A Clinical Case of 5 Times Irradiated Recurrent Orbital Hemangiopericytoma

Orbital hemangiopericytomas (HPCs) are rare mesenchymal tumors with a high tendency to recur. Treatment options are quite limited in case of a relapse, but re-irradiation can be useful. Most of the available data limit the possibility of re-irradiation, while novel techniques (e.g., pencil beam proton therapy [PT]) open new approaches for the safe repeating of treatment. To the best of our knowledge, this is the first well-documented case of multi-times (>3) irradiation of tumors located intracranially. The case reported here describes orbital HPCs with proton irradiation performed two times since 1999 in a 30-year-old woman with a medical history as well as surgery followed by conventional radiotherapy (RT) and chemotherapy, and two times stereotactic RT (in 2009 and 2013).In 2016 the patient came to our hospital with the 3rd relapse of the tumor, located in the left orbit, with an intracranial part, involving cavernous sinus, which was close to the temporal lobe. The 4th course of irradiation was done in May to June 2016 by pencil beam PT. Radiation necrosis occurred after 2 years and was treated with bevacizumab (BVZ). Three years later, another relapse was treated with PT and BVZ. The 9-month follow-up showed complete tumor response without signs of brain toxicity. The patient died due to a brain abscess 1 year after the 5th irradiation. This case shows a possibility of irradiation, applied 5 times to the same location, with promising results and manageable toxicity.

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Oncogenic osteomalacia caused by a phosphaturic mesenchymal tumor of the thoracic spine

Journal of Neurosurgery Spine ◽

10.3171/2009.1.spine08351 ◽

2009 ◽

Vol 10 (4) ◽

pp. 329-333 ◽

Cited By ~ 19

Author(s):

Elena Pirola ◽

Francesco Vergani ◽

Paolo Casiraghi ◽

Eugenio Biagio Leone ◽

Paolo Guerra ◽

...

Keyword(s):

Thoracic Spine ◽

Paraneoplastic Syndrome ◽

Tumor Resection ◽

Mesenchymal Tumor ◽

Phosphaturic Mesenchymal Tumor ◽

Oncogenic Osteomalacia ◽

Mesenchymal Tumors ◽

History Of ◽

Complete Tumor

Phosphaturic mesenchymal tumors that cause the paraneoplastic syndrome known as oncogenic osteomalacia are rare. The authors report on the case of a 57-year-old man with a history of osteomalacia and in whom was diagnosed a thoracic spine tumor at the T-4 level. Complete tumor resection was accomplished. The histological diagnosis was phosphaturic mesenchymal tumor (mixed connective tissue variant). After lesion removal, the paraneoplastic syndrome resolved. At the 24-month follow-up, no recurrence of the disease was observed. The clinical presentation, surgical technique, and follow-up in this case were reviewed in detail.

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Multislice imaging of gastrointestinal stromal tumors

10.32512/jmr.1.1.2018/3.14 ◽

2018 ◽

pp. 3-14

Keyword(s):

Computed Tomography ◽

Key Words ◽

Gold Standard ◽

Gastrointestinal Stromal Tumors ◽

Mesenchymal Tumors ◽

Stromal Tumors ◽

Preferential Localization ◽

Multislice Imaging ◽

Computed Tomography Diagnosis

Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors of the digestive tract (1%). These tumors express the CD 117 in 95% of cases. The stomach is the preferential localization (70%). Diagnosis is difficult and sometimes late. Progress of imaging has greatly improved the management and the prognosis. Computed tomography (CT) is the gold standard for diagnosis, staging, and treatment follow-up. The increasing recognition of GIST’s histopathology and the prolonged survival revealed some suggestive imaging aspects. Key words: gastro-intestinal stromal tumors; computed tomography; diagnosis

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Antiretroviral Treatment-Associated Labia Majora Lipohypertrophy: A Rare Case and Plastic Surgical Treatment Options

Journal of Clinical and Health Sciences ◽

10.24191/jchs.v2i1.5877 ◽

2017 ◽

Vol 2 (1) ◽

pp. 43

Author(s):

