biopsias renales han mejorado significativamente en su precisión diagnóstica y está indicada cuando el diagnostico tisular pueda cambiar el abordaje terapéutico de las masas renales pequeñas. Mientras tanto, el papel de las biopsias renales sigue creciendo y las limitaciones del procedimiento son menores en comparación con los beneficios que aporta(AU)

Objective of this manuscript is to provide an evidence-based analysis of the current status and future perspectives in kidney biopsies in small renal masses (BSRM). A PubMed search has been performed for all relevant urological literature regarding BSRM. A literature research of English, French and Spanish languages was performed using the Pubmed database from 2000 to February 2012 using the terms renal mass biopsy and renal tumor biopsy. Manuscripts providing a highest level of evidence were selected for the review. Clinical experience from author´s Institutions is also reflected in the manuscript. Considerable technical advances have been made in imaging over the last decade. The latter allow for a comprehensive sharp diagnosis of small renal masses (SRM). Therapeutic decision for SRM’s is supported by objective knowledge of histological features and renal biopsy represents an accurate and safe option to particularize treatment in renal incidentalomas. Furthermore, renal biopsies are incorporated in the application and follow-up of patients undergoing ablative therapies. An important number of clinical reports have been published in the subject but there is lack of technical standardization. The available experience is limited to referral centers and there are still up to 30% of biopsies that fail to provide clear diagnosis. Renal biopsies have significantly improved in its diagnostic accuracy and it is indicated when tissue diagnosis can change the therapeutic approach of SRM´s. Meantime, the role of renal biopsies keeps on growing and limitations of the procedure are less when compared to the benefits it provides(AU)

Intralobar pulmonary sequestration associated with bronchogenic cyst in adult.

Pulmonary sequestration and mediastinal bronchogenic cysts are rare but well known to thoracic surgeons. However, their association is exceptional. We report such a case in a young adult. The common origin of these 2 malformations is discussed.

A totally thoracoscopic approach for pulmonary anatomic segmentectomies.

Reported experience with video-assisted anatomic pulmonary segmentectomy is still limited. Over a 28-month period, totally thoracoscopic (TT) anatomic segmentectomies, i.e. using only endoscopic instrumentation and video-display without utility incision, were attempted on 50 patients (25 males and 25 females), aged 18-81 years (mean: 57 years). The indication was a clinical N0 non-small cell lung carcinoma in 25 cases, a solitary metastasis in nine cases and a benign lesion in 16 cases. The following segmentectomies were performed: right apicosuperior (9) right superior (6), right basilar (7), lingula sparing left upper lobectomy (7), left apicosuperior (4), lingula (4), left superior (6) and left basilar (7). It was associated with a radical lymphadenectomy in 20 cases. There was one conversion to thoracotomy. The mean operative time was 188±54 min, the mean intraoperative blood loss was 91±82 ml (range: 0-450 ml). There were four minor postoperative complications (11.7%). The median postoperative stay was 5.6±2.4 days. Out of the 25 patients operated on for a cN0 lung carcinoma, two were finally upstaged to N2. TT anatomic pulmonary segmentectomies are feasible and safe.

Abdominal pain and severe hyponatremia after lung cancer surgery.

We report a 54-year-old man who presented with abdominal pain and severe hyponatremia a few days after a left lower lobectomy for lung cancer. An abdominal computed tomography scan without contrast showed a bilateral adrenal hemorrhagic infarction, mainly on the right side. Serum sodium level was 113 mmol/L, and cortisol level was 0 microg/L. Anticardiolipin-type antibodies (immunoglobulin G isotype) level was 75 GPL/mL (normal value < 10). With hydrocortisone supplementation and curative doses of low-molecular-weight heparin, the patient recovered progressively and was discharged on postoperative day 17. Final diagnosis was bilateral adrenal gland hemorrhagic necrosis leading to adrenal insufficiency, associated with antiphospholipid syndrome. We discuss the mechanism and the role of the operation in the occurrence of this particularly rare and potentially life-threatening complication. Recommendations to prevent thrombosis in surgical patients who have antiphospholipid antibodies are lacking.

Computed tomography versus water-soluble contrast swallow in the detection of intrathoracic anastomotic leak complicating esophagogastrectomy (Ivor Lewis): a prospective study in 97 patients.

PURPOSE: Water-soluble contrast swallow (CS) is usually performed before refeeding for anastomosis assessment after esophagectomy with intrathoracic anastomosis but the sensitivity of CS is low. Another diagnostic approach is based on analysis of computed tomography (CT) scan with oral contrast and of CT mediastinal air images. We undertook to compare them prospectively. METHODS: Ninety-seven patients with an esophageal carcinoma operated by intrathoracic anastomosis were included prospectively in a study based on a CT scan at postoperative day 3 (without oral and intravenous contrast) and CT scan and CS at day 7. CT scan analysis consisted of assessing contrast and air leakage. In case of doubt, an endoscopy was done. RESULTS: A diagnosis of anastomotic leak was made in 13 patients (13.4%), in 2 cases before day 7 and in 3 beyond day 7. At day 3, 94 CT scans were performed, but the diagnostic value was poor. In 95 patients with both CS and CT scan at day 7, CS disclosed a leak in 5 of 11, and CT scan was abnormal in 8 of 11. Leakage of contrast and/or presence of mediastinal gas had the best negative predictive value (95.8%). Endoscopy was done in 16 patients with only mediastinal gas at day 7 CT scan. It disclosed a normal anastomosis in 11, fibrin deposits in 4, and a leak in 1. CONCLUSIONS: In comparison with CS only, CT at day 7 improves the sensitivity and negative predictive value for diagnosing an anastomotic leak. In case of doubt endoscopy is advisable. This approach provides an accurate assessment of the anastomosis before refeeding.