scholarly journals Clival Metastasis of Hepatocellular Carcinoma with an Initial Histopathological Diagnosis of Atypical Pituitary Adenoma

2019 ◽  
Vol 80 (01) ◽  
pp. e18-e22
Author(s):  
Hiroyuki Mishima ◽  
Junichi Ayabe ◽  
Masahide Watanabe ◽  
Sota Togin ◽  
Yuusuke Tsuchiya ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Pituitary Adenoma ◽  
Abducens Nerve ◽  
Residual Tumor ◽  
Whole Body ◽  
Subtotal Resection ◽  
Histopathological Diagnosis ◽  
Mri Imaging ◽  
Liver Mass ◽  
Atypical Pituitary Adenoma

AbstractHistologically, hepatocellular carcinoma (HCC) and atypical pituitary adenoma are similar, posing a potential clinical problem. A 76-year-old woman, whose past medical history was significant for hepatitis C virus (HCV), positivity without liver cirrhosis was presented with abducens nerve (CN VI) palsy. Contrast-enhanced magnetic resonance imaging (MRI) showed a clival tumor with infiltration of the right cavernous sinus. Subtotal resection was performed using a right anterior petrosal approach. Histological diagnosis was pituitary adenoma. Thirty-four days after the operation, MRI imaging showed residual tumor growth without any liver masses on computed tomography (CT). The patient underwent a second operation using an endoscopic transnasal transsphenoidal approach. Histological examination of the specimen gave a positive reaction for α-fetoprotein. Repeat whole-body CT showed an enhanced liver mass. Based on these findings, the lesion was diagnosed as metastatic HCC. The patient died of liver failure 6 months later. In this case, tumor diagnosis was difficult because of the histological similarity of HCC and pituitary adenoma, and the fact that the clival tumor grew prior to presentation of the liver mass on CT. This case emphasizes the importance of comparing the pathological diagnosis with the patient's clinical course.

scholarly journals Radiolabelled PSMA PET/CT or PET/MRI in hepatocellular carcinoma (HCC): a systematic review

2020 ◽  
Vol 8 (6) ◽  
pp. 461-467
Author(s):  
Francesco Dondi ◽  
Domenico Albano ◽  
Elisabetta Cerudelli ◽  
Maria Gazzilli ◽  
Raffaele Giubbini ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Case Reports ◽  
Whole Body ◽  
Cochrane Library ◽  
Whole Body Imaging ◽  
Mri Imaging ◽  
Psma Pet ◽  
Pet Ct ◽  
Diagnostic Role

Abstract Introduction Radiolabelled prostate-specific membrane antigen PSMA-based PET/CT or PET/MRI is a whole-body imaging technique usually performed for the detection of prostate cancer lesions. PSMA has been also demonstrated to be expressed by the neovasculature of many other solid tumors. The aim of this review is to evaluate the possible diagnostic role of radiolabelled PSMA PET/CT or PET/MRI in patients with hepatocellular carcinoma, by summarizing the available literature data. Methods A wide literature search of the PubMed/MEDLINE, Scopus, Embase and Cochrane library databases was made to find relevant published articles about the diagnostic performance of radiolabelled PSMA binding agents in PET/CT or PET/MRI imaging of patients with hepatocellular carcinoma. Results Ten case reports and three studies showed that hepatocellular carcinoma is PSMA-avid. Conclusion Radiolabelled PSMA imaging seems to be useful in analyzing hepatocellular carcinoma. Further studies enrolling a wider population are needed to clarify the real clinical and diagnostic role of radiolabelled PSMA in this setting.

Atypical Pituitary Adenoma: A Clinicopathologic Case Series

2016 ◽  
Vol 77 (S 01) ◽  
Author(s):  
Martin Rutkowski ◽  
Ryan Alward ◽  
Derek Southwell ◽  
Rebecca Chen ◽  
Jeffrey Wagner ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Case Series ◽  
Atypical Pituitary Adenoma

SURGERY FOR RESIDUAL DISEASE AFTER RADIOTHERAPY IN LOCALLY ADVANCED CERVICAL CANCER

2019 ◽  
Vol 65 (5) ◽  
pp. 721-725
Author(s):  
Elmira Shakirova ◽  
Andrey Panov ◽  
Alevtina Akhmetzyanova ◽  
Aliya Gafiullina ◽  
L. Ibragimova ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Residual Disease ◽  
Locally Advanced ◽  
Residual Tumor ◽  
Advanced Cervical Cancer ◽  
Mri Imaging ◽  
Recurrent Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Visible Effect ◽  
Adjuvant Hysterectomy

