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Teaching Point: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare congenital anomaly characterized by a steal phenomenon; it must be recognized, as a prompt treatment may prevent life-threatening complications such as myocardial infarction, mitral dysfunction, and malignant dysrhythmias in adults.
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Teaching Point: Female urethral diverticulum is a rare condition that is often a diagnostic challenge; magnetic resonance imaging (MRI) is efficient to confirm the diagnosis (especially if endovaginal ultrasound is inconclusive), to assess the diverticulum prior to surgery, and to detect related complications including intra-diverticular neoplasm.
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Teaching Point: The diagnosis of epiploic appendagitis in case of pain in the right iliac fossa in pregnant woman shouldn't be forgotten.
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Teaching Point: The acute appendicitis in a context of Malone appendicostomy complication is very rare but can occur and may be challenging to diagnose due to its unusual position.
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Teaching point: Unexplained persistent perineal pain poses a differential diagnosis, including pelvic nerve lesions. The rare occurrence of pelvic schwannoma is easily shown by a MRI as a T2-hyperintense enhancing mass.
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Teaching Point: This case highlights the extrapulmonary lymphatic abnormalities that may be associated with pulmonary lymphangioleiomyomatosis.
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Teaching point: Boerhaave syndrome is a very rare life-threatening surgical emergency, often misdiagnosed at the patient's admittance.
Subject(s)
Abdominal Pain/etiology , Angioedema/chemically induced , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Enalapril/adverse effects , Jejunal Diseases/chemically induced , Adult , Angioedema/complications , Angioedema/diagnosis , Female , Glomerulosclerosis, Focal Segmental/complications , Glomerulosclerosis, Focal Segmental/drug therapy , Humans , Hypertension/drug therapy , Hypertension/etiology , Jejunal Diseases/complications , Jejunal Diseases/diagnosis , Jejunum/blood supply , Jejunum/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
Background: This study assesses how the metastatic immune landscape is impacting the response to treatment and the outcome of colorectal cancer (CRC) patients. Methods: Complete curative resection of metastases (n = 441) was performed for two patient cohorts (n = 153). Immune densities were quantified in the center and invasive margin of all metastases. Immunoscore and T and B cell (TB) score were analyzed in relation to radiological and pathological responses and patient's disease-free (DFS) and overall survival (OS) using multivariable Cox proportional hazards models. All statistical tests were two-sided. Results: The spatial distribution of immune cells within metastases was nonuniform. Patients, as well as metastases of the same patient, had variable immune infiltrates and response to therapy. A beneficial response was statistically significantly associated with increased immune densities. Among all metastases, Immunoscore (I) and TB score evaluated in the least immune-infiltrated metastases were the strongest predictors for DFS and OS (five-year follow-up, Immunoscore: I 3-4: DFS rate = 27.9%, 95% CI = 15.2 to 51.3; vs I 0-1-2: DFS rate = 12.3%, 95% CI = 4.9 to 30.6; HR = 0.45, 95% CI = 0.28 to 0.70, P = .02; I 3-4: OS rate = 64.6%, 95% CI = 46.6 to 89.6; vs I 0-1-2: OS rate = 32.5%, 95% CI = 17.2 to 61.4; HR = 0.32, 95% CI = 0.15 to 0.66, P = .001, C-index = 65.9%; five-year follow-up, TB score: TB 3-4: DFS rate = 25.7%, 95% CI = 14.2 to 46.6; vs TB 0-1-2: DFS rate = 5.0%, 95% CI = 0.8 to 32.4; HR = 0.36, 95% CI = 0.22 to 0.57, P < .001; TB 3-4: OS rate = 63.7%, 95% CI = 46.4 to 87.5; vs TB 0-1-2: OS rate: 21.4%, 95% CI = 9.2 to 49.8; HR = 0.25, 95% CI = 0.12 to 0.51, P < .001, C-index = 67.8%). High TB score and Immunoscore patients had a median survival of 70.5 months, while low patients survived only 25.1 to 38.3 months. Nonresponding patients with high-immune infiltrates had prolonged DFS (HR = 0.28, 95% CI = 0.15 to 0.52, P = .001) and OS (HR = 0.25, 95% CI = 0.1 to 0.62, P = .001). The immune parameters remained the only statistically significant prognostic factor associated with DFS and OS in multivariable analysis (P < .001), while response to treatment was not. Conclusions: Response to treatment and prolonged survival of metastatic CRC patients were statistically significantly associated with high-immune densities quantified into the least immune-infiltrated metastasis.
Subject(s)
B-Lymphocytes , Colorectal Neoplasms/immunology , Liver Neoplasms/immunology , Lung Neoplasms/immunology , Lymphocytes, Tumor-Infiltrating , T-Lymphocytes , Aged , Antigens, CD20/analysis , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , B-Lymphocytes/chemistry , CD3 Complex/analysis , CD8-Positive T-Lymphocytes , Chemotherapy, Adjuvant , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Disease-Free Survival , Follow-Up Studies , Forkhead Transcription Factors/analysis , Hepatectomy , Humans , Leukocyte Common Antigens/analysis , Liver Neoplasms/secondary , Liver Neoplasms/therapy , Lung Neoplasms/secondary , Lung Neoplasms/therapy , Lymphocyte Count , Metastasectomy , Middle Aged , Neoplasm Metastasis , Pneumonectomy , Preoperative Period , Response Evaluation Criteria in Solid Tumors , Survival Rate , T-Lymphocytes/chemistry , Tumor Microenvironment/immunologyABSTRACT
OBJECTIVE: The right ventricle is often overlooked on chest and even cardiac MDCT studies. This article will review the normal anatomy of the right ventricle on MDCT and the signs of its functional alterations. CONCLUSION: MDCT signs of right ventricular dysfunction should be known and checked in relevant cases, such as pulmonary embolism in particular, and in any disease that affects both the structure and function of the lungs in general.
