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Neoadjuvant chemoradiotherapy ( CRT) before surgery results in a pathological complete response ( pCR) rate in about 1/3 of the patients, which is correlated with survival. It was hypothesized that volumetric tumor response to CRT would correlate with outcomes. Patients who completed trimodality therapy, where planning, pre-, and post- CRT computed tomography scans were available, and pathology was reviewed by a central pathologist, were eligible for analysis. Absolute and relative tumor volume change pretreatment and post-treatment were correlated with pCR, locoregional recurrence ( LRR), disease-free survival, and overall survival. Fifty-six patients were analyzed. pCR was observed in 30% of patients. Median follow up was 20.3 (range 4-89) months. The 2- and 4-year overall survival was 61.3% (95% confidence interval [ CI]: 45-74) and 25.0% (95% CI: 11-41); proportion disease free was 32.1% (95% CI: 19-46) and 20.6% (9-36) at 2 and 4 years, respectively. The median relative volume reduction was 17% (95% CI: −24, −3%). Using 20% as the criteria, the proportion of patients with pCR of ≥20% versus <20% was 13/25 (52%) versus 4/31 (13%) for those who did not (odds ratio 7.3; 95% CI: 2-27). The LRR at 2 and 4 years were 29.5% (95% CI: 16-43) and 36.2% (95% CI: 23-50). The relative tumor reduction ≥20% was significantly correlated with LRR (hazard ratio 0.24; 95% CI: 0.07-0.8; p 0.02) at 2 and 4 years, respectively. Relative tumor volume reduction following CRT is correlated with pCR and LRR. Further investigations are warranted to examine the effect of volume change, alone or in conjunction with other factors as potential predictors for pathological response. [ABSTRACT FROM AUTHOR]

Tomosynthesis (digital tomography) is a recently introduced low-dose alternative to CT in the evaluation of the lungs in patients with cystic fibrosis and pulmonary nodules. Previous studies have reported an adult effective dose of 0.12–0.13 mSv for chest tomosynthesis. The aim of this study was to determine the paediatric effective dose from the dose-area-product. During a 3-y period, 38 children with cystic fibrosis and 36 paediatric oncology patients were examined with chest tomosynthesis, totally 169 posteroanterior and 17 anteroposterior examinations (40 boys and 34 girls, mean age 13.7 y, range 7–20 y). Using recently reported paediatric chest tomosynthesis conversion factors (0.23–1.09 mSv Gy cm−2) corrected for sex, age and energy, the mean posteroanterior effective dose calculated was 0.17 mSv; using the proposed simplified conversion factors of 0.6 (8–10 y), 0.4 (11–14 y) and 0.3 mSv Gy cm−2 (15–19 y), the mean posteroanterior effective dose calculated was 0.15 mSv. As the difference in the calculated effective dose was minor, it is recommendable to use the simplified conversion factors. Using the conversion factor for adult chest tomosynthesis (0.26 mSv Gy cm−2), the mean effective dose was 0.11 mSv. Anteroposterior exposures had considerably higher effective dose. By using conversion factors adapted for children, the calculated risks from radiologic procedures will be more accurate. [ABSTRACT FROM AUTHOR]

The objective of this review is to evaluate the diagnostic accuracy of imaging methods for detection of mandibular bone tissue invasion by squamous cell carcinoma (SCC). A systematic review was carried out of studies in MEDLINE, SciELO and ScienceDirect, published between 1960 and 2012, in English, Spanish or German, which compared detection of mandibular bone tissue invasion via different imaging tests against a histopathology reference standard. Sensitivity and specificity data were extracted from each study. The outcome measure was diagnostic accuracy. We found 338 articles, of which 5 fulfilled the inclusion criteria. Tests included were: CT (four articles), MRI (four articles), panoramic radiography (one article), positron emission tomography (PET)/CT (one article) and cone beam CT (CBCT) (one article). The quality of articles was low to moderate and the evidence showed that all tests have a high diagnostic accuracy for detection of mandibular bone tissue invasion by SCC, with sensitivity values of 94% (MRI), 91% (CBCT), 83% (CT) and 55% (panoramic radiography), and specificity values of 100% (CT, MRI, CBCT), 97% (PET/CT) and 91.7% (panoramic radiography). Available evidence is scarce and of only low to moderate quality. However, it is consistently shown that current imaging methods give a moderate to high diagnostic accuracy for the detection of mandibular bone tissue invasion by SCC. Recommendations are given for improving the quality of future reports, in particular provision of a detailed description of the patients' conditions, the imaging instrument and both imaging and histopathological invasion criteria. [ABSTRACT FROM AUTHOR]

