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Purpose The purpose of this study was to evaluate the usefulness of contrast-enhanced ultrasonography (CEUS) in the bioptic sampling of soft tissue tumors (STT) compared with unenhanced ultrasonography alone. Methods This is a prospective longitudinal study of 40 patients subjected to ultrasonography (US)-guided core needle biopsy (CNB) to characterize a suspected STT. Three series of bioptic samplings were carried out on each patient, respectively using unenhanced US alone and CEUS in both the areas of the tumor enhanced or not by the contrast medium. All bioptic samples underwent a histological evaluation and the results were analyzed by comparing the histology of the biopsy with the definitive diagnosis in 15 surgically excised samples. Results 27 (67.5 %) of the 40 patients completed the entire study procedure; in 19 cases (70.3 %) the three bioptic samplings gave unanimous results, also when compared to the surgical specimen; in seven cases (25.9 %) use of CEUS allowed to obtain additional or more accurate information about the mass in question, compared to simple US guidance without contrast; in one patient (3.7 %) sampling obtained using unenhanced ultrasonography guidance and in the areas enhanced by the contrast agent had precisely the same results of the surgical specimen. Conclusions CEUS, due to its ability to evaluate microvascular areas, has proven to be a promising method in guiding bioptic sampling of soft tissue tumor, directing the needle to the most significant areas of the tumor. Given the small number of patients evaluated in our study, to achieve statistically significant results, it would be appropriate to obtain a larger sample size, since the very first results seem to be encouraging and to justify the increase of the population.Keywords Contrast-enhanced ultrasonography Á Soft tissue tumors Á Core needle biopsy Riassunto Scopo Lo scopo di questo studio è stato quello di valutare l'utilità dell'ecografia conmdc (CEUS) rispetto alla ecografia tradizionale, nel prelievo bioptico dei tumori dei tessuti molli (STT). Metodi si tratta di uno studio longitudinale prospettico di 40 pazienti sottoposti ad ago-biopsia ecoguidata (US-CNB) per la caratterizzazione di un STT sospetto. Sono stati prelevati 3 campioni bioptici su ogni paziente, utilizzando ecografia b-mode e CEUS sia nelle aree del tumore non evidenziate dal mezzo di contrasto che in quelle dotate di contrast-enhancement. Tutti i campioni bioptici sono stati sottoposti a valutazione istologica e sono stati analizzati i risultati confrontando l'istologico della biopsia con i 15 campioni asportati chirurgicamente, con diagnosi definitiva. (2015( ) 18:335-342 DOI 10.1007 Risultati 27 (67,5%) dei 40 pazienti hanno completato l'intera procedura di studio; in 19 casi (70,3%) i tre campioni bioptici hanno dato risultati unanimi, anche rispetto al modello chirurgico; in 7 casi (25,9%) l'uso della CEUS ha permesso di ottenere informazioni supplementari, o più precise, circa la massa in questione, rispetto al semplice esame ecografico ...

Pigmented villonodular synovitis (PVNS) is a rare pre-malignant disease that require aggressive treatment as surgical synovectomy, eventually followed by radiosynovectomy. Nevertheless, the disease often reoccurs after these treatments. To determine the safety and efficacy of intra-articular (IA) TNF-a blockade with etanercept (ETN), before extended arthroscopic synovectomy, in severe PVNS of the knee, two patients, (a 26-year-old man with B27+ undifferentiated spondylarthropathy and a 32-year-old femal with seronegative olygoarthritis), affected by diffuse knee PVNS (diagnosis made by histological examination), resistant to IA corticosteroid injections and to repeated arthroscopic synovectomy, were submitted, after protocol approval by human research committee and patient’s written informed consent to intra-articular etanercept (IA-ETN) treatment with a different dosage schedule: 12.5 mg weekly IA-ETN injection for 4 weeks, followed by extended arthroscopic synovectomy and of 25 mg IA-ETN injection for 4 weeks, respectively. Previous DMARDs treatment was continued in stable appropriate doses. Any adverse events were recorded throughout the study. The following parameters were considered as clinical endpoints: 1) Knee Joint Index (KJI: range 0-14); 2) Thompson index (THI: range 0-9) At the study entry and at the end of follow-up, high frequency ultrasound grey scale synovial thickening (US-ST) was also assessed. No adverse events were observed due to IA-ETN and to arthroscopic synovectomy. Marked improvement of knee disease activity over time and sustained functional recover was obtained. US-ST evaluation before treatment initiation and at the end of follow-up confirmed the regression of knee joint synovial proliferatio

Essential criteria for the radiologic evaluation of LAGB are: position of port and tubing; stoma size; and volume of each upper gastric portion.

A 30-year-old woman was referred to the Veneto Institute of Oncology (Padua, Italy) for a painful and fast-growing large mass in the triceps muscle of the left arm. The patient presented with semiflexion of the forearm and flexion of the hand because this position avoided the onset of pain. At physical examination, a mass with a diameter of 5 × 5 cm, hard, painful, and fixed inside the triceps muscle was found. One of the lymph nodes of the ipsilateral axilla was enlarged. Contrast-enhanced computed tomography (CT) of the limb showed a solid hyperdense oval lesion of 45 × 32 × 42 mm without welldefined margins and vascular infiltration (Fig. 1a). A fineneedle aspiration biopsy was performed on the mass. The final diagnosis was metastasis of melanoma. An ultrasound scan of axilla identified a lymph node highly suspicious for malignancy and fine-needle aspiration cytology confirmed the presence of cells of melanoma.A full skin examination and dermoscopy were also negative. Serum protein S-100B was elevated to 3.74 μg/l (normal range 0-0.1 μg/l); serum lactate dehydrogenase was normal. Whole-body staging with brain, chest, and abdominal CT scan showed three hepatic hemangiomas.The patient was diagnosed as stage III of melanoma of unknown primary (MUP). The clinic case was discussed at the multidisciplinary melanoma meeting. The primary limbsparing surgery was not considered possible because of the massive infiltration of triceps muscle and its compression/ infiltration of the artery and radial nerve. The biopsy was then tested for the BRAF mutation. The BRAF sequencing indicated a V600E mutation; therefore, this patient was eligible for treatment with the BRAF inhibitor dabrafenib. In case of dabrafenib failure, this patient was evaluated for chemotherapy or ipilimumab plus radiotherapy. The patient was started on dabrafenib (150 mg) orally twice a day. During treatment, the metastatic triceps mass and the axillary lymph node were clinically regressed, not painful, and palpable with difficulty, and the patient had a normal position of the arm. After 3 months of dabrafenib treatment, the brain, thoracic, and abdominal CT scan were still negative. The upper limb CT scan confirmed a reduction in the metastatic mass and vascularization (about 24 × 20 × 25 vs. 45 × 32 × 42 mm) (Fig. 1b). The clinical case was discussed again and the opinion was that the patient could be eligible for conservative surgery, which consisted of partial resection of triceps muscle with clear macroscopic margins and axillary lymph node dissection ( Fig. 2a and b). The histological report showed two lymph node metastases out of 41 examined lymph nodes and a solid tumor nodule without necrosis of 20 mm diameter.This neoplastic nodule showed infiltrative margins into the skeletal muscle with foci of lymphocytic inflammation at the periphery of the lesion and few areas of necrosis, and it was not surrounded by a capsule; the margins were clear (Fig. 3). Four weeks after surgery, protein S-100 was normalized and it was decided to start adjuvant low-...