A case of Muir-Torre syndrome on [18F]FDG PET/CT.

Muir-Torre syndrome (MTS) is a rare genetic disorder, considered a subtype of Lynch syndrome, that causes sebaceous cutaneous tumors and increases the risk of internal visceral tumors. We present a case of a 63-year-old male with a history of MTS with sebaceous tumors, colorectal, and urothelial cancers who underwent fluorine-18-deoxyglucose positron emission tomography/ computed tomography [18F]FDG PET/CT to follow-up on multiple [18F]FDG avid skin lesions and right pelvic lymph nodes. Although few reports are available detailing the utility of [18F]FDG PET/CT in this rare disease, this modality appears useful, and superior, to computed tomography in the diagnosis and follow-up of MTS.

Recurrent invasive ductal carcinoma of the breast with metastasis to the uterine cervix: A case report.

This article presents a case of cervical metastasis from recurrence of invasive ductal carcinoma of the breast >20 years after initial diagnosis. The diagnosis was made after the patient presented with three months of intermittent post-menopausal vaginal spotting. She underwent palliative radiotherapy combined with chemotherapy and was disease free at the time of writing. Cervical metastasis of a primary breast cancer is extremely rare and can present with a variety of symptoms. This case report highlights the importance of life-long gynecologic care and surveillance in patients with a history of breast cancer.

Should sacrouterine plication be added to lateral suspension surgery? A prospective study.

AIM: Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. METHODS: Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. RESULTS: In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). CONCLUSIONS: The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.

Beneficial effects of IVIG treatment on experimental-induced osteoporosis.

Objective: Estrogen (E2) plays a significant role in postmenopausal osteoporosis, and its deficiency is related to chronic low-grade inflammation. Intravenous immunoglobulin (IVIG) is composed of immunoglobulins derived from the plasma of healthy donors. Numerous anti-inflammatory pathways are responsible for IVIG's anti-inflammatory action The aim of this study is to investigate the effects of IVIG on experimental-induced osteoporosis. Materials and methods: Forty adult female Wistar rats were included in the study. Thirty rats underwent bilateral dorsal ovariectomy. Rats were grouped as Group 1 (n = 10, ovariectomy and saline); Group 2 (n = 10, ovariectomy and E2); Group 3 (n = 10, ovariectomy and IVIG), and Control group (n = 10, no oophorectomy). Histopathological examination of bone tissue, and biochemical analysis for beta-catenin, plasma Tumor Necrosis Factor-α, IL-6, receptor activator of nuclear-κB ligand (RANKL), and osteoprotegerin (OPG) levels were made. Results: The IVIG group had increased trabecular number, area, and thickness with increased bone mineral density as well as decreased trabecular separation compared with the saline group. IVIG group had lower serum RANKL and higher serum OPG levels when compared with the saline group. The bone marrow beta-catenin level was significantly higher in the control and ovariectomy + IVIG groups. Conclusion: IVIG has beneficial effects on experimentally induced osteoporosis with a possible action on inflammation and RANKL-ß-catenin pathway.

Objetivo: El estrógeno juega un papel importante en la osteoporosis posmenopáusica y su deficiencia está relacionada con la inflamación crónica de bajo grado. La inmunoglobulina intravenosa (IGIV) está compuesta por inmunoglobulinas derivadas del plasma de donantes sanos. El objetivo de este estudio es investigar los efectos de IVIG en la osteoporosis inducida experimentalmente. Materiales y métodos: 30 ratas se sometieron a ovariectomía dorsal bilateral. las ratas se agruparon como: Grupo 1 (n = 10, ovariectomía y solución salina); Grupo 2 (n = 10, ovariectomía y estrógeno); Grupo 3 (n = 10, ovariectomía e IVIG) y Grupo Control (n = 10, sin ovariectomía). Se realizó un examen histopatológico del tejido óseo y un análisis bioquímico de los niveles de beta-catenina, factor de necrosis tumoral α (TNF-α), IL-6, RANKL y osteoprotegerina (OPG) en plasma. Resultados: El grupo IVIG había aumentado el número, el área y el grosor trabecular con una mayor densidad mineral ósea, así como una menor separación trabecular en comparación con el grupo de solución salina. El nivel de beta-catenina en la médula ósea fue significativamente mayor en los grupos de control y de ovariectomía + IVIG. Conclusión: IVIG tiene efectos beneficiosos sobre la osteoporosis inducida experimentalmente con una posible acción sobre la inflamación y la vía RANKL-ß-catenina.

