Magnetic Resonance Imaging in the Preoperative T Staging of Gastric Cancer (A Critical Appraisal)

Background:Gastric cancer accounts for many cancer-related deaths, is one of the top leading cause of cancer-associated mortality. Tumor staging and classification depends upon histological, immune histochemical tests along with the radiological imaging. In the preoperative T staging of gastric cancer, Magnetic Resonance Imaging (MRI) has become principal attention in recent years.Aim:Evaluating the accuracy of MRI in the preoperative T staging of gastric cancer vis-a-vis post-operative pathological staging Methods: A total of 37 patients were initially taken in our study, out of which 13 patients were excluded as they underwent neo adjuvant chemoradiotherapy for the down staging of the tumor. The 24 patients became the sample size of our study and their magnetic resonance imaging (MRI) T stage was correlated with pathological T-stage.Results:The diagnostic accuracy of T1stage by MRI was 87.5%, with 94.7% specificity and 60% sensitivity (n=24, κ -value = 0.58; P-value<0.05). The diagnostic accuracy of T2stage by MRI was 87.5%, with 88.2% specificity and 85.7% sensitivity (n=24, κ-value= 0.69; P-value<0.05). The diagnostic accuracy of T3stage by MRI was 91.7% with 93.3% specificity and 88.9% sensitivity (n=24, κ -value= 0.82; P-value<0.05). The diagnostic accuracy of T4stage by MRI was 95.8%, with 100% specificity and 75% sensitivity (n=24, κ-value= 0.80; P-value<0.05).Conclusion:Because of high accuracy and specificity in determining the depth of invasion of gastric cancer, MRI proves to be an invaluable diagnostic tool in the preoperative T staging of gastric cancer and therefore is very useful in sidestepping unnecessary surgery by supervising the selection of treatment decisions

Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: a prospective study

Background: Characterisation of pancreatic cystic lesions has a direct role in their management and computed tomography is the mainstay of investigation for diagnosing and characterising them. Objectives: The aim of this study was to prospectively assess the diagnostic accuracy of contrast-enhanced computed tomography (CECT) in preoperative characterisation of pancreatic cystic lesions with histopathology as the reference standard. Method: A total of 38 patients with cystic pancreatic lesions diagnosed after clinical, laboratory and sonographic evaluation, irrespective of age, were preoperatively evaluated with CECT. Images were reviewed for the general characteristics of the lesions on pre-contrast and portal venous phase images and overall diagnostic accuracy calculated. Imaging findings were compared with histopathology, or cytology and/or intra-operative findings. Results: Serous cystadenoma (SCA) was the most common cystic pancreatic lesion found in 31.6% of patients followed by mucinous cystadenoma (MCA) (26.3%), solid pseudo-papillary tumour (SPT) (21.1%) and intra-ductal papillary mucinous neoplasm (IPMN) (10.5%). Three patients (7.9%) had simple cysts and one patient (2.6%) had a lymphangioma. The diagnostic accuracy of CECT for pancreatic cystic lesions was found to be 72.5%. Conclusion: The diagnostic accuracy of computed tomography (CT) was high for SCA, IPMN and pancreatic cysts, and low for MCA and SPT. Combination of a multiloculated cystic lesion with locule size of less than 20 mm, septal enhancement with relative lack of wall enhancement, central scar and lobulated outline are highly specific for SCA. Unilocular or macro-cystic pattern with locule size of more than 20 mm, female gender and wall enhancement with smooth external contour are pointers towards MCA. Solid cystic pancreatic head lesions in young females may be suggestive of SPT. A dilated main pancreatic duct in a cystic lesion with internal septations may point towards IPMN. Fluid attenuation lesions with imperceptible non-enhancing wall indicate pancreatic cysts. Lastly, pseudocysts and neuroendocrine tumours with cystic components are great mimickers of pancreatic cystic lesions, and a history of pancreatitis and hormonal profile of patients should always be sought

