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As it has been recently noted in two papers published in the JBRTBR (1, 2), prostate cancer is the second cause of male-cancer related death. The role of radiologists is crucial at the early stage of the disease, for local and distant staging, and during the follow up of the patient. We would like to take the opportunity to report on an uncommon case of peritoneal carcinomatosis observed during the long term follow up of a patient having prostate cancer. Based on these findings, there was a need for change of therapy, with a positive impact on the outcome.

Background: A 39-year-old patient took medical advice because of progressive fatigue, with nausea, fever, non specific abdominal pain, 3 weeks after coming back from Asia. He had been positive for HIV for 6 years. Blood tests show an increased CRP level (4 mg/dl, nl < 1 mg/dl).

Teaching point: Microcystic lymphangioma is a rare but benign lesion that should be differentiated from a neoplasm.

Teaching Point: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare congenital anomaly characterized by a steal phenomenon; it must be recognized, as a prompt treatment may prevent life-threatening complications such as myocardial infarction, mitral dysfunction, and malignant dysrhythmias in adults.

Teaching Point: Female urethral diverticulum is a rare condition that is often a diagnostic challenge; magnetic resonance imaging (MRI) is efficient to confirm the diagnosis (especially if endovaginal ultrasound is inconclusive), to assess the diverticulum prior to surgery, and to detect related complications including intra-diverticular neoplasm.

Teaching point: Unexplained persistent perineal pain poses a differential diagnosis, including pelvic nerve lesions. The rare occurrence of pelvic schwannoma is easily shown by a MRI as a T2-hyperintense enhancing mass.

Teaching Point: This case highlights the extrapulmonary lymphatic abnormalities that may be associated with pulmonary lymphangioleiomyomatosis.

The giant ulcer of esophagus is a rare entity in the context of human immunodeficiency syndrome. In front of this type of ulceration the radiologist must to distinguish between two types of ulcers HIV, cytomegalovirus (CMV). The differential diagnosis is necessary for orientation of the therapy and is the result of association between radiological, endoscopic and pathological findings.

Teaching Point: Female urethral diverticulum is a rare condition that is often a diagnostic challenge; magnetic resonance imaging (MRI) is efficient to confirm the diagnosis (especially if endovaginal ultrasound is inconclusive), to assess the diverticulum prior to surgery, and to detect related complications including intra-diverticular neoplasm. [ABSTRACT FROM AUTHOR]

Teaching Point: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA syndrome) is a rare congenital anomaly characterized by a steal phenomenon; it must be recognized, as a prompt treatment may prevent lifethreatening complications such as myocardial infarction, mitral dysfunction, and malignant dysrhythmias in adults. [ABSTRACT FROM AUTHOR]

Teaching point: Unexplained persistent perineal pain poses a differential diagnosis, including pelvic nerve lesions. The rare occurrence of pelvic schwannoma is easily shown by a MRI as a T2-hyperintense enhancing mass. [ABSTRACT FROM AUTHOR]

Teaching Point: The diagnosis of epiploic appendagitis in case of pain in the right iliac fossa in pregnant woman shouldn't be forgotten. [ABSTRACT FROM AUTHOR]

Background: This study assesses how the metastatic immune landscape is impacting the response to treatment and the outcome of colorectal cancer (CRC) patients.Methods: Complete curative resection of metastases (n = 441) was performed for two patient cohorts (n = 153). Immune densities were quantified in the center and invasive margin of all metastases. Immunoscore and T and B cell (TB) score were analyzed in relation to radiological and pathological responses and patient's disease-free (DFS) and overall survival (OS) using multivariable Cox proportional hazards models. All statistical tests were two-sided.Results: The spatial distribution of immune cells within metastases was nonuniform. Patients, as well as metastases of the same patient, had variable immune infiltrates and response to therapy. A beneficial response was statistically significantly associated with increased immune densities. Among all metastases, Immunoscore (I) and TB score evaluated in the least immune-infiltrated metastases were the strongest predictors for DFS and OS (five-year follow-up, Immunoscore: I 3-4: DFS rate = 27.9%, 95% CI = 15.2 to 51.3; vs I 0-1-2: DFS rate = 12.3%, 95% CI = 4.9 to 30.6; HR = 0.45, 95% CI = 0.28 to 0.70, P = .02; I 3-4: OS rate = 64.6%, 95% CI = 46.6 to 89.6; vs I 0-1-2: OS rate = 32.5%, 95% CI = 17.2 to 61.4; HR = 0.32, 95% CI = 0.15 to 0.66, P = .001, C-index = 65.9%; five-year follow-up, TB score: TB 3-4: DFS rate = 25.7%, 95% CI = 14.2 to 46.6; vs TB 0-1-2: DFS rate = 5.0%, 95% CI = 0.8 to 32.4; HR = 0.36, 95% CI = 0.22 to 0.57, P < .001; TB 3-4: OS rate = 63.7%, 95% CI = 46.4 to 87.5; vs TB 0-1-2: OS rate: 21.4%, 95% CI = 9.2 to 49.8; HR = 0.25, 95% CI = 0.12 to 0.51, P < .001, C-index = 67.8%). High TB score and Immunoscore patients had a median survival of 70.5 months, while low patients survived only 25.1 to 38.3 months. Nonresponding patients with high-immune infiltrates had prolonged DFS (HR = 0.28, 95% CI = 0.15 to 0.52, P = .001) and OS (HR = 0.25, 95% CI = 0.1 to 0.62, P = .001). The immune parameters remained the only statistically significant prognostic factor associated with DFS and OS in multivariable analysis (P < .001), while response to treatment was not.Conclusions: Response to treatment and prolonged survival of metastatic CRC patients were statistically significantly associated with high-immune densities quantified into the least immune-infiltrated metastasis. [ABSTRACT FROM AUTHOR]

