Skin involvement in leukemias may be the consequence of spe-cific infiltration (leukemia cutis), such condition being very rare inacute leukemias; on the contrary, the more frequent secondarynonspecificlesionsdonotcontainleukemiccellsandincludepurpura,maculopapules, erythroderma, herpes zoster or simplex lesions, bul-lae,furuncles,exfoliation,eczema,andEN.Inourpatient,ENwasevidentatdiagnosisofAML,andalthougha causal relationship between the two conditions could not be ascer-tained,thecompleteresolutionofENafterthefirstcourseofchemo-therapystronglysuggestsitscorrelationtoleukemia.
Purpose/Objective: At our hospital, a relevant fraction of post-prostatectomy patients (pts) are treated with intensitymodulated whole pelvis radiotherapy (WPRT), leading to the irradiation of an extended area of the intestinal cavity.Bowel loops (BL) need to be contoured and the dose volume histograms (DVH) are evaluated for possible gastrointestinal effects.The aim of this study is to evaluate the interobserver variability of the bowel volumes obtained by manual contouring, which is still the most used method for this structure.Materials and Methods: Six experienced observers (1 clinician, 1 radiotherapy technologist, 4 medical physicists) delineated BL contours for three pts enrolled in a multicentric prospectic observational project.The bowel lumen was contoured starting from the most cranial slice where lymph-node planning target volume (PTV) was present.It continued through sigmoid flexure until the rectum contour.Contouring tools included in Eclipse treatment planning system (TPS) were used to manually delineate BL.Contouring differences were quantified in terms of relative volume difference (RD%) and DICE index, that describes the agreement between two delineated contours.Differences between operators were tested with Wilcoxon test.Results: Mean (± standard deviation, SD) volumes of BL were: (482 ± 54)cc, (681 ± 50)cc (1278 ± 67)cc for pts A-B-C respectively (fig.1).From the point of view of volume variations, BL of the pt A resulted the most difficult to be contoured (11.2%).RD% with respect to average volume values were 17, 2, -11, 3,-14, 4 for each observer respectively.For pt B, RD% were -11, -3, 9, 5, -4 ,4; RD%=(6, -2, 6, -7, -1, -2) for pt C. In summary, observer 5 systematically underestimated the BL volumes with differences of 6.4% on average.This effect is probably due to the contouring habit of observer 5 of being strictly adherent to the bowel lumen and some loops can be missed.Concerning DICE analysis, average DICE values per pairs of observers were assessed.The best agreement was found between observer 1 and 5 (0,86±0.12,1SD), while the worst value for observer 4 and 6 (0.73 ±0.04, 1SD).Average DICE for all pair observers were 0.77±0.08,0.75 ± 0.04 and 0.83±0.04for pts A, B, C respectively.Differences between pts A-C (p=0.0067) and B-C (p=0,0001) resulted statistically significant.
Heterotopic pancreas in the gallbladder is uncommon.condition and its clinical presentation is as an intramural nodule near the cystic duct, with an incidental finding in most cases.Objective: to update Heterotopic pancreas condition in the gallblader. We reported a case of a 18-year-old female, suffering with biliar colic who was operated on with diagnosis of acute cholecystitis. Six mixed gallstones were found in the surgery and the gallbladder was distended and edematous with serosal exudate and the serosa appeared discolored and hemorrhagic. The wall was thickened with edema and hemorrhage. Microscopic findings were: congestive mucosa , edema, acute inflammatory cells and fibrin deposition on the wall and a subtle (myo)-fibroblastic proliferation. The nodule was diagnosed as macroscopic heterotopic pancreatic tissue in the gallbladder wall thickness, without neoplastic changes. Clinical presentation as acute cholecystitis has been rarely reported in the presence of heterotopic pancreatic tissue.