Outcome of the surgical treatment of bullous lung disease: a prospective study

This study aimed at evaluating the outcome of surgery for bullous lung disease by comparing the preoperative and postoperative subjective dyspnea score, pulmonary function and clinical features. This prospective study was conducted from May 2009 to October 2011, on 54 patients operated for bullous lung disease. Follow-up at 3-6 months consisted of taking a comprehensive history, physical examination, radiological work-up, and evaluation of changes in subjective dyspnea score, arterial blood gas analysis [ABG], and pulmonary function test [PFT]. After comparison with preoperative values, the student's paired t-test was used to calculate the statistical significance. With approximately 21.6 cases per year, the most common underlying lung pathology was primary bullous lung disease, followed by COPD. The most common presenting complaint was spontaneous pneumothorax in tall young adults in their fourth decade of life with a history of smoking. Bullectomy, with or without decortication, was done for all cases. Improvement in mean PaO2 [arterial partial pressure of oxygen], SaO2 [arterial oxygen saturation] and PaCO2 [arterial partial pressure of carbon dioxide] was seen in most cases but was statistically insignificant. Improvement in mean FEV1 [forced expiratory volume in 1st second], FVC [forced vital capacity] and FEV1 / FVC was statistically significant, with FEV1 being the most reliable indicator of postoperative progress. Improvement in subjective dyspnea score was statistically significant and showed an inverse correlation with FEV1. Those with diffuse pulmonary parenchymal involvement had poorer baseline values and less significant postoperative improvement. Complications occurred more commonly in those with diffuse disease. Mortality was seen exclusively in those with diffuse disease. We conclude that surgery is required for bullous lung disease more frequently in our community since we have a high number of young patients with primary bullous lung disease and localized parenchymal involvement and these patients have a good surgical outcome. Potentially fatal complications like pneumothorax and recurrent infections can therefore be prevented in them. Those with underlying diffuse disease and severely decreased FEV1 [especially below 1 L] also benefit from surgery but require careful patient selection

Clinicopathological study of male breast carcinoma: 24 years of experience

Because breast cancer in men is rare, few patients are available for prospective studies. To learn more about its epidemiology, risk factors, clinical features, genetics and pathology in our country, we conducted a retrospective study of all cases seen in recent decades at our institution. We identified each case of male breast cancer in the database at the Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India, between the years 1983 to 2007. We identified only 32 cases of male breast cancer over the 24-year period. Male breast cancer accounted for 32 [2.8%] of 1141 resected breast specimens, which included all breast lesions and 32 [4.1%] of 780 breast cancer cases. Of the 32 cases, 20 [62.5%] had various associated risk factors. Invasive ductal carcinoma was seen in 30 cases [93.7%]. Of 20 cases that underwent molecular studies, 16 [80%] patients had estrogen receptor positivity whereas 14 [70%] had progesterone receptor positivity. Six cases [30%] overexpressed HER2 and p53. The BRCA2 mutation was observed in 4 cases [40%] while no patient presented with the BRCA1 mutation. An incidence of 4.1% for male breast cancer indicates that this disease is not as uncommon as presumed in this part of the world. Breast cancer in men seems more frequently to be hormone receptor positive and the BRCA2 mutation confers a significant risk to men

Splenic vein aneurysm in association with extrahepatic portal hypertension

Splenic vein aneurysm [SVA] is an extremely uncommon condition with only 50 cases having been reported in the literature [1-5]. We report a unique case of SVA in a child with extrahepatic portal hypertension. Since the condition was correctly diagnosed on preoperative computed tomography-assisted splenoportovenography [CTSPV], a planned surgical intervention was undertaken

Gelastic seizures in a young boy: Evaluation by magnetic resonance imaging

To present an interesting case of gelastic seizures in a child who had an underlying brain lesion. Clinical Presentation and Intervention: A 10-year-old boy presented with recurrent episodes of uncontrollable laughter since the age of 6 years. Computed tomography showed a well-defined mass in the region of suprasellar and interpeduncular cisterns. Magnetic resonance imaging revealed a lesion, most likely a hamartoma, arising from the region of tuber cinerium. The lesion was subsequently resected and a marked improvement in the frequency and intensity of seizures was noted. This report shows that neuroimaging should be performed on patients with gelastic seizures to exclude any underlying structural lesion of causal significance