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Le Comité de cancérologie de l'Association française d'urologie propose une mise à jour des recommandations dans la prise en charge du cancer de la prostate (CaP) récidivé et/ou métastatique. Une revue systématique de la littérature de 2022 à 2024 a été conduite par le CCAFU concernant les éléments de prise en charge thérapeutique du CaP en récidive après traitement local ou métastatique, en évaluant les références avec leur niveau de preuve. L'imagerie moléculaire est le bilan standard de la récidive après traitement local. Sa réalisation ne doit pas retarder le traitement de rattrapage précoce. La suppression androgénique (SAd) est le pilier du traitement du CaP métastatique. L'intensification de la SAd est désormais un standard dans la prise en charge du CaP métastatique, associant au moins une hormonothérapie de nouvelle génération (HTNG). Pour les patients d'emblée métastatiques au diagnostic de haut volume, un traitement par docétaxel en plus de l'association SAd + HTNG peut être discuté pour les patients éligibles. Chez les patients avec un CaP résistant à la castration (CPRC), les inhibiteurs de PARP et radiothérapie interne vectorisée par ligands du PSMA sont de nouvelles options thérapeutiques. La combinaison et le séquençage des traitements dépendent de nombreux facteurs (caractéristiques du patient et de la maladie, lignes précédentes, statut génomique, imagerie moléculaire). Cette actualisation des recommandations françaises doit contribuer à améliorer la prise en charge des patients porteurs d'un CaP en récidive ou métastatique. The Oncology Committee of the French Urology Association is proposing updated recommendations for the management of recurrent and/or metastatic prostate cancer (PCa). A systematic review of the literature from 2022 to 2024 was conducted by the CCAFU on the elements of therapeutic management of PCa in recurrence after local or metastatic treatment, evaluating the references with their level of evidence. Molecular imaging is the standard assessment of recurrence after local treatment. It should not delay early remedial treatment. Androgen deprivation therapy (ADT) is the main stay of treatment for metastatic PCa. Intensification of ADT is now the standard treatment for metastatic PCa, involving at least one new-generation hormone therapy (ARPI). For patients with high-volume metastatic disease at the time of diagnosis, treatment with docetaxel in addition to ADT + ARPI may be discussed for eligible patients. In patients with castration-resistant PCa (CRPC), PARP inhibitors and PSMA radioligand therapy are new treatment options. The combination and sequencing of treatments depend on many factors (patient and disease characteristics, previous lines, genomic status, molecular imaging). This update of French recommendations should help to improve the management of patients with recurrent or metastatic PCa. [ABSTRACT FROM AUTHOR]

Metastatic gastrointestinal cancer is not an uncommon situation, especially for pancreatic, gastric, and colorectal cancers. In this setting, few data are available on the impact of the treatment of the primary tumour. Oligometastatic disease is associated with longer survival in comparison with more advanced disease. Metastasis-directed therapy, such as stereotactic body radiotherapy, seems related to better outcomes, but the level of evidence is low. In most tumour locations, prospective data are very scarce and inclusion in ongoing trials is strongly recommended. [ABSTRACT FROM AUTHOR]

Tumors of the Meckel cave are very rare lesions, especially if they are malignant. We report the case of a patient who presented with a breast metastasis in the Meckel cave and a clinical presentation similar to that of a fifth nerve schwannoma.

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Na cirurgia de remoção de neoplasias mamárias a obtenção de margens livres é importante para predizer a eficácia do procedimento. O objetivo deste estudo foi avaliar a relação das margens com os achados clínicos e histopatológicos de cadelas com neoplasia mamária submetidas à exérese cirúrgica. Foi realizado um estudo retrospectivo, no período de 2016 à 2020, de 169 cadelas diagnosticadas com neoplasia mamária maligna, onde foram obtidas informações quanto: avaliação das margens, localização, tamanho, apresentação clínica, grau de aderência, graduação e classificação histopatológica das neoplasias e o comprometimento de linfonodos regionais. As margens estavam comprometidas em 11 (6,5%) pacientes. As neoplasias malignas mais frequentes foram carcinoma em tumor misto (n=83; 29,64%). Pacientes com carcinoma anaplásico (n=6; 2,14%) apresentaram mais probabilidade de ter as margens comprometidas (p= 0,050), e os pacientes com adenomioepitelioma maligno (n=13; 100%), maiores chances de apresentarem as margens livres (p=0,021). Os pacientes que apresentaram os linfonodos com metástases, possuíram mais chance de as margens estarem comprometidas (p=0.041). Podemos concluir que os achados histopatológicos possuem relação com as margens cirúrgicas, enquanto os parâmetros clínicos como: localização, o tamanho, a apresentação não interferiram. Nesse estudo os pacientes acometidos com carcinomas anaplásicos apresentam uma maior chance de as margens estarem comprometidas, enquanto os acometidos por adenomioepitelioma maligno tenderam a apresentar as margens cirúrgicas livres de neoplasia.

O sertolioma é uma neoplasia testicular frequente em cães, assim como os tumores de células de Leydig e dos seminomas. O criptorquidismo é um fator de risco de alta relevância para o desenvolvimento de neoplasmas testiculares, como o tumor de células de Sertoli, visto que, do ponto de vista fisiológico, as gônadas masculinas estão em temperatura desfavorável para espermatogênese e manutenção celular normal. O presente relato de caso possui como objetivo descrever a conduta clínica, diagnóstica e terapêutica de um canino com sertolioma secundário ao criptorquidismo agravado de metástase pulmonar. O paciente apresentava sinais clínicos de hiporexia, apatia, vômitos, distensão abdominal e escurecimento repentino da pelagem. O diagnóstico definitivo foi estabelecido pela histopatologia após orquiectomia e retirada do testículo ectópico tumoral. Após 14 dias da intervenção cirúrgica, o paciente retornou para a clínica com queixa de melena, vômitos, adipsia, hiporexia, apatia e algia abdominal. Pelos resultados do exame ultrassonográfico correlacionado com a sintomatologia clínica, concluiu-se que o paciente desenvolveu pancreatite traumática secundária à manipulação visceral transoperatória. Devido ao agravamento do quadro, o paciente veio a óbito 15 dias após o procedimento. O relato de caso foi de grande importância para a equipe, pois a compreensão da enfermidade em questão e suas consequências permitem aos profissionais esclarecerem aos tutores a relevância da orquiectomia, principalmente, em animais criptorquidas.