Akmal Hisham ◽

Devananthan Ilenghoven ◽

Wan Syazli Wan Ahmad Kamal ◽

Salina Ibrahim ◽

Shah Jumaat Mohd Yussof

Keyword(s):

Highly Active Antiretroviral Therapy ◽

Daily Living ◽

Treatment Options ◽

Hiv Positive ◽

Highly Active ◽

Labia Majora ◽

The Face ◽

Central Fat

The emergence of highly active antiretroviral therapy (HAART) has revolutionized the prognosis of HIV-infected patients. However, the extended use of HAART is associated with a disfiguring complication termed lipodystrophy, a disorder of body fat maldistribution causing peripheral fat loss (lipoatrophy) and central fat accumulation (lipohypertrophy). Lipoatrophy commonly affects the face, legs, buttocks and arm, whilst lipohypertrophy frequently favours the abdomen, breast and dorsocervical region. To our knowledge, we present only the second documented case in the literature of a labia majora lipohypertrophy in a HIV-positive patient receiving long-term HAART. The severity of labial abnormality caused significant physical and functional morbidities. Labiaplasty with dermolipectomy of the labia majora and excisional lipectomy of the mons pubis was successfully performed. At a 6-month follow-up, patient had no recurrence with resolution of symptoms and resumption of normal activities of daily living (ADL).

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Efficacy and safety of oral dapsone in acne vulgaris – experience of a tertiary care teaching hospital in central Lahore

Journal of Fatima Jinnah Medical University ◽

10.37018/xqbw1463 ◽

2020 ◽

Vol 14 (2) ◽

pp. 87-90

Author(s):

Sadaf Amin Chaudhry ◽

Nadia Ali Zafar ◽

Rabia Hayat ◽

Ayesha Noreen ◽

Gulnaz Ali ◽

...

Keyword(s):

Side Effects ◽

Therapeutic Option ◽

Acne Vulgaris ◽

Treatment Options ◽

Tertiary Care ◽

Poor Response ◽

Global Assessment Scale ◽

Severe Acne ◽

Hematologic Profile

Background: Acne is the eighth most prevalent disease affecting 9.4% of the population worldwide and its prevalence in our country is estimated to be around 5%. Severe inflammatory acne is most likely to leave scars and in order to prevent facial disfigurement due to acne scarring, early treatment is desirable. Various treatment options have been formulated for acne, and are tailored according to the severity of the disease. Numerous clinical trials have been conducted till now, to determine the usefulness and side effect profile of such therapies, making acne treatment a highly studied area in dermatology. Objective of this study is to highlight the fact that oral Dapsone could be used as a cheaper alternate to isotretinoin in recalcitrant severe acne, especially in females where retinoids are sometimes contraindicated. Patients and methods: 51 patients, suffering from severe nodulocystic acne, fulfilling the criteria, were enrolled from the Department of Dermatology, Sir Ganga Ram Hospital, Lahore. All the study patients were given oral Dapsone 50mg for initial two weeks and then 100mg daily for the next 10 weeks along with oral cimetidine and topical clindamycin application twice daily. Investigator Global Assessment Scale (IGAS) was employed to measure effectiveness. The treatment was considered ʽeffectiveʹ if the patient achieves 2 or more than 2-grade improvement or almost clear or clear skin at the end of 12 weeks according to IGAS scale. The lesion counts were also done before the start of therapy (day 1) and at every two weeks follow up for 12 weeks. The change in lesion count observed between the baseline number and that seen at follow up visits was also used to evaluate the effectiveness of oral Dapsone. Safety was analyzed by fortnightly visits of the patients to look for any undesirable side effects and monitoring of the hematologic profile of the patients. Final follow up was done at the end of 16 weeks. Results: The study was conducted on 51 patients, with a ratio of 1:3 for males and females and a mean age of 25.2 years (SD ±5.81). At 12th week, patients had significant reduction in their acne lesions; with 7 patients (13.7%) showing completely clear skin, 17 patients (33.3%) had almost clear skin, 5 patients (9.8%) had 3-grade improvement. Twelve patients (23.5%) had 2-grade improvement from baseline score and only 2 patients (3.9%) had 1-grade improvement from baseline. Based on percentage reduction of lesions, excellent response was seen in 32 patients (62.7%), good response in 9 patients (17.6%), moderate response in 2 patients (3.9%), while no patient showed poor response. Dapsone was discontinued in 8 patients due to derangement of hematologic profile. Conclusion: Oral Dapsone, when given carefully, is a very effective therapeutic option in severe recalcitrant acne, with limited side effects.

