SUMMARY
Toward development of a precision medicine framework for metastatic, castration resistant prostate cancer (mCRPC), we established a multi-institutional clinical sequencing infrastructure to conduct prospective whole exome and transcriptome sequencing of bone or soft tissue tumor biopsies from a cohort of 150 mCRPC affected individuals. Aberrations of AR, ETS genes, TP53 and PTEN were frequent (40–60% of cases), with TP53 and AR alterations enriched in mCRPC compared to primary prostate cancer. We identified novel genomic alterations in PIK3CA/B, R-spondin, BRAF/RAF1, APC, β-catenin and ZBTB16/PLZF. Aberrations of BRCA2, BRCA1 and ATM were observed at substantially higher frequencies (19.3% overall) than seen in primary prostate cancers. 89% of affected individuals harbored a clinically actionable aberration including 62.7% with aberrations in AR, 65% in other cancer-related genes, and 8% with actionable pathogenic germline alterations. This cohort study provides evidence that clinical sequencing in mCRPC is feasible and could impact treatment decisions in significant numbers of affected individuals.
OBJECTIVE. A recent publication has drawn attention to the anterolateral ligament, a structure of the knee with which most radiologists are unfamiliar. We evaluate this structure on MRI; clarify its origin, insertion, meniscal relationship, and morphologic appearance; and identify its relationship with the Segond fracture. MATERIALS AND METHODS. A total of 53 routine knee MRI studies interpreted as normal were reviewed to characterize the anterolateral ligament. A further 20 knee MRI studies with a Segond fracture were assessed to determine a relationship between the fracture and the anterolateral ligament. RESULTS. In all 53 cases, a structure was present along the lateral knee connecting the distal femur to the proximal tibia, with meniscofemoral and meniscotibial components. This structure was somewhat ill defined and sheetlike, inseparable from the adjacent fibular collateral ligament proximally and iliotibial band distally. Aside from one case limited by anatomic distortion, all cases with a Segond fracture exhibited attachment of this structure to the fracture fragment (19/20 cases). CONCLUSION. An ill-defined sheetlike structure along the lateral knee exists attaching the distal femur, body of lateral meniscus, and proximal tibia. This structure has been referenced in the literature dating back to Paul Segond's original description of the Segond fracture in 1879. The structure is identifiable on MRI and appears to be attached to the Segond fracture fragment. For the radiologist, it may be best to forgo an attempt to separate this structure into discrete divisions, such as the anterolateral ligament, because these individual components are inseparable on routine MRI.
A detailed understanding of the intricacies of the distal radius fracture is necessary for the radiologist to provide a clinically relevant description.
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