Aims: Chemoradiation (CRT) is the standard treatment for locally advanced cervical cancer (LACC). However part of the patients develop recurrence during the first year after treatment despite good visible effect at the first follow-up. The role of completion surgery after radiotherapy (RT) is still debated. A number of papers have showed that up to 60% of patients have residual tumor after CRT and RT. But such a surgery is not widely recommended because of increased morbidity of the treatment. The aim of this study was to assess the results of surgery after radiotherapy of LACC. Method: We retrospectively evaluated data on 86 patients with cervical cancer IB - IIIB stages (mostly stage IIB) who underwent surgery in different modalities after CRT and RT with good clinical response in our department in 2015-2018. Results: When small asymptomatic residual disease was detected early after radiotherapy radical hysterectomy was feasible in most of the cases. Patients with clinical manifestation of recurrence had very poor prognosis. Surgery of recurrent cervical cancer sufficiently deteriorates quality of life, even if possible. Conclusion: Thorough examination with adding MRI imaging after initial treatment of cervical cancer needed to identify patients who may benefit from adjuvant hysterectomy.

Estimating Risk of Pituitary Apoplexy after Resection of Giant Pituitary Adenomas

2021 ◽  
Author(s):  
John T. Butterfield ◽  
Takako Araki ◽  
Daniel Guillaume ◽  
Ramachandra Tummala ◽  
Emiro Caicedo-Granados ◽  
...  
Keyword(s):  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Residual Tumor ◽  
Extent Of Resection ◽  
Morbidity And Mortality ◽  
Surgical Approaches ◽  
Subtotal Resection ◽  
Advantages And Disadvantages ◽  
Cranial Nerve Palsies ◽  
Giant Pituitary Adenomas

Abstract Background Pituitary apoplexy after resection of giant pituitary adenomas is a rare but often cited morbidity associated with devastating outcomes. It presents as hemorrhage and/or infarction of residual tumor in the postoperative period. Because of its rarity, its incidence and consequences remain ill defined. Objective The aim of this study is to estimate the rate of postoperative pituitary apoplexy after resection of giant pituitary adenomas and assess the morbidity and mortality associated with apoplexy. Methods A systematic review of literature was performed to examine extent of resection in giant pituitary adenomas based on surgical approach, rate of postoperative apoplexy, morbidities, and mortality. Advantages and disadvantages of each approach were compared. Results Seventeen studies were included in quantitative analysis describing 1,031 cases of resection of giant pituitary adenomas. The overall rate of subtotal resection (<90%) for all surgical approaches combined was 35.6% (95% confidence interval: 28.0–43.1). Postoperative pituitary apoplexy developed in 5.65% (n = 19) of subtotal resections, often within 24 hours and with a mortality of 42.1% (n = 8). Resulting morbidities included visual deficits, altered consciousness, cranial nerve palsies, and convulsions. Conclusion Postoperative pituitary apoplexy is uncommon but is associated with high rates of morbidity and mortality in subtotal resection cases. These findings highlight the importance in achieving a maximal resection in a time sensitive fashion to mitigate the severe consequences of postoperative apoplexy.

En Plaque Sphenoid Wing Meningiomas: Recurrence Factors and Surgical Strategy in a Series of 71 Patients

2009 ◽  
Vol 65 (suppl_6) ◽  
pp. ons100-ons109 ◽  
Author(s):  
Giuseppe Mirone ◽  
Salvatore Chibbaro ◽  
Luigi Schiabello ◽  
Serena Tola ◽  
Bernard George
Keyword(s):  
Cavernous Sinus ◽  
Residual Tumor ◽  
Complete Removal ◽  
Subtotal Resection ◽  
Presenting Symptoms ◽  
Time To Recurrence ◽  
Clinical Records ◽  
Mean Time ◽  
Case Basis

Abstract Objective: En plaque sphenoid wing meningiomas are complex tumors involving the sphenoid wing, the orbit, and sometimes the cavernous sinus. Complete removal is difficult, so these tumors have high rates of recurrence and postoperative morbidity. The authors report a series of 71 patients with sphenoid wing meningiomas that were managed surgically. Methods: The clinical records of 71 consecutive patients undergoing surgery for sphenoid wing meningiomas at Lariboisière Hospital, Paris, were prospectively collected in a database during a 20-year period and analyzed for presenting symptoms, surgical technique, clinical outcome, and follow-up. Results: Among the 71 patients (mean age, 52. 7 years; range, 12–79 years), 62 were females and 9 were males. The most typical symptoms recorded were proptosis in 61 patients (85.9%), visual impairment in 41 patients (57.7%), and oculomotor paresis in 9 patients (12.7%). Complete removal was achieved in 59 patients (83%). At 6 months of follow-up, magnetic resonance imaging scans revealed residual tumor in 12 patients (9 in the cavernous sinus and 3 around the superior orbital fissure). Mean follow-up was 76.8 months (range, 12–168 months). Tumor recurrence was recorded in 3 of 59 patients (5%) with total macroscopic removal. Among the patients with subtotal resection, tumor progression was observed in 3 of 12 patients (25%; 2 patients with grade III and 1 patient with grade IV resection). Mean time to recurrence was 43.3 months (range, 32–53 months). Conclusion: Surgical management of patients with sphenoid wing meningiomas cannot be uniform; it must be tailored on a case-by-case basis. Successful resection requires extensive intra- and extradural surgery. We recommend optic canal decompression in all patients to ameliorate and/or preserve visual function.

