scholarly journals Guidance of a steerable cannula robot in soft tissue using preoperative imaging and conoscopic surface contour sensing

2010 ◽  
Author(s):  
Ray A Lathrop ◽  
D Caleb Rucker ◽  
Robert J Webster
Keyword(s):  
Soft Tissue ◽  
Preoperative Imaging ◽  
Surface Contour ◽  
Steerable Cannula

scholarly journals Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors

2021 ◽  
Vol 29 (3) ◽  
pp. 230949902110575
Author(s):  
Sei Morinaga ◽  
Shinji Miwa ◽  
Norio Yamamoto ◽  
Katsuhiro Hayashi ◽  
Akihiko Takeuchi ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Surgical Margin ◽  
Positive Margin ◽  
Soft Tissue Tumors ◽  
Wide Excision ◽  
Preoperative Imaging ◽  
Malignant Soft Tissue Tumors ◽  
Unplanned Excision ◽  
Malignant Soft Tissue Tumor ◽  
Malignant Soft Tissue

Introduction Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. Methods Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1 year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. Results Mean patient age was 57.3 years (15–85 years) and the mean observation period was 72.5 months (14–181 months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5 cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS ( p < 0.01). Conclusion Most of the tumors underwent unplanned excisions were small (<5 cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.

MRI evaluation of soft tissue sarcomas

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e21523-e21523
Author(s):  
N. Faizi ◽  
R. Sharma ◽  
S. Sharma ◽  
S. Chandrashekhara ◽  
N. K. Shukla ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Subcutaneous Tissue ◽  
Demographic Data ◽  
Soft Tissue Sarcomas ◽  
The Body ◽  
Preoperative Imaging ◽  
Joint Involvement ◽  
Muscle Involvement ◽  
Female Ratio ◽  
Histopathological Findings

e21523 Background: Althouth soft tissue constitute large part of the body, STS are rare (1% of all neoplasms) and can arise anywhere in the body. Imaging is require to confirm the diagnosis and for staging. We conducted a prospective study to evaluate the role of MRI scan in characterization and staging of the tumor. Methods: This study between 2006 and 2008 included 20 patients with histologically proven soft tissue sarcoma in whom preoperative MRI of the local site was performed and the findings were correlated with the surgical and histopathological findings. Only those patients in whom surgical and histopathological findings were available were included in the study. All MRI were performed on 1.5 T MRI using body and appropriate surface coil. T1W, T2W, and STIR sequences were acquired in axial, coronal, and sagittal planes. Contrast enhanced MRI was performed in four patients. Surgical findings were recorded by the operating surgeon and resected specimens were analyzed by pathologist for assessing extent and histologic typing. All demographic data of the patient, the clinical features, preoperative imaging analysis, operative and histopathological findings were tabulated as per the given proforma. Results: Age of the patients was 16 - 72 years (mean age 44.4 years). Male female ratio was 2.3:1 . Eleven cases were recurrent. Most common histologic type was MFH (30%) while synovial sarcoma was second most common (20%) type of the STS in our study. Eighteen of 20 soft tissue sarcomas were of high grade. Average size on MRI was 9.25 cm (range) and operative size was 9.8 cm (range). Statistically significant agreement existed between MR and operative size. The sensitivity of MRI for individual muscle involvement was 92.3% and specificity was 96.5%. MRI had a sensitivity of 93% and specificity of 100% in predicting fascial involvement. MRI had 100% sensitivity and specificity in showing skin and subcutaneous tissue involvement. MRI had 100% negative predictive value in predicting NV bundle involvement. None of the patients had bone or joint involvement. No distant parenchymal metastases were seen. Specific diagnosis based on MRI image characteristics was suggested in 35% patients. Conclusions: Overall staging accuracy of MRI was 75% in staging of STS when correlated with surgical and histopathological MSKCC staging. No significant financial relationships to disclose.