O osteocondrossarcoma é um tumor de origem osteoide. Sua manifestação extra esquelética é rara, com uma taxa de apenas 1% em animais domésticos. Geralmente afeta órgãos viscerais, sendo extremamente raro em glândulas mamárias. O diagnóstico é complexo, baseando-se na produção de matriz condroide e óssea detectada em exames histopatológicos e interpretação morfológica. Trata-se de uma neoplasia agressiva com crescimento rápido e alto potencial de metástase, o que torna seu prognóstico reservado a desfavorável. O tamanho do tumor está diretamente relacionado ao risco de necrose, ulceração e metástase. Neste relato descrevemos o caso de uma cadela de raça SRD de 12 anos, apresentando uma massa ulcerada na mama inguinal direita e outros nódulos na cadeia mamária, observou-se edema em membro pélvico direito, foi realizada a mastectomia regional e encaminhado uma amostra para realizar exame histopatológico que constatou osteocondrossarcoma.

O câncer de colo uterino, uma das neoplasias mais comuns em mulheres, apresenta metástases em cerca de 13% dos casos no momento do diagnóstico, localizadas mais comumente em pulmão e fígado. Nesses casos, não há consenso sobre o tratamento de primeira linha, devendo-se considerar a apresentação clínica da paciente, sendo mais habitualmente utilizada a quimioterapia. É de conhecimento médico que implantes secundários de câncer colorretal e de tumores neuroendócrinos primários podem ser ressecados com segurança promovendo aumento de sobrevida do paciente. No entanto, novos estudos ainda estão sendo desenvolvidos sobre a alteração de mortalidade em casos de metástases secundárias à câncer de colo uterino. O objetivo desse artigo é relatar o caso de uma paciente com câncer cervical estadiamento IB que evoluiu com implantes pulmonares secundários sendo submetida a metastasectomia pulmonar em 2 tempos com quimioterapia adjuvante e, posteriormente, com metástases hepáticas sendo realizada segmentectomia hepática por intolerância à quimioterapia, e posterior reincidências dos nódulos hepáticos.

O aumento da expectativa de vida dos animais torna maior a incidência de neoplasmas. A neoplasia mamária está entre as enfermidades mais ocorrentes na espécie canina, sendo que 35 a 50 % das cadelas os tumores de mama são malignos. A maior importância das neoplasias malignas é a capacidade de gerar metástase, o que aumenta a possibilidade de óbito. O estadiamento clínico faz parte do atendimento oncológico, e visa estipular o prognóstico e o melhor tratamento. Sabendo-se da importância das neoplasias mamárias, objetiva-se realizar uma revisão sobre os principais aspectos desta afecção nas cadelas, bem como, prognóstico, tratamentos e terapias adjuvantes.

O carcinoma é uma neoplasia maligna podendo ser de tipo epitelial ou glandular e sendo propicio a metástase uma vez que entra em contato com o sistema linfático, podendo acometer os pulmões. Este trabalho tem como objetivo descrever um relato de caso de um cão sem raça definida acometido por nódulo em cauda, onde tutor relatou que havia surgido apenas a oito meses e animal se apresentou mais agressivo, o médico veterinário fez tratamento medicamentoso e após o tratamento o nódulo apresentou crescimento, foi solicitado exame citologia aspirativa por agulha fina que surgiu com o diagnóstico de carcinoma. Após a cirurgia, o histopatológico confirmou o carcinoma apócrino papilar, uma neoplasia de caráter maligno que é extremamente rara, mais presente na espécie felina, para tratamento de escolha foi realizada a cirurgia de caudectomia no paciente e quimioterapia.

O tumor venéreo transmissível canino é uma das neoplasias mais comuns principalmente em cães errantes, sendo classificado morfologicamente como uma neoplasia de células redondas. O presente trabalho tem por objetivo relatar um caso de tumor venéreo transmissível (TVT) metastático em uma cadela adulta sem raça definida (SRD). Na avaliação necroscópica, verificou-se a presença de neoformações na vulva/vagina, no baço e na pleura parietal, nas quais todas exibiam as mesmas características macroscópicas. Para elucidação do caso, realizaram-se exames citológicos e histológicos, com o intuito de observar padrões morfológicos semelhantes nos três tecidos analisados, sendo compatíveis com TVT. A metastização é uma complicação incomum nesse tipo de neoplasma, embora na literatura sejam encontrados relatos evidenciando a capacidade metastática do TVT, a ocorrência é com maior frequência em animais imunossuprimidos e os principais tecidos acometidos são os linfonodos regionais. Os órgãos cavitários, entretanto, também podem ser sítios de metástase, conforme averiguado no presente caso. Embora sejam raras, conclui-se que as metastizações podem ocorrer e realça-se a importância da inclusão do TVT como diagnóstico diferencial de neoplasias intracavitárias.

Implantation metastasis following stereotactic biopsy in the brain had been reported as a rare complication. A 36-years-old female patient was treated with ventriculoperitoneal (VP) shunt and stereotactic biopsy of a pineal parenchymal tumor of intermediate differentiation (PPTID) with hydrocephalus. The patient underwent five cycles of radiotherapy on the pineal area. Seven years after the procedure, the patient developed left hemiparesis with the brain MRI findings showing an enhanced mass along the biopsy tract. Craniotomy tumor removal was carried out and the pathological assessment was consistent with those of the PPTID. Radiation on metastase area and craniospinal was subsequently performed. The patient was disease-free during the 2-year follow-up assessments. The potential occurrence of implantation metastasis following the stereotactic biopsy of PPTID should be considered in the treatment plan and follow-up assessments and evaluations. Expanding the radiation area to cover the entire biopsy tract may be favorable to lower the risk of implantation metastasis.

O adenomioepitelioma é uma lesão cuja terminologia sugere ser um tumor benigno, mas observado na literatura médica com potencialidade para o aparecimento de metástases, principalmente em gânglios axilares. Os autores apresentam um caso ocorrido após a lactação. A lesão foi tratada com cirurgia local e a paciente continua em segmento contínuo.

