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Due to their small size, numerous cellular divisions of the still growing and developing tissues and organs, as well as a longer life expectancy, children are approximately three times more sensitive to the same doses of ionizing radiation than adults. This is especially the case with the computerized tomography (CT) examinations, which despite making only 17 % of the ionizing radiological examinations, account for as much as 49 % of the total patient irradiation. Because of this, the Image Gently campaign in the early 2010s was thinking about abandoning the CT examinations in pediatric radiology and replacing them with the ultrasound or magnetic resonance imaging as the methods of choice. The appearance of Flash CT technology, which simultaneously shortens the recording time and reduces radiation doses, has led to the abandonment of this way of thinking. This is also supported by the fact that, on the one hand, CT examinations are practically irreplaceable in the cases of trauma, while on the other hand, children, as well as members of all the other age groups, are constantly exposed to a smaller or larger amount of the environmental ionizing radiation (Earth, space, airplanes). In this sense, it is increasingly recommended to use the low dose CT (LDCT) techniques individually adapted to each patient, due to their small amount of ionizing radiation. On this track, we have tried to make a review of the latest findings on the mentioned problem based on the scientific papers published over the past three years (2016-2018). They show that the CT examinations are not only abandoned in the pediatric radiology, but that on the contrary, in the cases of numerous indications LDCT examinations make the gold standard. [ABSTRACT FROM AUTHOR]

Aim: Primary vaginal cancer is rare, comprising about 3% of all gynaecological malignancies. Solitary bone metastases to appendicular skeleton are extremely rare and there are only few published reports. We report the case of isolated metastasis in the tibia as a feature of primary squamous vaginal carcinoma. We present this case because of its rarity and for documentation and discussion purposes. Case report: We present a case of a 44-year old woman diagnosed with squamos vaginal cancer in June 2015. Computed tomography of the thorax, abdomen and pelvis revealed no distant metastases. She was treated with interstitial intracavitary brachytherapy and concomitant chemoradiotherapy. In March 2016 she was admitted to our hospital because of the swelling and the pain in the lower right leg. There was no history of trauma and plain radiographs were normal. Two months later, after further progression of pain, plain radiographs showed intramedullary permeative bone lesion with cortical disruption of tibial dyaphisis and local soft tissue swelling. MRI and core needle biopsy confirmed vaginal cancer metastasis containing tumor cells identical to the primary tumor. The patient was treated with radiotherapy and chemotherapy. Despite the treatment there was further progression of the disease with multiple bone metastases and eventually lung and brain metastases. Conclusion: This case report is another reminder that although extremely rare, solitary metastatic bone lesions of vaginal cancer are possible. Since symptoms mimic various benign conditions, it is important to consider bone metastasis as possible diagnosis in patients with progressive bone pain not responding to analgesic treatment. [ABSTRACT FROM AUTHOR]

CT urography (CTU) is an imaging method tailored specifically for the evaluation of the upper urothelial tract and urinary bladder. High diagnostic accuracy in detecting primary and recurrent urothelial tumours, their differentiation from benign lesions, anatomic variation and malformation characterization, and evaluation of important pathology in the surrounding tissues, renders CTU a valuable imaging study of the urothelial tract. Haematuria, initial staging and post treatment follow up of upper urinary tract and bladder malignancies are the most important indications for CTU. Triple phase and split bolus techniques are most commonly used CTU protocols that consist of a non-contrast, nephrographic, and excretory phase, obtained by three or two acquisitions. CTU scanning protocols are tailored to achieve adequate image quality with optimal opacification and distension of the urinary tract at the lowest achievable radiation dose within the range of 5-15 mSv, comparable to the doses of intravenous urography. Detailed patient history, clinical examination, and urine analysis are essential for proper patient selection and targeted CTU protocol, which are the most important tools for increasing diagnostic accuracy and lowering patient radiation dose of CT urography. [ABSTRACT FROM AUTHOR]

