The value of diffusion-weighted imaging in diagnosing gallbladder malignancy: performance of a new parameter.

AIM: To assess the value of the ratio of signal intensities at high and low b-values (b800/b0 ratio) during diffusion-weighted imaging (DWI) for gallbladder cancer diagnosis. MATERIALS AND METHODS: All patients presenting with suspicious gallbladder lesions between January 2011 and December 2016 who underwent DWI and histopathological diagnoses of the lesions were assessed. RESULTS: Thirty-two patients (24 men, eight women) were identified. Eighteen patients had benign gallbladder lesions while 14 had malignant lesions. The mean apparent diffusion coefficient (ADC) value was 1.62 (±0.57)×10-3 mm2/s for benign cases and 1.27 (±0.39)×10-3 mm2/s for malignant cases; this difference was not significant (p=0.0773). The mean b800/b0 ratio was 0.31 (±0.19) for benign cases and 0.48 (±0.13) for malignant cases; this difference was significant (p=0.007). The ROC curve for b800/b0 had an AUC of 0.782 (95% confidence interval [CI]: 0.616-0.947) with a sensitivity and specificity of 85.7% and 72.2%, respectively, at a cut-off point of 0.33. CONCLUSION: The b800/b0 ratio can help differentiate benign and malignant gallbladder lesions and may be more reliable than ADC values in quantitative DWI assessments.

Primary myxoid chondrosarcoma of the breast.

Primary breast chondrosarcoma has been rarely reported in the literature. Conservative breast surgery has never been part of the management of previously reported cases. Surgery remains the mainstay management of such a disease as it is resistant to chemotherapy and radiotherapy. In this report, we present a case of rare primary myxoid chondrosarcoma of the breast that was managed successfully with a conservative approach.

Sentinel lymph node biopsy (SLNB) in management of N0 stage T1-T2 lip cancer as a "same day" procedure.

Current management of N0 stage lip Squamous Cell Carcinoma (SCC) are prophylactic neck dissection, radiotherapy, or "watch and see" policy. The aim is the evaluation of the role of sentinel lymph node biopsy (SLNB) in their management based upon actual and not hypothetical presence of cervical lymph node (CLN) micrometastases as a same day procedure. Fourteen patients between November 2003 and August 2005 were included, nine men and five women, median age:57 years, (range 34-65 years). SLNB using preoperative lymphoscintigraphy and intra-operative localisation with patent blue and radioactive Tc(99m) Human Serum Albumin was performed. The median follow-up period was 26 months. Successful patent blue localisation in 13/14 whilst successful radio-localisation in all patients. Micrometastases were detected in 1/14 whom underwent therapeutic neck dissection. No local recurrence or regional lymph node involvement were detected. SLNB is a technically feasible and accurate approach for detection of CLN micrometastases in N0 stage lip SCC using the triple diagnostic localisation technique as a same day procedure.

Vaginal reconstruction with a greater omentum-pedicled graft combined with a vicryl mesh after anterior pelvic exenteration. Surgical approach with long-term follow-up.

Resection of anterior vaginal wall that occurs with some cases of anterior pelvic exenteration leaves the patient with a small and narrow vagina. This affects their sexual life leading to major psychologic problems, especially in young women. The aim of this study is to evaluate a new technique of vaginal reconstruction following anterior pelvic exenteration with clinical and cytohistologic follow-up. Between March 2002 and November 2004, ten sexually active female patients underwent vaginal reconstruction after radical cystectomy that required en bloc removal of the anterior vaginal wall, with a pedicle graft of greater omentum combined with a vicryl mesh. The mean age of the patients was 38 years. The mean operative time of the reconstructive procedure was 50 min. There were no complications regarding the reconstructive procedure. On follow-up, the neovagina accepted two fingers easily and showed a pink-colored smooth lining. Seven patients reported successful attempts of sexual intercourse. It was concluded that reconstruction of vagina after anterior pelvic exenteration in sexually active women can be done safely with the use of vicryl mesh combined with a pedicled omental graft. It is a simple, reliable, and not time-consuming technique. The long-term follow-up was very beneficial in detection of complete healing, postoperative infections, and hormonal activity of the graft and recurrence of malignancy.