Hepatocellular adenoma: An unsolved diagnostic enigma

Hepatocellular adenoma (HCA) is a rare benign liver tumour associated with the use of oral contraceptives or other steroid medications which occurs predominantly in young and middle-aged women. Unlike other benign liver tumours, an HCA may be complicated by bleeding and malignant transformation. HCAs have been divided into four subtypes based on molecular and pathological features: hepatocyte nuclear factor 1α-mutated HCA, inflammatory HCA,β-catenin-mutated HCA, and unclassified HCA.β-cateninmutated HCA has the highest risk of haemorrhage or malignant transformation. In the latest upgrade of the guidelines regarding the management of benign liver tumours published in 2016 by the European Association for the Study of the Liver, magnetic resonance imaging (MRI) was recognized to be superior to all other imaging modalities in detecting HCAs and in being able to subtype HCAs up to 80%, with positive identification of 1α-mutated HCA or inflammatory HCA achievable with > 90% specificity. This review analyzed the imaging features of HCA using MRI with hepato-specific contrast agents, focusing on the limitations in the HCA characterization.

Magnetic resonance imaging:A new tool for diagnosis of acute ischemic colitis?

AIM： To define the evolution of ischemic lesions with 7T magnetic resonance imaging （7T-MRI） in an animal model of acute colonic ischemia. METHODS： Adult Sprague-Dawley rats were divided into two groups. Group I underwent inferior mesenteric artery （IMA） ligation followed by macroscopic observa- tions and histological analysis. In group H, 7T-MRI was performed before and after IMA ligation and followed by histological analysis. RESULTS： Morphological alterations started to develop 1 h after IMA ligation, when pale areas became evident in the splenic flexure mesentery and progressively wors-ened up to 8 h thereafter, when the mesentery was less pale, and the splenic flexure loop appeared very dark. The 7T-MRI results reflected these alterations, showing a hyperintense signal in both the intraperitoneal space and the colonic loop wall 1 h after IMA ligation; the lat- ter progressively increased to demonstrate a reduction in the colonic loop lumen at 6 h. Eight hours after IMA ligation, MRI showed a persistent colonic mural hyper- intensity associated with a reduction in peritoneal free fluid. The 7T-MRI findings were correlated with histolog- ical alterations, varying from an attenuated epithelium with glandular apex lesions at 1 h to coagulative necro- sis and loss of the surface epithelium detected 8 h after IMA ligation. CONCLUSION： MRI may be used as a substitute for invasive procedures in diagnosing and grading acute ischemic colitis, allowing for the early identification of pathological findings.

Management of Painful Bone Metastases: The Interaction between Radiation Therapy and Zoledronate

Background: Advanced cancers frequently metastasize to bone, and the presence of bone metastases is the most common cause of cancer-related pain. Pain management requires a multidisciplinary approach that involves the use of analgesics, bisphosphonates, radiotherapy, chemotherapy, surgery. The aim of our study was to evaluate the enhancement of radiotherapy on painful bone metastases in patients treated also with bisphosphonates. Materials and Methods: We analyzed the differences in benefit on pain and on quality of life comparing two groups of treatment. The first group comprised 104 patients treated with Radiotherapy (RT), the second one included 50 patients treated with radiotherapy associated to zoledronic acid (RT + Z). All patients completed before, during and after treatment, a questionnaire that rated the grade of pain, the pharmacological type of analgesic therapy and patient’s performance status. For each patient a total score was calculated, from a minimum value of 0% to a maximum of 20%, then expressed as a percentage. Patients were classified as responder if at the follow-up reported a reduction of over 20% of the initial score, no-change if there was a reduction of between 0% and 20%, progression if there was an increasing of the score. Results: In the group RT + Z we found fewer patients that started radiation therapy with severe pain (16% vs 32%), no patient had pain of grade 10, and a higher proportion of asymptomatic patients (12% vs 4%) was observed. In the RT alone group a higher percentage of patients started treatment assuming strong opioid more than once a day (26% vs 24%) and a reduction in number of these patients was about 14% compared with the reduction of 23.6% observed in the group RT + Z. Furthermore an increased total score was calculated only in the 6% of patient belonged to group RT alone. Finally, in the group RT + Z responder patients are 52%, compared to 36% of the RT group, non-responder were 36% versus 60% in the RT. The risk of adverse events (Pz) in the RT + Z was Pz = 0.36, with an odds (Oz) equal to 0.56, while the risk of adverse events (Pc) in the RT group was Pc = 0.60 with an odds (OC) of 1.5. The odds ratio was OR = 0.37, showing a value in favor of treatment RT + Z. Conclusions: In our retrospective observational study it is relevant a clear potentiation of benefit effects related to palliative radiation therapy in patients receiving also bisphosphonate therapy, so obtaining a better control over pain, a decreased need for pain relief and consequently an improved quality of life.

