Divided naevus of the penis: two paediatric cases with dermoscopic findings.

Divided or kissing naevi are located on adjacent parts of the body that are separated during embryogenesis. Divided naevus of the penis (DNP) is exceedingly rare, with < 15 cases reported in the English language literature. Divided penile naevi affect the glans penis and inner foreskin, which are anatomical structures believed to have a common embryological origin. We report the clinical, dermoscopic and histopathological findings of two children with DNP. To our knowledge, this is the first report of patients with DNP seen in South America, and the first in which dermoscopic findings are discussed; these included a large globular pattern in one patient, and homogeneous, streaked and globular patterns in the other.

Reflectance confocal microscopy as a new tool in the in vivo evaluation of desquamative gingivitis: patterns in mucous membrane pemphigoid, pemphigus vulgaris and oral lichen planus.

BACKGROUND: Desquamative gingivitis refers to a clinical manifestation associated with several mucocutaneous disorders. The most common are mucous membrane pemphigoid, pemphigus vulgaris and lichen planus. Their specific diagnosis is better established by histopathological and immunofluorescence evaluation. OBJECTIVES: To examine cases of desquamative gingivitis using reflectance confocal microscopy (RCM) and compare the findings with those of normal gingiva. To compare RCM findings in desquamative gingivitis with conventional histopathology of the biopsied lesions, in order to establish criteria for this noninvasive diagnostic technique. METHODS: A total of 25 cases of suspected mucous membrane pemphigoid, pemphigus vulgaris and lichen planus were included. RCM was performed on the gingiva of a healthy person and on gingival lesions. All lesions were biopsied in order to perform a RCM-histopathological correlation. RESULTS: Reflectance confocal microscopy examination of the gingival lesions suspected to be mucous membrane pemphigoid revealed a separation at the level of the dermal-epidermal junction, filled with small, bright structures interpreted as blood cells. Histopathological and immunofluorescence findings confirmed the diagnosis. For pemphigus vulgaris, RCM features were intraepithelial clefts with round, detached cells interpreted as acantholytic keratinocytes, similar to the histopathological features. Hyperkeratosis and spongiosis associated with infiltration of inflammatory cells, seen as small, bright cells intermingling with the honeycomb keratinocyte epithelial structure, were seen in lichen planus. Mildly bright, round structures interpreted as necrotic keratinocytes and mildly bright, stellate structures, interpreted as melanophages, were also seen in the dermis. These features were present on histopathology, confirming the diagnosis of lichen planus. CONCLUSION: We propose that RCM is a useful tool to help distinguish between the three most common causes of desquamative gingivitis.

A novel nomogram predicting lymph node invasion among patients with prostate cancer: The importance of extracapsular extension at multiparametric magnetic resonance imaging.

PURPOSE: To develop a novel risk tool that allows the prediction of lymph node invasion (LNI) among patients with prostate cancer (PCa) treated with robot-assisted radical prostatectomy (RARP) and extended pelvic lymph node dissection (ePLND). METHODS: We retrospectively identified 742 patients treated with RARP + ePLND at a single center between 2012 and 2018. All patients underwent multiparametric magnetic resonance imaging (mpMRI) and were diagnosed with targeted biopsies. First, the nomogram published by Briganti et al. was validated in our cohort. Second, three novel multivariable logistic regression models predicting LNI were developed: (1) a complete model fitted with PSA, ISUP grade groups, percentage of positive cores (PCP), extracapsular extension (ECE), and Prostate Imaging Reporting and Data System (PI-RADS) score; (2) a simplified model where ECE score was not included (model 1); and (3) a simplified model where PI-RADS score was not included (model 2). The predictive accuracy of the models was assessed with the receiver operating characteristic-derived area under the curve (AUC). Calibration plots and decision curve analyses were used. RESULTS: Overall, 149 patients (20%) had LNI. In multivariable logistic regression models, PSA (OR: 1.03; P= 0.001), ISUP grade groups (OR: 1.33; P= 0.001), PCP (OR: 1.01; P= 0.01), and ECE score (ECE 4 vs. 3 OR: 2.99; ECE 5 vs. 3 OR: 6.97; P< 0.001) were associated with higher rates of LNI. The AUC of the Briganti et al. model was 74%. Conversely, the AUC of model 1 vs. model 2 vs. complete model was, respectively, 78% vs. 81% vs. 81%. Simplified model 1 (ECE score only) was then chosen as the best performing model. A nomogram to calculate the individual probability of LNI, based on model 1 was created. Setting our cut-off at 5% we missed only 2.6% of LNI patients. CONCLUSIONS: We developed a novel nomogram that combines PSA, ISUP grade groups, PCP, and mpMRI-derived ECE score to predict the probability of LNI at final pathology in RARP candidates. The application of a nomogram derived cut-off of 5% allows to avoid a consistent number of ePLND procedures, missing only 2.6% of LNI patients. External validation of our model is needed.