MRI-based radiomic features for identifying recurrent prostate cancer after proton radiation therapy.

PURPOSE: Magnetic Resonance Imaging (MRI) evaluation of recurrent prostate cancer (PCa) following proton beam therapy is challenging due to radiation-induced tissue changes. This study aimed to evaluate MRI-based radiomic features so as to identify the recurrent PCa after proton therapy. METHODS: We retrospectively studied 12 patients with biochemical recurrence (BCR) following proton therapy. Two experienced radiologists identified prostate lesions from multi-parametric MRI (mpMRI) images post-proton therapy and marked control regions of interest (ROIs) on the contralateral side of the prostate gland. A total of 210 radiomic features were extracted from lesions and control regions on the T2-weighted (T2WI) and Apparent Diffusion Coefficient (ADC) image series. Recursive Feature Elimination with Cross-Validation method (RFE-CV) was used for feature selection. A Multilayer Perceptron (MLP) neural network was developed to classify three classes: cancerous, benign, and healthy tissue. The 12-core biopsy results were used as the gold standard for the segmentations. The classifier performance was measured using specificity, sensitivity, the area under receiver operating characteristic curve (AUC), and other statistical indicators. RESULTS: Based on biopsy results, 10 lesions were identified as PCa recurrence while eight lesions were confirmed to be benign. Ten radiomic features (10/210) were selected to build the multi-class classifier. The radiomics classifier gave an accuracy of 0.83 in identifying cancerous, benign, and healthy tissue with a sensitivity of 0.80 and specificity of 0.85. The model yielded an AUC of 0.87, 95% CI [0.72-1.00] in differentiating cancer from the benign and healthy tissues. CONCLUSIONS: Our proof-of-concept study demonstrates the potential of using radiomic features as part of the differential diagnosis of PCa on mpMRI following proton therapy. The results need to be validated in a larger cohort.

Cine MRI in the Evaluation of Pulmonary Arteriovenous Malformations.

We present findings on cine magnetic resonance imaging (MRI) using steady-state free precession (SSFP) pulse sequences in a patient with pulmonary arteriovenous malformation (PAVM). The technique has the advantage of demonstrating the pulsation of lesions during the cardiac cycle on cine images. It may not replace but may complement other MRI sequences in the characterization of pulmonary lesions in selected cases. To our knowledge, no prior video of cine images of PAVM has been provided in the literature.

MRI-based nomograms and radiomics in presurgical prediction of extraprostatic extension in prostate cancer: a systematic review.

PURPOSE: Prediction of extraprostatic extension (EPE) is essential for accurate surgical planning in prostate cancer (PCa). Radiomics based on magnetic resonance imaging (MRI) has shown potential to predict EPE. We aimed to evaluate studies proposing MRI-based nomograms and radiomics for EPE prediction and assess the quality of current radiomics literature. METHODS: We used PubMed, EMBASE, and SCOPUS databases to find related articles using synonyms for MRI radiomics and nomograms to predict EPE. Two co-authors scored the quality of radiomics literature using the Radiomics Quality Score (RQS). Inter-rater agreement was measured using the intraclass correlation coefficient (ICC) from total RQS scores. We analyzed the characteristic s of the studies and used ANOVAs to associate the area under the curve (AUC) to sample size, clinical and imaging variables, and RQS scores. RESULTS: We identified 33 studies-22 nomograms and 11 radiomics analyses. The mean AUC for nomogram articles was 0.783, and no significant associations were found between AUC and sample size, clinical variables, or number of imaging variables. For radiomics articles, there were significant associations between number of lesions and AUC (p < 0.013). The average RQS total score was 15.91/36 (44%). Through the radiomics operation, segmentation of region-of-interest, selection of features, and model building resulted in a broader range of results. The qualities the studies lacked most were phantom tests for scanner variabilities, temporal variability, external validation datasets, prospective designs, cost-effectiveness analysis, and open science. CONCLUSION: Utilizing MRI-based radiomics to predict EPE in PCa patients demonstrates promising outcomes. However, quality improvement and standardization of radiomics workflow are needed.

