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Purpose This prospective, observational first in human study evaluated the safety and effectiveness of WRAPSODYTM Cell-impermeable Endoprosthesis (Merit Medical Systems, Inc.) in the treatment of arteriovenous fistula and arteriovenous graft access circuit stenosis. Materials and Methods Investigators conducted a prospective analysis of 46 patients with access circuit stenosis from three centres. Treatment sites included the peripheral outflow veins (e.g. cephalic arch, basilic vein swing point; 16 fistula and 10 graft patients); the graft-vein anastomosis (9 patients); and the central veins (up to, but not including the SVC; 11 patients). Primary outcome measures included 30-day freedom from access circuit-related safety events and 30-day target lesion primary patency. Secondary outcome measures included procedural success; device- and procedure-related adverse events; target lesion primary patency; access circuit primary patency; and secondary patency. In-person follow-up was scheduled at 1, 3, 6, and 12 months. An independent data monitoring/clinical event committee adjudicated all reinterventions and device/procedure-relatedness for adverse events. Results All initial procedures were successful. All but one patient was free from safety events through the first 30 days (97.8% (45/46)). This event was not device-related. Over the remainder of the study, one adverse event was adjudicated as possibly device-related. Six- and 12-month target lesion primary patency rates were 97.7% (42/43) and 84.6.% (33/39), respectively. Six- and 12-month access circuit primary patency rates were 84.4% (38/45) and 65.9% (29/44), respectively. Conclusion Results suggest that the study device is safe and effective for treatment of stenoses in the peripheral and central veins of arteriovenous access circuits. Level of Evidence Level 2b, cohort study.

Obstruction or occlusion of the central veins (Central venous disease, CVD) represents a major complication in hemodialysis patients (HD) limiting central venous access available for a central venous catheter placement. Endovascular treatment with percutaneous transluminal angioplasty (PTA) is the first therapeutic option to restore patency and gain access. This case presents our initial experience of a HD patient with CVD treated with a combination therapy of a balloon PTA to the left brachiocephalic trunk, through the right hepatic vein and standard catheter placement technique to the previously occluded junction of the left internal jugular vein to the left subclavian vein.

Cancer and COVID-19 are both well-established risk factors predisposing to thrombosis. Both disease entities are correlated with increased incidence of venous thrombotic events through multifaceted pathogenic mechanisms involving the interaction of cancer cells or SARS-CoV2 on the one hand and the coagulation system and endothelial cells on the other hand. Thromboprophylaxis is recommended for hospitalized patients with active cancer and high-risk outpatients with cancer receiving anticancer treatment. Universal thromboprophylaxis with a high prophylactic dose of low molecular weight heparins (LMWH) or therapeutic dose in select patients, is currentlyindicated for hospitalized patients with COVID-19. Also, prophylactic anticoagulation is recommended for outpatients with COVID-19 at high risk for thrombosis or disease worsening. However, whether there is an additive risk of thrombosis when a patient with cancer is infected with SARS-CoV2 remains unclear In the current review, we summarize and critically discuss the literature regarding the epidemiology of thrombotic events in patients with cancer and concomitant COVID-19, the thrombotic risk assessment, and the recommendations on thromboprophylaxis for this subgroup of patients. Current data do not support an additive thrombotic risk for patients with cancer and COVID-19. Of note, patients with cancer have less access to intensive care unit care, a setting associated with high thrombotic risk. Based on current evidence, patients with cancer and COVID-19 should be assessed with well-established risk assessment models for medically ill patients and receive thromboprophylaxis, preferentially with LMWH, according to existing recommendations. Prospective trials on well-characterized populations do not exist.

Superior vena cava syndrome (SVCS) is a clinical entity characterized by signs and symptoms arising from the obstruction or occlusion of the thin-walled superior vena cava (SVC) and can result in significant morbidity and mortality. Despite the rise of benign cases of SVCS, as a thrombotic complication of intravascular devices, it is most commonly seen secondary to malignancy as a consequence of thrombosis, direct invasion of tumor cells inside the vessel, or external compression. SVCS can be the initial presentation of a previously undiagnosed tumor in up to 60% of cases. Lung cancer and non-Hodgkin lymphoma (NHL) are responsible for up to 85%-90% of malignancy-related SVCS, while metastatic cancers account for approximately 10%. Herein, we review the pathophysiology, etiology, clinical presentation, diagnosis, and management of malignancy-related SVCS.