High grade non-germinal centre-like diffuse large B-cell lymphoma double expressor presenting as a hydrocoele

2021 ◽  
Vol 14 (12) ◽  
pp. e247381
Author(s):  
Donnacha Hogan ◽  
Brian Hayes ◽  
Clodagh Keohane ◽  
Derek Barrry Hennessey
Keyword(s):  
Soft Tissue ◽  
B Cell ◽  
Multidisciplinary Team ◽  
Cell Lymphoma ◽  
Soft Tissue Mass ◽  
B Cell Lymphoma ◽  
Preoperative Imaging ◽  
Tissue Mass ◽  
Large B Cell Lymphoma ◽  
Large B Cell

A 72-year-old man was referred to our urology outpatient department with a left hemi-scrotal swelling increasing in size over a matter of weeks, initially suspicious for a left hydrocoele. Initial investigation with ultrasound (US) identified a heterogenous enlargement of the left testis and epididymis with a soft tissue mass extending through the inguinal canal. Subsequent CT detected this soft tissue mass to extend along the left gonadal vein to the level of the left renal vein. A biopsy of the retroperitoneal mass confirmed a diagnosis of diffuse large B-cell lymphoma. Immunohistochemical staining further categorised this lymphoma as double expressor but not double hit.Through multidisciplinary team involvement the patient was treated with combination steroids and chemotherapy. Given the scrotal involvement this was considered a sanctuary site for chemotherapy therefore the patient also received radiotherapy to the scrotum. He recovered well following his treatment. This case highlights how early specialist referral can identify rare variants of disease. Essential preoperative imaging with US prior to treating a presumed hydrocoele prevented inappropriate surgical excision. A multidisciplinary team approach improved the patient’s outcome and is hoped to have improved his chances of recurrence-free survival.

Angiomatosis of soft tissue as an important differential diagnosis for intramuscular venous malformations

2016 ◽  
Vol 32 (7) ◽  
pp. 474-481 ◽  
Author(s):  
Johanna Aronniemi ◽  
Jouko Lohi ◽  
Päivi Salminen ◽  
Pia Vuola ◽  
Kimmo Lappalainen ◽  
...  
Keyword(s):  
Soft Tissue ◽  
Vascular Malformations ◽  
Low Flow ◽  
Preoperative Imaging ◽  
Differential Diagnostics ◽  
Venous Malformations ◽  
Number Of Patients ◽  
Insufficient Response ◽  
Tissue Specimens

Background We aimed to improve management of extremity low-flow vascular malformations by analyzing the histology and imaging of venous malformations (VMs) not responsive to sclerotherapy. Method We reviewed patient records of 102 consecutive patients treated with sclerotherapy for extremity VM in our institution to identify patients who had undergone surgery due to insufficient response. We semi-quantitatively analysed the tissue specimens and compared histological findings to those in preoperative imaging. Result The number of patients operated on was 19 (18.6%); 15 of them had lower-extremity intramuscular lesions. The histological pattern of 13 of these 15 lesions corresponded to angiomatosis of soft tissue (AST). All other lesions treated surgically were VMs. The histology of AST was distinctive but magnetic resonance imaging findings often overlapped with those of VM. Conclusion AST is easily mixed with intramuscular VM. The differentiation of these two entities has therapeutic importance. We emphasize the role of histology in the differential diagnostics of intramuscular slow-flow vascular malformations.

scholarly journals Recurrent Schwannomatosis of the Hand

Hand ◽  
2020 ◽  
Vol 15 (5) ◽  
pp. NP73-NP79
Author(s):  
Razvan Nicolescu ◽  
Nikhil A. Agrawal ◽  
Rowland W. Pettit ◽  
David T. Netscher
Keyword(s):  
Soft Tissue ◽  
Index Finger ◽  
Skin Flap ◽  
Relevant Literature ◽  
Rare Condition ◽  
Careful Consideration ◽  
Preoperative Imaging ◽  
Peripheral Nerve Sheath Tumors ◽  
Right Hand ◽  
Soft Tissue Masses