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Data Driven Mathematical Model of FOLFIRI Treatment for Colon Cancer

Cancers ◽

10.3390/cancers13112632 ◽

2021 ◽

Vol 13 (11) ◽

pp. 2632

Author(s):

Aparajita Budithi ◽

Sumeyye Su ◽

Arkadz Kirshtein ◽

Leili Shahriyari

Keyword(s):

Mathematical Model ◽

Colon Cancer ◽

Cancer Patients ◽

Immune Cell ◽

Treatment Options ◽

Data Driven ◽

T Helper ◽

Primary Tumors ◽

Cell Fractions

Many colon cancer patients show resistance to their treatments. Therefore, it is important to consider unique characteristic of each tumor to find the best treatment options for each patient. In this study, we develop a data driven mathematical model for interaction between the tumor microenvironment and FOLFIRI drug agents in colon cancer. Patients are divided into five distinct clusters based on their estimated immune cell fractions obtained from their primary tumors’ gene expression data. We then analyze the effects of drugs on cancer cells and immune cells in each group, and we observe different responses to the FOLFIRI drugs between patients in different immune groups. For instance, patients in cluster 3 with the highest T-reg/T-helper ratio respond better to the FOLFIRI treatment, while patients in cluster 2 with the lowest T-reg/T-helper ratio resist the treatment. Moreover, we use ROC curve to validate the model using the tumor status of the patients at their follow up, and the model predicts well for the earlier follow up days.

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Robotic Radiosurgery for Persistent Postoperative Acromegaly in Patients with Cavernous Sinus-Invading Pituitary Adenomas—A Multicenter Experience

Cancers ◽

10.3390/cancers13030537 ◽

2021 ◽

Vol 13 (3) ◽

pp. 537

Author(s):

Felix Ehret ◽

Markus Kufeld ◽

Christoph Fürweger ◽

Alfred Haidenberger ◽

Paul Windisch ◽

...

Keyword(s):

Disease Control ◽

Effective Treatment ◽

Cavernous Sinus ◽

Treatment Options ◽

Cavernous Sinus Invasion ◽

Robotic Radiosurgery ◽

Patient Morbidity ◽

Biochemical Remission ◽

Patients Experience

Background: The rates of incomplete surgical resection for pituitary macroadenomas with cavernous sinus invasion are high. In growth hormone-producing adenomas, there is a considerable risk for persistent acromegaly. Thus, effective treatment options are needed to limit patient morbidity and mortality. This multicenter study assesses the efficacy and safety of robotic radiosurgery (RRS) for patients with cavernous sinus-invading adenomas with persistent acromegaly. Methods: Patients who underwent RRS with CyberKnife for postoperative acromegaly were eligible. Results: Fifty patients were included. At a median follow-up of 57 months, the local control was 100%. The pretreatment insulin-like growth factor 1 (IGF-1) levels and indexes were 381 ng/mL and 1.49, respectively. The median dose and prescription isodose were 18 Gy and 70%, respectively. Six months after RRS, and at the last follow-up, the IGF-1 levels and indexes were 277 ng/mL and 1.14, as well as 196 ng/mL and 0.83, respectively (p = 0.0001 and p = 0.0002). The IGF-1 index was a predictor for biochemical remission (p = 0.04). Nine patients achieved biochemical remission and 24 patients showed biochemical disease control. Three patients developed a new hypopituitarism. Conclusions: RRS is an effective treatment for this challenging patient population. IGF-1 levels are decreasing after treatment and most patients experience biochemical disease control or remission.