To report our preliminary results upon feasibility, efficacy and safety of percutaneous splanchnic nerves cryoneurolysis for the treatment of abdominal pain refractory to conservative medication in patients with pancreatic cancer MATERIALS METHODS: Institutional database research (retrospective review of prospectively collected data from April 2019 till August 2020) identified 5 patients with pancreatic cancer and pain refractory to conservative medication who underwent percutaneous cryoneurolysis of splanchnic nerves. In all patients, percutaneous cryoneurolysis was performed with posterolateral paravertebral approach using a 17 Gauge cryoprobe under computed tomography guidance and local anesthesia. Self-reported pain scores were assessed before and at the last follow-up using a pain inventory with visual analog scale (VAS) units.Mean patient age was 63.81 years (male-female: 3-2). Mean pain score prior to cryoanalgesia of splanchnic nerves was 9.4 VAS units. This score was reduced to a mean value of 2.6, 2.6 and 3 VAS units at 1, 3 and 6 months of follow-up, respectively. All patients reported significantly reduced analgesic usage. No complication was reported according to the CIRSE classification system. The mean procedure time was 44.4 min (range 39-50 min), including local anesthesia, cryoprobe(s) placement, ablation and post-procedural CT evaluation.Percutaneous cryoanalgesia of the splanchnic nerves is a minimally invasive, safe and effective procedure for pancreatic cancer pain relief. A larger, randomized trial is justified to substantiate these findings.

Portal vein system thrombosis (PVT) is an infrequent but potentially serious complication after laparoscopic splenectomy. Patients with β-thalassemia are at higher risk as they have splenomegaly and hypercoagulability.Forty-eight β-thalassemia patients who underwent hand-assisted laparoscopic splenectomy or laparoscopic splenectomy were studied prospectively with pre- and postoperative Doppler ultrasonography or computed tomography scanning.The incidence of PVT was 8.3% (95% confidence interval [CI] 0.2%-16.4%) (4 of 48 patients). Spleen weight was the only independent factor associated with the presence of PVT. The odds ratio for spleen weight (100 g increase) was 1.46 (95% CI 1.10-1.94, P=.010). Receiver operator characteristic curve analysis showed that the optimal cutoff of spleen weight to the prediction of PVT was 1543 g. Thrombosis resolution was observed after a median of 165 days.Patients with β-thalassemia who undergo laparoscopic-assisted splenectomy are at high risk of postoperative PVT. Close postoperative surveillance and aggressive coagulation prophylaxis are needed in these patients. Larger studies are required to confirm the present findings.

Purpose: Aim of this study is to present our initial experience with the use of the retrograde popliteal artery access in patients with certain anatomic lesions. Methods: Between September 2008 and September 2010, 24 patients underwent a transpopliteal retrograde subintimal recanalization. Instead of its usage when antegrade recanalization failed, the “facedown” technique was preferred as a first choice in patients with common femoral artery stenosis or occlusion, proximal lesions of the superficial femoral artery (SFA) with no stump, severe obesity, tandem iliac, and SFA lesions. Results: Technical success was achieved in 91.7% of patients.The complication rate was 12.5%. The primary patency at 6, 12, and 18 months was 86.4%, 65.8%, and 65.8%, respectively. Conclusions: The retrograde popliteal artery approach can be considered as the primary SFA recanalization strategy in carefully selected patients, with competitive immediate and midterm results.