Background: Peripheral nerve sheath tumors (PNSTs) are neoplastic soft tissue masses generated from the abnormal proliferation of Schwann cells. Often, these tumors occur in isolation and are known as schwannomas or neurilemmomas. The presence of multiple schwannomas is known as schwannomatosis. The purpose of this article is 2-fold: (1) to review the relevant literature and describe a unique case of this rare condition; and (2) to emphasize salient clinical considerations in the diagnosis and treatment of schwannomatosis. Methods: In this report, we describe the case of a 52-year-old white man who presented with multiple recurrent soft tissue masses of the right hand. On initial presentation, he described pain across his right hand and index finger, which persisted despite numerous prior operations. The index finger had a flexion contracture around the location of the proximal interphalangeal joint, and there were multiple tender masses along the length of the finger and palm. Results: Segmental excision of the affected radial digital nerve was performed. A pulp flap based on contralateral neurovascular bundle resulted in a sensate, pain-free digit. Tissue pathology confirmed the diagnosis of multiple neurilemmomas. Conclusions: We report the success of a radial digital neurectomy in a patient with widespread neurilemmomas, who had previously excluded that painful digit from use. It was through careful consideration of the preoperative differential diagnosis, by valuing the preoperative imaging, and by considering all surgical options with specific attention paid to skin flap design that this good outcome of a fully sensate, pain-free, mobile index finger was achieved.

scholarly journals Evaluation of vascular invasion in patients with musculoskeletal tumors of lower extremities: use of time-resolved 3D MR angiography at 3-T

2017 ◽  
Vol 59 (5) ◽  
pp. 586-592 ◽  
Author(s):  
Teng Jin ◽  
Gang Wu ◽  
Xiaoming Li ◽  
Xiaoyuan Feng
Keyword(s):  
Soft Tissue ◽  
Lower Extremity ◽  
Femoral Artery ◽  
Vascular Invasion ◽  
Mr Angiography ◽  
Soft Tissue Tumors ◽  
Preoperative Imaging ◽  
Time Resolved ◽  
Musculoskeletal Tumors ◽  
Noise Ratio

Background Time-resolved angiography with stochastic trajectories (TWIST) sequence makes considerable progress in temporal and spatial resolution, which presents high potential in evaluation of vascular diseases. Purpose To assess magnetic resonance imaging (MRI) using TWIST MR angiography (MRA) sequence in the assessment of vascular invasion for bone and soft-tissue tumors in comparison to computed tomography angiography (CTA) as the reference standard. Material and Methods Thirty-three patients with lower extremity musculoskeletal tumors were imaged with conventional MR and TWIST MRA. CTA was performed 48 h later. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) of the femoral artery were calculated. Vascular invasion as determined by MRA and CTA was separately analyzed. Vascular invasion by MRA and CTA were analyzed with kappa coefficients to determine agreement between the imaging methods. Results Seven cases of bone and 26 cases of soft tissue tumors were examined. SNR and CNR of the femoral artery were excellent for TWIST MRA (mean ± SD values of 317 ± 80 and 276 ± 76, respectively). Based on the TWIST sequence, the vessels were free of tumor in 16 cases. Vascular displacement was found in 11 cases and vascular stenosis in six cases. The MRA findings conflicted with CTA findings in only one case. The kappa value was 0.953 ( P < 0.01). In five cases, vascular malformations were found with TWIST MRA but not CTA. Conclusion TWIST MRA enables accurate delineation of anatomical structures and tumor arterial involvement, providing reliable preoperative imaging information with respect to lower extremity musculoskeletal tumors.

scholarly journals Imaging and Pathological Features of Alveolar Soft Part Sarcoma: Analysis of 16 Patients

2021 ◽  
Author(s):  
Malvika Gulati ◽  
Abhenil Mittal ◽  
Adarsh Barwad ◽  
Rambha Pandey ◽  
Sameer Rastogi ◽  
...  
Keyword(s):  
Young Adults ◽  
Soft Tissue ◽  
Soft Part ◽  
Alveolar Soft Part Sarcoma ◽  
Preoperative Imaging ◽  
Histopathological Diagnosis ◽  
Imaging Features ◽  
Common Site ◽  
Hyperintense Signal ◽  
Characteristic Imaging

