Inflammatory myofibroblastic tumour of an unusual presentation in the uterine cervix: a case report.

BACKGROUND: Inflammatory myofibroblastic tumour is an infrequent mesenchymal neoplasia of unknown aetiology and variable behaviour, ranging from rather benign lesions to locally aggressive and even metastatic disease. Its presence has been described in almost all organs; however, its location in the female genital tract has rarely been reported. CASE PRESENTATION: We present the case of a 47-year-old female, who was studied in our institution for a recent medical history of several weeks of dyspareunia and abdominal pain. She underwent pertinent studies including ultrasonography and CT scan. Under suspicion of degenerated leiomyoma, a total hysterectomy was performed. Unexpectedly, the pathological study of the surgical specimen showed very few tumour cells with focal fusiform morphology surrounded by an abundant inflammatory infiltrate; a thorough immunohistochemistry study lead to myofibroblastic tumour of the cervix diagnosis. A PET-CT scan did not show metastatic disease. The patient did not undergo any adjuvant treatment, and she is currently on surveillance with no evidence of disease relapse. CONCLUSIONS: Inflammatory myofibroblastic tumour remains a rare entity yet to be fully elucidated. The diagnosis is based on pathological study due to the lack of typical clinical manifestations and typical radiological images. Surgical resection is the most frequent treatment, whereas chemotherapy and radiotherapy are restricted to locally advanced or metastatic disease. Tirosine kinase inhibitor crizotinib has shown promising results especially in tumours harbouring ALK mutation.

Imaging Crohn disease: MR enterography.

Magnetic resonance enterography in Crohn disease management has been rapidly growing in importance during recent years. Being familiar to this technique is essential for radiologists and also, to some extent, for gastroenterologists. Our aim is to study and describe the imaging findings in magnetic resonance enterography in Crohn disease to develop a comprehensive and useful review article and imaging atlas.

Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: first year of experience.

OBJECTIVE: to describe the experience at two tertiary centres during the first year of use of magnetic resonance enterography (MRE) for the management of Crohn's disease (CD): indications and influence of the technique in clinical decision making. MATERIALS AND METHODS: retrospective descriptive study in which patients who underwent MRE were included consecutively. Epidemiological and clinical data were collected from the patients, as well as the indication for the study and how it influenced clinical decision making in the 10 days following the radiological study. RESULTS: 24 MREs were performed in suspected CD and 126 known CD; partial bowel obstruction in 53 patients (42%), monitoring of medical treatment in 34 (27%), due to incomplete ileocolonoscopy in 16 (13%), extension study of the small intestine in 15 (12%) and suspected complicated CD in 8 patients (6%). The MRE influenced in a change in treatment in 83 (55.3%) patients: 16 (10.7%) started with immunosuppressants, 41 (27.3%) with anti-TNFα were started on or switched, 15 (10%) were ordered surgery and in 3 (2%) changed from combined therapy to monotherapy. The MRE had less influence on clinical decision making in the group in which the indication was suspected CD (p < 0.05). CONCLUSIONS: the use of MRE helped on decision making in more than half of patients, especially with regards to decisions related to the use of biological therapies and the indication for surgery. MRE was less useful in suspected CD patients.

Uso de la enterografía por resonancia magnética en el manejo de la enfermedad de Crohn de intestino delgado: primer año de experiencia / Using of magnetic resonance enterography in the management of Crohn's disease of the small intestine: first year of experience

Objetivo: describir la experiencia de dos centros terciarios durante el primer año de uso de la enterografía por resonancia magnética (enteroRM) para el manejo de la enfermedad de Crohn (EC): indicaciones e influencia en la toma de decisiones clínicas. Material y métodos: estudio descriptivo retrospectivo. Se incluyeron de forma consecutiva a pacientes a los que se realizaba una enteroRM. Se recogieron los datos epidemiológicos y clínicos de los pacientes, la indicación de la prueba y como influyó sobre la toma de decisiones clínicas en los 10 días posteriores a la realización de la prueba radiológica. Resultados: se realizaron 24 enteroRM por sospecha de EC y 126 por seguimiento clínico en pacientes con EC conocida: clínica suboclusiva en 53 (42%), monitorización de los tratamientos médicos en 34 (27%), completar el estudio por ileocolonoscopia incompleta en 16 (13%), estudio de extensión en intestino delgado en 15 (12%) y finalmente la sospecha de EC complicada en 8 pacientes (6%). La realización de la enteroRM influyó en el tratamiento en 83 (55,3%) pacientes. Dieciséis (10,7%) pacientes con inmunosupresores, 41 pacientes (27,3%) iniciaron o cambiaron de anti-TNFa, en 15 pacientes (10%) se indicó la cirugía y en 3 pacientes (2%) la enteroRM indujo a cambiar de terapia combinada a monoterapia. La enteroRM en la sospecha de EC influyó menos en las decisiones clínicas que cuando se indicaba por seguimiento (p < 0,05). Conclusiones: la enteroRM ayudó a decidir en más de la mitad de los pacientes, en especial en el seguimiento clínico para el manejo de las terapias biológicas y la indicación de la cirugía. Fue menos útil cuando la indicación fue la sospecha de EC(AU)

Objective: to describe the experience at two tertiary centres during the first year of use of magnetic resonance enterography (MRE) for the management of Crohn’s disease (CD): indications and influence of the technique in clinical decision making. Material and method: retrospective descriptive study in which patients who underwent MRE were included consecutively. Epidemiological and clinical data were collected from the patients, as well as the indication for the study and how it influenced clinical decision making in the 10 days following the radiological study. Results: 24 MREs were performed in suspected CD and 126 known CD; partial bowel obstruction in 53 patients (42%), monitoring of medical treatment in 34 (27%), due to incomplete ileocolonoscopy in 16 (13%), extension study of the small intestine in 15 (12%) and suspected complicated CD in 8 patients (6%). The MRE influenced in a change in treatment in 83 (55.3%) patients: 16 (10.7%) started with immunosuppressants, 41 (27.3%) with anti- TNFa were started on or switched, 15 (10%) were ordered surgery and in 3 (2%) changed from combined therapy to monotherapy. The MRE had less influence on clinical decision making in the group in which the indication was suspected CD (p < 0.05). Conclusions: the use of MRE helped on decision making in more than half of patients, especially with regards to decisions related to the use of biological therapies and the indication for surgery. MRE was less useful in suspected CD patients(AU)