We evaluated the variation of calcitonin gene related peptide (CGRP) expression in patients with mixed invasive with extensive in situ ductal carcinomas (IDC + DCIS) and pure IDC, in relation to mammographic breast density (%BD), proliferation-seeking radiotracer (99m)Tc(V) dimercaptosuccinic acid (DMSA) uptake (scintimammographic-SMM), proliferation index Ki-67, and estrogen receptor (ER) status. We also assessed CGRP expression with histological grade.We studied retrospectively 24 women with suspicious findings on mammography who were evaluated preoperatively with (99m)Tc(V)DMSA scintimammography. Histology revealed 12 IDC (grade II in 8, grade III in 4 patients; mean size ± SD, 2.6 ± 1.3 cm; mean age ± SD, 66.5 ± 13.1 years) and 12 IDC + DCIS (grade II in 6, grade III in 6 patients; DCIS component mean size ± SD, 5.3 ± 1.8 cm; IDC component mean size ± SD, 2.5 ± 1.1 cm; mean age ± SD, 58.5 ± 15.1 years). Immunohistochemistry for CGRP, Ki-67, and ER status was performed in all 24 surgical specimens. BD and SMM were calculated by computer-assisted methods and were statistically correlated with CGRP expression. BD, SMM, Ki-67, and ER were statistically compared between IDC and IDC + DCIS, whereas CGRP, Ki-67, and ER were compared between patients with BD25 and25%. CGRP was also compared (t test) between grade II and grade III in both groups.Overall positive correlation was found between BD and CGRP (r = 0.577, P 0.001). Positive correlation was established between SMM and CGRP only in IDC + DCIS (r (SMM(IDC+DCIS)-CGRP) = 0.634, P 0.05). CGRP and Ki-67 were significantly higher in patients with BD25% compared with25% BD patients (P = 0.00008 and P = 0.014, respectively). BD and SMM were significantly higher in CGRP(+) than in CGRP(-) patients as well as in IDC + DCIS compared with IDC. Ki-67 was significantly higher, whereas ER was significantly lower, in IDC + DCIS than in IDC. In all patients, CGRP was significantly higher in grade II as compared with grade III (P = 0.005). In the mixed group (IDC + DCIS), grade II cancers had also significantly higher CGRP values as compared with grade III ones (P = 0.004). In pure IDC, no statistical difference was found between grade II and III (P = 0.4).ΒD, SMM, CGRP, and Ki-67 were significantly increased, whereas ER was significantly decreased, in IDC + DCIS as compared with IDC, indicating that IDC + DCIS is an entity that is more aggressive, ER independent, and possibly associated with a pathway linked to stromal involvement and CGRP activity.

We present a 28-year-old man with a large symptomatic arteriovenous fistula (AVF) treated with embolization using the Amplatzer vascular plug (AVP). Although embolization may be considered the first-line therapy in the treatment of AVFs, there is an inherent high risk of migration of the embolic agents into the venous and pulmonary circulations. This case is illustrative of the ease and safety of using this device in high-flow renal AVFs.

Percutaneous biliary drainage procedures in patients with nondilated ducts are demanding, resulting in lower success rates than in patients with bile duct dilatation. Pertinent clinical settings include patients with iatrogenic bile leaks, diffuse cholangiocarcinomas, and sclerosing cholangitis. We describe a method to facilitate these procedures with the combined use of a 2.7-Fr microcatheter and a 0.018-in. hydrophilic wire.

Surgery of hydatid cysts is often complicated with intrabiliary rupture (IBR), which if not recognized may lead to biliary fistula with rather high rates of morbidity and mortality. We report our experience with the application of radiofrequency (RF) ablation for the treatment of an operated hepatic echinococcal cyst which was complicated with biliocystic communication and cysteocutaneous fistula with bile leakage. RF ablation was performed under CT guidance into the remaining cyst through the cutaneous fistula. Since ablation of the cyst and the fistula the patient has been asymptomatic.

Hemangiopericytoma is a rare primary tumor originating from Zimmerman’s pericytes, with significant metastatic potential. Hepatic metastatic disease requires an aggressive approach by a multidisciplinary team of dedicated oncology specialists, to prolong survival in selected patients. We report on a patient with recurrent hepatic metastases of grade II intracranial hemangiopericytoma 5 years after initial treatment, managed by a stepwise combination of liver resection, radiofrequency ablation, and transarterial embolization. Although metastatic disease implies hematogenous dissemination, long-term survival after liver resection has been reported and major hepatectomies are justified in patients with adequate local control. Liver resections combined with transarterial embolization are highly recommended, due to hypervascularity of the tumor.