Prevention and Treatment of Radiation Induced Skin Damage in Breast Cancer

Introduction: Skin toxicity is a frequent side effect of radio and chemo-treatments in patients treated for breast cancer after conservative surgery. The aim of this paper is to report our experience in the management of skin toxicity evaluating radiotherapy planning and using preventive local aids. Materials and Methods: We have observed 300 patients undergoing radiotherapy. All received the prescription of a prophylactic moisturizing cream. Skin toxicity was valuated according to Acute Radiation Morbidity Scoring Criteria of the RTOG. Moreover, in a subgroup of 100 patients, we correlated the study of breast volume and features of treatment plans, with the addition of topic prophylactic treatment, using an oral therapy based on Resveratrol, Lycopene, Vitamin C and Anthocyanins (Ixor?). In another subgroup, 100 patients were subjected to corneometry assessing numerically skin hydration before, during and after radiotherapy. Results: In all patients, we related skin toxicity and the type of cream used. All patients completed the radiotherapy treatment, and G4 cutaneous toxicity was not observed in any of them. In patients treated with topic treatment and therapy based on Resveratrol, Lycopene, Vitamin C and Anthocyanins (Ixor?), the protective effect of (Ixor?) is more detected in patients with PTV (Planning Target Volume) <500 ml, when Dmax reaches values lower or equal to 107%, but not exceeding 110% of the prescribed dose, and in patients undergoing adjuvant chemotherapy with anthracyclines and taxanes. The values of corneometry allow us to evaluate the moisturizing effect for products used, and identify cases of skin toxicity in a first phase. Conclusions: Our study confirms the value of moisturizers in the prevention and resolution of radiotherapy-induced skin damage. An instrumental assessment of skin hydration with corneometry can help the radiation oncologist to use strategies that prevent the onset of toxicity of high degree.

Analysis of size and shape differences between ancient and present-day Italian crania using metrics and geometric morphometrics based on multislice computed tomography

The Museum of Human Anatomy in Naples houses a collection of ancient Graeco-Roman crania.The aim of this study was to use multislice computed tomography(MSCT)to evaluate and objectively quantify potential differences in cranial dimensions and shapes between ancient Graeco-Roman crania(n=36)and modern-day southern Italian crania(n=35)and then to characterize the cranial changes occurring over more than 2000 years,known as secular change.The authors used traditional metric criteria and morphometric geometry to compare shape differences between the sets of crania.Statistically significant differences in size between the ancient and modern crania included shorter facial length,narrower external palate,smaller minimum cranial breadth,shorter right and left mastoid processes,and wider maximum occipital and nasal breadth.The shape changes from the ancient to modern crania included a global coronal enlargement of the face and cranial diameters,with more anterior projection of the face at the anterior nasal spine,but also posterior projection at the glabella and the nasion.It is not possible to determine whether these differences result exclusively from secular changes in the cranium or from other factors,including a mix of secular change and other unknown factors.To the best of our knowledge,this is the first MSCT-based study to compare ancient Graeco-Roman and modern-day southern Italian crania and to characterize shape and size differences.