Magnetic Resonance Imaging Virtual Biopsy of Common Solid Renal Masses-A Pictorial Review.

ABSTRACT: The expanded application of radiologic imaging resulted in an increased incidence of renal masses in the recent decade. Clinically, it is difficult to determine the malignant potential of the renal masses, thus resulting in complex management. Image-guided biopsies are the ongoing standard of care to identify molecular variance but are limited by tumor accessibility and heterogeneity. With the evolving importance of individualized cancer therapies, radiomics has displayed promising results in the identification of tumoral mutation status on routine imaging. This article discusses how magnetic resonance imaging features can guide a radiologist toward identifying renal mass characteristics.

18 F-FDG PET/CT Findings of Leptomeningeal Metastasis in Nasopharyngeal Carcinoma.

ABSTRACT: Nasopharyngeal carcinoma (NC) is an epithelial tumor with distinctive prevalence in East and Southeast Asia. Most patients with NC only experience regional metastasis. In cases of distant metastasis, prognosis is grim. Leptomeningeal spread of the disease is a rare occurrence, which is sparsely described in the literature. We present a case of a 33-year-old man with a history of high-grade NC with leptomeningeal metastasis. Initial MRI lumbar spine demonstrated subtle findings consistent with leptomeningeal disease. These findings are easily discernible on 18 F-FDG PET/CT.

The Role of Pelvic Ultrasound in Evaluating the Success of Tension-free Vaginal Tape (TVT).

Objectives: This study aims to assess the lack of response to treatment in individuals undergoing mid-urethral sling surgery for stress urinary incontinence (SUI) using ultrasound findings of the pelvic floor. Methods: The study included patients who underwent the tension-free vaginal tape (TVT) procedure for stress urinary incontinence within the period spanning from January 2016 to January 2021. The physical examination involved maintaining bladder filling at an average volume of 200-400 mL, and treatment failure was determined by the presence of SUI during the Valsalva maneuver. Results: The study comprised a total of 214 patients, where it was observed during the stress test that 32 patients (25.8%) had an unsuccessful outcome following mid-urethral sling surgery. In the unsuccessful group, the distance of the mesh-posterior urethra was lower (4.09±0.39 vs. 4.91±0.51; p<0.001), the posterior urethrovesical angle was lower when at rest, but the angle increased more significantly during the Valsalva maneuver, and the bladder neck angle was narrower (p<0.001). Conclusion: We obtained lower mean values of mesh-posterior urethral distance in unsuccessful patients compared to those found in the group of cured patients. Pelvic floor ultrasound can predict the success of TVT surgeries but there is as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence.

Breast cancer in a Hispanic patient with Werner syndrome.

Werner Syndrome is a rare autosomal recessive condition characterized by premature aging and increased risk of malignancies due to gene mutations associated with DNA stability. We present the first case report of a 29-year-old Hispanic female with WS diagnosed with breast cancer. Diagnostic mammography and ultrasound, breast MRI and PET examinations revealed two lesions biopsy proven as invasive ductal carcinoma. The patient underwent neoadjuvant chemotherapy and radical mastectomy. Recurrence occurred 10 months postoperatively with molecular analysis demonstrating TP53 mutations. The multifactorial assessment of breast cancer in this case study is crucial towards optimizing screening, diagnosis and management of this disease in patients with WS.

Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis.

OBJECTIVE: Although obesity can result in high morbidity and mortality in surgical outcomes because of multiple comorbidities, determinants of outcome in obese patients who underwent endometrial cancer surgery remain unclear. The aim of this study is to assess the relationship between body mass index (BMI) and surgical outcomes in obese patients with endometrial cancer. METHODS: An institutional retrospective review of the demographic details, clinical characteristics, and follow-up data of 142 patients with endometrial cancer who underwent surgery during a 72-month period was performed. The patients were divided into three groups based on their BMI; patients with BMI < 25 were identified as normal weight, patients with BMI between 25 and 30 were accepted as overweight, and those with BMI ≥ 30 kg/m2 were identified as obese. The groups' demographic and clinical variables were compared. RESULTS: Of the 142 patients, 42 were in the normal weight group, 55 in the overweight group, and 45 in the obese group. Age, surgical procedures, blood loss, preoperative health status, and metastatic lymph nodes did not show a significant difference between groups. However, surgery time and total lymph nodes were higher in the obese group. (p = 0.02, p = 0.00, and p = 0.00, respectively). Common complications were anemia, fever, intestinal injury, deep vein thrombosis, fascial dehiscence and urinary infection. There was no significant difference according to the complications. CONCLUSION: Our results indicated that higher BMI was significantly associated with a longer duration of endometrial cancer surgery. Minimally invasive surgeries and conventional laparotomy could be performed safely in obese patients.

Association of Obesity and Surgery Outcomes in Patients with Endometrial Cancer: A Single-Center Analysis

Abstract Objective Although obesity can result in high morbidity and mortality in surgical outcomes because of multiple comorbidities, determinants of outcome in obese patients who underwent endometrial cancer surgery remain unclear. The aim of this study is to assess the relationship between body mass index (BMI) and surgical outcomes in obese patients with endometrial cancer. Methods An institutional retrospective review of the demographic details, clinical characteristics, and follow-up data of 142 patients with endometrial cancer who underwent surgery during a 72-month period was performed. The patients were divided into three groups based on their BMI; patients with BMI < 25 were identified as normal weight, patients with BMI between 25 and 30 were accepted as overweight, and those with BMI ≥ 30 kg/m2 were identified as obese. The groups' demographic and clinical variables were compared. Results Of the 142 patients, 42 were in the normal weight group, 55 in the overweight group, and 45 in the obese group. Age, surgical procedures, blood loss, preoperative health status, and metastatic lymph nodes did not show a significant difference between groups. However, surgery time and total lymph nodes were higher in the obese group. (p = 0.02, p = 0.00, and p = 0.00, respectively). Common complications were anemia, fever, intestinal injury, deep vein thrombosis, fascial dehiscence and urinary infection. There was no significant difference according to the complications. Conclusion Our results indicated that higher BMI was significantly associated with a longer duration of endometrial cancer surgery. Minimally invasive surgeries and conventional laparotomy could be performed safely in obese patients.

Pericardial Effusion during Proton Therapy in a Patient with Chemorefractory Hodgkin Lymphoma.

We present a case of recurrent pericardial effusion presenting during proton therapy in a 24-year-old female receiving mediastinal treatment for classical Hodgkin lymphoma. Pericardial effusion is typically considered an event accompanying lymphoma diagnosis or as a subacute or late effect of radiotherapy. Rarely has it been described as occurring during radiation treatment with photon-based radiotherapy, let alone proton therapy. It is unclear what underlying cause triggered recurrent effusion in this patient. Identifying and managing pericardial effusion during treatment delivery is important to consider as it may affect radiation dosimetry, particularly with proton therapy. Doing so will help ensure patients receive optimal treatment and minimize the risks of morbidity and mortality.

Prediction of Pregnancy Complications With Maternal Biochemical Markers Used in Down Syndrome Screening.