Percutaneous radiofrequency thermal ablation (RFA) has been used to treat primary and secondary liver tumors under ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) guidance for the past decade [Park et al., Radiol Clin North Am 38:545-561, 2000; Siperstein and Gotomirski, Cancer J 6:S293-S301, 2000; Kelekis et al., Eur Radiol 13:1100-1105, 2003]. RFA is a low-cost, minimally invasive treatment that has recently attracted attention for treating tumors in different solid organs with promising results [Dupuy and Goldberg, J Vasc Interv Radiol 12:1135-1148, 2001; Friedman et al., Cardiovasc Intervent Radiol 27:427-434, 2004]. It can be provided with minimal hospitalization, and experienced practitioners have reported low complication rates [Dupuy and Goldberg, J Vasc Interv Radiol 12:1135-1148, 2001; Livraghi et al., Radiology 226:441-451, 2003]. Patients with lung malignancies (primary lung cancer or pulmonary metastases), who cannot be operated, might be candidates for RFA treatment. It can also be used in association with other treatments (i.e., chemotherapy, radiotherapy) for better disease control. Combination of the above with RFA may help reduce morbidity and mortality. Many ways to apply energy to the tumor exist (monopolar and bipolar RFA, microwave, laser, brachytherapy). In this review we will focus on expandable monopolar systems, which despite their deficiencies are the most popular in the interventional radiology sector.

Introduction Penile metastases are an extremely rare occurrence, and most primary malignancies are located in the urinary bladder, prostate, rectum, and rectosigmoid. Although very few cases of penile metastases have been reported, those of lung cancer as the primary tumor are very rare. Among the latter, squamous cell carcinomas constitute the majority, whereas adenocarcinomas are almost exceptions. To the best of our knowledge, only two cases have been reported. Case presentation We report the case of a 59-year-old Greek man who presented with persistent cough and chest pain that had started one month prior to a medical appointment. A physical examination, complete laboratory work-up, computed tomography scanning (of the chest, brain, and abdomen), pelvic magnetic resonance imaging, penile ultrasonography, bone scanning, and histological analyses were conducted. Afterward, a lung adenocarcinoma metastatic to the bones, brain, adrenals, lymph nodes, and penis was diagnosed. The primary lesion was a mass of 4cm in diameter in the apical segment of the lower lobe of the right lung. The patient was treated with bone and brain radiotherapy and various cycles of first- and second-line chemotherapy, and partial response was achieved five months after the initial appointment. Conclusions Although these metastatic sites are well known to occur from a primary pulmonary malignancy, penile metastasis is extremely rare. Its identification requires prompt awareness by the physician despite the dismal prognosis. Furthermore, since the penis usually is omitted from the physical examination and lung cancer is the leading cause of cancer-related deaths, more penile metastases may be detected in the future, making early detection and appropriate management of great importance.

The case of a 72-year-old male patient with HCC is presented in whom percutaneous RFA was used as the sole first-line anticancer treatment, since he denied having partial hepatectomy. The patient underwent RFA two more times, at 1.5 years for treating a local tumor progression at the initial ablation site and at 11 years after the first session for treating a new remote intrahepatic recurrence. He revealed a long-term survival of more than 12 years so far and still remains in excellent clinical status.

Percutaneous portal vein embolization (PPVE) induces hypertrophy of the future liver remnant before hepatic resection. The ideal embolic material has not yet been determined. We compared N-butyl-2-cyanocrylate (NBCA) with sodium acrylate–vinyl alcohol copolymer particles using a swine model. Twelve pigs underwent PPVE. Six pigs (group A) were embolized with NBCA, and 6 pigs (group B) were embolized with sodium acrylate–vinyl alcohol copolymer particles. Computed tomographic volumetry of the embolized lobe (EL) and the nonembolized lobe (NEL), along with liver function tests, was performed before and at 14 and 28 days after embolization. Tissue samples from both lobes were taken 14 and 28 days after PPVE. NEL-volume and NEL-ratio increases were significantly higher in group A at 14 and 28 days after PPVE (78 and 52% and 91 and 66%, respectively) than in group B (32 and 12% and 28 and 10%, respectively) (p

