Clinical applications of (18)F-FDG PET in the management of hepatobiliary and pancreatic tumors.

The assessment of hepatobiliary and pancreatic tumors is commonly achieved by ultrasound, computed tomography (CT), and magnetic resonance. The 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) detects increased glucose metabolism associated with neoplastic lesions, provides high accuracy in most cancer imaging applications and is now widely used in clinical practice. However, PET is not always useful and accurate knowledge of appropriate indications is essential for a proper clinical management. (18)F-FDG is transported into cells and phosphorylated by the enzyme hexokinase to (18)F-FDG-6-phosphate, which cannot proceed down the glycolytic pathway and therefore is accumulated in the malignant tissue. PET allows accurate quantification of FDG uptake in tissue, and previous studies have demonstrated that standardized uptake values provide highly reproducible parameters of tumor glucose use (Weber et al., J Nucl Med 40:1771-1777, 1999). The recent development and diffusion of hybrid PET-CT scanners allows functional and anatomic data to be obtained in a single examination, improving lesion localization and resulting in significant diagnostic improvement (Wahl, J Nucl Med 45:82S-95S, 2004). Moreover, CT can be performed diagnostically with the use of intravenous and oral contrast and simultaneous PET-contrast-enhanced CT scanning appears to be an efficient method in cancer evaluation. However, in most centers, a low-dose CT is routinely performed without contrast media infusion.Proper patient preparation, scanning protocol, combined assessment of PET and CT data, and the evaluation of conventional imaging findings are essential to define disease and to avoid diagnostic pitfalls. The role of PET and PET-CT in malignancies of the liver, biliary tract, and pancreas is here reviewed; normal patterns, representative cases, and common pitfalls are also presented.

Série de casos de neoplasia intraepitelial vulvar tratados com imiquimode / Case series of vulvar intraepithelial neoplasia treated with imiquimod

O termo neoplasia intraepitelial vulvar (NIV) inclui as lesões precursoras do câncer de vulva, sendo divididas em NIV escamosa e não escamosa. A NIV escamosa compreende a NIV tipo usual, a qual se encontra relacionada à infecção pelo HPV, à multicentricidade de lesões, à atividade sexual e ao fumo,sendo mais frequentemente observada em mulheres jovens. Já a NIV diferenciada está relacionada ao líquen escleroso, não estando associada à infecção induzida por HPV, nem ao comportamento sexual, acometendo pacientes mais idosas. A NIV não escamosa está relacionada à doença de Paget e ao melanoma in situ. O tratamento padrão da NIV é cirúrgico e consiste na excisão ampla da lesão com margem de segurança. Este estudo objetiva avaliar ouso do imiquimode creme a 5% no tratamento da NIV tipo usual de forma isolada e/ou, associado ao procedimento cirúrgico. O imiquimode já é utilizadocom eficácia no tratamento de lesões condilomatosas genitais. Além disso, tem-se mostrado eficaz em lesões de NIV tipo usual.

The term vulvar intraepithelial neoplasia (VIN) includes the precursor lesions of vulvar cancer, being divided into squamous VIN and non-squamous VIN. The squamous VIN refers to the usual type VIN, which is related to HPV infection, multicentricity of lesions, sexual activity and smoking beingmore frequently observed in young woman. The VIN differentiated type, which is related to vulvar dermatoses, such as lichen sclerosus, is not associated with HPV-induced infection or sexual behavior and affects older patients. Thenon-squamous VIN is related to Paget's disease and melanoma in "situ".The standard VIN's treatment is a surgical wide excision of the lesion with a safety margin. This study aims to test the use of imiquimod 5% cream in thetreatment of usual type VIN isolated, and/or associated with surgical procedure. The imiquimod is already successfully used in the treatment of genital condylomatous lesions. Moreover, it has been shown to be effective in usual type VIN lesions.