Les manifestations cutanées et vasculaires des cancers sont nombreuses. Parmi les acrosyndromes vasculaires paranéoplasiques, nous rapportons un cas d'un syndrome des orteils bleus révélant un cancer de la prostate en analysant les causes de ce syndrome avec les données de la littérature. Un homme de 56 ans, ayant un phénomène de Raynaud des membres supérieurs depuis 2 à 3 ans, consultait pour 4 orteils bleus du pied gauche évoluant depuis 18 mois, sans ulcération, les pouls étant bien perçus. Les explorations vasculaires (écho-doppler, angio-IRM) et cardiaques étaient normales. Il n'y avait aucune anomalie biologique et immunologique, excepté une élévation des PSA. Les biopsies prostatiques confirmaient le diagnostic de carcinome prostatique et le scanner abdomino-pelvien les localisations osseuses et ganglionnaires. La révélation d'un cancer de la prostate avec métastases osseuses par un syndrome des orteils bleus est une situation rare. Devant un syndrome des orteils bleus sans anomalie clinique évidente, notamment athéromateuse, les explorations doivent comprendre la recherche d'un cancer qui peut en être révélateur. Cutaneous and vascular manifestations of cancer are numerous. Among paraneoplastic acral vascular syndrome, we report a case of blue toe syndrome as the first manifestation of a prostate cancer following with analysis of this syndrome according literature. A 56-year-old man, with Raynaud's phenomenon of the upper limbs for 2 to 3 years, had 4 blue toes of the left foot evolving for 18 months, without ulceration, the pulses being present. Vascular and cardiac explorations (ultrasound, angio-MRI) were normal. There was no biological or immunological abnormality except an elevated PSA level. Prostate biopsies confirmed diagnosis and abdomino-pelvic CT scan proved the bone and lymph node metastasis. The revelation of a prostate cancer with bone metastases by a blue toe syndrome is a rare situation. In a patient with a blue toe syndrome with no obvious clinical or biological abnormality, especially atheromatous, investigations should include a search for cancer, which can be revealed by blue toes. [ABSTRACT FROM AUTHOR]

Introduction: Lymph node metastasis is a well-known prognostic factor for laryngeal carcinoma. However, current nodal staging systems provide limited information regarding prognosis. Additional parameters should be considered to improve prognostic capacity. Objectives: To assess the prognostic values of metastatic lymph node number, ipsilateral/contralateral harvested lymph nodes, and lymph node ratio in patients undergoing surgical treatment of laryngeal squamous cell carcinoma. Methods: Seventy-four patients diagnosed with laryngeal squamous cell carcinoma primarily managed surgically were included in this study. The patients’ pathological and survival data were obtained from their medical records. The effects of harvested lymph nodes and lymph node ratio on disease-free survival, disease-specific survival, and overall survival were analyzed. Results: Ipsilateral, contralateral, and bilateral evaluations of harvested lymph nodes showed no significant associations with prognosis. Lymph node ratio was significantly associated with overall survival when evaluated bilaterally. Metastatic lymph node number showed more suitable stratification than TNM classification. Conclusions: Metastatic lymph node number and bilateral lymph node ratio parameters should be taken into consideration to improve the prognostic capacity of TNM.

Le recours à une biopsie vertébrale reste très fréquemment d'actualité, dans la prise en charge des patients atteints de spondylodiscites infectieuses, sans germe identifié ou métastases vertébrales, sans cancer primitif mis en évidence, afin d'obtenir une preuve bactériologique et/ou histologique de la maladie. Les services de rhumatologie qui restent complètement autonomes dans la réalisation de ces biopsies vertébrales sont peu nombreux. Nous décrivons ici une technique de biopsies vertébrales sous assistance robotisée. Celle-ci a pour objectifs d'être plus précise que les techniques actuelles, plus confortable pour le patient, et de réduire la durée moyenne de séjour des patients hospitalisés en rhumatologie. La biopsie est réalisée au bloc opératoire par un duo rhumatologue/neurochirurgien guidé par un robot. La précision de la biopsie repose sur l'acquisition de l'anatomie rachidienne tridimensionnelle par un scanner à capteur plan couplé au robot. Cette technique de biopsies vertébrales s'acquiert facilement et permet au rhumatologue d'être autonome de la première consultation au diagnostic étiologique, puis au traitement des spondylodiscites infectieuses. Cette technique est cependant dépendante de la disponibilité d'un bloc opératoire équipé. The use of a vertebral biopsy remains very frequently relevant in the management of patients with infectious spondylodiscitis without identified germs or vertebral metastases without identified primary cancer in order to obtain bacteriological and/or histological proof of the disease. There are few Rheumatology departments which remain completely independent in carrying out these vertebral biopsies. We describe here a technique of spinal biopsies under robotic assistance. This aims to be more precise than current techniques, more comfortable for the patient, and to reduce the average length of stay of patients hospitalized in rheumatology. The biopsy is performed in the operating room by a rheumatologist/neurosurgeon duo guided by a robot. The precision of the biopsy is based on the acquisition of three-dimensional spinal anatomy by a plane sensor scanner coupled to the robot. This technique of vertebral biopsies is easily acquired and allows the rheumatologist to be independent from the first consultation to the aetiological diagnosis, then to the treatment of infectious spondylodiscitis. This technique is however dependent on the availability of an equipped operating theater. [ABSTRACT FROM AUTHOR]

Objective: to evaluate and correlate the quality of life domains of patients with liver metastasis of colorectal cancer undergoing chemotherapy. Method: cross-sectional, observational study with 106 patients selected in three hospitals in southern Brazil. Data were collected using the Quality of Life Questionnaire Core 30 and Quality of Life Questionnaire Colorectal Liver Metastases, analyzed descriptively and by Spearman’s correlation test. Results: sexual life (45.08%), emotional function (43.08%) and fatigue (40.15%) had the worst scores with the Quality of Life Questionnaire Colorectal Liver Metastases. All correlations between the domains are significant, demonstrating that a domain with a low score interferes in all others. Conclusion: patients with liver metastasis from colorectal cancer undergoing chemotherapy showed changes in quality of life domains. [ABSTRACT FROM AUTHOR]

Copyright of RGO: Revista Gaúcha de Odontologia is the property of RGO: Revista Gaucha de Odontologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