The purpose of this study was to assess the relationship of mammographic breast density (BD) and cell proliferation/focal adhesion kinase activation–seeking radiotracer technetium 99m pentavalent dimercaptosuccinic acid ( 99m Tc(V)-DMSA) uptake in women with different breast histologies, that is, mild epithelial hyperplasia (MEH), florid epithelial hyperplasia (FEH), mixed ductal carcinoma in situ with invasive ductal carcinoma (DCIS + IDC), and pure IDC. Fifty-five women with histologically confirmed mammary pathologies were submitted preoperatively to mammography and 99m Tc(V)-DMSA scintimammography. The percentage and intensity of 99m Tc(V)-DMSA uptake and the percentage of BD were calculated by computer-assisted methods and compared (t-test) between the breast pathologies. In breasts with increased BD, FEH and DCIS + IDC were found. On the contrary, pure IDC and MEH were identified in breasts with significantly lower BD values. In breasts with increased 99m Tc(V)-DMSA area and intensity of uptake, FEH was the main lesion found compared to all other histologies. Linear regression analysis between BD and 99m Tc(V)-DMSA uptake area and intensity revealed significant coefficients of correlation (r 5 .689, p , .001 and r 5 .582, p , .001, respectively). Increased BD correlates with the presence of FEH and mixed DCIS + IDC but not with pure IDC or MEH. Its close relationship to 99m Tc(V)-DMSA, which also showed an affinity to FEH, indicates that stromal microenvironment may constitute a specific substrate leading to progression to different subtypes of cancerous lesions originating from different pathways.

Introduction Recent studies have reported a risk reduction in the progression of benign breast disease to breast carcinoma through COX-2 pathways. Case presentation We present a case of severe epithelial hyperplasia in a 47-year-old woman with increased breast density submitted to scintimammography by the proliferation-imaging tracer Technetium-99m-labelled pentavalent dimercaptosuccinic acid, before and after an oral ibuprofen treatment for 4 weeks. The radiotracer uptake after ibuprofen intake was significantly reduced, both visually and by semi-quantitative analysis, based on a calculation of lesion-to-background ratios. Conclusion In proliferating breast lesions, scintigraphically displayed reduction in Technetium-99m-labelled pentavalent dimercaptosuccinic acid uptake may indicate inhibition by ibuprofen in the pathway of malignant epithelial cell transformation.

Introduction Lipomas can be found anywhere in the body with the majority located in the head and neck region as well as in the shoulder and back. They are not very common in the hand and those involving the fingers are very rare. Although, it is not the only case reported, lipoma of the index finger is very uncommon. Case presentation A 52-year-old Caucasian man presented with a lipoma of the right index finger. He complained of no pain but he had difficulty in manual movements. Treatment was surgical excision of the lipoma. There has been no recurrence for two years. Conclusion Although lipomas of the fingers are rare entities, their awareness is imperative since the differential diagnosis from other soft tissue tumors and from the special lipomatous subtype involved is quite extensive.

We describe the case of a 24-year-old hemophilic man who had been a human immunodeficiency virus (HIV)-positive for the past 22 years and presented to our hospital with bilateral breast enlargement with the presence of microcalcifications. Etiology of breast enlargement in male HIV population and differential diagnosis between true gynecomastia and lipomastia are also discussed.

To present our results in a series of 35 patients with malignant pulmonary lesions, who underwent radiofrequency thermal ablation (RFA) during a period of 18 months.In our institution, 55 RFA sessions under computed tomography (CT) guidance were performed on 48 pulmonary malignant lesions (23 inoperable primary and 25 metastatic) in 35 patients.Total necrosis was noted in 19 primary (82.6%) and in 19 metastatic lesions (76%). In four primary (17.4%) and in six metastatic lesions (14%), partial necrosis was achieved, and a second RFA session was performed. The 6-month spiral CT follow-up demonstrated recurrence in seven lesions (14.5%) (four primary and three metastatic), which were treated with an additional RFA session. Two of the patients who underwent the procedure died of disseminated disease after one year, accounting for a 1-year survival rate of 94.2%. Mean survival was 14.48 +/- 3.3 months.RFA is an effective method for treating unresectable lung carcinoma and lung metastases.