The phosphatase and tensin homologue deleted on chromosome 10 mediates radiosensitivity in head and neck cancer.

BACKGROUND: For locally advanced squamous cell carcinoma of the head and neck (HNSCC), the recurrence rate after surgery and postoperative radiotherapy is between 20 and 40%, and the 5-year overall survival rate is approximately 50%. Presently, no markers exist to accurately predict treatment outcome. Expression of proteins in the human epidermal growth factor receptor (EGFR) pathway has been reported as a prognostic marker in several types of cancer. METHODS: The aim of this study was to investigate the prognostic value of proteins in the EGFR pathway in HNSCC. For this purpose, we collected surgically resected tissue of 140 locally advanced head and neck cancer patients, all treated with surgery and postoperative radiotherapy. RESULTS: In a multivariate analysis, expression of the phosphatase and tensin homologue deleted on chromosome 10 (PTEN) was significantly related to worse locoregional control (LRC; HR: 2.2, 95% CI: 1.1-4.6; P=0.03), independent of lymph node metastases (HR: 5.6, 95% CI: 1.2-27.4; P=0.03) and extranodal spread (HR: 2.7; 95% CI: 1.2-6.5; P=0.02). In vitro clonogenic radiosensitivity assays confirmed that overexpression of PTEN resulted in increased radioresistance. CONCLUSION: Our study is the first report showing that expression of PTEN mediates radiosensitivity in vitro and that increased expression in advanced HNSCC predicts worse LRC.

Solitary thyroid metastasis from colon cancer: a rare case report.

Malignant metastases to the thyroid are rare and are even rarer from a colorectal primary. As these metastases are often asymptomatic, they are usually discovered incidentally on imaging performed as follow-up for the primary tumour. In this report, we present a case of metastatic sigmoid adenocarcinoma to the thyroid diagnosed and treated at our institution.

Ultrasound findings in the omental bursa: a short pictorial essay.

The omental bursa is a complex and important anatomical region. It serves as a barrier to block pathological processes, but it is also a channel for disease spread in the abdominal cavity. It is a large recess of the peritoneal cavity formed by a double-layered fold of serous peritoneum situated inferiorly to the liver, posteriorly to the lesser omentum and the stomach and anteriorly to the pancreas. Ultrasound (US) has an important role in the study of the omental bursa, as it is generally the first examination to be performed in the presence of abdominal pain. US is inexpensive, widely available and able to identify many of the alterations that may occur in the abdomen. However, US findings are often varied and unspecific, ranging from fluid collections to diffuse infiltration. Familiarity with the various diseases that may affect the omental bursa is essential in order to be able to identify them during US examination of the abdomen. US imaging is useful in the follow-up after treatment and to guide drainage of fluid collections.

Brain tumours in south Brazil: a retrospective study of 438 cases.

All brain tumours diagnosed since 1967 in a University Hospital in the Southern region of Brazil were reviewed and clinical information concerning age, sex, symptoms and evolution were analysed. 88.1% of tumours were primary neoplasms and the rest secondary deposits. There was a male predominance and the second and fifth decades of life were the most affected. The main presenting symptoms were headache, vomiting, hemiparesis, loss of vision and epilepsy. The commonest tumour was of astrocytic origin (36.3%) amongst which the malignant ones, including glioblastoma multiforme, predominated. These tumours were frequent in the cerebral hemispheres (31.3%), particularly in the frontal lobes. The time of evolution from the beginning of the clinical manifestations until the first hospital admission was also studied. The authors discuss the clinical and pathological observations in relation to other large series analysed in the literature.

Catecholaminergic polymorphic ventricular tachycardia. An important diagnosis in children with syncope and normal heart.