The purpose of this case series is to present the common features of intraosseous mucoepidermoid carcinoma (IMC) of the jaws in plain film and CT imaging. Two oral and maxillofacial radiologists reviewed and characterized the common features of four biopsy-proven cases of IMC in the jaws in plain film and CT imaging obtained from the files of the Department of Oral Radiology, Faculty of Dentistry, University of Toronto, Toronto, Canada. The common features are a well-defined sclerotic periphery, the presence of internal amorphous sclerotic bone and numerous small loculations, lack of septae bordering many of the loculations, and expansion and perforation of the outer cortical plate with extension into surrounding soft tissue. Other characteristics include tooth displacement and root resorption. The four cases of IMC reviewed have common imaging characteristics. All cases share some diagnostic imaging features with other multilocular-appearing entities of the jaws. However, the presence of amorphous sclerotic bone and malignant characteristics can be useful in the differential diagnosis. [ABSTRACT FROM AUTHOR]

OBJECTIVES Recent studies have shown the usefulness of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) in differentiating between World Health Organization (WHO) histological subgroups of thymic epithelial tumours. However, these reports may have included many advanced cases of these lesions (Masaoka stage III or IV) of high-risk subtypes. The objective of our present study was to assess the usefulness of FDG-PET for distinguishing the histological subtypes of early stage thymic epithelial tumours (Masaoka stage I or II). METHODS Twenty patients who had undergone an FDG-PET examination prior to treatment and had been diagnosed with an early stage thymic epithelial tumour between July 2005 and July 2011 were enrolled in the present study. All patients underwent a total thymectomy. This cohort was divided into two groups according to the WHO histological classification of their lesion, i.e. low-risk tumours (types A, AB or B1) in one group and high-risk tumours (types B2, B3 or thymic carcinoma) in the other. Focal FDG accumulation was evaluated by determining the maximum standardized uptake value (SUV-max). RESULTS The patient cohort for this study included 13 men and 7 women ranging in age from 26 to 70 years (mean 55 years). The low-risk group included seven cases (type A, 0; type AB, 7; type B1, 0), and the high-risk group comprised 13 cases (type B2, 7; type B3, 3; thymic carcinoma, 3). The SUV-max values of the low-risk and high-risk tumours were 3.09 ± 0.51 and 6.19 ± 3.13, respectively, and this was a significant difference. For the differential diagnosis of low-risk and high-risk tumours, sensitivity and specificity were 92.3% and 83.3%, respectively, when an SUV-max of 3.5 was used as a cutoff. CONCLUSIONS FDG-PET is a useful method for distinguishing histological types of early stage thymic epithelial tumours. [ABSTRACT FROM AUTHOR]