Primary non-Hodgkin's lymphoma of the esophagus is a rare disease. A case of primary isolated non-Hodgkin's lymphoma of the esophagus in a 77-year-old man without acquired immunodeficiency syndrome is presented. We describe the clinical features and the imaging findings (barium swallow, endoscopic ultrasonography and CT) of a biopsy proven B-cell lymphoma with diffuse transmural involvement of the esophagus wall, which was discovered incidentally. We also briefly review the literature.

Background Hughes-Stovin syndrome is a rare entity. The aetiology of Hughes-Stovin syndrome is still unknown and the natural course of the illness is usually fatal; however it is supposed to be a clinical variant manifestation of Behçet disease. Case presentation We report the case of an 18 years old, greek male patient with Hughes-Stovin syndrome, who initially presented with deep vein thrombosis. There were no findings consistent with Behçet disease and the haemoptysis was treated successfully with methylprednisolone. Pathogenesis, imaging investigation and treatment of this syndrome are also briefly discussed. Conclusion In young men presenting with venous thrombosis as revealed on imaging examination, with platelet count and coagulation tests within normal and hemoptysis the eventuality of Hughes-Stovin syndrome is to be considered.

Acute lower gastrointestinal bleeding, is often a dramatic situation, associated with mortality rate up to 28%. Currently transcatheter alternatives have found their place in the therapeutic spectrum of this situation. An interesting question is when should this procedure be performed and which are the difficulties when performing it. We present the case of a 75-year old woman with acute massive lower gastrointestinal bleeding on the tenth post-operative day of a colic and partial ileal resection. Superselective angiography of the superior mesenteric artery was obtained that disclosed marked contrast extravasation of distal branches of the left colic artery as well as from a small branch feeding the distal enteric anastomoses. Clinical success was achieved after superselective embolization which was accomplished by using polyvinyl alcohol particles. The patient was discharged 5 days later and there were no procedure-related complications during 6-month follow-up period. So, especially in post-operative patients who are considered to be poor candidates for surgical treatment, arterial embolotherapy should be established not only as treatment option, but also as first line therapy for LGI bleeding.

Lower extremity's venous pathology was traditionally investigated by intravenous venography. Nowadays Color Doppler flow imaging is widely accepted as a well established, noninvasive method for the evaluation of deep pelvic and lower extremity's venous system. The vast majority of authors conclude that the method can safely replace diagnostic venography in all patients with venous thrombosis, thrombophlebitis and valve or communicating veins insuffciency. Optimal performance of Color Doppler flow imaging as a diagnostic tool for the whole lower limb veins requires: Proper equipment specifications and settings. Knowledge of regional venous anatomy. Established examination protocols. Evaluation of morphological and functional findings. Documentation of the findings. All these steps are described as a sequence of guidelines, photographs and multiple ultrasonographic images. Our paper can be useful to all physicians or sonographers involved with color Doppler studies for the evaluation of lower limb venous diseases and abnormalities.

Appendicitis is the most common abdominal emergency occurring in 7%-12% of the population. The aim of this article was to pictorially present the spectrum of appendix and acute appendicitis appearances on computed tomography (CT). The various appearances on CT of the normal appendix are shown as well as the CT criteria for the differentiation of perforated and non-perforated appendicitis.

Percutaneous imaging-guided tumor ablation is a widely accepted method for the treatment of primary and secondary lung tumors. Although it is generally feasible and effective for local tumor control, some conditions may affect its feasibility and effectiveness. Herein the authors report their experience with two patients with lung malignancies contiguous to the aorta who were successfully treated with radiofrequency ablation, even though it initially appeared highly risky due to the possible fatal complications.