Abstract Context Alveolar soft part sarcoma (ASPS) is a rare soft tissue tumor most commonly occurring in deep intramuscular plane of lower extremities of adolescents and young adults. It is a highly vascular, slow growing tumor with malignant potential having lung as the most common site of metastases at the time of presentation. Aims The aim is to review the imaging findings of ASPS and determine characteristic imaging features of this rare tumor. Materials and Methods Sixteen patients having histopathological diagnosis and preoperative imaging of ASPS attending the dedicated sarcoma clinic at our institute were included in the study. The demographic, clinical, and imaging data were retrieved from the case records and then evaluated for characteristic imaging features which may raise suspicion of ASPS. Results The patients ranged from 3 to 72 years of age and with a slight male preponderance. Of the eight CECTs evaluated, 62.5% tumors showed well-defined lobulated margins, 87.5% cases showed intense enhancement with presence of feeder vessels. On CEMRI of 10 patients, 70% had well circumscribed lobulated margins with intense enhancement and tortuous flow voids in most of them. All cases showed T2 hyperintense signal. Fourteen of 16 (87.5%) patients had metastatic disease with lung as the most common site (92.8%). Conclusion ASPS is a rare soft tissue sarcoma seen in children and young adults. Imaging may mimic a vascular malformation due to the presence of tortuous feeders. Misdiagnosis at an early stage may lead to later metastatic presentation of the disease, thus emphasizing the need to suspect it on imaging.

scholarly journals Analysis of Factors Associated with Temporal Hollowing after Pterional Craniotomy

2020 ◽  
Vol 53 (01) ◽  
pp. 071-082
Author(s):  
Thanakorn Thiensri ◽  
Akaluk limpoka ◽  
Chairat Burusapat
Keyword(s):  
Soft Tissue ◽  
Predictive Factors ◽  
Operative Time ◽  
Soft Tissues ◽  
Statistical Significance ◽  
Preoperative Imaging ◽  
Temporalis Muscle ◽  
Temporal Area ◽  
Pterional Craniotomy ◽  
Soft Tissue Volume

Abstract Background Temporal hollowing is a common complication after pterional craniotomy. Etiologies of hollowing are still in debate and inconclusive. The objective of this study is to determine the etiology and predictive factors of temporal hollowing after pterional craniotomy. Methods A retrospective study of patients who underwent pterional craniotomy was conducted. Inclusion criteria included older than 18 years, having undergone unilateral pterional craniotomy, and with no craniofacial anomaly or temporal defect. Volumes of bone, temporalis muscle, and extratemporalis layer were calculated. Results A total of 51 patients were included. Bone volumes of surgical and nonsurgical sites were 219.12 + 23.02 cm3, and 228.39 + 22.76 cm3, respectively (p = 0.04). Difference of bony volume was 9.10 cm3 (3.99%). Volumes of temporalis muscle in surgical and nonsurgical sites were 12.86 + 3.95 cm3, and 18.10 + 6.08 cm3, respectively (p < 0.005). Difference of muscle volume was 5.08 cm3 (28.32%). Volume of extratemporalis soft tissue in surgical and nonsurgical sites were 11.99 + 5.70 cm3, and 17.31 + 7.76 cm3, respectively (p < 0.005). Difference of soft tissue volume was 5.56 cm3 (31.68%). No statistical significance of the difference of bony, muscle, and soft tissue volumes were found between causes of disease, operative time, and postoperative radiation. Conclusions Hollowing after pterional craniotomy is an unavoidable result. Bone, temporalis muscle, and soft tissues are combined etiologies. No predictive factors including age, sex, causes, operative time, radiation, and surgical technique are demonstrated. Volume of temporal area reduction was 19.74 cm3. Immediate reconstruction is recommended and volume of reconstruction is calculated from preoperative imaging.

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