Andreas Koureas

Biweekly Carboplatin/Gemcitabine in Patients with Advanced Urothelial Cancer Who Are Unfit for Cisplatin-Based Chemotherapy : Report of Efficacy, Quality of Life and Geriatric Assessment

Objective: We evaluated safety and efficacy of first-line gemcitabine/carboplatin in unfit-for-cisplatin patients with advanced urothelial carcinoma and the effect on the quality of life and functional status of elderly patients (aged >70). Methods: Unfit patients had ECOG performance status (PS) ≧2, creatinine clearance <50 ml/min or comorbidities precluding cisplatin administration. Carboplatin at area under the curve of 2.5 and gemcitabine 1,250 mg/m2 were administered biweekly. Elderly patients were stratified into group 1 (no activities of daily living (ADL) or instrumental ADL dependency and no comorbidities), group 2 (instrumental ADL dependency or 1–2 comorbidities) and group 3 (ADL dependency or ≧2 comorbidities). Results: Thirty-four patients were enrolled: 68% had PS 2–3, 69% a creatinine clearance <50 ml/min and 65% had 1 or more comorbidities. There were 3 cases of grade 3 toxicity (9%). Response rate was 24% [95% confidence interval (CI) 11–41]. Median follow-up was 8 months, median progression-free survival 4.4 months (95% CI 1.03–7.75) and median overall survival 9.8 months (95% CI 4.7–14.9). Patients in geriatric assessment groups 1 and 2 had a significantly longer median progression-free survival compared to group 3 [6.9 months (95% CI 1.3–12.4) vs. 1.9 months (95% CI 0.5–3.2); p = 0.005]. Conclusion: First-line gemcitabine/carboplatin combination is active in unfit-for-cisplatin patients with advanced urothelial carcinoma. Pretreatment quality of life and geriatric assessment may be useful in selecting patients likely to benefit from this treatment.

Imaging of a supernumerary kidney.

Abstract. A 33-year-old female patient was investigated for a right lower quadrant pain. The investigation, which included an excretory urography and a computed tomography examination, revealed a normal kidney on the right side and another two normal sized, complete kidneys on the left side, which appeared to have a small parenchymal bridge. The patient was treated surgically for a cyst of the right ovary.

Surgical Challenges in the Treatment of Leiomyosarcoma of the Inferior Vena Cava: Analysis of Two Cases and Brief Review of the Literature

BACKGROUND Leiomyosarcoma of the inferior vena cava (IVC) is a rare tumor of mesenchymal origin. Optimal treatment should include complete resection of the malignant lesion with preservation of venous return. We present our experience from two patients treated in our hospital in the last 3 years. METHODS AND RESULTS The first case is that of a 54-year-old woman, with a 9 cm a primary IVC leiomyosarcoma extending from the level of the right renal vein to the common iliac veins. The patient underwent radical tumor resection and reconstruction of the IVC with a polytetrafluoroethylene patch. She received adjuvant chemotherapy and is free of recurrence almost 3 years after surgery. The second case is that of a 56-year-old woman presenting with back pain due to an 8-cm retroperitoneal mass in close proximity to the right renal vein. She underwent exploratory laparotomy, where initially the effort of en bloc resection of the mass failed. Eventually, partial resection of the IVC was performed and the defect was primarily repaired. Pathological examination confirmed primary leiomyosarcoma of the IVC. She received adjuvant chemotherapy, but was referred to our hospital with local recurrence 6 months after the operation and is suffering from disseminated abdominal disease almost a year postsurgery. CONCLUSION Radical surgical en bloc resection is the mainstay of treatment for IVC leiomyosarcomas. Extensive vascular reconstruction techniques may be necessary to restore adequate venous return to the IVC after tumor resection, and combination with adjuvant chemoradiotherapy has been shown to prolong disease-free survival rates.

Degenerative endplate changes of the lumbosacral spine: dynamic contrast-enhanced MRI profiles related to age, sex, and spinal level.

To investigate differences in perfusion profiles between degenerative endplate marrow changes and normal vertebral marrow in relation to spinal level, age, and sex with dynamic contrast‐enhanced magnetic resonance imaging (DCE MRI).

Gastric glomus tumor: A case report

Gastric glomus tumors are rare mesenchymal tumors of the gastrointestinal tract. We describe a 72-year-old patient who presented with episodes of melena and was subsequently investigated for a tumor of the antrum of the stomach. Surgical resection revealed a 2 × 2 × 1.7 cm well circumscribed submucosal tumor, extending into the muscularis propria. The histopathologic examination of the specimen demonstrated a glomus tumor of the stomach. We discuss the preoperative investigation, the diagnostic problems and the surgical treatment of the patient with this rare submucosal lesion.