PURPOSE To present our results in a series of 35 patients with malignant pulmonary lesions, who underwent radiofrequency thermal ablation (RFA) during a period of 18 months. MATERIALS AND METHODS In our institution, 55 RFA sessions under computed tomography (CT) guidance were performed on 48 pulmonary malignant lesions (23 inoperable primary and 25 metastatic) in 35 patients. RESULTS Total necrosis was noted in 19 primary (82.6%) and in 19 metastatic lesions (76%). In four primary (17.4%) and in six metastatic lesions (14%), partial necrosis was achieved, and a second RFA session was performed. The 6-month spiral CT follow-up demonstrated recurrence in seven lesions (14.5%) (four primary and three metastatic), which were treated with an additional RFA session. Two of the patients who underwent the procedure died of disseminated disease after one year, accounting for a 1-year survival rate of 94.2%. Mean survival was 14.48 +/- 3.3 months. CONCLUSION RFA is an effective method for treating unresectable lung carcinoma and lung metastases.

Objectives: Experimental data suggest a role for calcitonin gene-related peptide (CGRP) in normal breast development and angiogenesis. This pilot study correlated CGRP with neoangiogenesis and the uptake of the tumor-seeking, proliferation-imaging radiotracer pentavalent technetium-99m dimercaptosuccinate ( 99m Tc-(V)DMSA) in invasive and preinvesive breast lesions. Methods: Among women evaluated preoperatively by 99m Tc-(V)DMSA scintimammography, 29 invasive ductal carcinomas (IDCs) were retrospectively studied: 15 isolated (Group I); 14 mixed with preinvasive pathologies (ductal carcinoma in situ [DCIS] and/or epithelial hyperplasia [EH]; Group M). CGRP staining and neoangiogenesis were compared between invasive and DCIS/EH regions and were correlated. 99m Tc-(V)DMSA displayed a diffusely increased uptake pattern corresponding to DCIS/EH; its lesion-to-background (L/B) ratio was compared between images acquired at 10 and 60 minutes and its retention ratio (RR) was correlated with CGRP. Results: Seven of 15 group I and 10 of 14 group M patients (58.6% of the population) were CGRP-positive. CGRP was prevalent in the DCIS/EH component of mixed-lesions (even in the surrounding normal epithelium of nearly half), with declining intensity as advancing from DCIS/EH to high-grade IDC. Similarly, neoangiogenesis was considerably higher in DCIS/EH than in group I pure IDCs. A significant CGRP-neoangiogenesis correlation was verified only in group I. The diffuse 99m Tc-(V)DMSA uptake exhibited significant, time-related L/B increase and a RR positively correlating with CGRP. Conclusions: CGRP expression and neoangiogenesis are intensified in mixed invasive-preinvasive breast lesions; an underlying relation may exist, requiring further investigation. CGRP also appears associated with 99m Tc-(V)DMSA'S propensity to depict preinvasive pathologies. This relationship could denote an additional proliferative role for CGRP.

Osteoid osteoma is a benign, bone-forming tumor. The diaphyses of the long bones are the sites of predilection (at least 50% of all cases occurring in the femur and the tibia). Also this lesion has a male preponderance and the majority of cases present in the second and third decade. We represent an unusual localization of osteoid osteoma in the patella of a 51-year old woman.