OBJECTIVE: To determine whether first- and second-trimester maternal serum biomarkers are useful for the prediction of pregnancy complications like preterm birth, intrauterine growth restriction (IUGR), and macrosomia. METHODS: We conducted a retrospective analysis of 353 women having first- or second-trimester combined test for Down syndrome screening who delivered at our institution between January 2018 and December 2020. Associations between first- and second-trimester serum markers and adverse pregnancy outcomes among those who underwent prenatal screening for Down syndrome in our clinic were studied. The adverse pregnancy outcomes, serum levels of pregnancy-associated plasma protein-A (PAPP-A), ß-human chorionic gonadotropin (ß-hCG), and maternal serum alpha-fetoprotein (ms-AFP) were recorded and analyzed. Correlation analyses of PAPP-A, free ßhCG, and ms-AFP with pregnancy outcomes were studied. We sought to predict the risks of preterm delivery (PTD, <37 weeks gestational age), low birth weight (LBW, <2500 grams) and macrosomia (>4000 grams). RESULTS: A total of 353 women who had first- and second-trimester screening test for Down syndrome were included. Two hundred fifty (70.08%) of them had first-trimester and 103 (41.2%) had second-trimester test. Mean age of the patients who underwent screening test for Down syndrome was 29.3±5.9, mean maternal weight was 67.3±13.6, mean gestational weeks at birth was 38.6±2.1 weeks and mean birth weight was 3260.9±511.1, preterm birth rate was 40/353 (11.3%), IUGR rate was 21/353 (5.9%), macrosomia rate was 17/353 (4.8%), stillbirth rate was 3/353 (0.8%). When laboratory and clinical parameters affecting birth weight and birth weeks were analysed in correlation analysis, both birth week and birth weight were found to be positively correlated with maternal weight. Of first-trimester markers Papp-A MoM (Multiples of Median) was found to be positively correlated with fetal birth weight (p = 0.044). Of second-trimester biochemical parameters ms-AFP was found to be negatively correlated with fetal birth weight (p = 0.039). CONCLUSION: The study concluded that there is a relationship between serum markers and adverse pregnancy outcomes. Significant associations were found between the levels of first- and second-trimester serum markers PAPP-A, AFP and IUGR, macromia and additionally significant association was found between maternal weight and both delivery week and fetal weight. These results can highlight the pregnancies at risk and follow-up intervals may be arranged according to risk scala which may help at antenatal follow-up of high-risk patients.

A Practical Technique to Improve Visualization of Sentinel Nodes in Axillary Region on Breast Lymphoscintigraphy: Medial Breast Traction by Patient.

A standard method of performing breast lymphoscintigraphy is anterior and lateral views after periareolar intradermal injection of a radiotracer. However, a sentinel lymph node may be obscured by the activity at injection site, especially on anterior view. Also, breast tissue may cause attenuation to prevent sentinel node visualization. Repeat images during medial traction of breast by patient is an effective technique to improve visualization of sentinel lymph nodes in axillary region.

Adverse Outcomes of Preeclampsia in Previous and Subsequent Pregnancies and the Risk of Recurrence.

OBJECTIVES: We evaluated the fetal and maternal outcomes of pregnant women with preeclampsia who gave birth in our hospital; we also evaluated preeclampsia recurrence rates in these patients and their fetal and maternal outcomes in their subsequent pregnancy. METHODS: In this retrospective cohort study, 126 patients whose medical records were accessed completely and who got pregnant again and gave birth in our hospital were analyzed. The primary aim was to show the recurrence rate of preeclampsia, while the secondary aim was to evaluate the maternal and fetal results of the first pregnancy in which preeclampsia developed and the subsequent pregnancy. RESULTS: The incidence of preeclampsia was found to be 2.1% in our clinic. The first pregnancy in which preeclampsia developed; 111 (80.2%) pregnancies resulted in a live birth, 7 (5.6%) resulted in termination, and 8 (6.3%) resulted in stillbirth. Neonatal death occurred in 10 (7.9%) pregnancies. While 105 of the subsequent pregnancies resulted in a live birth, 10 (7.9%) resulted in abortion, 9 (7.1%) resulted in stillbirth, and 2 (1.6%) resulted in termination due to preeclampsia. Neonatal death developed in 3 (2.6%) pregnancies. In the subsequent pregnancy, preeclampsia developed in 70 (55.5%) patients and 39 (55.7%) of these had preeclampsia with severe features. CONCLUSION: The present study guides us on the risk factors related to preeclampsia and the rate of fetomaternal adverse outcomes and emphasizes the need for strict and regular antenatal follow-up in the subsequent pregnancies of women who have a history preeclampsia. Improvement of maternal and fetal morbidity and mortality in this way is the utmost goal.