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MRI-Based Radiomics Analysis for the Pretreatment Prediction of Pathologic Complete Tumor Response to Neoadjuvant Systemic Therapy in Breast Cancer Patients: A Multicenter Study

Cancers ◽

10.3390/cancers13102447 ◽

2021 ◽

Vol 13 (10) ◽

pp. 2447

Author(s):

Renée W. Y. Granzier ◽

Abdalla Ibrahim ◽

Sergey P. Primakov ◽

Sanaz Samiei ◽

Thiemo J. A. van Nijnatten ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Patients ◽

Systemic Therapy ◽

Tumor Response ◽

Added Value ◽

Breast Cancer Patients ◽

Neoadjuvant Systemic Therapy ◽

Clinical Models ◽

Combined Models ◽

Complete Tumor

This retrospective study investigated the value of pretreatment contrast-enhanced Magnetic Resonance Imaging (MRI)-based radiomics for the prediction of pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients. A total of 292 breast cancer patients, with 320 tumors, who were treated with neo-adjuvant systemic therapy and underwent a pretreatment MRI exam were enrolled. As the data were collected in two different hospitals with five different MRI scanners and varying acquisition protocols, three different strategies to split training and validation datasets were used. Radiomics, clinical, and combined models were developed using random forest classifiers in each strategy. The analysis of radiomics features had no added value in predicting pathologic complete tumor response to neoadjuvant systemic therapy in breast cancer patients compared with the clinical models, nor did the combined models perform significantly better than the clinical models. Further, the radiomics features selected for the models and their performance differed with and within the different strategies. Due to previous and current work, we tentatively attribute the lack of improvement in clinical models following the addition of radiomics to the effects of variations in acquisition and reconstruction parameters. The lack of reproducibility data (i.e., test-retest or similar) meant that this effect could not be analyzed. These results indicate the need for reproducibility studies to preselect reproducible features in order to properly assess the potential of radiomics.

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Squamous cell carcinoma of the scrotum in HIV: two case reports

African Journal of Urology ◽

10.1186/s12301-021-00177-3 ◽

2021 ◽

Vol 27 (1) ◽

Author(s):

Jeff John ◽

Ken Kesner ◽

John Lazarus

Keyword(s):

Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Squamous Cell ◽

Case Reports ◽

Treatment Options ◽

Punch Biopsy ◽

Delayed Treatment ◽

Clinical Presentations ◽

T1 N0 M0

Abstract Background Squamous cell carcinoma (SCC) of the scrotum was the first malignancy known to be associated with exposure to an occupational carcinogen—in this case, soot trapped in the breeches of chimney sweeps. Better civil rules and regulations and the replacement of hearths with other forms of heating have rendered SCC of the scrotum a rarity. We report two cases of scrotal SCC with vastly differing clinical presentations and management. Case presentation Case 1 had T1 N0 M0 disease and presented with a small (< 2 cm), innocuous-looking, non-healing ulcer of eight years duration. A punch biopsy revealed a superficially invasive SCC confirmed on immunohistochemical profiling. A wide local excision of the lesion was subsequently performed. Follow-up at three years showed no signs of recurrence. Case 2 presented with T4 N1 M1 disease and rapidly progressing locally destructive mass. A punch biopsy of the scrotal lesion confirmed invasive moderately differentiated focally keratinising SCC. The metastatic evaluation confirmed the presence of metastatic, extensive para-aortic lymphadenopathy. He was managed with cisplatin-based chemoradiotherapy. Conclusion Early detection and management of patients with SCC of the scrotum are essential. If the diagnosis is delayed, treatment options become limited, and the prognosis is poor. Notwithstanding the rarity of this disease, multicentre trials are needed to provide more precise guidelines as to the optimal management of these patients.

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Extracorporeal shockwave therapy versus musculoskeletal mesotherapy for Achilles tendinopathy in athlete

Egyptian Rheumatology and Rehabilitation ◽

10.1186/s43166-020-00033-2 ◽

2020 ◽

Vol 47 (1) ◽

Author(s):

Reem EL-Mallah ◽

Enas A. Elattar

Keyword(s):