The biological behavior and prognosis of gliomas depend largely on cellular proliferation, resistance to chemotherapy, and metastatic potential. Proliferative propensity has significant implications on patient management but its assessment requires tissue sampling; the non-invasive estimation of brain tumor proliferation represents therefore a major goal. Pentavalent technetium-99 m dimercapto-succinic acid [99m Tc-(V)DMSA] is a tumor-seeking radiotracer displaying affinity for gliomas; its intracellular accumulation is directly linked to cell proliferation. We performed a tomographic 99m Tc-(V)DMSA brain scan in a 35-year-old male baring a recurrent glioblastoma multiforme, to depict its proliferative disposition. The patient had been diagnosed 14 months earlier and had been submitted to surgery, followed by adjuvant radiotherapy and temozolomide-based chemotherapy. On clinical suspicion of recurrence 5 months later, magnetic resonance imaging (MRI) revealed a lesion at the site of preceded surgery, which was treated by imatinib mesylate. No improvement was ascertained the following months and radiographic assessment verified tumor progression. Scintitomography revealed avid radiotracer uptake in the entirety of the lesion (the distribution of radioactivity closely conforming to the morphological tumor boundaries), an indication that the neoplasm demonstrated no substantial proliferation decline in response to imatinib. The patient deceased a few weeks later. Mounting in vivo and in vitro evidence indicates that 99m Tc-(V)DMSA is a credible non-invasive proliferation depicter, its cellular accumulation linked closely to phosphate uptake and kinase pathway activation. A potential role in patient management, prognosis estimation, and therapy response monitoring could occur for this tracer.

A case of a 24-year-old male with jaundice and epigastric pain is reported. The patient underwent a thorough clinical, laboratory, and imaging investigation. Computerized tomography revealed a 9 cm mult 10 cm choledochal cyst. Magnetic resonance imaging and magnetic cholangiopancreatography were performed, during which he developed an "acute abdomen", with radiological evidence of biliary peritoneal leak. Urgent surgery revealed rupture of the distended malformed common bile duct. A peritoneal drain was instilled and a more definitive surgical procedure was accordingly scheduled. Hepatobiliary scintigraphy following surgery verified these findings, as well as confirmed the adequacy of the urgent surgery. A combination of radiological and nuclear medicine techniques substantially contributes to the diagnosis of choledochal cyst rupture and the adequacy of surgical intervention.

Increased serum carbohydrate antigen (CA) 19-9 is a quite uncommon manifestation of breast cancer both on early disease and on relapse. A 53-year-old woman with invasive ductal breast carcinoma underwent left-sided mastectomy. Two years later she palpated a subcutaneous mass at the mastectomy scar, arousing suspicion of local relapse. Surgery and histopathology revealed infiltration by breast adenocarcinoma and she was treated with chemotherapy. At that time serum tumor markers, carcinoembryonic antigen (CEA) and CA 15-3 were within normal range. Over the next six months she displayed an increase of serum CEA while serum CA 15-3 remained within normal range. In an attempt to search for a second neoplasm possibly of gastrointestinal (GI) origin, abdominal computed tomography (CT), magnetic resonance imaging (MRI), magnetic resonance cholangio-pancreatography (MRCP), endoscopy of the upper GI tract and colonoscopy were performed, as well as measurement of serum CA 19-9. While no indication of a GI neoplasm was detected, she displayed an over 10-fold increase of serum CA 19-9. The patient had also an X-ray mammography and technetium-99m hexakis-2-methoxyisobutylisonitrile ((99m)Tc-MIBI) scintimammography (SM). Whilst mammography was negative for contralateral disease recurrence, SM was suggestive of axillary lymph node involvement. Axillary lymph node dissection confirmed an extensive metastatic infiltration of these nodes by breast adenocarcinoma. Three months later serum CA 19-9 and CEA became normal. The interest of this case lies on the unexpected high serum CA 19-9 values found in a breast relapsed adenocarcinoma and in the important contribution of SM in diagnosing the axillary lymph node metastatic infiltration.

Introduction Angioplasty with the use of cutting balloons has been suggested by some case reports and small series for the treatment of renal artery stenoses that are resistant to conventional balloon catheters. Based on this limited experience, the use of this technology has been suggested as safe. Herein, we report a renal artery rupture following angioplasty with a cutting balloon. The complication was salvaged with a stent graft. Case presentation A 30-year-old white female patient with resistant hypertension caused by a severe renal artery stenosis attributed to fibromuscular dysplasia, was submitted to conventional balloon angioplasty without success. Dilatation of the lesion with a cutting balloon resulted in arterial rupture, with concomitant retroperitoneal hematoma. Conclusion Cutting balloon angioplasty of renal artery lesions resistant to conventional balloon angioplasty should not be considered as safe as previously thought. When proceeding with such a procedure, a stent graft should be available for immediate use.