Syncope in children is primarily related to vagal hyperreactivity, but ventricular tachycardia (VT) way rarely be seen. Catecholaminergic polymorphic VT is a rare entity that can occur in children without heart disease and with a normal QT interval, which may cause syncope and sudden cardiac death. In this report, we describe the clinical features, treatment, and clinical follow-up of three children with syncope associated with physical effort or emotion and catecholaminergic polymorphic VT. Symptoms were controlled with beta-blockers, but one patient died suddenly in the fourth year of follow-up. Despite the rare occurrence, catecholaminergic polymorphic VT is an important cause of syncope and sudden death in children with no identified heart disease and normal QT interval.

[Catheter ablation of atrial flutter. Electrophysiological characterization of posterior and septal isthmus block]. / Ablação por cateter do flutter atrial. Caracterização eletrofisiológica da interrupção da condução pelos istmos posterior e septal.

PURPOSE: Evaluate the different types of conduction blocks obtained between inferior vena cava-tricuspid annulus (posterior isthmus) and between tricuspid annulus-coronary sinus ostium (septal isthmus) after radiofrequency (RF) catheter ablation of atrial flutter (AFL). METHODS: In 16 procedures, 14 patients (pts), 9 male, with type I AFL underwent RF ablation. Atrial activation around tricuspid annulus was performed with a 10-bipole "Halo" catheter (H1-2; H19-20). In sinus rhythm, isthmus conduction was evaluated during proximal coronary sinus (PCS) and low lateral right atrium (H1-2) pacing, before and after linear ablation. According to the wave front of impulse propagation we assessed absence of block (bidirectional conduction); incomplete block (bidirectional conduction with delay in one front of impulse propagation) and complete block (absence of conduction). The PCS/H1-2 interval was measured before and after ablation. RESULTS: Complete isthmus block was achieved in 7 (44%) and incomplete block in 4 (25%) procedures. Conduction block was not achieved in 5 procedures. At a mean follow-up of 12 months, there were no recurrences in the pts with complete block, whereas AFL recurred in the 6 pts with incomplete or no conduction block (p < 0.001). Pts with complete block had delta PCS/H1-2 interval (74.0 +/- 26.0 ms) greater than incomplete (30.5 +/- 7.5 ms) or absent block (p < 0.05). CONCLUSION: The verification of complete isthmus conduction block with atrial multipolar mapping is an effective strategy to assess electrophysiological success and absence of late recurrence in common atrial flutter ablation.

Breast elastography: A literature review.

Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls.Breast elastography is a new sonographic imaging technique which provides information on breast lesions in addition to conventional ultrasonography (US) and mammography. Elastography provides a noninvasive evaluation of the stiffness of a lesion. Today, two technical solutions are available for clinical use: strain elastography and shear wave elastography. Initial evaluations of these techniques in clinical trials suggest that they may substantially improve the possibility of differentiating benign from malignant breast lesions thereby limiting recourse to biopsy and considerably reducing the number of benign breast biopsy diagnoses. This article reviews the basics of this technique, how to perform the examination, image interpretation and the results of major clinical studies. Although elastography is easy to perform, training and technical knowledge are required in order to obtain images permitting a correct interpretation. This paper will highlight the technique and point out common pitfalls.

Baker's cyst in pediatric patients: Ultrasonographic characteristics.

OBJECTIVE: Evaluate incidence, etiology, and sonographic features of Baker's cyst in children. MATERIALS AND METHODS: We examined 16 pediatric patients, with the clinical diagnosis of Baker's cyst. The possibility to confirm or to exclude the presence of the lesion, assess the structure, presence of bilateralism and joint effusion were considered. Three subjects had known juvenile arthritis, 2 hemophilia, 11 a popliteal swelling in the absence of concomitant diseases. RESULTS: In all patients it was possible to confirm (11) or to exclude (5) the presence of Baker's cyst. The idiopathic forms (6) exhibited anechoic structure; in patients with arthritis (3) there was hypertrophic synovium; in hemophilic patients at the presentation (2) anechoic structure with layering (serum and red blood cells); in chronic hemophilia synovial hypertrophy was seen. Joint effusion was constantly present in children with hemophilia and arthritis and in 1 case of idiopathic cyst. CONCLUSION: Baker's cysts in children are rare. Ultrasound is able to confirm or to exclude the presence of the lesion and it is able to evaluate characteristics, bilateralism and association with joint effusion.