OBJECTIVE The objective of this study is to evaluate the accuracy of extended cervical mediastinoscopy (ECM) in the staging of bronchogenic carcinoma (BC) of the left lung based on our updated experience. METHODS From 1998 to 2003, 89 patients underwent routine ECM for staging of BC of the left lung. In 2004, routine positron emission tomography (PET) was included in our staging protocol and ECM was reserved for those with positive mediastinal or hilar PET images, large lymph nodes on computed tomography (CT) scan or central tumours. Following this protocol, from 2004 to 2010, we performed 132 selective ECM. ECM was considered positive when metastatic nodes or tumour involvement directly in the subaortic or para-aortic regions was confirmed pathologically. Patients with negative ECM underwent subsequent thoracotomy for tumour resection and systematic nodal dissection (SND). RESULTS Two hundred and twenty-one ECMs were performed from 1998 to 2010 (89 routine and 132 selective). In the routine ECM protocol, four cases were positive and thoracotomy was contraindicated. The remaining 85 patients were operated and five had nodal disease in subaortic (LN5) or para-aortic (LN6) stations. In the selective ECM protocol (n = 188), 132 patients underwent ECM and in 19 it was positive; the remaining 113 patients underwent thoracotomy and SND found involved LN5 or LN6 in six patients; the other 56 patients underwent direct thoracotomy and four had positive LN5 or LN6. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of ECM were 0.67, 1, 1, 0.94 and 0.95, respectively. The staging values of routine/selective ECM protocols were 0.44/0.65, 1/1, 1/1, 0.94/0.94 and 0.94/0.95, respectively. CONCLUSIONS Selective ECM protocol according to CT and PET findings has high negative predictive value and accuracy. Therefore, its selective use is recommended because it saves around 30% ECM without decreasing staging values of the current protocol. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Neck and thorax single photon emission computed tomography with computed tomography (SPECT–CT) improves the reliability of postablation 131I whole-body scan (WBS) for differentiated thyroid cancer (DTC). The aim of this study was to assess the prognostic value for persistent or recurrent disease of postablation 131I scintigraphy combining WBS and neck and thorax SPECT–CT with that of the previously known predictive factors. METHODS: This is a single referral center prospective study with a median follow-up of 29 months. Postablation 131I WBS and neck and thorax SPECT–CT were performed in 170 consecutive patients treated between 2006 and 2008. Stimulated serum thyroglobulin (Tg) and anti-thyroglobulin antibodies (TgAb) levels were measured. The impact on disease-free survival of age; gender; postablation 131I scintigraphy; stimulated serum Tg level; T, N, and M status; and macroscopic lymph node involvement was assessed by univariate and multivariate analyses. RESULTS: Persistent or recurrent disease was observed in 32 (19%) patients. In the whole group of patients, only positive WBS with SPECT–CT was related to an increased risk of persistent or recurrent disease (hazards ratio (HR)=65.21, 95% confidence interval (CI)=26.03–163.39, P<0.0001). In patients without TgAb (n=146), both positive WBS with SPECT–CT (HR=18.86, 95% CI=5.02–70.85, P<0.0001) and serum Tg level ≥58 ng/ml (HR=4.42, 95% CI=1.18–16.53, P=0.0271) were associated with an increased risk. CONCLUSION: In patients with DTC, the cross analysis of postablation 131I scintigraphy with neck and thorax SPECT–CT and stimulated serum Tg level enables early assessment of the risk of persistent or recurrent disease. [ABSTRACT FROM AUTHOR]

Abstract: Objective: [18F]Fluorodeoxyglucose positron emission tomography-computerized tomography (PET-CT) scan is a tool widely used in the diagnosis and staging of lung cancer. Referral bias is present when the results of a diagnostic study affect the decision to proceed with definitive testing. This bias artificially increases the sensitivity and decreases the specificity, and may inappropriately alter the decision to undergo definitive testing. The accuracy of PET-CT scan in suspected lung cancer and the role of referral bias were investigated. Methods: From January 2005 through June 2007, 584 consecutive patients undergoing PET-CT scan for suspected lung cancer were studied. Endpoints measured included qualitative and quantitative results of PET-CT scans and pathologic results from patients, who underwent invasive procedures for diagnosis, staging and/or therapy. A positive PET scan was defined as one in which the standard uptake value (SUV) was greater than 2.5. A standard mathematical model, based on overall results of PET-CT scan in all patients, was used to create adjustments to account for the effect of referral bias. Results: A total of 414 (71%) of PET-CT scans were reported as positive, while 170 (29%) were negative. Attempt at tissue diagnosis occurred in 417 patients (71%); surgical intervention was performed in 246 (42%). Whereas 86% (355/414) of patients with a positive PET-CT scan underwent tissue sampling, only 36% (62/170) with a negative PET-CT scan had an attempt (p <.001). In patients with a positive study, a higher SUV was associated with an attempt at tissue diagnosis (p <.001). Before adjustment, the sensitivity and specificity of the PET-CT scan for any cancer were 87% and 43%. After adjustment, sensitivity fell to 75%, while specificity rose to 64%. The unadjusted sensitivity of PET-CT scan for detecting mediastinal disease was only 79%. Conclusions: The estimate of the accuracy of PET-CT scan is significantly influenced by referral bias, and a strong reliance is placed on its results. Furthermore, patients with a positive PET-CT scan are more likely to undergo tissue sampling as the SUV increases. Given the relatively low sensitivity of the PET-CT scan in detecting disease and its poor performance in the mediastinum, the PET-CT scan may have too high an impact on the decision to undergo further invasive diagnostic procedures. Patients should not be deferred from tissue sampling based solely on a negative PET-CT scan. [Copyright &y& Elsevier]

