Therapeutic recommendations for early stage Hodgkin lymphomas.

Combined modality treatment has been the standard option for the treatment of early stage Hodgkin lymphoma for several decades. Because of the high success rate and the risk of late toxicities, recent clinical trials have focused on reducing the treatment burden. Field and dose of radiotherapy, and number of cycles of chemotherapy have been successfully reduced, particularly for favourable early stage patients. However, the impact of these treatment reductions on the rate of secondary malignancies remains still unclear. Positron emission tomography-computed tomography (PET-CT) scanning has emerged as a very important tool for disease staging and end of treatment assessment. Interestingly, a PET performed after 2 cycles of ABVD (adriamycin, bleomycin, vinblastine, dacarbazine) has been correlated with final outcome and was recently evaluated in a randomized clinical trial to evaluate individualized therapy based on PET response after 2 or 3 cycles of ABVD. These trials aimed to identify good prognosis (early PET-negative) patients who could be spared radiotherapy, but also patients with a bad prognosis (early PET-positive) who need more intensive treatment. More recently, new drugs, such as brentuximab vedotin and checkpoint inhibitors, have shown efficacy in relapsed/refractory patients and are currently under evaluation in early stage patients.

Metabolic and morphological measurements of subcutaneous and visceral fat and their relationship with disease stage and overall survival in newly diagnosed pancreatic adenocarcinoma : Metabolic and morphological fat measurements in pancreatic adenocarcinoma.

PURPOSE: The relationship between tumor metabolism and stage, subcutaneous and visceral fat thickness, and their glucose metabolism and overall survival in patients recently diagnosed with pancreatic carcinoma was assessed. METHODS: Thirty-eight consecutive patients were studied. Subcutaneous fat thickness (SFT), visceral fat thickness (VFT), and their corresponding FDG SUVmean, as well as SUVmean and SUVmax values of the primary tumor (PT) were derived from FDG-PET CT imaging. Results obtained as well as clinical variables obtained, including gender and BMI, were related to patient outcome. Median follow-up was 382 days (range: 36-917 days). RESULTS: Median age was 66 years (13 women). Mean BMI was 24.6 (SD: 4.5). Lymph node (LN) involvement was diagnosed in 17 patients and 14 patients presented with distant metastases. Mean SUV max and SUVmean values of the PT were 9.0 (SD 5.9) and 4.2 (SD 2.1). Mean values of SFT and VFT were, respectively, 11.9 mm (range 1-31.7 mm) and 11.5 mm (range 0-49.8 mm). The corresponding SUVmean values were 0.4 (range 0-1.0) and 0.6 (range 0.0-1.6). SUVmean values of SFT proved significantly lower in LNpositive versus LNnegative patients (p = 0.021), in patients with and without metastatic disease (p = 0.017) and in stage III+IV patients versus stage I+II patients (p = 0.03). An inverse logarithmic relationship was found between SUVmean values of subcutaneous fat and SUVmean values of the PT (p = 0.02). Only disease stage dichotomized according to stage I+IIA versus stage IIB+III+IV was predictive of overall survival (p = 0.05). CONCLUSION: Glucose metabolism of subcutaneous fat in de novo diagnosed pancreas carcinoma patients presenting with lymph node involvement and metastatic disease is significantly reduced and inversely correlated to the primary tumor metabolism. Of the various fat-related variables studied, none proved significantly related to outcome.

Management of Graves' disease during pregnancy in the Poitou-Charentes Region.

Graves' disease (GD) during pregnancy involves risks for the mother, foetus and neonate. OBJECTIVE: To compile an inventory of the clinical practices regarding the management of GD during pregnancy in the Poitou-Charentes region of France. This was a retrospective, multicentre study covering the period 2005 to 2012. Ninety-five pregnancies were reviewed: 14 GD diagnosed during pregnancy, 24 GD already treated with synthetic antithyroid drugs (SAT) prior to pregnancy, 25 GD in remission before pregnancy and 32 GD who had undergone thyroidectomy prior to pregnancy. In patients under SAT and/or with TSH receptor antibody levels (TRAb)>3N at the 2nd (T2) and/or 3rd trimester (T3) of pregnancy, a foetal thyroid ultrasound (FTU) was performed in 18/32 cases and neonatal thyroid screening (NTS) in 14/20 cases. One case of foetal hyperthyroidism, two of neonatal hyperthyroidism and three of foetal hypothyroidism (including one neonatal hypothyroidism) were observed. Propylthiouracil was the preferred treatment prescribed, whatever the trimester. A congenital malformation was observed in 4/19 foetuses exposed to carbimazole during the 1st trimester (T1). In operated patients, TSH levels were>2.5mIU/L during T1 in 23/32 cases, while TRAb were not assayed during pregnancy in 12/32 cases. The management of GD during pregnancy could be improved by adjusting SAT therapy during its course, titrating levothyroxine prior to conception and in early pregnancy in thyroidectomised patients, and a more targeted use of FTU during T2 and T3 and of neonatal thyroid screening.

Nodular sclerosing Hodgkin's disease mimicking Riedel's invasive fibrous thyroiditis.

Riedel's thyroiditis appears in the form of a hard cervical mass with rapid onset, and it is associated with extensive fibrosis that compresses nearby structures, such as the trachea and supra-aortic vessels; its diagnosis is essentially histopathological. Although its histological characteristics have been well established, there are some diagnostic pitfalls. We report here the case of a 37-year-old woman, with clinical and histopathological data suggesting Riedel's disease. Fibrosis regressed after treatment with corticosteroids, relieving the compressed airways. However, in contrast with the latest knowledge on this disease, the IgG4 serum levels were consistently normal, and positron emission tomography in search of extensive fibrosis revealed an abnormal metabolic activity of the bone marrow. The final diagnosis revised by the histopathologist was that of nodular sclerosing Hodgkin's lymphoma. This case allows us to review the diagnostic approach when facing a thyroid mass with extremely rapid evolution.