RESUMO Relata-se um caso de melanoma oral disseminado em uma cadela de dois anos, com protrusão de bulbo ocular unilateral e quadro convulsivo progressivo. Os exames de imagem revelaram aumento de volume nas regiões submandibular, maxilar e cerebral, padrão nodular pulmonar e aumento das dimensões ovarianas. A citologia da massa submandibular indicou proliferação epitelial maligna, enquanto a biópsia excisional foi sugestiva de melanoma amelanótico. Na necropsia, havia uma massa gengival localmente infiltrativa e nodulações brancas nos linfonodos, nos rins, no pulmão, no cérebro e nos ovários, indicativas de metástase. O diagnóstico histopatológico consistiu de neoplasia maligna metastática indiferenciada, indicativo de melanoma amelanótico. Células caracterizadas por núcleo com cromatina espessa, múltiplos nucléolos bem evidentes, mitoses atípicas e multinucleações consistiram nos principais critérios de malignidade. No espaço peritrabecular ósseo facial, havia rara diferenciação pigmentar melanocítica, confirmada histoquimicamente pela técnica de Fontana-Massom e Giemsa. Algumas células foram positivas pela imuno-histoquímica para PNL-2 e Melan-A, e o diagnóstico de melanoma amelanótico disseminado foi firmado. A indiferenciação neoplásica marcante, com disseminação metastática multissistêmica e acometimento mútuo de sítios anatômicos pouco comuns, conjuntamente com a ampla variação dos padrões celulares, foi responsável pelo desafio diagnóstico do presente caso, ressaltando o papel decisivo da imuno-histoquímica para confirmação diagnóstica. A importância clínica deste trabalho consiste ainda em alertar a comunidade clínica e científica acerca da dificuldade diagnóstica, devendo-se considerar o melanoma amelanótico como diferencial mesmo em casos de lesões orais menos perceptíveis e/ou desprovidas de pigmentação.

Introduction: Nasopharyngeal carcinoma, an epithelial-derived malignant tumor which because of its anatomical location and atypical early symptoms, when diagnosed invasion and metastasis often have occurred. This requires a better understanding of the development mechanism, identifying diagnostic markers, and developing new treatment strategies. Objective: To study the relationship of LMP1 and Cripto-1 in nasopharyngeal carcinoma. Methods: The expression of LMP1 and Cripto-1 in specimens obtained from nasopharyngeal carcinoma patients (n = 42) and nasopharyngitis patients (n = 22) were examined. The expression of LMP1 and Cripto-1 in LMP1-negative and LMP1-positive (CNE1-LMP1) cells were also examined. Results: The expression of LMP1 and Cripto-1 was significantly higher in nasopharyngeal carcinoma than in nasopharyngitis (p

RESUMO Meningiomas são os principais tumores primários do sistema nervoso central (SNC) que afetam cães e gatos. Na maioria dos casos, são neoplasias benignas, geralmente expansivas, causando compressão do SNC, e raramente fazem metástase para outros órgãos. O presente trabalho tem como objetivo relatar a ocorrência de um meningioma microcístico com metástase pulmonar em um canino de 11 anos de idade, com sinais clínicos de andar cambaleante, compressão da cabeça contra objetos, agitação, salivação e agressividade. Na necropsia, foram observadas, no encéfalo, massas bem delimitadas pardo-avermelhadas, firmes, de aspecto granular, localizadas no córtex parietal e nos núcleos da base. Inúmeras micronodulações de aspecto semelhante foram observadas no pulmão. Histologicamente observaram-se nódulos formados por células neoplásicas fusiformes, com núcleos grandes e alongados e nucléolos evidentes, dispostas de forma frouxa, formando vacúolos e microcistos. À imuno-histoquímica, o meningioma apresentou marcação fortemente positiva para citoqueratina e negativa para vimentina. Por meio da histopatologia e da imuno-histoquímica, foi possível estabelecer a classificação histológica de meningioma microcístico, bem como diferenciá-lo de outras doenças que cursam com sinais nervosos.

Exosomes or other extracellular vesicles released from cells play an important role in cell-to-cell communication by transferring bio-information (DNA, coding/non-coding RNA, and proteins), which indicates parental cell status to recipient cells in the extracellular environment. Increasingly, evidence shows that tumor-derived exosomes mediate tumor pre-metastatic niche (PMN) remodeling to establish a supportive and receptive niche to promote tumor cell colonization and metastasis. Uptake of genetic information by target cells in the extracellular environment triggers epigenetic changes that contribute to PMN formation. Here, we provide a comprehensive overview of the current understanding of exosomes-mediated reprogramming of cells in PMN formation.

Penile metastasization is an uncommon condition, mostly derived from primitive advanced abdominal cancers, with disabling symptoms. Palliative treatment, in reason of poor prognosis patients, is frequently surgical with destructive management. We report two cases of penile metastasis, from primitive prostatic adenocarcinoma and primitive urothelial carcinoma, effectively managed with radiation treatment at our institution. A three-dimensional conformal radiation therapy with 42 Gy to the planning target volume in 14 fractions was delivered. Radiation treatment was safely delivered, with low toxicity profile and achieved adequate symptoms control without compromising genitourinary functions. Radiation therapy should be considered in management of rare penile metastases. [ABSTRACT FROM AUTHOR]

Purpose: To present the technique of combined temperature monitoring and hydrodissection of the anterior epidural space during thermal ablation in the thoracic spine.Materials and Methods: Data from 8 patients were retrieved retrospectively with thoracic spinal metastases located near the posterior wall of the vertebral body. Thermal ablation was performed with temperature monitoring and hydrodissection of the anterior epidural space.Results: Technical success, defined as a fulfilled ablation protocol without changes of the temperature of the epidural space below 10°/above 45° that could not be controlled by active hydrodissection, was 100%. The mean time to deploy the thermosensor was 19.5 ± 4.8 min (range 13-35). There was one post-operative transient intercostal neuralgia. No spinal cord or nerve root injuries arose. Two local recurrences occurred at a mean follow-up of 20 ± 9 months.Conclusion: Transosseous temperature monitoring of the anterior epidural space in the thoracic spine is a feasible technique and seems safe. [ABSTRACT FROM AUTHOR]

