Forestier A., Buob D., Mirault T., Puech P., Gnemmi V., Launay D., Hachulla E., Hatron P. Y., Lambert M.   No specific imaging pattern can help differentiate IgG4-related disease from idiopathic retroperitoneal fibrosis: 18 histologically proven cases.  Clin. Exp. Rheumatol..  2018
Fauconnier A., Borghese B., Huchon C., Thomassin-Naggara I., Philip C. A., Gauthier T., Bourdel N., Denouel A., Torre A., Collinet P., Canis M., Fritel X.   [Epidemiology and diagnosis strategy: CNGOF-HAS Endometriosis Guidelines].  Gynecol Obstet Fertil Senol.  2018 ;46 :223-230

Based on the best evidence available, we have provided guidelines for clinical practice to target the nature of endometriosis as a disease, the consequences of its natural history on management, and the clinical and imaging evaluation of the disease according to the level of care (primary care, specialized or referral). The frequency of endometriosis is unknown in the general population; endometriosis requires management when it causes symptoms (pain, infertility) or when it affect the function of an organ. In the absence of symptom, there is no need for follow-up or screening of the disease. Endometriosis may be responsible for various pain symptoms such as severe dysmenorrhea, deep dyspareunia, painful bowel movements or low urinary tract signs increasing with menstruation, or infertility. A careful evaluation of the symptoms and their impact on the quality of life should be made. The first-line examinations for the diagnosis of endometriosis are: digital examination and pelvic ultrasound. The second-line examinations are: the pelvic exam by an expert clinician, the pelvic MRI and/or the transvaginal ultrasound by an expert. MRI and ultrasound carrying different and complementary information. Other examinations may be considered as part of the pre-therapeutic assessment of the disease in case of specialized care. Diagnostic laparoscopy may be suggested in case of clinical suspicion of endometriosis whereas preoperative examinations have not proved the disease, it must be part of a management plan of endometriosis-related pain or infertility. During management, it is recommended to give comprehensive information on the different therapeutic alternatives, the benefits and risks expected from each treatment, the risk of recurrence, fertility, especially before surgery. The information must be personalized and take into account the expectations and preferences of the patient, and accompanied by an information notice given to the patient.

Farre C., Azahaf M., Nachury M., Branche J., Gerard R., Wils P., Desreumaux P., Ernst O., Pariente B.   Correlation between the Lemann Index and the Inflammatory Bowel Disease-Disability Index in Crohn''''s disease.  J. Crohns Colitis.  2018 ;12 :S193-S193
Dupont C., Vermandel M., Reyns N., Mordon S.   [Photodynamic therapy for the treatment of glioblastoma in neurosurgery].  Med Sci (Paris).  2018 ;34 :901-903
Dupont C., Vermandel M., Leroy H. A., Quidet M., Lecomte F., Delhem N., Mordon S., Reyns N.   INtraoperative photoDYnamic Therapy for GliOblastomas: Study Protocol for a Phase I Clinical Trial.  Neurosurgery.  2018

BACKGROUND: Glioblastoma (GBM) is characterized by marked proliferation, major infiltration, and poor prognosis. Despite current treatments, including surgery, radiation oncology, and chemotherapy, the overall median survival is 15 mo and the progression-free survival is 7 to 8 mo. Because of systematic relapse of the tumor, the improvement of local control remains an issue. In this context, photodynamic therapy (PDT) may offer a new treatment modality for GBM. OBJECTIVE: To assess the feasibility of intraoperative PDT early after surgical resection of GBM without unacceptable and unexpected toxicities. METHODS: The INDYGO clinical trial (INtraoperative photoDYnamic Therapy for GliOblastomas) treatment will be carried out in addition to the current standard of care (SOC) of glioblastoma: maximum resection surgery followed by concomitant radio-chemotherapy and adjuvant chemotherapy. PDT treatment will be delivered during surgery early, after the fluorescence-guided resection. Immunological responses and biomarkers will also be investigated during the follow-up. A total of 10 patients will be recruited during this study. EXPECTED OUTCOMES: Clinical follow-up after the SOC with PDT is expected to be similar (no significant difference) to the SOC alone. DISCUSSION: This INDYGO trial assesses the feasibility of intraoperative 5-aminolevulinic acid PDT, a novel seamless approach to treat GBM. The technology is easily embeddable within the reference treatment at a low-incremental cost. The safety of this new treatment modality is a preliminary requirement before a multicenter randomized clinical trial can be further conducted to assess local control improvement by treating infiltrating and nonresected GBM cells.