MR imaging features and tumor biomarkers of screen-detected and non-screen detected breast cancers: preliminary results of a comparative study

PURPOSE To investigate differences in clinical features, MRI findings and tumor biomarker characteristics in screen-detected (SCD) and non-screendetected (NSCD) cancers. MATERIAL AND METHODS A total of 62 women (mean age, 48.4 years; range, 33-68 years) with biopsy confirmed breast cancer who underwent preoperative breast MRI were retrospectively evaluated by two expert radiologists. The women were divided into two groups according to the mode of cancer detection (Group A: screen- detected, Group B: non-screen/symptomatic cancer) and clinical, histopathological, MRI characteristics and biomarker features in each group were evaluated. RESULTS NSCD tumors had significantly greater size (3.5 cm vs. 2.1 cm) and Ki-67 expression (68.4% vs. 41.7%) in comparison to SCD cancers. NSCD cancers were less likely to have strongly positive progesterone receptors (Pr) and more likely to have Ki-67 > 15% or positive nodal status (47.4% vs. 8.3%). Increased breast density (ACR C and D: 78.9% vs. 50%ACR A and B) and intense background parenchymal enhancement (BPE, moderate/marked: 42.1% vs. 8.3% minimal/mild) were significantly more frequent in NSCD cases. CONCLUSION NSCD cancers had higher prevalence of poor prognostic characteristics in comparison to SCD tumors, including larger tumor size, higher Ki-67 index, and positive nodes. Increased fibroglandular tissue and intense BPE were both strongly associated with NSCD cancers, supporting their use as potential MR biomarkers in breast cancer risk models.

US-CT-MRI Findings: Staging-Response-Restaging of Bone and Soft Tissue Tumors

Primary malignant bone tumors are a rare and diverse group of tumors. Osteosarcoma is the commonest malignant neoplasm among the primary bone tumors (excluding multiple myeloma), accounting for 30 % of all such malignancies. Soft-tissue sarcomas are a rare (1 % adult cancers and 6 % of childhood cancers), heterogeneous group of malignant tumors that can affect any age and gender, and are often highly aggressive. Soft-tissue sarcomas occur in the extremities in about 50 % of cases, with a predilection for the lower extremities (80 %). Magnetic resonance imaging has the most important role in staging and characterising all primary bone tumors. The primary goal of treatment is to achieve local control of the disease through a limb- salvage procedure: however, if the lesion is too advanced an amputation or even disarticulation may be required. The decision depends on many factors such as tumor size, extracompartmental spread, relationship to vessels, nerves and joints. Identification of the compartments is very important in case of imaging guided biopsy. Treatment of soft-tissue and bone sarcomas requires a multidisciplinary team that includes radiologists, surgeons and oncologists in order to provide optimal treatment with limb preserving therapies.

Congenital Bronchial Atresia with a Calcified Mucocele

Chest CT confirmed the presence of a branching calcified lesion in the apicoposterior bronchus of the left upper lobe ( fig. 2 ). Distal to the lesion, the lung parenchyma appeared hyperinflated with sparse vascularity. Imaging findings were consistent with congenital bronchial atresia with a calcified mucocele. Two years later, follow-up chest CT did not show any changes while the patient remained asymptomatic. Diagnosis of congeniA 31-year-old female was referred to our department to further evaluate an abnormal finding of a routine chest X-ray. She had a 5 pack-year smoking history, no history of lower respiratory tract infection or other pulmonary disease, and no constitutional symptoms. Physical examination was unremarkable. Chest X-ray ( fig. 1 ) revealed a lobulated branching opacity with distal hyperinflation in the left upper lobe. Published online: March 26, 2011

Recurrent Pulmonary Embolism Due to Giant Hepatic Hamangioma Treated With Hepatectomy Under Vascular Exclusion

Giant hepatic hemangiomas are benign tumors that measure more than 4 cm and are usually asymptomatic. Pulmonary embolism (PE) is an extremely rare manifestation of giant hepatic hemangiomas. We report a case of a 44-year-old woman who suffered of recurrent pulmonary emboli that, after thorough work up, were attributed to thrombi formation inside a giant hepatic hemangioma. A right hepatectomy under vascular exclusion was performed and the hemangioma, measuring 17 cm, was resected. Two years later the patient remains asymptomatic. The report highlights the value of investigating giant liver hemangiomas in case of PE. In such cases, the hemangioma should be resected preferably under occlusion of the venous outflow of the liver to avoid PE intraoperatively.

Plain X-ray, computed tomography and magnetic resonance imaging findings of telangiectatic osteosarcoma: a case report

An 18-year-old male patient presented with chronic nonspecific pain of three months located at his left proximal tibia. The patient was admitted to our department for plain X-ray, computed tomography and magnetic resonance imaging examination. Plain X-ray and computed tomography revealed a geographic lytic lesion at the medial aspect of the proximal tibia. Biopsy of the lesion showed telangiectatic osteosarcoma. Image findings of all modalities are presented.