In toenemende mate wordt de cruciale en unieke functie van het abdomen in het reguleren van verscheidene lichaamsprocessen onderstreept. Het is dan ook van waarde om kennis te nemen van dit actuele naslagwerk met de meest relevante artikels op het gebied van gastro-enterologie. Zo wordt in dit e-book, dat werken uit het Tijdschrift voor Geneeskunde […]

Dit e-book biedt een verzameling van uiteenlopende artikels over oncologie, die in 2021-2022 gepubliceerd zijn in het Tijdschrift voor Geneeskunde en Gezondheidszorg. De auteurs hebben een noemenswaardige gedachtewisseling over de vroegdetectie van prostaatkanker middels PSA-bepaling en reiken u een systematische review naar het nut van PARP-remmers aan. Bijkomend worden het Vlaamse Bevolkingsonderzoek Dikkedarmkanker en de […]

Teaching Point: A chondroid lipoma is a rare benign adipocytic neoplasm, containing a chondromyxoid matrix, that may mimic a myxoid liposarcoma and myxoid chondrosarcoma.

Paraneoplastic dermatomyositis in rectal cancer: importance of rapid diagnosis and therapy, but uncertainty about the best approach A 55-year-old woman, recently diagnosed with peritoneal metastasized rectal adenocarcinoma, developed a rash on her face, hands and torso, shortly after starting chemotherapy, as well as progressive proximal myalgia. Based on the typical symptoms, the increased creatine kinases (CK) levels after a biochemistry test and the characteristic abnormalities after an EMG, the diagnosis of dermatomyositis was made. Dermatomyositis (DM) is a rare autoimmune disease characterized by inflammation of the skin and muscles, which may also be accompanied by systemic manifestations. The etiology of dermatomyositis is still not fully understood. When dermatomyositis develops at older age, however, it is often a paraneoplastic syndrome. DM is a disease that can have a rapid and severe course. Thereby, fast recognition and adequate treatment are extremely important. The symptoms, diagnosis and treatment options are discussed in the article on the basis of the current literature.

Soft tissue sarcomas are rare, but early, accurate diagnosis with subsequent appropriate treatment is crucial for the clinical outcome. The ESSR guidelines are intended to help radiologists in their decision-making and support discussion among clinicians who deal with patients with suspected or proven soft tissue tumors. Potentially malignant lesions recognized by ultrasound should be referred for magnetic resonance imaging (MRI), which also serves as a preoperative local staging modality, with specific technical requirements and mandatory radiological report elements. Radiography may add information about matrix calcification and osseous involvement. Indeterminate lesions, or lesions in which therapy is dependent on histology results, should be biopsied. For biopsy, we strongly recommend referral to a specialist sarcoma center, where an interdisciplinary tumor group, with a specialized pathologist, radiologist, and the surgeon are involved. In sarcoma, a CT scan of the chest is mandatory. Additional staging modalities are entity-specific. There are no evidence-based recommendations for routine follow-up in surgically treated sarcomas. However, we would recommend regular follow-up with intervals dependent on tumor grade, for 10 years after the initial diagnosis.

We present a rare case of an intra-articular synovial lipoma, which was diagnosed in a patient after a knee trauma. MRI is the imaging modality of choice to suggest the diagnosis preoperatively, by demonstrating a well-delineated fat-containing lesion. The differential diagnosis of an intra-articular lipomatous lesion consists of lipoma arborescens and synovial lipoma.

A 36-year-old man with proptosis of the left eye complained of frontal headache. His medical history was relevant for amblyopia and loss of visual acuity on the left side. Opthalmological examination revealed an oculomotor nerve paralysis of the left eye. Subsequent Magnetic Resonance Imaging (MRI) showed a well delineated T2 hyper(asterisk in Fig. A) and T1 hypointense (not shown) cystic intraorbital mass. The lesion further extended intracranially through the superior orbital fissure in close proximity with the left oculomotor cistern (Fig. B, oculomotor cistern right (arrow) and cystic lesion (arrowhead) at the level of the oculomotor cistern left). The left optic nerve was displaced superomedially and was clearly delineated along its further course. After intravenous gadolinium administration, faint peripheral enhancement was noted (arrow in Fig. C). The MRI findings are compatible with an arachnoidal cyst arising from the oculomotor nerve cistern. Surgical fenestration of the lesion was performed by a left-sided pterional approach. Histopathological analysis of the cyst wall showed collagenous tissue lined with arachnoidal cells, in keeping with an arachnoidal cyst arising from the oculomotor nerve cistern.

Lunotriquetral coalition (LTC), the most frequent and often bilateral type of carpal coalition, is in general considered as asymptomatic. In rare cases - however - fibrocartilaginous LTC may be an uncommon cause of ulnar sided pain in the wrist due to the pseudarthrosis or a post-traumatic disruption of LTC. Two rare cases of symptomatic LTC are presented and the role of MRI is emphasized. MRI shows the pseudarthrosis and may additionally show bone marrow edema and subcortical cysts. In symptomatic cases surgical lunotriquetral fusion may be considered as treatment option.