Collinet P., Fritel X., Revel-Delhom C., Ballester M., Bolze P. A., Borghese B., Bornsztein N., Boujenah J., Bourdel N., Brillac T., Chabbert-Buffet N., Chauffour C., Clary N., Cohen J., Decanter C., Denouël A., Dubernard G., Fauconnier A., Fernandez H., Gauthier T., Golfier F., Huchon C., Legendre G., Loriau J., Mathieu-d''Argent E., Merlot B., Niro J., Panel P., Paparel P., Philip C. A., Ploteau S., Poncelet C., Rabischong B., Roman H., Rubod C., Santulli P., Sauvan M., Thomassin-Naggara I., Torre A., Wattier J. M., Yazbeck C., Canis M.   [Management of endometriosis: CNGOF-HAS practice guidelines (short version)].  Gynecol Obstet Fertil Senol.  2018 ;46 :144-155

First-line investigations to diagnose endometriosis are clinical examination and pelvic ultrasound. Second-line investigations include pelvic examination performed by a referent clinician, transvaginal ultrasound performed by a referent echographist, and pelvic MRI. It is recommended to treat endometriosis when it is symptomatic. First-line hormonal treatments recommended for the management of painful endometriosis are combined with hormonal contraceptives or levonorgestrel 52mg IUD. There is no evidence to recommend systematic preoperative hormonal therapy for the unique purpose of preventing the risk of surgical complications or facilitating surgery. After endometriosis surgery, combined hormonal contraceptives or levonorgestrel SIU 52mg are recommended as first-line therapy in the absence of desire of pregnancy. In case of initial treatment failure, recurrence, or multiple organ involvement by endometriosis, medico-surgical and multidisciplinary discussion is recommended. The laparoscopic approach is recommended for the surgical treatment of endometriosis. HRT may be offered in postmenopausal women operated for endometriosis. In case of infertility related to endometriosis, it is not recommended to prescribe anti-gonadotropic hormone therapy to increase the rate of spontaneous pregnancy, including postoperatively. The possibilities of fertility preservation should be discussed with the patient in case of surgery for ovarian endometrioma.

Chanavaz-Lacheray I., Darai E., Descamps P., Agostini A., Poilblanc M., Rousset P., Bolze P. A., Panel P., Collinet P., Hebert T., Graesslin O., Martigny H., Brun J. L., Dechaud H., Mezan De Malartic C., Piechon L., Wattiez A., Chapron C., Golfier F.   [Definition of endometriosis expert centres].  Gynecol Obstet Fertil Senol.  2018 ;46 :376-382

OBJECTIVES: The College national des gynecologues obstetriciens francais (CNGOF), in agreement with the Societe de chirurgie gynecologique et pelvienne (SCGP), has set up a commission in 2017 to define endometriosis expert centres, with the aim of optimizing endometriosis care in France. METHODS: The committee included members from university and general hospitals as well as private facilities, representing medical, surgical and radiological aspects of endometriosis care. Opinion of endometriosis patients' associations was obtained prior to writing this work. The final text was presented and unanimously validated by the members of the CNGOF Board of Directors at its meeting of October 13, 2017. RESULTS: Based on analysis of current management of endometriosis and the last ten years opportunities in France, the committee has been able to define the contours of endometriosis expert centres. The objectives, production specifications, mode of operation, missions and funding for these centres were described. The following missions have been specifically defined: territorial organization, global and referral care, communication and teaching as well as research and evaluation. CONCLUSION: Because of its daily impact for women and its economic burden in France, endometriosis justifies launching of expert centres throughout the country with formal accreditation by health authorities, ideally as part of the National Health Plan.