OBJECTIVE: BRAF V600E is a potential marker of poor prognosis in papillary thyroid cancers (PTC). In a previous report, we showed that recurrent PTC with no radioiodine (131I) uptake are frequently associated with BRAF mutations, a low expression of thyroid-related genes and a high expression of glucose type-1 transporter gene. AIM: The aim of the present study was to assess BRAF status in a large series of recurrent PTC patients, considering paired primary and recurrent cancers. The BRAF genotype was correlated with the ability to concentrate 131I and/or 2-[18F]fluoro-2-deoxi-D-glucose (18F-FDG) in the recurrent cancers, serum markers of recurrence, and patient outcome. DESIGN AND METHODS: We studied 50 PTC patients with recurrent cervical disease submitted to a re-intervention, followed up in median for 9 years. BRAF analysis was conducted by direct sequencing and mutant allele-specific PCR amplification. In 18 cases, molecular analysis was also assessed in the primary cancer. Out of 50 patients, 30 underwent 18F-FDG-positron emission tomography–computed tomography. RESULTS: BRAF V600E-positive recurrent patients were found 131I-negative in 94% of cases (P<0.001); 73% of the cancers carrying BRAF V600E were both 131I-negative and 18F-FDG positive. In paired primary and recurrent PTC, BRAF V600E was observed in 79% of the primary cancers and 84% of their recurrences. Three patients with 131I-negative and BRAF V600E-positive recurrent cancers deceased during follow-up. CONCLUSIONS: BRAF mutations are more common in thyroid recurrences with no 131I uptake than in 131I-positive cases. They are correlated with the ability to concentrate 18F-FDG, and they can appear, albeit rarely, as a de novo event in the course of PTC recurrences. [ABSTRACT FROM AUTHOR]

The article discusses research on the sensitivity of computed tomographic colonography (CTC) in detecting colon cancer. It investigates instances why CTC fails to detect colon cancer. It stresses that aid of National Cancer Registry database of Great Britain from January 1, 2004 to December 1, 2008 is critical in the determination of CTC's sensitivity through CTC reports and patients' records. It concludes that CTC has reached 95 per cent sensitivity in the diagnosis of colon cancer.

The aim of this study is to compare blinded with partially blinded detection of gastric cancer with multidetector (MD) CT by using surgery and endoscopic submucosal dissection (ESD) as reference standards. 44 patients with gastric cancer underwent MDCT with air as an oral contrast agent. Surgery was performed on 37 patients, ESD on six and surgery after ESD on one. To provide comparison cases of blinded evaluation, 38 MDCT examinations were added for cases where no focal gastric lesion was seen on endoscopy. Two radiologists, blinded to the presence, number and location of the tumours, evaluated axial and axial plus multiplanar reformation (MPR) images of 82 MDCT examinations with or without gastric cancer. For partially blinded evaluation, the same radiologists, blinded to the location and number of tumours, evaluated axial and axial plus MPR images of 44 MDCT examinations of gastric cancer. Differences in assessment were resolved by consensus. 45 gastric cancers were found in surgical and ESD specimens. Detection rates of gastric cancer from axial and axial plus MPR images during blinded evaluation and from axial and axial plus MPR images during partially blinded evaluation were 62% (28/45), 64% (29/45), 64% (29/45) and 71% (32/45), respectively. There was no statistical significance for the comparison between blinded and partially blinded detection rates of gastric cancer. The detection rate of gastric cancer with MDCT during blinded evaluation showed no specific difference compared with the detection rate of gastric cancer with MDCT during partially blinded evaluation. [ABSTRACT FROM AUTHOR]