Breast carcinoma is the most common malignant disease in the female and one of the leading causes of death among women worldwide. Chronic inflammation and immunosuppressive environment achieved by the interaction of tumour and infiltrating immune cells are the hallmarks of cancers, including breast cancer. Natural killer cells are one of innate immune cells in tumour bed that possess great antitumour potential due to their ability to kill tumour cells without prior sensitization. They also play an important role in priming of type I immune responses and are considered to be main source of Interferon-γ. Unfortunately, antitumour activity of natural killer cells is often suppressed by proinflammatory cytokines secreted in tumour microenvironment and suppression of NK cells activity often correlates with therapy response and general outcome of patient with breast carcinoma. Different types of breast cancer are associated with different subsets of natural killer cells that possess different immunoregulatory function. Identification of specific tumour associated natural killer cell subset endowed with different functional capabilities might help practitioners in therapy decisions, therapy response monitoring, as well as in predicting overall prognosis of breast cancer patients. The purpose of this review is to give an overview of natural killer cells and their subsets, their role in pathogenesis of breast cancer and to discuss NK cells as potential useful therapy and prognostic tool for breast carcinomas. [ABSTRACT FROM AUTHOR]

Magnetic resonance imaging (MRI) is not the initial imaging technique in pediatric abdominal neoplasms, but it is an excellent method to assess tumor extension due to superb soft-tissue contrast. The main disadvantage is time-consuming procedure that frequently warrants general anesthesia in children. Novel CT machines provide excellent images of the body (e.g. lung parenchyma) with significantly reduced radiation burden, mostly without general anesthesia. Here we present typical pediatric abdominal tumors where MRI is inevitable part of treatment planning. With neuroblastoma MRI can accurately assess potential invasion of the spinal canal and bone marrow, which is beyond the scope of ultrasound. MRI is optimal modality to evaluate therapeutic response and detect residual or recurrent disease. It reliably reveals tumor necrosis, hemorrhage, and cystic degeneration, but cannot detect calcifications within the tumor tissue (e.g. neuroblastoma). Due to its capacity to comprehensively assess liver parenchyma, vascular and biliary structures, MRI is the method of choice to evaluate resectability of liver neoplasms. MR reliably reveals tumor invasion into the paravertebral soft tissues and neural structures of the spinal canal. Beyond morphology, MRI obtain functional information from the tissue when diffusion weighted imaging (DWI), dynamic contrast-enhanced MRI (DCE-MRI) or MR spectroscopy are applied. For example, high cellular tumor tissue or abscess will cause restriction of water diffusion which can be quantified. Increase of water diffusion corresponds to decrease in cellularity indicating favorable response to chemotherapy. Furthermore, using DWI we can guide biopsy needle to the most cellular part of the tumor to obtain representative sample. [ABSTRACT FROM AUTHOR]

Triple-negative breast cancer (TNBC) has the worst prognosis and the highest immunogenic potential of all breast cancer subtypes. It is characterized by a lack of estrogen and progesterone receptors as well as HER2. A major component of the tumor microenvironment (TME) of TNBC is tumor-infiltrating lymphocytes (TILs). A chaperone heat shock protein 70 (HSP70) is involved in several pathways that enable tumour growth and progression, as well as in immune modulation. Immunohistochemical analysis of HSP70 expression in immune cells, as well as expression of immunosuppressive markers CTLA4 and PD-L1 and major TILs components: CD8, CD4 and Tregs were analyzed in the superficial and deep tumor layer of primary TNBC and compared with established clinicopathological parameters. Clinical data and surgical tissue samples from 68 TNBC patients who underwent initial surgery were included in the analysis and 36 control samples from benign breast tissue biopsies. A higher expression of TILs, CD4, CD8 and PD-L1 was found in the invasive tumor front (ITF), as compared to the tumor center (TC) (p < 0001). HSP70 positive immune cells (HSP70(+) IC) in TC were associated with adverse clinical and pathological markers: higher stage of disease (P = 0.013), higher grade (P = 0.05) and a higher pN status (P < 0.001). In addition, higher expression of HSP70(+) IC from TC was correlated with the higher expression of FOXP3(+)T cells both in ITF (N = 61, rho=0.42, p < 0.001) and in metastatic tissue from the draining lymph nodes (N = 13, rho=0.61, P = 0.026). Correlations between HSP70 immune cells expression and individual TILs components support the hypothesis of its active role in inducing immunosuppression and tumor progression. Routine determination of HSP70 expression, in immune cells of TC, may be of added value in the clinical decision-making process concerning axillary surgery. [ABSTRACT FROM AUTHOR]