scholarly journals Thoracic spine metastasis presenting 18 years after complete resection of a phaeochromocytoma

2019 ◽  
Vol 12 (8) ◽  
pp. e229621
Author(s):  
Lúcia Fadiga ◽  
Joana Saraiva ◽  
Isabel Paiva ◽  
Francisco Carrilho
Keyword(s):  
Neuroendocrine Tumours ◽  
External Beam Radiotherapy ◽  
Primary Tumour ◽  
Hypertensive Crisis ◽  
Cord Compression ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
History Of ◽  
Iodine 131

Phaeochromocytomas are rare neuroendocrine tumours (NET) with malignant behaviour in about 10% of cases. The median time from the diagnosis of primary tumour and bone metastasis is 3.4 years. We report a case of a 66-year-old woman presenting with a hypertensive crisis and back pain. She has a history of a phaeochromocytoma completely resected 18 years before. MRI showed a neoplastic mass on the 10th thoracic vertebra (T10), with fracture and spinal cord compression. The CT-guided biopsy was consistent with metastasis of a NET. Therefore, she was treated with phenoxybenzamine and external beam radiotherapy. However, clinical (dorsal pain) and biochemical (ie, elevated chromogranin A) signs suggested persistent disease and the patient was treated with iodine-131 metaiodobenzylguanidine and T10 kyphoplasty. After 8 years, she remains clinically stable. This case demonstrates that phaeochromocytomas may reveal malignant behaviour several years after diagnosis, and therefore patients should be maintained under long term surveillance.

scholarly journals Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hind S. Alsaif ◽  
Ali Hassan ◽  
Osamah Refai ◽  
Khaled Awary ◽  
Haitham Kussaibi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Malignancy ◽  
Ct Guided ◽  
Case Presentation ◽  
Hepatic Tuberculosis ◽  
Ct Guided Biopsy ◽  
History Of ◽  
Abdominal Examination ◽  
Peripheral Arterial ◽  
High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

Single institutional series of neuroendocrine tumours managed in the Australian capital territory.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14703-e14703
Author(s):  
Laeeq Malik ◽  
Yu Jo Chua ◽  
Nadeem Butt ◽  
Desmond Yip
Keyword(s):  
Neuroendocrine Tumours ◽  
Histological Grade ◽  
Tumour Size ◽  
Primary Tumour ◽  
Limited Information ◽  
Australian Capital Territory ◽  
Long Term Outcome ◽  
Male Predominance ◽  
Australian Capital

e14703 Background: Neuroendocrine tumours (NETs) have been regarded as indolent tumors with significantly variable clinical behavior. Limited information is available on long-term clinical outcome and clinically applicable prognostic factors.We performed a retrospective review of NETS managed in the Australian Capital Territory (ACT) over a 12-year period,with examination of epidemiology and various prognostic clinicopathologic factors. Methods: This multicenter analysis included patients in ACT and surrounding New South Wales treated with histologically proven neuroendocrine tumor (lung carcinoids excluded). The cases were identified from hospital databases. Data was analysed according to epidemiological, clinical and histopathological characteristics. Results: The cohort of 107 patients showed slight male predominance. Median age at diagnosis was 62 years and tumour size of 1.2 cm. The most common primary tumour site was jejunum/ileum (32%) followed by rectum (22%) and pancreas (11.2 %). Most patients had localised disease at initial diagnosis (n- 73/107 (68%). Distant metastases were seen in 32% (n-34/107) on initial staging with liver being most common site. Most patients were symptomatic at diagnosis while 22.4% cases were found incidentally. Second malignancies in particular of gastrointestinal origin were diagnosed in 33.6% (n-36/107). Surgical debulking was the most common treatment (59.8%) while 18% had multi-modality therapy. At a median followup of 25 months from diagnosis, 76 patients (78%) were still alive. Median time to first relapse was 15 months. 5 year survival rate was 75% for NETs originating from jejunum/ilieum on Kaplan-Meier analysis. Increasing age, tumor size, male gender, high histological grade, high Ki 67 index, raised plasma chromogranin A and urine 5 HIAA at the time of diagnosis were associated with shorter 5-year survival. Conclusions: The epidemiologic characteristics and long-term outcome in our series was comparable to reported studies from other centers. This analysis confirmed some important prognostic factors that could be considered for risk stratification and therapeutic management in patients with NETs.