Although the correct diagnosis of inguinal hernias can often be made by clinical examination, there are several situations in which imaging methods represent the best option for evaluating such hernias, their content, and the possible complications. In addition, bulging of the inguinal region is not always indicative of a hernia, because other lesions, including tumors, cysts, and hematomas, also affect the region. The objective of this pictorial essay is to demonstrate what can be identified within inguinal hernias. Differentiating the types of herniated structures is of absolute importance for planning the appropriate treatment. [ABSTRACT FROM AUTHOR]

We report a patient with isolated ptosis secondary to orbital metastasis but no evidence of a neoplastic process on magnetic resonance imaging (MRI). A 69-year-old male was referred to our hospital with ptosis of the right upper eyelid and secondary frontalis muscle overaction on the left side for six months. The palpebral fissure was 3mm on the right and 16mm on the left, and levator function was 6mm and 19mm respectively. Three years previously, he had undergone surgical resection of the left lower lobe of the lung due to a T1 N0 M0 adenocarcinoma, and no recurrence had since been observed. An MRI was performed to rule out ptosis secondary to metastasis. Thyroid dysfunction and myasthenia were also ruled out. The ptosis was attributed to an isolated microvascular third nerve palsy. A standard external levator advancement was performed. Six months after the surgery, the patient presented with intense pain, minimal ptosis, edema and diplopia. A new MRI revealed an orbital metastasis measuring 2.4×1.0×1.6cm in the superior orbit, exerting mass effect on the superior rectus and the levator palpebrae superioris muscle. A positron emission tomography scan revealed a recurrence of the lung cancer with multiple bony metastases. The patient underwent chemotherapy consisting of the taxol-carboplatin protocol. Our report highlights the importance of a high index of suspicion of a neoplastic etiology in patients with mild symptoms and a history of cancer even if imaging does not initially reveal a mass or infiltration., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Les localisations métastatiques des tumeurs de vessies sont dominées par l´atteinte ganglionnaire, suivie de l´os, le poumon, le foie et enfin le péritoine. Les métastases osseuses sont situées, par ordre de fréquence, au niveau de la région thoracique, lombaire puis cervical. Le sacrum constitue un site rare de métastase osseuse, caractérisé le plus souvent par un volume tumoral élevé et donc une éventuelle chirurgie difficile. Nous rapportons ici le cas d´un patient âgé de 56 ans, diabétique sous Anti-diabétiques oraux (ADO), qui se présente en consultation pour hématurie depuis 8 mois associée à une douleur de la région sacrée depuis 2 mois. À l´examen, nous retrouvons une augmentation de volume de la région glutéale droite, associée à des signes inflammatoires (A). Une tomodensitométrie (TDM) pelvienne a mis en évidence la présence d´une formation tissulaire au niveau de la face latérale gauche de la vessie, avec des calcifications, associée à une volumineuse masse ostéolytique sacrée de 10 cm de grand axe, avec un épaississement des parties molles en regard (B). La biopsie réalisée est revenue en faveur d´un carcinome urothélial. Le patient a été adressé en oncologie pour traitement systémique.

Les métastases cutanées du carcinome indifférencié du cavum représentent une entité clinique rare, de pronostic défavorable. Nous rapportons à travers cette observation le cas d´un jeune patient de 16 ans qui présente 6 mois après la fin de sa radiochimiothérapie concomitante, pour un carcinome indifférencié du cavum, une métastase cutanée unique au niveau du scalp avec une évolution rapide et le patient est décédé un mois après le diagnostic de la métastase. Vu son pronostic sombre, le diagnostic de métastases cutanées doit toujours être évoqué devant des lésions cutanées chez les patients ayant un antécédent de cancer.

Com o progresso da medicina veterinária, ocorreu um prolongamento da vida dos animais domésticos, crescendo também a ocorrência de doenças crônicas como, por exemplo, o aparecimento do câncer. É unânime na literatura médica veterinária a importância da avaliação completa do paciente para a resolução do diagnóstico, prognóstico e terapia dos animais portadores de neoplasias. O histórico e os achados físicos consistem da localização anatômica e dos órgãos acometidos. Os sinais clínicos geralmente são inespecíficos. Anorexia/hiporexia, perda de peso e emaciação são sinais comuns às várias formas de surgimento do linfoma. O diagnóstico definitivo é efetivado pela análise citológica e/ou histopatológica dos tecidos acometidos. O presente trabalho teve como objetivo relatar um caso de um cão da raça Labrador Retriver de 8 anos de idade que se apresentava diarreico com emagrecimento progressivo, inapetência e vômito. Na palpação era notável uma consistência dura de aproximadamente 3 cm. Foi indicado exames complementares como radiografia, ultrassonografia abdominal e hemograma completo. Confirmando a presença de uma massa neoplásica na região abdominal; porém, não se soube ao certo em que órgão se localizava com suspeita de que estaria presente no baço. O cão foi encaminhado para uma cirurgia de laparotomia exploratória com possível esplenectomia. Foi observado que cerca de 75 a 80% do intestino estava acometido por lesões neoplásicas. Diversos fragmentos foram encaminhados para a histopatologia. O resultado da histopalogia concluiu um linfosarcoma de caráter maligno, apresentando metástase no pâncreas.