Treatment Options ◽

Visual Analogue Score ◽

Achilles Tendinopathy ◽

Extracorporeal Shockwave Therapy ◽

Extracorporeal Shockwave ◽

Shockwave Therapy ◽

Tendon Thickness ◽

Vas Scores ◽

Tendon Pathology

Abstract Background Achilles tendinopathy (AT) is considered the commonest tendon pathology, occurring mainly in athletes. Different conservative treatment options have been introduced but with short-term effects; however, extracorporeal shockwave therapy (ESWT) and mesotherapy (MT) injections were claimed to provide longer effects and could be used in cases failure of response to conservative treatments. The objective of our prospective 12-week study was to compare the effect of ESWT and MT on chronic Achilles tendinopathy in athletes by both clinical and ultrasonographical assessment. Results Forty patients with chronic AT diagnosed clinically and with high-resolution ultrasound (US) randomly allocated in two groups first received weekly ESWT session, and the other group underwent weekly MT sessions for 4 consecutive weeks. Both groups improved during the treatment and follow-up period. The mean visual analogue score (VAS) decreased in both the ESWT group and the MT group. Mean American Orthopedic Foot and Ankle Society (AOFAS) hindfoot score and VAS scores were not significantly different between ESWT and MT groups at the 4th and the 12th week of follow-up. However, US assessment significantly improved after 12 weeks in the ESWT group (as regards tendon thickness, calcifications, and Doppler signal), and for the mesotherapy group, there was the only improvement of tendon thickness. Conclusion ESWT showed improvement of pain and inflammation and calcifications of AT than MT injections, which was documented by US improved findings at week 12 follow up.

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Duration of response after DEB-TACE compared to lipiodol-TACE in HCC-naïve patients: a propensity score matching analysis

European Radiology ◽

10.1007/s00330-021-07905-x ◽

2021 ◽

Author(s):

Irene Bargellini ◽

Valentina Lorenzoni ◽

Giulia Lorenzoni ◽

Paola Scalise ◽

Gianni Andreozzi ◽

...

Keyword(s):

Propensity Score ◽

Tumor Progression ◽

Tumor Response ◽

Complete Response ◽

Tumor Burden ◽

Local Tumor Control ◽

Lower Number ◽

Tumor Control ◽

Duration Of Response

Abstract Objectives To retrospectively compare long-term outcomes of first-line drug-eluting particle (DEB)- transarterial chemoembolization (TACE) and lipiodol-TACE, in patients with unresectable hepatocellular (HCC). Methods We retrospectively reviewed our database to identify adult patients with treatment-naïve unresectable HCC, who underwent TACE from 2006 to 2013. Patients were excluded in the absence of complete medical records relative to first TACE, 1-month follow-up, and/or sufficient follow-up data. Periprocedural complications, duration of hospitalization, 1-month tumor response by mRECIST, time to tumor progression (TTP) and target tumor progression (TTTP), and overall survival (OS) were evaluated. Results Out of an initial series of 656 patients, 329 patients were excluded for unavailability of sufficient baseline and/or follow-up data. The remaining 327 patients underwent either lipiodol-TACE (n = 160) or DEB-TACE (n = 167). Patients treated with lipiodol-TACE had a significantly higher tumor burden. By propensity score, patients were matched according to baseline differences (BCLC stage, uninodular or multinodular HCC, and unilobar or bilobar HCC), resulting in 101 patients in each treatment group. Lipiodol-TACE was associated with a significantly higher incidence of adverse events (p = 0.03), and longer hospitalization (mean, 2.5 days vs 1.9 days; p = 0.03), while tumor response, TTP, and OS were comparable. In patients achieving 1-month complete response (CR) of target tumor, TTTP was significantly (p = 0.009) longer after DEB-TACE compared to lipiodol-TACE (median, 835 vs 353 days), resulting in a lower number of re-treatments during the entire follow-up (0.75 vs 1.6, p = 0.01). Conclusion Compared to lipiodol-TACE, DEB-TACE offers higher tolerability, reduced hospitalization, and more durable target tumor response after CR. Key Points • Compared to lipiodol-TACE, DEB-TACE is better tolerated and has reduced side effects, which translates into shorter hospitalization. • When complete radiological response according to the mRECIST is obtained 1 month after the procedure, DEB-TACE offers a more durable local tumor control compared to lipiodol-TACE. • In these patients, the longer duration of response after DEB-TACE translates into a lower number of re-interventions.

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