Pulmonary metastases

2020 ◽  
pp. 4360-4361
Author(s):  
S.G. Spiro
Keyword(s):  
Doubling Time ◽  
Pulmonary Metastases ◽  
Lung Metastases ◽  
Primary Tumour ◽  
Performance Status ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Male Sex ◽  
Tumour Doubling Time ◽  
Suspicious Lesions

Malignant metastasis to the lung is common. It may present as a solitary enlarging nodule, as multiple nodules ranging enormously in size and number, and/or with diffuse lymphatic involvement. Diagnosis can usually be secured by percutaneous CT-guided biopsy and most suspicious lesions will be PET positive. Resection remains the treatment of choice, and good prognostic factors include the time from treatment of the primary tumour to the development of lung metastases, the fewer the number, the absence of extrapulmonary metastases, and the longer the tumour doubling time. The most favourable group are younger patients with a good performance status, with sarcomas who present with lesions a year or more after successful treatment of the primary disease. Factors including older age, male sex, and more lung metastases predict poorer survival after resection of any initial pulmonary metastases.

scholarly journals Long-Term Outcomes and Prognostic Analysis of Computed Tomography-Guided Radioactive 125I Seed Implantation for Locally Recurrent Rectal Cancer After External Beam Radiotherapy or Surgery

2021 ◽  
Vol 10 ◽  
Author(s):  
Hao Wang ◽  
Lu Wang ◽  
Yuliang Jiang ◽  
Zhe Ji ◽  
Fuxin Guo ◽  
...  
Keyword(s):  
Adverse Effects ◽  
External Beam Radiotherapy ◽  
Long Term Outcomes ◽  
Ct Guided ◽  
Seed Implantation ◽  
Radiation Induced ◽  
Locally Recurrent ◽  
Grade 3 ◽  
Short Time

BackgroundManagement of locally recurrent rectal cancer (LRRC) after surgery or external beam radiotherapy (EBRT) remains a clinical challenge, given the limited treatment options and unsatisfactory outcomes. This study aimed to assess long-term outcomes of computed tomography (CT)-guided radioactive 125I seed implantation in patients with LRRC and associated prognostic factors.MethodsA total of 101 patients with LRRC treated with CT-guided 125I seed implantation from October 2003 to April 2019 were retrospectively studied. Treatment procedures involved preoperative planning design, 125I seed implantation, and postoperative dose evaluation. We evaluated the therapeutic efficacy, adverse effects, local control (LC) time, and overall survival (OS) time.ResultsAll the patients had previously undergone surgery or EBRT. The median age of patients was 59 (range, 31–81) years old. The median follow-up time was 20.5 (range, 0.89–125.8) months. The median LC and OS time were 10 (95% confidence interval (CI): 8.5–11.5) and 20.8 (95% CI: 18.7–22.9) months, respectively. The 1-, 2-, and 5-year LC rates were 44.2%, 20.7%, and 18.4%, respectively. The 1-, 2-, and 5-year OS rates were 73%, 31.4%, and 5%, respectively. Univariate analysis of LC suggested that when short-time tumor response achieved partial response (PR) or complete response (CR), or D90>129 Gy, or GTV ≤ 50 cm3, the LC significantly prolonged (P=0.044, 0.041, and <0.001, respectively). The multivariate analysis of LC indicated that the short-time tumor response was an independent factor influencing LC time (P<0.001). Besides, 8.9% (9/101) of the patients had adverse effects (≥grade 3): radiation-induced skin reaction (4/101), radiation-induced urinary reaction (1/101), fistula (2/101), and intestinal obstruction (2/101). The cumulative irradiation dose and the activity of a single seed were significantly correlated with adverse effects ≥grade 3 (P=0.047 and 0.035, respectively).ConclusionCT-guided 125I seed implantation is a safe and effective salvage treatment for LRRC patients who previously underwent EBRT or surgery. D90 and GTV significantly influenced prognosis of such patients.

scholarly journals Chest Pain? An Unusual Presentation of Vertebral Osteomyelitis

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Cristian Landa ◽  
Stanley Giddings ◽  
Pramod Reddy
Keyword(s):  
Tissue Culture ◽  
Pulmonary Embolism ◽  
Chest Pain ◽  
Vertebral Osteomyelitis ◽  
Cord Compression ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Rule Out

We present a case of vertebral osteomyelitis presenting as chest pain. The patient initially underwent a CT chest angiogram to rule out a pulmonary embolism, which incidentally showed a soft tissue vertebral mass at T3-T4 disk space. Subsequent thoracic vertebral MRI was consistent with osteomyelitis with cord compression. Tissue culture from a CT-guided biopsy grew MRSA. The patient was successfully treated with Vancomycin. This is a rare presentation of vertebral osteomyelitis which poses an interesting diagnostic challenge.

Ganglion cyst arising from the composite occipito-atlanto-axial joint cavity in a cat

2014 ◽  
Vol 27 (04) ◽  
pp. 319-323
Author(s):  
S. Sadahiro ◽  
M. Nishimura ◽  
Y. Miyazaki ◽  
M. Shibata ◽  
T. Aikawa
Keyword(s):  
Ganglion Cyst ◽  
Clinical Signs ◽  
Cord Compression ◽  
Histological Evaluation ◽  
Dorsal Spinal Cord ◽  
Joint Cavity ◽  
Initial Inability ◽  
History Of ◽  
Atlanto Axial Joint