As evidências atuais sugerem que a cirurgia oncológica, usada no tratamento de tumores sólidos, aumenta o risco de metástase. Nesse sentido, uma ampla gama de células tumorais expressa Canais de Sódio Dependentes de Voltagem (CSDV), cujos papéis biológicos não estão relacionados à produção de potencial de ação. Nas células epiteliais tumorais, o CSDV é parte integrante de estruturas celulares denominadas invadópodes, que participam da proliferação, migração e metástase celular. Estudos recentes mostraram que a lidocaína pode diminuir a recorrência do câncer através de efeitos diretos nas células tumorais e de propriedades imunomoduladoras na resposta ao estresse. O objetivo desta revisão narrativa é analisar o papel do CSDV nas células tumorais e descrever o possível efeito antiproliferativo da lidocaína na patogênese das metástases. Foi realizada uma revisão crítica da literatura de Abril de 2017 a Abril de 2019. Os artigos encontrados no PubMed (2000 − 2019) foram analisados. Pesquisamos textos de linguagem livre e descritores MeSH‐lidocaína; canais de sódio dependentes de voltagem; células tumorais; invadópodes; estresse cirúrgico; proliferação celular; metástase; recorrência do câncer − em artigos publicados em inglês, espanhol e português. Foram selecionadas 62 publicações. Em estudos empregando animais, a lidocaína atua bloqueando o CSDV e outros receptores, diminuindo a migração, invasão e metástase. Esses estudos precisam ser replicados em humanos submetidos a cirurgia oncológica. The current evidence suggests that oncological surgery, which is a therapy used in the treatment of solid tumors, increases the risk of metastasis. In this regard, a wide range of tumor cells express Voltage‐Gated Sodium Channels (VGSC), whose biological roles are not related to the generation of action potentials. In epithelial tumor cells, VGSC are part of cellular structures named invadopodia, involved in cell proliferation, migration, and metastasis. Recent studies showed that lidocaine could decrease cancer recurrence through its direct effects on tumor cells and immunomodulatory properties on the stress response. The aim of this narrative review is to highlight the role of VGSC in tumor cells, and to describe the potential antiproliferative effect of lidocaine during the pathogenesis of metastasis. A critical review of literature from April 2017 to April 2019 was performed. Articles found on PubMed (2000 − 2019) were considered. A free text and MeSH‐lidocaine; voltage‐gated sodium channels; tumor cells; invadopodia; surgical stress; cell proliferation; metastasis; cancer recurrence − for articles in English, Spanish and Portuguese language − was used. A total of 62 were selected. In animal studies, lidocaine acts by blocking VGSC and other receptors, decreasing migration, invasion, and metastasis. These studies need to be replicated in humans in the context of oncological surgery. [ABSTRACT FROM AUTHOR]

Le cancer du sein est la première cause de décès par cancer chez la femme dans le monde. Les principaux sites métastatiques sont l’os, le poumon, le foie, le cerveau et les ganglions. Les métastases amygdaliennes sont extrêmement rares. Nous rapportons l’observation d’une patiente âgée de 48 ans suivie pour un carcinome canalaire infiltrant du sein type Luminal A depuis 2011. Le traitement initial a consisté en une chirurgie, une chimiothérapie et une hormonothérapie adjuvante. Après un intervalle libre de 5 ans, la patiente a présenté une rechute métastatique isolée au niveau de l’amygdale gauche. Une résection chirurgicale puis une chimiothérapie a été proposée. A travers ce travail nous proposons une revue de littérature sur les métastases amygdaliennes.

Nous rapportons le cas d'une patiente de 56 ans, sans antécédents pathologiques notables, ayant consulté aux urgences pour une baisse de l'acuité visuelle de l'éil droit, installée depuis 2 semaines. A l'examen ophtalmologique, on trouve une acuité visuelle réduite au mouvement de doigts, avec au fond d'éil un décollement de rétine séreux associé à une masse sous rétinienne comblant une majeure partie de la cavité vitréenne (A). Une échographie oculaire en mode B a été réalisée et a mis en évidence une masse choroïdienne isoéchogène (B) vascularisée prenant le doppler (C) sans excavation, mesurant 18 mm de grand axe associée un décollement séreux de la rétine, fortement évocatrice d'une métastase oculaire. Un bilan général a été réalisé et notamment une mammographie qui a révélé l'existence d'un nodule du sein droit stade 4 selon la classification BI RADS. Une Tomodensitométrie thoraco abdomino pelvienne, et cérébrale dans le cadre du bilan d'extension a montré la présence de nombreuses métastases cérébrale, osseuse et hépatique. Le diagnostic de cancer du sein métastatique a donc été posé, et la patiente a été référé en Oncologie pour prise en charge spécialisée. Les métastases oculaires sont les tumeurs intraoculaires les plus fréquentes. Les carcinomes mammaires représentent la principale cause des métastases choroïdiennes, justifiant un bilan exhaustif lors de la mise en évidence de ces tumeurs intra oculaires.

Fluorescence‐guided cytoreductive surgery is one of the most promising approaches for facile elimination of tumors in situ, thereby improving prognosis. Reported herein is a simple strategy to construct a novel chainlike NIR‐II nanoprobe (APP‐Ag2S‐RGD) by self‐assembly of an amphiphilic peptide (APP) into a nanochain with subsequent chemical crosslinking of NIR‐II Ag2S QDs and the tumor‐targeting RGD peptide. This probe exhibits higher capability for cancer cell detection compared with that of RGD‐functionalized Ag2S QDs (Ag2S‐RGD) at the same concentration. Upon intraperitoneal injection, superior tumor‐to‐normal tissue signal ratio is achieved and non‐vascularized tiny tumor metastatic foci as small as about 0.2 mm in diameter could be facilely eliminated under NIR‐II fluorescent imaging guidance. These results clearly indicate the potential of this probe for fluorescence‐guided tumor staging, preoperative diagnosis, and intraoperative navigation. [ABSTRACT FROM AUTHOR]

This article contains a morphological description of a case of early presentation lymphoma in a lamb, characterised by its unusual clinical history and advanced lesions. The primary tumour was located in the skin in the carpal region, and metastases were observed in the brain, right eye, all the pulmonary lobes, the myocardium and endocardium of the heart, left adrenal gland, abdominal portion of the vagal nerve, serosa of the rumen, the body of lumbar vertebra L3, and the submandibular, mediastinal and mesenteric lymph nodes. Histopathological examination revealed that it was a large cell lymphoma. Immunohistochemical analysis was carried out with antibodies for MUM1/IRF4, CD79a, CD3, CD10 and Ki67, used here for the first time as markers to characterise a lymphoma in this species. The result revealed that it was a B-cell lymphoma. [ABSTRACT FROM AUTHOR]

Background: This research examined the connection between circulating FGF21 and clinicopathological findings in papillary thyroid carcinoma. Methods: This analytical cross-sectional research was conducted on patients with papillary thyroid cancer at the Seyyed Shirazi Endocrinology Clinic in Gorgan, Iran. Laboratory data, including demographics, ultrasonography and pathology reports, and FGF21 levels, were collected. The data was analyzed with SPSS 25. Normal distribution was evaluated by using Kolmogorov-Smirnov and Shapiro-Wilk tests. Group differences were evaluated with Chi-square, independent sample t-test and Mann-Whitney U tests. A p-value less than 0.05 was considered significant. Results: In this research, 83% of patients were female, and the mean±SD age was 42.51±13.28 years old. The mean±SD and FGF21 concentrations in 49 patients were 716.41±458.7, the median was 489 pg/ml, and 24 (49%) patients were in the high FGF21 group. There was no statistically significant relation between FGF21 level and age (P=0.95), sex (P=>0.99), tumor size (P=0.68), tumor stage (P=>0.99), lymphadenopathy (P=>0.99), lymph node metastasis (P=0.24), triglycerides (P=0.93), total cholesterol (P=0.47), LDL (P=0.08), and HDL (P=0.08). However, FGF21 levels were significantly associated with fasting blood glucose (P=0.03), body mass index (BMI) (P=