Ganglioneuroblastoma: Case report and review of the literature.

Neuroblastoma are among the most important tumors of extracranial origin in pediatric patients. They arise from embryonal cells involved in the development of the sympathetic nervous system, whose differentiation has been arrested [1,2]. They are the tumors most frequently diagnosed during the first decade of life. Their evolution is unpredictable, ranging from progression to spontaneous regression or maturation, and their location and metastatic potential vary. Little is known about the cause of these tumors and the risk factors associated with their development. This article describes a typical case of ganglioneuroblastoma and provides a review of the literature on this type of tumor.Sommario Il neuroblastoma è uno dei più importanti tumori pediatrici di derivazione extracranica; esso origina dalle cellule embrionali coinvolte nello sviluppo del sistema nervoso simpatico a causa di un blocco nel loro processo di differenziamento [1,2]. È la più frequente neoplasia della prima decade di vita; la sua progressione biologica è imprevedibile, regressione spontanea, maturazione a ganglioneuroma, localizzazione e metastatizzazione variabili. Poco è noto a riguardo dei fattori di rischio e della sua eziopatogenesi. Viene presentato un caso tipico di ganglioneuroblastoma e riesaminata la letteratura su questa neoplasia.

Post-traumatic hematoma of the epididymis: Case-report.

Scrotal trauma accounts for less than 1% of all trauma-related injuries. Traumatic injuries of the epididymis are extremely rare.Here we report a rare case of hematoma of the epididymis, diagnosed with US, in a 10-year-old boy after a sport injury.

Testicular ischemia after inguinal hernia repair.

Testicular ischemia is a rare complication of inguinal hernia repair. It results from the injury to the vessels that course along the inguinal canal. Typically it is painful at the beginning and asymptomatic later. Ultrasonographic appearance and aspects of testicular ischemia result in diffusely hypoechoic and disomogeneous testis, with complete lack of intratesticular vascular signal on color-Doppler and cremasteric vessels hypertrophy in chronic cases.This report describes a testicular ischemia seen in a patient referred to because of hernia recurrence, without any sign or symptom of acute scrotum. Ultrasound examination showed the most frequent complications after inguinal hernia repair: both hernia recurrence and testicular ischemia.

Ultrasound guided fine-needle aspiration cytology of breast lesions.

Breast biopsy consists in the collection of cells or tissue fragments from a breast lesion and their analysis by a pathologist. There are several types of breast biopsy defined on the basis of the type of needle used: fine-needle aspiration and biopsy performed with a spring-based needle. This article focuses on fine-needle aspiration performed under sonographic guidance.It is used mainly to assess cysts that appear to contain vegetations or blood or that are associated with symptoms; lesions and solid nodules that are not unequivocally benign; and axillary lymph nodes that appear suspicious on physical examination and/or sonography.In addition to distinguishing between benign and malignant lesions, ultrasound guided fine-needle aspiration also plays an important role in tumor grading and in immunocytochemical identifying specific tumor markers. This article describes the technique used and the possible causes of false negative and false positive findings. Despite its limitations, fine-needle aspiration has become a fundamental tool for the identification and preoperative management of malignant breast lesions.

Lymphoma of the scrotum in patients with Down's syndrome: US appearance. Mini-pictorial essay.

Down's syndrome is relatively common, and patients who are affected have an increased risk of developing acute leukemia, but not solid tumors. Studies performed in larger patient populations have shown that solid tumors, including lymphomas, are significantly less frequent in Down patients than in children and adults who are not Trisomy 21-affected.Testicular lymphomas are rare and extremely aggressive. Ultrasound (US) combined with color Doppler is essential in the diagnosis and evaluation of treatment results in these lesions. As they are very rare, it was decided to publish this mini-pictorial essay.

Varicocele: Ultrasonographic assessment in daily clinical practice.

