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Background Kidney cancer is a lethal neoplasm that affects several thousands of people every year. Renal cell carcinoma (RCC) is the most common histologic type. Recent developments in the therapeutic approach include antiangiogenic targeted approaches and Immunotherapy. Thus, the therapeutic algorithm of RCC patients and the survival outcomes have changed dramatically. Methods Herein we present a retrospective study of the patients treated in our Department with an antiangiogenic agent -Axitinib, a tyrosine kinase inhibitor- as a third or further line treatment. Statistical analysis was performed with SPSS, including the available clinicopathological data of the patients included. Results Axitinib was found to be active in patients who received this treatment beyond second line. The toxicity profile of this regimen did not reveal any unknown adverse events. Conclusions Our real world data reflect that axitinib is a safe and effective option, even beyond the second line.

Gallbladder duplication can present a clinical challenge primarily due to difficulties with diagnosis and identification. Recognition of this anomaly and its various types is important since it can complicate a gallbladder disease or a simple hepatobiliary surgical procedure. The case report of a 63-year-old woman who presented with cholangitis and underwent a successful laparoscopic management of symptomatic gallbladder duplication is described, emphasizing several important considerations. Using ERCP, MRCP and 3D reconstructions the two cystic ducts with one common bile duct were identified. A review of the literature in referral of this variant, its anatomical classifications and significance to clinical and surgical practice is included. In conclusion, gallbladder anomalies should be anticipated in the presence of a cystic lesion reported around the gallbladder when evaluating radiologic studies. In case of surgery, preoperative diagnosis is essential to prevent possible biliary injuries or reoperation if accessory gallbladder has been overlooked during initial surgery. Laparoscopic cholecystectomy remains feasible for intervention can be safely done and awareness is necessary to avoid complications or multiple procedures.

e16527Background: NAC prior to radical cystectomy (RC) with MVAC or GC represents a standard for non-metastatic MIBC. DDGC has shown similar efficacy and favorable toxicity to DDMVAC in metastatic ...

Multiple myeloma (MM) is characterized by the presence of four different patterns of marrow involvement on Magnetic Resonance Imaging (MRI): focal, normal, diffuse and variegated. Diffusion-Weighted Imaging (DWI), which derives its contrast mainly from differences in the diffusivity of water molecules in tissue, with calculation of Apparent Diffusion Coefficient (ADC) values may be used as an adjunct method to increase diagnostic confidence of MRI. This technique has, so far, been applied to a small number of MM patients with promising early results for initial assessment and prognosis. The aim of this prospective study was to evaluate ADC values in a large number of MM patients and establish mean values for each MRI pattern, in search for a more precise MRI technique, which may serve as yet another prognostic tool for this disease. Between 2012 and 2014, 99 patients with newly diagnosed, untreated MM (52M/47F, median age 65 years; range 37-89 years) underwent MRI of the thoracic and lumbosacral spine, including DWI: 34/99 had anemia (Hb 2 mg/dL) and 13/99 patients had LDH >250 U/L. The same MRI protocol was applied to 16 healthy, gender and age-matched controls to calculate mean ADC values of normal bone marrow. DWI of the lumbosacral spine was performed with an Echo Planar Imaging sequence using 5 b -values (0, 150, 250, 500, 750 sec/mm2) and ADC maps were generated. In MM patients with a normal or a diffuse MRI pattern, as well as in healthy controls, region of interest (ROI) measurements were obtained on the ADC map from each of the five lumbar vertebral bodies avoiding the region of the basivertebral vessels and any focal non-myelomatous lesion and the mean ADC value was calculated. In MM patients with a focal pattern, ROIs were placed on several focal lesions and the highest ADC value was recorded; in these patients an additional ROI was placed on an uninvolved vertebra in order to record the ADC value of apparently normal bone marrow. Based on visual assessment of T1-weighted images, 21 MM patients had focal, 26 diffuse, 3 variegated and 49 normal MRI pattern. Mean ADC values (±SD, x10-3 mm2/sec) of the bone marrow in MM patients were: 0.360±0.110 (range: 0.153-0.593) for the normal MM pattern, 1.046±0.232 (range: 0.715-1.536) for the focal MM pattern and 0.770±0.135 (range: 0.552-1.017) for the diffuse MM pattern. Mean ADC value of apparently normal marrow in patients with a focal MM pattern was 0.415±0.108 (range: 0.113-0.589), while that of healthy controls was 0.325±0.135 (range: 0.152-0.542). One way analysis of variance (ANOVA) showed a significant difference in ADC values within the groups of the study (p To our knowledge, this is the first study that evaluates and compares ADC values in the different MRI patterns of MM. We have shown that ADC values of MRI myeloma patterns differ significantly. DWI, by providing a quantitative means of assessing bone marrow involvement, assists the interpretation of other MRI sequences and improves the accuracy of pattern assignment. Disclosures Terpos: Amgen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Honoraria, Membership on an entity's Board of Directors or advisory committees, Other: travel expenses; Celgene: Honoraria, Other: travel expenses; Novartis: Honoraria. Dimopoulos:Genesis: Honoraria; Janssen-Cilag: Honoraria; Celgene: Honoraria; Novartis: Honoraria; Janssen: Honoraria; Amgen: Honoraria; Onyx: Honoraria.