RESUMO: O sistema linfático mamário de animais saudáveis e neoplásicos é pouco estudado. Inexistem respostas detalhadas quanto ao padrão de comunicação entre as cadeias linfáticas mamárias com as abdominais e pélvicas em animais sadios ou com neoplasmas na referida glândula. Por essa razão, pretendeu-se avaliar a ocorrência dessa comunicação linfática intrabdominal, verificando também se a cadeia linfática inguinoilíaca poderia ser adequadamente abordada via cirurgia laparoscópica. Para tanto, os animais foram distribuídos, de forma randômica, em três grupos cirúrgicos: pacientes submetidos à técnica de coloração linfática com o corante azul de metileno estéril (G1); animais submetidos à técnica de impregnação linfática com o corante verde de indocianina (G2); animais submetidos à técnica demarcação linfática, utilizando solução fisiológica de NaCl a 0,9% (G3). Em todos os grupos, foi realizada a aplicação intradérmica, do corante ou solução fisiológica, ao redor da mama inguinal direita, em tempos distintos de 12h ou 30min, antes da incisão de pele. Após, foram coletadas, por videolaparoscopia, duas regiões contendo tecido adiposo, laterais às artérias ilíacas interna e externas, buscando avaliar a presença e o número de linfonodos extirpardos. Por último, realizou-se a ovário-histerectomia eletiva pelos mesmos portais de acesso. Foram considerados ainda, o tempo de cirurgia e as complicações e dificuldades técnicas trans e pós-operatórias. A técnica proposta de linfadenectomia inginoilíaca intrabdominal não obteve êxito na coleta de linfonodos. As técnicas de marcação linfática realizadas, utilizando tanto o azul de metileno a 1%, como o verde de indocianina a 1%, não evidenciaram nenhuma marcação transoperatória nos tempos estudados. Em relação às complicações e dificuldades técnicas trans e pós-operatórias, observou-se, em todos os animais, reações de hipersensibilidade cutânea ao uso dos corantes. As técnicas propostas não apresentaram maiores dificuldades de execução ou complicações transoperatórias.

La localisation secondaire sous-cutanée de carcinome vésiculaire de la thyroïde est inhabituelle. Elle représente au plus 5,8% de sites métastatiques préférentielles de la thyroïde. Il s'agit d'une femme de 60 ans, présentant une énorme tuméfaction hypervasculaire du tissu sous-cutané du crâne, d'évolution lente, après 7 ans d'une lobectomie droite de la thyroïde. Le bilan anatomo-pathologique a conduit au diagnostic de carcinome vésiculaire de la thyroïde. Une intervention chirurgicale consistait à réduire la lésion du crâne ainsi qu'une thyroïdectomie a été réalisée. Actuellement, elle est en attente d'un traitement par l'iode radio-actif. La métastase de carcinome vésiculaire du scalp existe malgré que c'est rare. Toutefois, à ce stade le pronostic reste défavorable.

ABSTRACT: Meningiomas are the most frequent neoplasms involving the brain in dogs and cats, and are occasionally observed in the spinal cord. They cause compression of the central nervous system; however, do not infiltrate the neuropile and rarely metastasize to other organs. The present study describes a case of anaplastic spinal meningioma with extra neural metastasis in a 20 years-old cat. Clinically, the feline presented a clinical history of 120 days with paresis of the hind limbs and loss of the tail’s movements, with subsequent death. At necropsy, there was an irregular and soft whitish mass involving the meninges from the lumbar intumescence to the sacral region of the spinal cord. Similar white nodular masses were observed in the lungs, liver and kidneys. Microscopically, both were composed of a poorly limited and infiltrative neoplastic proliferation composed by spindle, round and epithelioid cells, with a high cellular pleomorphism. On IHC, there was a severe immunostaining for vimentin and S100. Histopathologic and IHC analysis are important tools for definitive diagnosis of meningiomas in cats, and differentiation of other common neurologic disorders in these animals.

L'objectif de cette étude rétrospective était de détailler les différents aspects épidémiologiques, cliniques, thérapeutiques et pronostiques du cancer du cavum d'emblée métastatique dans le centre Tunisien. Il s'agit d'une étude portant sur 51 patients atteints d'un cancer du nasopharynx (CNP) histologiquement prouvé et métastatique d'emblée, soit au moment du diagnostic , colligés dans les services ORL du CHU Farhat Hached de Sousse et les services de radiothérapie du centre tunisien, à savoir du CHU Farhat Hached de Sousse, et du centre médical Ibn Khaldoun de Hammam Sousse, entre Janvier 1995 et Décembre 2010. Cinquante et un patients atteints de cancer du nasopharnx, d'emblée métastatiques ont été recensés. L'âge moyen était de 49 ans. Le Sex-Ratio était de 6,2. Les métastases osseuses étaient les plus fréquentes (94,1%), suivies par les métastases hépatiques (34,6%). Sur le plan thérapeutique, la majorité de nos patients a reçu une chimiothérapie (41 patients), dont 31 en association avec une radiothérapie. Le protocole adriamycine et cisplatine a été le plus fréquemment utilisé (92,6%). Vingt patients ont eu une radiothérapie cervicofaciale à intention curative (doses d" 70 Gy), quatorze autres patients ont reçu au niveau du cavum une radiothérapie à visée symptomatique ( doses de 30Gy en 10 séances) associée à une irradiation des sites métastatiques dans 9 cas. Les survies globales à 2 ans et à 5 ans étaient respectivement de 29% et de 10%. Au stade de métastases inaugurales, le cancer du cavum est une maladie grave, rapidement mortelle malgré les avancées thérapeutiques. Au vue des données de notre étude et de celles de la littérature, la chimiothérapie à base de cisplatine et la radiothérapie cervico-faciale à doses curatives et celle des métastases a permis d'obtenir de longues survies et même des réponses complètes. Les futurs essais pourraient tester de nouvelles molécules en vue d'une intensification thérapeutique.

