This is the first report suggestive of CR in a face allotransplantation after immunosuppression minimization.

As duodenal neuroendocrine tumors (NETs) are rare, their optimal management has not been clearly established. The aim of this study was to evaluate the feasibility and outcome of endoscopic treatment of duodenal NETs. We reviewed the files of all patients who underwent endoscopic resection of a sporadic duodenal or ampullary NET between 1996 and 2014 at two centers. A total of 29 patients with 32 uT1N0M0 NETs < 20 mm were included. Treatment consisted of endoscopic mucosal resection in 19 cases, and cap aspiration in 13 cases. Prior submucosal saline injection was used in 15 cases. Mortality was 3 % (one severe bleeding). Morbidity was 38 % (11/29). At post-resection analysis, mean tumor size was 8.9 mm (range 3 - 17 mm), 29 lesions were stage pT1, one was pT2, and 2 were pTx because of piecemeal resection. All NETs were well differentiated. A total of 27 lesions were classified as grade 1 and 5 were grade 2. The resection was R0, R1, and Rx for 16, 14, and 2 lesions, respectively. Three R1 patients underwent additional surgical treatment, with no residual tumor on the surgical specimen but with positive metastatic lymph nodes in two cases. One patient was lost to follow-up. Finally, 24 patients were included in the follow-up analysis. The median follow-up period was 56 months (range 6 - 175 months). Two patients presented a tumor recurrence during the follow-up period. Endoscopic treatment of small duodenal NETs was associated with significant morbidity, a difficulty in obtaining an R0 specimen, and the risk of lymph node metastasis. Nevertheless, it represents an interesting alternative in small grade 1 duodenal lesions and in patients at high surgical risk.

Purpose: To characterize and compare hepatocellular carcinoma and liver metastases of colorectal metastatic cancer (CMC) by means of quantitative liver perfusion MRI. Materials and Methods:Liver perfusion was assessed in 26 HCC and CMC patients (50 nodules) by means of contrast-enhanced MRI. Six perfusion parameters-hepatic perfusion index (HPI), mean transit time (MTT), distribution volume (DV), total blood flow (F T ), arterial blood flow (F A ), and portal blood flow (F P )-were calculated in tumor nodules and the adjacent hepatic parenchyma. Results:The values of F T , F A , F P , and DV were significantly higher in the HCC than in the CMC group, whereas MTT was significantly higher in the CMC group. There was no significant difference in HPI. Arterial blood flow was higher than portal blood flow in the CMC group, while portal blood flow was slightly higher than arterial blood flow in the HCC group. Conclusion:The present work describes the use of dynamic MRI to quantitatively assess liver perfusion, which in the future may help studying liver cancers on the basis of their microvascular characteristics. BLOOD REACHES THE LIVER by two pathways: first, by the hepatic artery, which carries between 25% and 30% of the total hepatic blood flow; and second, by the portal vein carrying between 70% and 75%.The proportion between hepatic artery and portal perfusion varies according to the pathologic status of the liver. Liver cancers differ in their type of vascularization. In general, hepatocellular carcinoma (HCC), the most frequent primary malignant liver tumor (1), is hypervascular and vascularized initially by the hepatic artery. In contrast, colorectal metastatic cancer (CMC) is hypovascular. Also, the vascular architecture of the intra-cancerous mass differs from that of the surrounding liver parenchyma according to the size and differentiation grade: the cancer mass is fed by both the portal vein and the hepatic artery in the early stages, while the hepatic artery is the only source for end-stage HCC and CMC (2-9). In clinical practice, the ability to quantitatively assess liver perfusion parameters has considerable potential (10). Indeed, quantification of hepatic and portal blood flow may prove useful to study liver cancer and metastases and to assess delivery of drugs in health and diseases. For example, obtaining information about the degree of the arterial and portal contribution in the tumors vascularization may play a role in determining when to use some kinds of therapy like arterial chemoembolization and antiangiogenic therapy. Time-intensity curve analysis of MR imaging of the liver after contrast agent injection enables perfusion parameters to be estimated (11)(12)(13)(14). The aim of the present prospective study was to noninvasively quantify the differences in liver perfusion in the two most frequent groups of liver cancer, i.e., HCC and CMC, using firstpass dynamic MRI. To the best of our knowledge, this is the first quantitative comparison of perfusion parameters in these cancers to use multisli...