Aim Nodal stage is a strong prognostic factor of oncological outcome of rectal cancer. To compensate for the variation in total number of harvested nodes, calculation of the lymph node ratio ( LNR) has been advocated. The aim of the study was to compare the impact, on the long-term oncological outcome, of the LNR with other predictive factors, including the quality of total mesorectal excision ( TME) and the state of the circumferential resection margin. Method Consecutive patients having elective surgery for nonmetastatic rectal cancer were extracted from a prospectively maintained database. Retrospective uni- and multivariate analyses were performed based on patient-, surgical- and tumour-related factors. The prognostic value of the LNR on overall survival ( OS) and on overall recurrence-free survival ( ORFS) was assessed and a cut-off value was determined. Results From 1998 to 2013, out of 456 patients, 357 with nonmetastatic disease were operated on for rectal cancer. Neoadjuvant radiochemotherapy was administered to 66.7% of the patients. The mean number of lymph nodes retrieved was 12.8 ± 8.78 per surgical specimen. A lower lymph node yield was obtained in patients who received neoadjuvant chemoradiotherapy (11.8 vs 14.2; P = 0.014). The 5-year ORFS was 71.8% and the 5-year OS was 80.1%. Multivariate analysis confirmed LNR, the quality of TME and age to be independent prognostic factors of OS. LNR, age and perineural infiltration were independently associated with ORFS. Low- and high-risk patients could be discriminated using an LNR cut-off value of 0.2. Conclusion LNR is an independent prognostic factor of OS and ORFS. In line with the principles of optimal surgical management, the quality of TME and lymph node yield are essential technical requirements. [ABSTRACT FROM AUTHOR]

Teaching Point: The acute appendicitis in a context of Malone appendicostomy complication is very rare but can occur and may be challenging to diagnose due to its unusual position. [ABSTRACT FROM AUTHOR]

The article describes the case of extramedullary haemopoiesis and spinal cord compression in a man with acute paraplegia.

Teaching Point: The acute appendicitis in a context of Malone appendicostomy complication is very rare but can occur and may be challenging to diagnose due to its unusual position.

Teaching Point: The diagnosis of epiploic appendagitis in case of pain in the right iliac fossa in pregnant woman shouldn’t be forgotten.

Teaching point: Boerhaave syndrome is a very rare life-threatening surgical emergency, often misdiagnosed at the patient’s admittance.

Teaching point: Metastatic involvement has to be considered in the differential diagnosis for diffuse bladder wall thickening

Inflammatory myofibroblastic tumor (IMT) is a rare tumor, classified by WHO of intermediate biological potential with tendency for local recurrence and small risk for distant metastasis. Histologically IMT is a mixture of inflammatory cells and myofibroblastic spindle cells proliferation. To our knowledge there is no MRI description of mesenteric IMT in the literature. We would like to emphasize the correlation between medical imaging and anatomical pathology based on our experience of a mesenteric IMT in a 28-year-old patient.

Background: We present a case of a 23-year-old man having drug addiction. He is managed by the department of hematology for an idiopathic medullar aplasia. Two months before his admission, he was treated with bone marrow transplantation. During follow-up, we noted a nonspecific recent cutaneous lesion. He was admitted for acute digestive symptoms including anorexia, nausea, vomiting and abdominal pain.