Beylot-Barry M., Mermin D., Maillard A., Bouabdallah R., Bonnet N., Duval-Modeste A. B., Mortier L., Ingen-Housz-Oro S., Ram-Wolff C., Barete S., Dalle S., Maubec E., Quereux G., Templier I., Bagot M., Grange F., Joly P., Vergier B., Vially P. J., Gros A., Pham-Ledard A., Frison E., Merlio J. P.   A single-arm phase II trial of lenalidomide in relapsing or refractory primary cutaneous large B-cell lymphoma leg-type.  J. Invest. Dermatol..  2018 ;138 :1982-1989

Although the combination of rituximab and polychemotherapy has improved prognosis of primary cutaneous diffuse large B-cell lymphoma, leg type, the advanced age of patients limits therapeutic options in relapsing/refractory cases. A multicenter, single-arm, phase II trial was conducted to assess the benefits and safety of lenalidomide in refractory/relapsing primary cutaneous diffuse large B-cell lymphoma, leg type. The primary endpoint was the 6-month overall response rate. Secondary endpoints were 12-month overall response rate, overall and specific survival, duration of response, progression-free survival, safety, and identification of prognostic factors. Among the 19 patients included, the 6-month overall response rate was 26.3% (90% confidence interval [CI] = 11-47.6), including four complete responses and one partial response. At 12 months, there were still two complete responses and one partial response. Median progression-free survival was 4 months. Median overall and specific survivals were 19.4 and 23.8 months, respectively. Reduced doses tended to be associated with higher 6-month overall response rate and progression-free survival. Absence of the MYD88(L265P) mutation was associated with a higher overall response under treatment (80.0% vs. 33.3%; P = 0.05). The most common grade 3 adverse events were hematologic. Two grade 5 adverse events occurred (sepsis and pulmonary embolism). Lenalidomide at reduced doses may allow prolonged responses in a few patients and represents a therapeutic option in relapsing/refractory primary cutaneous diffuse large B-cell lymphoma, leg type.

Baroncini M., Balédent O., Ardi C. E., Delannoy V. D., Kuchcinski G., Duhamel A., Ares G. S., Lejeune J. P., Hodel J.   Ventriculomegaly in the Elderly: Who Needs a Shunt? A MRI Study on 90 Patients.  Acta Neurochir. Suppl..  2018 ;126 :221-228

OBJECTIVE: In the case of ventriculomegaly in the elderly, it is often difficult to differentiate between communicating chronic hydrocephalus (CCH) and brain atrophy. The aim of this study is to describe the MRI criteria of CCH, defined by a symptomatic patient with ventriculomegaly and that improved after shunt placement. MATERIALS AND METHODS: Magnetic resonance imaging was prospectively evaluated in 90 patients with ventriculomegaly. Patients were classified into three groups: patients without clinical signs of CCH (control, n = 47), patients with CCH treated by shunt placement with clinical improvement (responders, n = 36), and patients with CCH treated using a shunt without clinical improvement (nonresponders, n = 7). MRI parameters of the two groups of interest (responders vs. controls) were compared. RESULTS: Compared with controls, Evans' index (p = 0.029), ventricular area (p < 0.01), and volume (p = 0.0001) were higher in the responders. In this group, the callosal angle was smaller (p 33.5 cm(2), a callosal angle <90.8 degrees and a SVa > 136.5 muL/R-R. In multivariate analysis, responders remained associated with SVa and callosal angle, with a c-statistic of 0.90 (95%CI, 0.83-0.98). CONCLUSION: On suspicion of CCH, a large ventricular area, a small callosal angle, and an increased aqueductal stroke volume are important MRI arguments that can be associated with the clinical evaluation and dynamic testing of CSF to confirm the indication for a shunt.