INTRODUCTION: Varicoceles are abnormal dilatations of the pampiniform venous plexus. They are classified as primary or secondary, depending on their cause, and staged clinically on the basis of their extension and on the presence or the absence of spontaneous or induced reversal of blood flow. MATERIALS AND METHODS: We examined 95 patients (age range: 3-77 years) using Color Doppler ultrasound with settings optimized for the study of slow flow. All patients found to have varicoceles underwent ultrasonographic assessment of the kidneys and retroperitoneum. Findings were classified with a simplified version of the Sarteschi system. RESULTS: 41 (43.1%) of the patients were found to have varicoceles, which were classified as grade 1 in 11 cases, grade 2 in 13, grade 3 in 10, and grade 4 in 7 according to the simplified Sarteschi classification. DISCUSSION: Our results are with those reported in the literature. They confirm that varicoceles are a frequent finding and ultrasonography is currently the best imaging technique for its diagnosis and also for the post-surgery follow-up.

Ultrasound anatomy of the neck: The infrahyoid region.

The infrahyoid region of the neck includes the visceral, anterior cervical, posterior cervical, carotid, retropharyngeal, and perivertebral spaces. The visceral space contains the thyroid, parathyroid glands, larynx, hypopharynx, the cervical trachea, and esophagus, the recurrent laryngeal nerve. The carotid space contains two parts, which extend from the skull base to the aortic arch and are delimited by the three layers of the deep cervical fascia (superficial, middle, and deep). It contains the internal carotid artery, the internal jugular vein, cranial nerves (IX-XII), the sympathetic plexus (suprahyoid compartment), the common carotid artery, the internal jugular vein, vagus nerve (infrahyoid compartment). The retropharyngeal space is a midlinespace containing adipose tissue that extends from the skull base to the upper mediastinum. It is located posterior to the pharynx and cervical esophagus, anterior to the danger area and the perivertebral space.THE PERIVERTEBRAL SPACE EXTENDS FROM THE SKULL BASE TO THE CLAVICLES AND INCLUDES TWO PARTS: prevertebral and paraspinal. The prevertebral space includes the prevertebral muscles (long muscles of the neck and head), the scalene muscles (anterior, middle, and posterior), the roots of the brachial plexus, the phrenic nerve, the vertebral arteries and veins, and the vertebral bodies. The paraspinal space contains the paraspinal muscles and the posterior elements of the cervical spine.The posterior cervical space is a deep space located posterior to the sternocleidomastoid muscle. It contains the accessory nerve, the accessory chain lymph nodes, the pre-axillary component of the brachial plexus, and the dorsal scapular nerve. The anterior cervical space is located deep to the strap muscles and sternocleidomastoid muscle. It surrounds the front and sides of the visceral space and is related posteriorly to the carotid space. This article reviews the ultrasound features of the structures located in the infrahyoid region of the neck.

Scrotal pain as the first clinical manifestation of testicular seminoma: A case report.

Seminomas are the malignant testicular tumors most commonly diagnosed in young adult males. It consists of undifferentiated cells derived from the embryonic gonad. The tumor presents as a scrotal mass that may or may not be associated with pain. On ultrasonography, the mass appears hypoechoic with well-defined margins and an echo structure that tends to be homogeneous. Color Doppler studies reveal rich vascularization. This report describes a case of seminoma that presented with scrotal pain. The typical findings on ultrasonography and color Doppler were fundamental for correct diagnosis of this tumor.

Pathological gambling severity is associated with impulsivity in a delay discounting procedure.

Research and clinical expertise indicates that impulsivity is an underlying feature of pathological gambling. This study examined the extent to which impulsive behavior, defined by the rate of discounting delayed monetary rewards, varies with pathological gambling severity, assessed by the South Oaks Gambling Screen (SOGS). Sixty-two pathological gamblers completed a delay discounting task, the SOGS, the Eysenck impulsivity scale, the Addiction Severity Index (ASI), and questions about gambling and substance use at intake to outpatient treatment for pathological gambling. In the delay discounting task, participants chose between a large delayed reward (US $1000) and smaller more immediate rewards (US $1-$999) across a range of delays (6h to 25 years). The rate at which the delayed reward was discounted (k value) was derived for each participant and linear regression was used to identify the variables that predicted k values. Age, gender, years of education, substance abuse treatment history, and cigarette smoking history failed to significantly predict k values. Scores on the Eysenck impulsivity scale and the SOGS both accounted for a significant proportion of the variance in k values. The predictive value of the SOGS was 1.4 times that of the Eysenck scale. These results indicate that of the measures tested, gambling severity was the best single predictor of impulsive behavior in a delay discounting task in this sample of pathological gamblers.