The Effect of Prednisolone Treatment on Pregnancy Rates in in vitro Fertilization Patients with Positive Thyroid Autoantibodies.

OBJECTIVE: This study aims to investigate the effect of prednisolone treatment on the pregnancy rates of in vitro fertilization (IVF) patients with positive thyroid autoantibodies. METHODS: This study was conducted in the IVF unit of Gazi University Faculty of Medicine. It included 158 patients who underwent intracytoplasmic sperm injection using the long-term protocol of a gonadotropin-releasing hormone (GnRH) agonist that was positive for thyroid autoantibodies. Each test's reference value was used as a positive measure of anti-thyroid peroxidase and anti-TG antibodies. On the day of oocyte intake, 44 of 158 patients were started on prednisolone, and the other 114 patients were followed up without medication. RESULTS: In the control group, pregnancy did not occur in 67.5% of the patients; it was determined that 21.1% were pregnant, 5.3% had biochemical pregnancies, 4.4% had twin pregnancies, 0.9% had triplet pregnancies, and 0.9% had ectopic pregnancies. In the extended prednisolone group, pregnancy did not occur in 56.8% of the patients; it was determined that 36.4% of them were pregnant, 4.5% had twin pregnancies, and 2.3% had biochemical pregnancies. An increase in pregnancy rate was observed in the extended prednisolone group, while a statistically significant difference was found between the groups in terms of the mean values of prednisolone according to pregnancy status (p<0.05). It was thus determined that the rate of conception increased in the extended prednisolone group compared to the controls. CONCLUSION: There is a strong relationship between the presence of thyroid autoantibodies and poor IVF results. The coadministration of prednisolone can improve the clinical pregnancy rate in women affected by thyroid autoimmunity.

Pancreatic metastasis from papillary thyroid carcinoma: Case report and literature review.

Papillary thyroid carcinoma (PTC) is the most common type of thyroid malignancy. Papillary thyroid carcinoma generally spreads locally to the cervical lymph nodes, but distant metastases are seen in 5%-7% of cases. Most distant metastases occur in the bone, lung, and brain. Pancreatic metastases of PTC are extremely rare. Herein we present a patient with PTC treated with total thyroidectomy and two rounds of radioactive iodine (RAI) ablation that was subsequently found to have a pancreaticmetastasis detected on fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) imaging 3 years from the initial diagnosis.

Recurrent Metastatic Breast Cancer in Internal Mammary Lymph Nodes along the Translocated Left Internal Mammary Artery Bypass Graft.

Internal mammary lymph node (IMLN) is the second most common site for nodal metastases in breast cancer. The authors present a case of a 58-year-old woman with a history of coronary artery bypass graft surgery 1 year prior who presented with a neck mass. Imaging showed an enlarged IMLN along the course of the translocated left internal mammary artery (LIMA) bypass graft on the surface of the heart, and the patient was later proven to have recurrent breast cancer. To the authors' knowledge, this is the first case report in the literature of a breast cancer recurrence in an IMLN along the postoperative translocated LIMA bypass graft. Keywords: Adults, CT, PET/CT, Breast, Thorax, Lymphatic, Metastases © RSNA, 2021.