Introduction: Squamous cell carcinoma is the most common neoplasm of the larynx, and its evolution depends on tumor staging. Vascular endothelial growth factor is a marker of angiogenesis, and its expression may be related to increased tumor aggressiveness, as evidenced by the presence of cervical lymphatic metastases. Objectives: To evaluate the expression of the vascular endothelial growth factor marker in non-glottic advanced squamous cell carcinoma of the larynx (T3/T4) and correlate it with the presence of cervical lymph node metastases. Methods: Retrospective clinical study and immunohistochemical analysis of vascular endothelial growth factor through the German scale of immunoreactivity in products of non-glottic squamous cell carcinomas. Results: This study analyzed 15 cases of advanced non-glottic laryngeal tumors (T3/T4), four of which exhibited cervical lymphatic metastases. There was no correlation between vascular endothelial growth factor expression and the presence of cervical metastases. Conclusion: Although vascular endothelial growth factor was expressed in a few cases, there was no correlation with the spread of cervical lymph metastases.

Copyright of Pesquisa Veterinaria Brasileira is the property of Colegio Brasileiro de Patologia Animal - CBPA and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Meningiomas are the most frequent neoplasms involving the brain in dogs and cats, and are occasionally observed in the spinal cord. They cause compression of the central nervous system; however, do not infiltrate the neuropile and rarely metastasize to other organs. The present study describes a case of anaplastic spinal meningioma with extra neural metastasis in a 20 years-old cat. Clinically, the feline presented a clinical history of 120 days with paresis of the hind limbs and loss of the tail's movements, with subsequent death. At necropsy, there was an irregular and soft whitish mass involving the meninges from the lumbar intumescence to the sacral region of the spinal cord. Similar white nodular masses were observed in the lungs, liver and kidneys. Microscopically, both were composed of a poorly limited and infiltrative neoplastic proliferation composed by spindle, round and epithelioid cells, with a high cellular pleomorphism. On IHC, there was a severe immunostaining for vimentin and S100. Histopathologic and IHC analysis are important tools for definitive diagnosis of meningiomas in cats, and differentiation of other common neurologic disorders in these animals. [ABSTRACT FROM AUTHOR]

Copyright of Arquivo Brasileiro de Medicina Veterinaria e Zootecnia is the property of Universidade Federal de Minas Gerais, Escola de Veterinaria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Epithelial-to-mesenchymal transition is a cellular process associated with cancer invasion and metastasis. However, the antimetastatic effects of chimaphilin remain elusive. In this study, we attempted to investigate the potential use of chimaphilin as an inhibitor of TGF-β1-induced epithelial-to-mesenchymal transition in U2OS cells. We found that TGF-β1 induced epithelial-to-mesenchymal transition to promote U2OS cell invasion and metastasis. Western blotting demonstrated that chimaphilin inhibited U2OS cell invasion and migration, increased the expression of the epithelial phenotype marker E-cadherin, repressed the expression of the mesenchymal phenotype marker vimentin, as well as decreased the level of epithelial-to-mesenchymal-inducing transcription factors Snail1 and Slug during the initiation of TGF-β1-induced epithelial-to-mesenchymal transition. In this study, we revealed that chimaphilin up-regulated the E-cadherin expression level and inhibited the production of vimentin, Snail1, and Slug in TGF-β1-induced U2OS cells by blocking PI-3K/Akt and ERK 1/2 signaling pathway. Additionally, the TGF-β1-mediated phosphorylated levels of Smad2/3 were inhibited by chimaphilin pretreatment. Above all, we conclude that chimaphilin represents an effective inhibitor of the metastatic potential of U2OS cells through suppression of TGF-β1-induced epithelial-to-mesenchymal transition. [ABSTRACT FROM AUTHOR]

La polyadénofibromatose ou l'adénofibromatose est définie par la présence d'au moins 3 adénofibromes, uni ou bilatéraux atteignant une taille importante responsable de troubles trophiques. Nous rapportons une observation colligée au service des maladies respiratoires du Centre Hospitalier Universitaire Ibn Rochd de Casablanca. Il s'agit d'une patiente âgée de 46ans, suivie depuis l'âge de 30 ans pour une adénofibromatose bilatérale opérée à 4 reprises. Suite à un bilan préopératoire d'une mastectomie bilatérale, une radio du thorax a été réalisée objectivant un hémithorax droit opaque avec refoulement des éléments du médiastin. L'examen clinique retrouvait un syndrome d'épanchement liquidien de l'hémithorax droit et une adénopathie cervicale sus claviculaire gauche. La ponction biopsie pleurale confirmait la localisation pleurale d'un carcinome peu différencié et invasif compatible avec une origine mammaire. La bronchoscopie après évacuation pleurale objectivait un aspect infiltré de tout l'arbre bronchique, dont les biopsies concluaient au même résultat anatomopathologique. Le traitement préconisé était une polychimiothérapie. L'évolution était marquée par l'apparition de métastases hépatiques. A travers cette observation nous concluons que les adénofibromes nécessitent une surveillance régulière vu le risque de dégénérescence vers le cancer du sein qui est une cause fréquente de métastases pleuropulmonaires.

L'incidence d'apparition de métastases caverneuses après traitement radical d'une tumeur de vessie est exceptionnelle et est de l'ordre de 1%. Le délai d'apparition est en moyenne de 8 mois après la chirurgie, avec certains cas ou il arrive à 10 ans. Le diagnostic est confirmé par la biopsie qui met en évidence l'origine urothéliale. Nous rapportons ici le cas d'un patient de 56 ans, tabagique, ayant bénéficié en Janvier 2017 d'une cystoprostatectomie totale, qui consulte 2 mois plus tard pour une induration de la verge, sans autre signe associé. Le priapisme et la gangrène de la verge d'origine infectieuse ont été évoqués mais vu le contexte clinique, le diagnostic de métastase caverneuse était le plus probable. Le patient a refusé à deux reprises une biopsie, sur deux consultations à 15 jours d'intervalle (A, B). Une biopsie a été acceptée par le patient à la 3ème consultation (C, D), elle a confirmé le diagnostic de métastase caverneuse.