Respiratory motion complicates target volume definition for patients with lung cancer. The use of slow CT to aid in the definition of moving target volumes was investigated. Standard and slow scans of an oscillating phantom were acquired using gantry rotation periods of 0.8 and 1.5 s and pitches of 0.95 and 0.50, respectively. The resultant images of three spheres within the phantom, labelled as A, B and C with diameters of 3.7, 2.8 and 2.2cm, were analysed. The central co-ordinates of each volume were determined, and the ratio of the target volume outlined on CT (TVCT) to the true target volume (TV) was calculated. For 1.5 cm peak-to-trough (PIT) motion, standard CT mean ratios of 0.8, 0.8 and 0.7 were obtained for spheres A, B and C, respectively, whereas slow CT resulted in a mean ratio of 0.9 for all three spheres. For 2.5 cm motion, standard CT mean ratios of 0.8, 0.7 and 0.7 were obtained, whereas the slow CT mean ratios were 0.9, 0.9 and 0.8. The deviation of the central co-ordinate for the slow CT volumes was within 0.1 cm whereas deviations of up to 0.7 cm were seen using standard CT. This study indicates the potential benefit of using slow CT, even on modern scanners capable of rotation periods only down to 1.5 s, to define moving target volumes more accurately and reproducibly moving target volumes, and aid in the management of respiratory motion for patients with lung cancer. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The International Mesothelioma Interest Group (IMIG) classification is the most widely used staging system but is based on post-resectional parameters. We aimed to test the association between clinical and pathological staging and to identify possible discrepancies. Methods: We identified 164 consecutive patients (144 males and 20 females, with mean age 58 years) who underwent radical surgery (114 extrapleural pneumonectomy; 50 radical pleurectomy/decortication) for malignant pleural mesothelioma (MPM). The patients were clinically staged with CT±MRI (CT, computed tomography; MRI, magnetic resonance imaging). Results: Clinical T (cT) stage proved to be the same as pathological T (pT) stage in 44%; understaged in 46% and overstaged in 10%. Clinical N (cN) stage proved to be the same as pathological N (pN) stage in 56%; understaged in 31% and overstaged in 13%. Disease-free interval (DFI) was associated with cT stage (median DFI 29 months, SE 13, 95% CI 3–54 months for cT1; median 5, SE 3, 95% CI 3–6 months for cT4, p =0.02) but not clinical N stage (median DFI 12 months, SE 1, 95% CI 9–15 months for cN0; median DFI 11 months, SE 0.3, 95% CI 10–12 months for cN2, p =0.5) and was associated with both pT (median DFI 31 months, SE 17, 95% CI 0–64 months for pT1; median DFI 8 months, SE1, 95% CI 6–11 months for pT4, p =0.03) and pN stage (median DFI 14 months, SE 3, 95% CI 9–20 months for pN0; median DFI 10 months, SE 1, 95% CI 8–13 months for pN2, p =0.02). Overall survival was associated with cT stage (median survival 25 months, SE 3, 95% CI 20–30 months for cT1; median survival 11 months, SE 3, 95% CI 10–11 months for cT4, p =0.01) but not cN stage (median survival 15 months, SE 2, 95% CI 11–19 months for cN0; median survival 15 months, SE 2, 95% CI 12–19 months for cN2, p =0.49) and pN stage (median survival 22 months, SE 3, 95% CI 19–27 months for pN0; median survival 14 months, SE 1, 95% CI 12–17 months for pN2, p =0.01) but not pT stage (median survival 27 months, SE 4, 95% CI 19–35 months for pT1; median survival 12 months, SE 2, 95% CI 9–15 months for pT4, p =0.06). Pathological IMIG stage was associated with DFI and overall survival; however, preoperative IMIG stage was less useful. Conclusions: There are deficiencies in the current staging system for MPM and discrepancies between clinical and pathological systems. Future improvements are needed in clinical descriptors of nodal status and pathological descriptors of T stage. Subsequent IMIG stage grouping also needs revision. [Copyright &y& Elsevier]

Abstract: Objective: Accurate preoperative staging is essential to provide the best treatment for lung cancer. The objective of the present study was to determine agreement between preoperative and surgical–pathological staging and to analyse the impact of any disparity on treatment. Methods: This is a descriptive study of a series of 176 lung cancer cases treated by surgery between 2005 and 2007. Preoperative staging was based on clinical information and computed tomography (CT), positron emission tomography (PET), PET-CT, bronchoscopy and mediastinoscopy. In all cases, surgical–pathological staging was based on the analysis of surgical samples and the findings during surgery. Both preoperative and pathological stage determination were based on the TNM (tumour, node, metastasis) classification established in 1997. Concordance was measured by calculating agreement rates and the kappa value. Results: Preoperative and surgical–pathological staging agreed in 102 cases, an agreement rate of 58% and kappa value of 0.54 (95% confidence interval (CI) 0.44–0.63). The highest kappa value (0.68, 95% CI 0.53–0.82) was obtained in stage IA patients. Patients who underwent PET or PET-CT had a better kappa index (0.56, 95% CI 0.45–0.67, vs 0.39, 95% CI 0.21–0.56). Surgical–pathological staging validated surgery in 145 cases (82%), while 21 (12%) were revised to stage IIIA N2 and 10 (6%) to non-surgical stages. Conclusions: Global agreement between preoperative and surgical–pathological staging was moderate. The best agreement was found in stages IV and IA. [Copyright &y& Elsevier]

