Bruno Beomonte Zobel

Diagnosis of deep infiltrating endometriosis: accuracy of magnetic resonance imaging and transvaginal 3D ultrasonography.

PurposeTo compare two different imaging modalities, magnetic resonance (MR), and three-dimensional sonography (3DUS), in order to evaluate the specific role in preoperative work-up of deep infiltrating endometriosis.Materials and methods33 women with endometriosis underwent 3DUS and MR followed by surgical and histopathological investigations. Investigators described the disease extension in the following sites: torus uterinus and uterosacral ligaments (USL), vagina, rectovaginal-septum, rectosigmoid, bladder, ovaries. Results were compared with surgical and histopathological findings.ResultsOvarian and deep pelvic endometriosis were found by surgery and histology in, respectively, 24 (72.7%) and 22 (66.6%) of the 33 patients. Sensitivity and specificity values of 3DUS for the diagnosis of endometrial cysts were 87.5% and 100%, respectively; those of MRI were 96.8% and 91.1%, respectively. Sensitivity and specificity of 3DUS for the diagnosis of deep infiltrating endometriosis in specific sites were: USL 50% and 94.7%; vagina 84% and 80%; rectovaginal-septum 76.9% and 100%; rectosigmoid 33.3% and 100%; bladder 25% and 100%. Those of MR were: USL 69.2% and 94.3%; vagina 83.3% and 88.8%; rectovaginal-septum 76.4% and 100%; restosigmoid 75% and 100%; bladder 83.3% and 100%.ConclusionsMR accurately diagnoses deep infiltrating endometriosis; 3DUS accurately diagnoses deep infiltrating endometriosis in specific locations.

Modification of Abdominal Fat Distribution After Aromatase Inhibitor Therapy in Breast Cancer Patients Visualized Using 3-D Computed Tomography Volumetry

INTRODUCTION/BACKGROUND The purpose of this study was to describe modification of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) distributions in breast cancer patients after aromatase inhibitor (AI) therapy using computed tomography (CT) volumetric measurement of abdominal body fat distribution. PATIENTS AND METHODS Sixty-four consecutive patients who were receiving adjuvant AI therapy were included in this study. Patients were evaluated using CT before and after at least 6 months of AI therapy with imaging follow-up of 4.3 ± 2.2 years. Abdominal fat distribution was automatically calculated using a workstation that obtained total abdominal adipose tissue (TAAT) area (mm(3)). SAT was manually segmented and VAT was determined as TAAT - SAT. Percentages were calculated for change of TAAT, VAT, and SAT. VAT/SAT ratio was calculated. RESULTS Percentage of TAAT after AI therapy was increased by a mean of 9.1% from baseline (16,280.3 ± 6953.3 mm(3)) to (17,763.6 ± 6850.8 mm(3)). Two groups of patients were observed; those with an increase in TAAT and those with a decrease. Modification of VAT/SAT ratio was observed (from 1.38 to 1.69) in all subjects, reflecting a relative increased volume of VAT (mean, 18%) and slight mean reduction of SAT (mean 1.9%). CONCLUSION In our study, therapy with AI in breast cancer patients was accompanied with a change in fat distribution to relatively greater VAT/SAT ratio in patients, regardless of whether they gained or lost weight after therapy. Because this pattern of fat distribution is associated with metabolic disorders, attention must be paid to these clinical manifestations in patients during their follow-up management.

Unilateral Blepharoptosis from Renal Cell Carcinoma

Blepharoptosis is the drooping or inferior displacement of the upper eyelid. Blepharoptosis can be either congenital or acquired. Tumour metastasis is one of the acquired causes of blepharoptosis. The lungs, locoregional lymph nodes, bone and liver are the usual sites of metastases of renal cell carcinoma (RCC); however, unusual locations of RCC have also been reported. Herein, we describe a case of a 47-year-old man with unilateral ptosis and blurred vision due to metastatic RCC. We describe the different causes of blepharopstosis, the path that led to the diagnosis, and how RCC can metastasize to unusual anatomical regions such as the orbit. Symptoms such as exophthalmos, lid edema, diplopia, ptosis, cranial nerve paralysis or blurred vision may mime a benign disease; however, they could also be the symptoms of a systemic malignancy.

Neuroendocrine tumor presenting like lymphoma: a case report

IntroductionNeuroendocrine tumors are a rare but diverse group of malignancies that arise in a wide range of organ systems, including the mediastinum. Differential diagnosis includes other masses arising in the middle mediastinum such as lymphoma, pericardial, bronchogenic and enteric cysts, metastatic tumors, xanthogranuloma, systemic granuloma, diaphragmatic hernia, meningocele and paravertebral abscess.Case presentationWe present a case of 42-year-old Caucasian man with a neuroendocrine tumor of the middle-posterior mediastinum and liver metastases, which resembled a lymphoma on magnetic resonance imaging.ConclusionThe differential diagnosis in patients with mediastinal masses and liver lesions should include neuroendocrine tumor.

Pelvic‐cutaneous fistula after retropubic vaginal tape placement

improved and we considered other treatment options, aiming for a stepwise decline of uterine size. One possibility was the use of GnRH agonists because they can decrease uterine volume by 35% to 65% [3], but it is unclear whether they are safe to use in the presence of acute DVT with a potential flareup effect causing transient stimulation in estrogen release. The second option was UAE, primarily because 2–4 months after the procedure a 40% to 60% reduction of uterine volume may be Fig. 1. Computed tomography image of the patients enlarged uterus due to fiborids. expected [4]. However, postembolizaton syndromemay affect 15% and serious infectious complications 1%–2% of cases [4]. Furthermore, systemic inflammation may worsen the DVT to an uncertain degree. After multidisciplinary discussions with radiologists and vascular specialists, UAE was performed approximately 2 months after initial diagnosis. At this point we replaced LMWH with oral anticoagulation (therapeutic range of INR 2.0–3.0). The patient was hospitalized 4 months after UAE with systemic inflammation secondary to an infarcted and infected submucous fibroid. The uterus was significantly smaller, now reaching the umbilicus, and mobile. An ultrasound scan of the pelvic vein revealed the resolution of the thrombus. Following intravenous antibiotic treatment and appropriate LMWH therapy, total abdominal hysterectomy was performed. Three months later the patient was well without anemia, DVT, or PE. Although benign, fibroids may cause severe morbidity. There are questions that remain unanswered in this case, e.g. the proper timing of surgery, use of vena cava filters, and the influence of GnRH agonists on DVT. Multidisciplinary collaboration is needed to define appropriate and optimal treatment options when clear guidelines are not defined.