Skeletal involvement is described in 25% of patients with non-Hodgkin's lymphoma, typically as secondary, rarely as primary lymphoma of bone. Joint infiltration is very rare and monoarthritis can be a secondary synovial reaction to adjacent bone disease or direct synovial involvement. We describe an unusual case of monoarthritis of the elbow in a middle-aged man without signs and/or symptoms associated with malignancy and with no previous rheumatic disease. Synovial biopsy revealed a diffuse infiltrate of large atypical lymphocytic B cells diagnosed by morphological and immunohistochemical findings as a malignant lymphoma. Staging procedures including total body CT scan, bone marrow biopsy, technetium-99m methylene diphosphonate bone scintigraphy were normal. We discuss the case and the review of literature and suggest that in the evaluation of patients with an unclassified arthritis, synovial or bone biopsy should be strongly considered.
The purpose of this study was to retrospectively characterize benign and malignant prostate peripheral zone tissue by using endorectal MRI and 3D ¹H MRS. Fifty-two men with untreated biopsy-proven prostate cancer underwent combined endorectal MRI and MRSI. Whole-mount step-section histopathologic analysis constituted the reference standard. Biopsy correctly detected 74 locations; MRI correctly detected 72 locations; MRS correctly detected 72 locations; MRI + MRS correctly detected 78 locations. Cohen's test showed that biopsy had a lower degree of agreement with histology than MRI + MRS combined. The ratio of [(Cho + Cr)]/Cit correlates with the pathologic Gleason score. The addition of 3D¹H MRSI to MRI can improve diagnosis of prostate cancer contributing indirectly to improve local staging. In addition, the correlation between metabolic 3D¹H MRSI data with pathological Gleason grade may offer a non-invasive means to better predict prostate cancer aggressiveness.
Esophageal inflammatory fibrous polyps are extremely rare benign neoplasms. The manuscript illustrates a case of a man complaining of pyrosis and gastroesophageal reflux symptoms. Diagnostic work-up showed an expansive lesion of the distal esophagus simulating malignancy but with negative, repeated, multiple biopsies. The considerable size of the lesion, and the suspicion of a malignant tumor because of the presence of ulceration, indicated esophagectomy with extensive lymphadenectomy and intrathoracic esophagogastroplasty. The diagnosis of inflammatory polyp of the esophagus was achieved postoperatively. The Discussion deals with a review of the literature and considers the performed operation a good choice considering the hypothesis of a malign neoplastic evolution of this lesion.
Our study suggests that by using image fusion between colour-Doppler TRUS and endorectal MRI, it is possible to improve the accuracy of pathological staging in patients who are candidates for radical prostatectomy.
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