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Aggressive angiomyxoma (AAM) is a rare benign tumor that arises from connective tissue, prominently located in the vulva, vagina, perineum, and pelvis and is mainly found in women aged about 20-40 years old. Giant intraabdominal tumors have rarely been described. These tumors develop slowly over time and are often difficult to diagnose due to various clinical findings, especially in the early stages. Even though surgery is the primary treatment method, the possibility of complete resection is sometimes limited because the tumor tends to infiltrate nearby structures, leading to local recurrence. Only about 10% of AAM cases can be accurately diagnosed before treatment, which causes ineffective outcomes. This article demonstrates a case of giant intra-abdominal AAM precisely diagnosed by suspicious signs on CT and MRI scans before starting treatment.

The computerized tomography (CT) used for target volumes contouring is an essential step of the radiotherapy process. The CT technical factors must be adapted to explored organs and anatomic regions : data acquisition parameters and reconstruction algorithm, digestive or intravenous contrast. The choice of these parameters and its consequences for contouring are discussed. Respiratory motion must be considered for some organs. Helical CT allow a data acquisition during one apnoea. Knowledge of these technical factors is essential for good contouring and for the future use of multiple row detectors. Precise exams protocols depending on lesions, on treatment methods and patients are demanded. Close cooperation between radiation oncologists, physicists and radiologists is not only a wish but becomes a necessity. [Copyright &y& Elsevier]

Objectif La radiothérapie stéréotaxique hépatique avec tracking requière l’implantation de marqueurs fiduciels intrahépatiques. Nous rapportons ici notre expérience et décrivons une nouvelle méthode d’implantation. Matériel et méthodes Nous avons implanté 1444 marqueurs fiduciels, 834 simples, 610 liés, chez 328 patients pour le traitement de 424 lésions hépatiques. Deux méthodes d’implantations ont été comparées: la méthode standard, qui consiste en une implantation de marqueur fiduciel par marqueur fiduciel et la méthode en cube consistant à implanter deux paires de marqueurs fiduciels liés de manière à former deux arrêtes d’un cube au centre duquel se situe la tumeur. Nous avons utilisé la méthode standard de mai 2007 à mai 2010 chez 153 patients (631 marqueurs fiduciels non liés) et la méthode en cube chez 175 patients d’avril 2010 à mars 2013 (813 marqueurs fiduciels, 610 liés et 203 non liés). Résultats La durée d’intervention était plus courte avec la méthode en cube (46 contre 61 min ; p < 0,0001). Le nombre médian de points d’insertion cutanés et sous capsulaires était plus faible avec la méthode en cube (respectivement deux contre quatre; p < 0,0001). Les taux de complications (totales, sévères et mineures) étaient significativement plus bas avec la méthode d’implantation en cube qu’avec la méthode standard (5,7 contre 13,7 % p < 0,013). Les complications graves ne sont survenues qu’avec la méthode standard. Les taux de succès d’implantation étaient de 98,9 % avec la méthode en cube contre 99,3 % avec la méthode standard. Conclusion Nous proposons ici une nouvelle technique de pose de marqueurs fiduciels intrahépatiques reposant sur l’utilisation de marqueurs fiduciels liés permettant moins de points d’entrée et un temps plus court d’implantation. Cette technique est moins sujette à des complications et la migration des marqueurs fiduciels. [ABSTRACT FROM AUTHOR]

Background: The incidence of atypical ductal hyperplasia (ADH) is increasing due to mass screening. Because of the underestimation risk of malignancy, the management remains controversial. Our goal was to analyze clinicopathologic features of patients with ADH diagnosed on directional vacuum-assisted biopsy (DVAB). The objectives of this continuous retrospective study were to evaluate the underestimation rate of malignancy and to identify predictors of upgrade to carcinoma. Methods: Between 2003 and 2010, 3159 patients underwent stereotactic DVAB in our institute. We retrospectively evaluate clinical, mammographic and pathological features of 298 cases of ADH who underwent surgical excision in our center (93.1%). Patients with concurrent history of breast cancer, intraductal carcinoma (DCIS) associated, or with no follow-up or surgical excision on place were excluded. Histological scar of macrobiopsy was systematically searched in surgical specimens. A pathologic upgrade was defined by presence of invasive cancer or DCIS on surgical specimen. Statistical tests used were the chi-square or Fisher's exact test. Results: Among the 298 studied DVAB, 224 ADH were isolated (75.2%), 46 associated to flat epithelial atypia (15.4%) and 28 to lobular neoplasia (9.4%). 98.4% patients presented microcalcifications at diagnosis. In 52 cases, lesions were upgraded to DCIS (n = 38) or invasive cancer (n = 14). The underestimated rate was 17.5%. In 67.3% cases, upgrade lesions were low or intermediate grade DCIS. Only the history of contralateral breast cancer was significantly correlated with the underestimated rate (p = 0.04). There was no statistical difference between these 52 cases and the 246 others for: family history, size of calcification, sampling number, histological lesion, and quality of calcifications removal. Conclusions: In this study, DVAB may not be considered a therapeutic procedure in case of ADH, even in the case of complete removal of microcalcifications. It is still challenging to identify a subgroup of ADH cases with a low upgrade rate. [ABSTRACT FROM AUTHOR]