scholarly journals The Changing Paradigm for the Surgical Treatment of Large Vestibular Schwannomas

2018 ◽  
Vol 79 (S 04) ◽  
pp. S362-S370 ◽  
Author(s):  
Constantin Tuleasca ◽  
Alda Rocca ◽  
Mercy George ◽  
Etienne Pralong ◽  
Luis Schiappacasse ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Residual Tumor ◽  
University Hospital ◽  
Tumor Control ◽  
Subtotal Resection ◽  
Consecutive Series ◽  
Cochlear Function ◽  
Nerve Preservation ◽  
The Past

Objective Planned subtotal resection followed by Gamma Knife surgery (GKS) in patients with large vestibular schwannoma (VS) has emerged during the past decade, with the aim of a better functional outcome for facial and cochlear function. Methods We prospectively collected patient data, surgical, and dosimetric parameters of a consecutive series of patients treated by this method at Lausanne University Hospital during the past 8 years. Results A consecutive series of 47 patients were treated between July 2010 and January 2018. The mean follow-up after surgery was 37.5 months (median: 36, range: 0.5–96). Mean presurgical tumor volume was 11.8 mL (1.47–34.9). Postoperative status showed normal facial nerve function (House–Brackmann I) in all patients. In a subgroup of 28 patients, with serviceable hearing before surgery and in which cochlear nerve preservation was attempted at surgery, 26 (92.8%) retained serviceable hearing. Nineteen had good or excellent hearing (Gardner–Robertson class 1) before surgery, and 16 (84.2%) retained it after surgery. Mean duration between surgery and GKS was 6 months (median: 5, range: 3–13.9). Mean residual volume as compared with the preoperative one at GKS was 31%. Mean marginal dose was 12 Gy (11–12). Mean follow-up after GKS was 34.4 months (6–84). Conclusion Our data show excellent results in large VS management with a combined approach of microsurgical subtotal resection and GKS on the residual tumor, with regard to the functional outcome and tumor control. Longer term follow-up is necessary to fully evaluate this approach, especially regarding tumor control.

Metastases to the Pituitary Gland: Histological Patterns of Spread and Review of the Literature

2021 ◽  
Author(s):  
B K Kleinschmidt-DeMasters
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Surgical Excision ◽  
Disease Course ◽  
Review Of The Literature ◽  
Metastatic Cells ◽  
Filling Pattern ◽  
Pituitary Metastases ◽  
Atypical Pituitary Adenoma ◽  
Disease Stages

Abstract Few studies have focused on histological patterns of metastatic spread to the pituitary gland. We review our experience and that in the literature, 1970–present. Departmental cases, 1998–2021, were assessed for anterior versus posterior gland and/or capsular involvement and cohesive tumor obliterating underlying pituitary architecture versus metastatic cells filling pituitary acini with relative acinar preservation. Eleven autopsy/15 surgical cases, including 2 metastases to pituitary adenomas, were identified. Cohesive/obliterative patterns predominated histologically in both surgical and autopsy cases, but acinar filling by metastatic cells was extensive in 3/26 cases, focal in 5/26, and had resulted in initial erroneous impressions of atypical pituitary adenoma/pituitary carcinoma in 1 case and pituitary adenoma with apoplexy in another, likely due to focusing on necrotic areas in the specimen where the acinar pattern had been broken down and not appreciating nearby areas with acinar filling by metastatic cells. Although most pituitary metastases produce readily identifiable cohesive/obliterative patterns, diagnostic challenges remain with the less frequently seen “acinar filling” pattern. A dichotomy exists between patients with symptomatic pituitary metastases occurring early in the disease course and requiring surgical excision versus patients in whom asymptomatic small pituitary metastases are found incidentally at autopsy, the latter almost invariably in late disease stages, with widely disseminated metastatic disease.

scholarly journals Atypical Pituitary Adenoma: A Clinicopathologic Case Series

2017 ◽  
Vol 78 (S 01) ◽  
pp. S1-S156
Author(s):  
Martin Rutkowski ◽  
Ryan Alward ◽  
Rebecca Chen ◽  
Jeffrey Wagner ◽  
Arman Jahangiri ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Case Series ◽  
Atypical Pituitary Adenoma
Sign in / Sign up

Export Citation Format

Share Document