SummaryA four-year-old, female spayed Domestic Longhaired cat was referred for evaluation with a two month history of initial inability to jump progressing to ambulatory tetraparesis. Magnetic resonance imaging studies demonstrated a cystic lesion arising from the composite occipito-atlanto-axial joint cavity and extending to the region of the occipital bone and the axis. The lesion surrounded the spinal canal, causing moderate dorsal spinal cord compression at the atlanto-occipital joint. A dynamic myelographic study demonstrated attenuation of the dorsal contrast column at the atlanto-occipital joint when the cervical spine was positioned in extension. Partial excision of the cyst capsule by a ventral approach resulted in long-term (64 months) resolution of clinical signs. Histological evaluation was consistent with a ganglion cyst. An intra-spinal ganglion cyst arising from the composite occipito-atlanto-axial joint cavity may be considered as an uncommon differential diagnosis for cats with cervical myelopathy.

scholarly journals Rare, post-periodontitis spondylodiscitis caused by Fusobacterium nucleatum in a patient with multiple sclerosis: challenge of diagnosis and treatment

2021 ◽  
Vol 14 (3) ◽  
pp. e239664
Author(s):  
Dritan Pasku ◽  
Siddharth Shah ◽  
Ahmed Aly ◽  
Nasir A Quraishi
Keyword(s):  
Multiple Sclerosis ◽  
Fusobacterium Nucleatum ◽  
Mri Scan ◽  
Surgical Biopsy ◽  
Ct Guided ◽  
Commensal Flora ◽  
Immunsuppressive Therapy ◽  
Ct Guided Biopsy ◽  
History Of

Fusobacterium nucleatum is part of the commensal flora of the oral cavity, frequently associated with periodontal infections. We describe the case of a 49-year-old woman, on immunsuppressive therapy for multiple sclerosis, who presented with a 3-month history of debilitating back pain. She had a recent episode of periodontitis, and was under regular dental review. Her MRI scan demonstrated findings suggestive of L2–L3 spondylodiscitis. Her CT-guided biopsy yielded negative cultures and the patient failed two courses of empirical antibiotic treatment. With clinical and radiological disease progression, she underwent a percutaneous disc washout and biopsy, which subsequently grew F. nucleatum. Treatment with clindamycin and metronidazole was commenced orally for 6 weeks. She improved gradually, and at 1 year follow-up was asymptomatic. The diagnosis of spondylodiscitis caused by F. nucleatum is challenging. The perseverance on identification by surgical biopsy, minimally invasive washout and targeted antibiotics are the mainstay of effective treatment.

scholarly journals Thoracic spine Langerhans cell histiocytosis in a child with achondroplasia

2019 ◽  
Vol 12 (7) ◽  
pp. e228801
Author(s):  
Zoe Chan ◽  
Lesley Simpson ◽  
Pasquale Gallo
Keyword(s):  
Spinal Cord ◽  
Langerhans Cell Histiocytosis ◽  
Cord Compression ◽  
Langerhans Cell ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Leg Weakness ◽  
Radiological Response ◽  
Posterior Soft Tissue

Multifocal bone Langerhans cell histiocytosis (LCH) is usually treated with prednisolone and vinblastine. We present a case conservatively treated with indomethacin with good clinical and radiological response. A 7-year-old achondroplastic boy presented with worsening thoracic back pain and leg weakness. An admission MRI spine showed a pathological T1 vertebrae fracture with posterior soft tissue extension compressing and distorting the spinal cord. A CT guided biopsy revealed an LCH. Steroids were avoided to reduce osteopenia risk and further vertebral fragility. Considering the risk of a thoracic surgical approach in a child with this background, he was managed conservatively with indomethacin and a Sternal Occipital Mandibular Immobilizer (SOMI) Brace. Pain resolved completely within 6 months and the brace was discontinued. Serial follow-up scans showed progressive resolution of the pathological T1 fracture and complete resolution of the spinal cord compression.

scholarly journals Colorectal cancer presenting with dysarthria and ataxia: a case of isolated leptomeningeal metastasis

2011 ◽  
Vol 93 (7) ◽  
pp. e133-e135 ◽  
Author(s):  
RP Lahiri ◽  
KM Burnand ◽  
A Bandi ◽  
N Farooq ◽  
T Sathesh-Kumar
Keyword(s):  
Primary Tumour ◽  
Leptomeningeal Metastasis ◽  
Bowel Habit ◽  
Resonance Imaging ◽  
Abdominal Lymph Node ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
Thoracic And Abdominal ◽  
Abdominal Lymphadenopathy ◽  
Cerebellar Symptoms

We report the case of a 72-year-old man who presented with weight loss, anorexia and a change in bowel habit. Computed tomography (CT) of the chest, abdomen and pelvis demonstrated widespread thoracic and abdominal lymphadenopathy and a lesion within the splenic flexure. This was confirmed as an adenocarcinoma after a colonoscopic biopsy. A CT guided biopsy of the abdominal lymph node confirmed the adenocarcinoma. Within three days of admission, the patient developed worsening, progressive cerebellar symptoms that left the patient aphasic and bed bound. CT of the head was reported as normal. Magnetic resonance imaging of the head demonstrated widespread leptomeningeal metastases. We describe a case of isolated leptomeningeal metastasis from a colorectal primary tumour.

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