Objective: To assess the performance of current clinical recommendations for the evaluation of an adrenal incidentaloma. Design and methods: Literature review. Electronic databases (Pubmed, Ovid and citation searches from key articles) from 1980 to 2008 were searched. Eligible studies were those deemed most applicable to the clinical scenario of a patient referred to an endocrinologist for assessment of an incidentally detected adrenal mass. Surgical series, histopathological series and oncological series were reviewed and most were excluded. Results: The prevalence of functional and malignant lesions presenting as adrenal incidentaloma was similar to that quoted in most reviews, other than a lower incidence of adrenal carcinoma (1.9 vs 4.7%) and metastases (0.7 vs 2.3%). The development of functionality or malignancy during follow-up was rare (!1% becoming functional and 0.2% becoming malignant). During follow-up, false-positive rates of the recommended investigations are typically 50 times greater than true positive rates. The average recommended computed tomography (CT) scan follow-up exposes each patient to 23 mSv of ionising radiation, equating to a 1 in 430 to 2170 chance of causing fatal cancer. This is similar to the chance of developing adrenal malignancy during 3-year follow-up of adrenal incidentaloma. Conclusion: Current recommendations for evaluation of adrenal incidentaloma are likely to result in significant costs, both financial and emotional, due to high false-positive rates. The dose of radiation involved in currently recommended CT scan follow-up confers a risk of fatal cancer that is similar to the risk of the adrenal becoming malignant. This argues for a review of current guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The use of VATS metastasectomy remains controversial because of doubt surrounding its ability to remove palpable but CT occult lesions. We aim to evaluate our policy of elective VATS and compare it with our results with open metastasectomy. Methods: Pulmonary metastasectomy was performed for metastatic colorectal adenocarcinoma in 52 patients: 27 open and 25 VATS over 8 years. The age and sex distribution was similar: median age was 66 for open and 69 years for VATS, p =0.48, 70% male in open and 64% male in VATS, p =0.31. Liver metastases were present in 37% in the open and 32% in the VATS group, p =0.46. The choice of surgical approach was dependent on the distance of the lesion from the surface of the lung. We examined the survival using the Kaplan–Meier method and we tested for differences in the incidence of missed lesions, pulmonary disease progression and repeat metastasectomy. Results: There was no in-hospital mortality. There was no difference in the incidence of missed lesions (1 in VATS, none in open, p =0.48), pulmonary disease progression (11 in open, 9 in VATS, p =0.47) or recurrence in the same lobe (4 in open, 3 in VATS, p =0.54). Median follow-up was 22 (1–70) months and there was no difference to the estimated actuarial survival. Mean survival for the open group was 47 months, SE 6 with 95% CI 36–59 months and mean survival for the VATS group 35.4 months, SE 3 with 95% CI 30–41.3 months. The estimated 1- and 2-year survival was 90% and 80% for open and 90% and 72% for VATS. Conclusions: The selective use of VATS therapeutic metastasectomy in conjunction with multi-detector CT is justified in metastatic colorectal adenocarcinoma. The insertion of the surgical digit is not mandatory. Trust the radiologist''s eye. [Copyright &y& Elsevier]

We report 2 cases of splenic postchemotherapy histiocyte-rich pseudotumor. Each patient had a history of diffuse large B-cell lymphoma, treated with multiagent chemotherapy. Computed tomography scans performed on both patients showed splenic masses. A positron emission tomography scan performed on 1 patient showed increased metabolic activity. The preoperative diagnosis in both patients was recurrent lymphoma, prompting splenectomy. The splenectomy specimens showed multiple, tan-white, firm nodules, up to 3.5 cm in diameter, that were histologically composed of central necrotic B cells (CD20+/CD3-), consistent with necrotic lymphoma, surrounded by numerous lipid-laden (xanthomatous) histiocytes. Clinical staging studies at the time of splenectomy showed no other sites of disease. We conclude that these histologic and immunophenotypic findings represent chemotherapy-induced tumor necrosis with a florid histiocytic reaction mimicking residual viable lymphoma. Others have used descriptive terminology or the term xanthomatous pseudotumor for these lesions that have been only rarely reported in the spleen previously. [ABSTRACT FROM AUTHOR]