Diffuse MRI pattern of marrow involvement correlates with poor prognosis in patients with multiple myeloma (MM) both in the conventional chemotherapy and novel agent era. Sometimes the differentiation of diffuse from normal MRI marrow involvement in MM patients is difficult, particularly in cases of anemia and of low plasma cell marrow infiltration. Diffusion-Weighted Imaging (DWI) is an MRI technique which is based on differences in the diffusivity of water molecules in the respective tissue. Quantitative analysis of DWI can be achieved by calculating the Apparent Diffusion Coefficient (ADC) values from images with two or more different diffusion weightings. There are very limited data in the literature regarding ADC values in MM patients and almost no data for the ADC values in patients with different MRI patterns of marrow involvement. Thus our objective was to calculate and compare ADC values in newly diagnosed patients with MM, to identify possible differences among diffuse, focal, and normal MM MRI patterns and to establish, if possible, a threshold value which might distinguish diffuse from normal MRI patterns. We evaluated 44 patients (18M/26F, median age 66 years; range: 37-89 years) with newly diagnosed, untreated, MM patients and 16 healthy, gender and age-matched controls, with MRI of the lumbosacral spine, using a 1.5 Tesla unit. Conventional MR images were obtained according to bone marrow MRI protocols; MRI patterns of involvement were normal in 22, focal in 11 and diffuse in 11 patients. DWI was obtained with an Echo Planar Imaging sequence using 5 b-values (0, 150, 250, 500, 750 sec/mm2). In MM patients with a normal or a diffuse pattern, as well as in healthy controls, region of interest (ROI) measurements were obtained from each of the five lumbar vertebral bodies avoiding the region of the basivertebral vessels and any focal non-myelomatous lesion and the mean ADC value was calculated. In MM patients with a focal pattern, ROIs were placed on several focal lesions and the highest ADC value was recorded; in these patients an additional ROI was placed on an uninvolved vertebra in order to record the ADC value of apparently normal marrow. Mean ADC values (±SD, x10-3 mm2/sec) were: 0.346±0.107 (range: 0.186-0.544) for the normal MM pattern, 1.188±0.359 (range: 0.715-2.015) for the focal MM pattern and 0.821±0.149 (range: 0.642-1.017) for the diffuse MM pattern [Figure]. Mean ADC value of apparently normal marrow in patients with a focal pattern was 0.403±0.142 (range: 0.113-0.589), while that of healthy controls was 0.325±0.135 (range: 0.152-0.542). One way analysis of variance (ANOVA) showed a significant difference in ADC values within the groups of the study (p We conclude that normal, focal and diffuse MRI patterns of marrow involvement in patients with MM have distinct ranges of ADC values on DWI. An ADC value above 0.593×10-3 mm2/sec is diagnostic of diffuse myelomatous infiltration of the bone marrow with extremely high accuracy and can be used in cases where diffuse pattern cannot be differentiated from normal pattern in conventional MRI. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

A 27-year-old drug-abuser presented with tachypnoea, sinus tachycardia, and hypotension (systolic blood pressure 86 mmHg). He had been stubbed with >20 table-knife punctures at his left axillary area ( Panel A ) at a street brawl 1h before. His jugular veins were prominent, he had pulsus paradoxus, and 86% O2 saturation at blood gases. He was not bleeding …