Traumatic lesions of the distal radio-ulnar joint (DRUJ) occur frequently in conjunction with fractures of the distal radius. They are a common cause of pain and limited range of motion after distal radial fractures. Due to the complex anatomy they are however often ignored or underappreciated. Distal radial fractures and luxations of the DRUJ often disturb the normal curvature of the radial notch and cause damage to the cartilage of this joint. The growth of the radius may be disrupted, resulting in a positive ulnar variance, and possibly give rise to complications such as ulnar abutment and motion restriction. Ulnar styloid fractures - sometimes barely visible on plain film - may give rise to symptomatic bony pseudarthrosis, dislocation and laceration of the tendon of the m. extensor carpi ulnaris and a rare posttraumatic deformity of the ulnar epiphysis. Also the possibility of lesions at the adjacent triangular fibrocartilage complex and the joint capsule should be kept in mind. This paper presents a pictorial review of the complex functional anatomy and pathologic conditions of this joint and emphasises why the DRUJ should be evaluated independently and thoroughly. The merit of each imaging modality is mentioned. A correction article relating to Fig. 2 and Fig. 27 can be found here: http://dx.doi.org/10.5334/jbr-btr.966.

Chondrosarcoma of the synovium is rare. It may arise de novo from the synovium or pre-existing synovial chondro- matosis may undergo malignant transformation into chondrosarcoma. Diagnosing a malignant transformation of the synovium remains a big challenge. It is based on the correlation of clinical findings, imaging and histology, as illustrated in this case report.

Noonan syndrome (NS) is an etiologically heterogeneous disorder caused by mutations in the RAS-MAPK signaling pathway. Noonan-Like/Multiple Giant Cell Lesion (NL/MGCL) syndrome is initially described as the occurrence of multiple gnathic giant cell lesions in patients with phenotypic features of NS. Nowadays, NS/MGCL syndrome is considered a variant of the NS spectrum rather than a distinct entity. We report the case of a 14-year-old female patient carrying a SOS1 mutation with a unilateral giant cell lesion of the right mandible. Cross-sectional imaging such as CT and MRI are not specific for the diagnosis of oral giant cell lesions. Nonetheless, intralesional scattered foci of low SI on T2-WI, corresponding to hemosiderin deposits due to hemorrhage, can help the radiologist in narrowing down the differential diagnosis of gnathic lesions in patients with NS.

CASE REPORT:We report a 71-year-old obese white female who presented with sudden right calf pain after a long distance flight. Symptoms were initially regarded as venous in origin. Duplex investigation ruled out deep vein thrombosis. Ultimately she presented to our department with complaints of claudication. Clinical evaluation and a new duplex scan showed occlusion of the right popliteal artery. Further evaluation with CT-angiography showed, besides occlusion of the right popliteal artery, a floating thrombus in the infrarenal abdominal aorta. The thrombus was treated with a bare-metal stent placed through a femoral approach. CT-scans at 1 and 3 months demonstrated complete exclusion of the thrombus. The claudication of the right calf resolved spontaneously. Floating thrombus of the infrarenal abdominal aorta is a rare cause of distal arterial embolisation. CT-scan with contrast enhancement is the preferred diagnostic technique. Endovascular repair seems to be the treatment of choice and in our opinion a covered stent is not required. Anticoagulation therapy needs to be guided on an individual patient basis

We present three cases of fracture of the proximal tibia in young children who were jumping on a trampoline. The typical radiological findings and the underlying mechanism of trauma are discussed. The key radiological features are: a transverse hairline fracture of the upper tibia often accompanied by a buckle fracture of the lateral or medial tibial cortex, buckling of the anterior upper tibial cortex and anterior tilting of the epiphyseal plate. New types of injuries related to specific recreational activities are recognized. It is often helpful to associate a typical injury with a particular activity. Trampoline related injuries have increased dramatically over the last years. The most common lesions are fractures and ligamentous injuries, in particular a transverse fracture of the proximal tibia. However the radiological findings can be very subtle and easily overlooked. It is therefore important to be aware of the typical history and radiological findings.

CASE REPORT:We report a 69-year-old Caucasian male who presented with irreversible ischemia to the left foot. CT-scan showed, besides occlusion of both superficial femoral arteries, a chronic contained rupture of an abdominal aortic aneurysm. The aneurysm was excluded with a stent graft placed through a femoral approach in a semi-urgent procedure. CT-scans at 1, 3 and 6 months demonstrated continued exclusion of the aneurysm. Chronic ruptures are a rare but important subset of ruptured abdominal aortic aneurysms. CT-scan with contrast enhancement is the gold standard diagnosing technique. Treatment consists of prompt surgical intervention with endovascular repair being increasingly used as an alternative to an open surgical approach.

In the foot and ankle region, benign neoplasms and pseudotumoural soft tissue lesions are significantly more frequent than malignant tumours. The pseudotumoural lesions constitute a heterogeneous group, with highly varied aetiology and histopathology. This article reviews the imaging features of the most common pseudotumours of the soft tissues in the foot and ankle. Although the imaging characteristics of several of the lesions discussed are non-specific, combining them with lesion location and clinical features allows the radiologist to suggest a specific diagnosis in most cases.

Spontaneous cholecystocutaneous abscesses or fistulae are rare complications of neglected biliary calculous disease which have become extremely rare during the last decades. We report a case of spontaneous cholecystocutaneous abscess in a 69-year-old male who presented with a mass in the right subcostal region.The diagnosis was made by CT scan with multiplanar reformating. Treatment consisted of incision and drainage of the abdominal wall abscess followed by cholecystectomy in a one-stage protocol.