Abstract: Background: We have used doses of 60Gy or higher for neoadjuvant chemoradiotherapy for select patients with advanced non-small cell lung cancer (NSCLC), including patients with N2 disease and those with Pancoast lesions, to avoid gaps in radiotherapy in case surgery is ultimately not offered. Methods: A retrospective cohort study using a prospective database. Patients underwent initial staging with CT, PET/CT and lymph node biopsy (mediastinoscopy, endoscopic esophageal ultrasound and endobronchial ultrasound) and then received neoadjuvant high dose radiotherapy and chemotherapy, followed by thoracotomy with intent to cure. Results: Between January 1998 and June 2008 there were 216 patients who were eligible for this study. The median dose of radiation was 60Gy (range 60–72Gy). Lobectomy was performed in 152 patients (70%) about 7 weeks after radiotherapy finished (mean 51 days, range 34–89 days).The bronchus was buttressed with an intercostal muscle flap in 97% patients. Median hospital stay was 4.5 days (range 2–57). Major morbidity occurred in 17%. There were five (2.3%) deaths. There were no bronchial-pleural fistulas after lobectomy, but two occurred after right pneumonectomy. Predictors of morbidity were FEV1 <50% (p <0.001), DLCO <60% (p <0.001) and age >75 years (p =0.008). The overall 5-year Kaplan–Meier survival was 34%. It was 42% for those who underwent R0 resection, 38% for those with initial N2 disease and 45% for the 71 complete responders. Conclusions: Pulmonary resection after high dose (≥60Gy) neoadjuvant chemoradiotherapy is safe. Lobectomy can be safely performed and bronchopleural fistula prevented. Sixty Gy allows for maximal medical therapy in case resection is not offered. Since complete response rates may be higher than when 45Gy is used and since surgery is safe, its use deserves further investigation. [Copyright &y& Elsevier]

Abstract: Objective: The prediction of pulmonary functional reserve is mandatory in therapeutic decision-making for patients with resectable lung cancer, especially those with underlying lung disease. Volumetric analysis in combination with densitometric analysis of the affected lung lobe or segment with quantitative computed tomography (CT) helps to identify residual pulmonary function, although the utility of this modality needs investigation. Methods: The subjects of this prospective study were 30 patients with resectable lung cancer. A three-dimensional CT lung model was created with voxels representing normal lung attenuation (−600 to −910 Hounsfield units). Residual pulmonary function was predicted by drawing a boundary line between the lung to be preserved and that to be resected, directly on the lung model. The predicted values were correlated with the postoperative measured values. Results: The predicted and measured values corresponded well (r =0.89, p <0.001). Although the predicted values corresponded with values predicted by simple calculation using a segment-counting method (r =0.98), there were two outliers whose pulmonary functional reserves were predicted more accurately by CT than by segment counting. The measured pulmonary functional reserves were significantly higher than the predicted values in patients with extensive emphysematous areas (<−910 Hounsfield units), but not in patients with chronic obstructive pulmonary disease. Conclusion: Quantitative CT yielded accurate prediction of functional reserve after lung cancer surgery and helped to identify patients whose functional reserves are likely to be underestimated. Hence, this modality should be utilized for patients with marginal pulmonary function. [Copyright &y& Elsevier]

A 69-year-old man with sudden strong back pain was transported to our hospital by ambulance. The computed tomography scan revealed an intra-aortic floating mass with a stalk arising from the descending aortic wall, which was thought to be a thrombus. The floating mass displayed the characteristics of a thrombus rather than a neoplastic tumour on magnetic resonance imaging scan. Under extracorporeal circulation, the descending aorta was cut open, and the mass was resected. Subsequently, a stent graft was placed to cover the abnormal aortic intima to prevent recurrent thrombus formation. The pathological diagnosis revealed an adenocarcinoma, not a thrombus. We could not detect the origin of malignancy despite additional examinations. Brain metastasis developed, and the patient died of recurrent pneumonia and urinary tract infection. These findings emphasize the importance of a precise plan of action for rare diseases. [ABSTRACT FROM AUTHOR]