Angiofollicular lymph node hyperplasia is a disease of unknown etiology in which two distinct histologic forms are recognized: the hyalin vascular and the plasma‐cell types. Up to the current time only a few multicentric cases have been described. The authors describe an unusual case of the multicentric type, which furthermore showed an excellent response to low dosis radiotherapy. Complete, lasting remission was induced and the patient became asymptomatic.

The growing relevance of prostate carcinoma in the developed world requires serious attention to focus on the risk-benefit relationships of the treatments used. Given the increasingly complex therapeutic approach to prostate carcinoma, an extensive range of knowledge is required. Androgen deprivation plays a central role in this disease. The management of androgen deprivation-derived toxicity in the form of hot flashes, metabolic syndrome, osteoporosis, cognitive disorders, etc., is of growing interest. The drug treatment of hot flashes involves hormone management that is not without oncological risk and moreover generates considerable toxicity. Antidepressants in turn play an important role in the non-hormone treatment of this disorder. Trazodone, a serotonin reuptake inhibitor/5-HT2A receptor antagonist affording more selective action upon the receptors implicated in hot flashes, could be of great interest. Trazodone shows great affinity for the 5-HT2A receptors and moderate affinity for the 5-HT1A receptors. Serotonin (5-hydroxytryptamine, or 5-HT) levels are known to be lowered in postmenopausal women, and normalize when replacement therapy is provided. This suggests that abrupt sexual hormone deprivation gives rise to a reduction in blood serotonin - with a subsequent increase in its hypothalamic 5-HT2A receptors. These receptors would be implicated in the physiopathology of hot flashes; as a result, the blocking of such receptors is one of the principal therapeutic measures. The use of trazodone, increasing the serotonin concentrations and blocking the 5-HT2A and 5-HT1A receptors, could be viewed as a novel management approach more in line with the physiopathology of hot flashes. Well designed comparative studies are needed to establish the efficacy of such treatment. Other issues pending clarification would be the most effective dose and duration of treatment for controlling hot flashes.

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implantation (post-CT) using a biomechanical model-based deformable image registration (DIR) for cervical cancer brachytherapy. Materials/Methods: We retrospectively analyzed the pre-MRI and post-CT imaging in sixteen cervical cancer patients previously treated with HDR brachytherapy. For each patient, pre-MRI was registered and deformed to post-CT based on mesh controlling structures (rectum, bladder, uterus, and cervix). Prospective HR-CTV contours (HR-CTV-BT) were originally generated on the post-CT based on the physical exam, disease extension, and physician expertise. For this study, the high risk clinical target volume (HR-CTV) and gross target volume (GTV) were delineated by an expert radiation oncologist on the pre-MRI. MR-based HR-CTV and GTV were projected onto post-CT using reversed deformation vector fields, denoted as HR-CTV' and GTV', respectively. HR-CTV' and GTV' were then compared with the prospective HR-CTV-BT and scored by the same attending based on their potential utility in optimal target volume delineation on post-CT. The integrity and accuracy of the DIR algorithm was evaluated using Dice indices, mesh point difference, and center of mass (COM) difference between physician-drawn and DIR-mapped contours on the post-CT images. Results: The average dice indices (standard deviation) between the physician-drawn and the DIR-mapped structures on the post-CT image for cervix, uterus, rectum, and bladder are 0.85 (0.11), 0.89 (0.10), 0.73 (0.17), and 0.88 (0.09), respectively, indicating a relatively accurate pre-MRI deformation. Mesh point differences (in cm) for these four controlling structures have an average (maximum) of 0.14 (0.77), 0.08 (0.7), 0.10 (0.40), 0.07 (0.43), respectively, which also indicates a reliable and accurate image deformation. Differences in COM (in cm) between physician-drawn and DIR-mapped HR-CTV and GTV have an average (standard deviation) of 1.25 (0.63) and 1.12 (0.58), respectively. Upon expert review, the HR-CTV' and GTV' were found to be clinically useful (13 out of 16, 81%) and would result in either a confirmation or modification of the HR-CTV-BT for brachytherapy plans. Conclusion: Our study shows promise for the incorporation of a biomechanical model-based DIR algorithm for target volume delineation in MRI guided CT based brachytherapy for cervical cancer. Using this model, we found that 81% of the CT based prospective and treated brachytherapy volumes could have been confirmed or modified using the deformed preimplantation MRI.

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