Successful treatment with radiation therapy for desmoid-type fibromatosis with unilateral hydronephrosis: a case report

Abstract Background Desmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone. Case presentation A 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications. Conclusion We experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.

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Treatment of May–Thurner Syndrome in a Patient with an Iliac Artery Stent

Vascular and Endovascular Review ◽

10.15420/ver.2020.10 ◽

2020 ◽

Vol 3 ◽

Author(s):

Raleene Gatmaitan ◽

Keagan Werner-Gibbings ◽

Tommaso Donati ◽

Prakash Saha ◽

Stephen Black

Keyword(s):

Surgical Management ◽

Iliac Artery ◽

Common Iliac Artery ◽

Clinical Manifestations ◽

Iliac Vein ◽

Stent Insertion ◽

Common Iliac Vein ◽

Medical Implants ◽

The Right ◽

Venous Stents

May–Thurner syndrome (MTS) is caused by compression of the left iliac vein by the right iliac artery, leading to clinical manifestations of outflow obstruction in the lower limb and deep vein thrombosis. There have been increasing reports of iatrogenic MTS caused by medical implants. The authors report the case of a 60-year-old man who developed MTS after stenting of the right common iliac artery. Due to the debilitating nature of the patient’s symptoms of venous congestion in the left leg, he proceeded with endovascular venoplasty and venous stent insertion with concurrent intra-arterial balloon angioplasty of the existing right common iliac artery stent. Technical success and primary patency of arterial and venous stents were achieved. The patient remained asymptomatic at 6 weeks and 3 months follow-up and arterial and venous stents were found to be patent on duplex ultrasound. Surgical management of MTS may include thrombolysis, thrombectomy, venoplasty and stenting of the left common iliac vein. Care must be taken to preserve existing medical implants during treatment of MTS. The authors demonstrate that concurrent angioplasty of the right common iliac artery during treatment of the vein is an effective method of preventing arterial stent disruption during surgical management of MTS.

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Leiomyosarcoma of the external iliac vein

Vascular ◽

10.1258/vasc.2011.cr0305 ◽

2012 ◽

Vol 20 (3) ◽

pp. 178-180 ◽

Cited By ~ 1

Author(s):

Wakako Fukuda ◽

Satoshi Taniguchi ◽

Ikuo Fukuda

Keyword(s):

Tumor Resection ◽

External Iliac Artery ◽

Iliac Vein ◽

Japanese Woman ◽

Complete Resection ◽

Pathological Examination ◽

En Bloc ◽

External Iliac Vein ◽

Old Japanese ◽

The Right

Leiomyosarcoma of the iliac vein is an uncommon tumor. We report a case of a 63-year-old Japanese woman with leiomyosarcoma of the right external iliac vein. The patient complained of right inguinal pain and swelling. Computed tomography demonstrated a mass surrounding the right external iliac artery and vein. Metastases in the lungs and liver were found. Complete resection of the tumor along with the involved vessels was performed. Polytetrafluoroethylene grafts were used to reconstruct the vessels. Pathological examination revealed leiomyosarcoma of the external iliac vein. Although the prognosis of leiomyosarcoma is poor, en bloc tumor resection is the treatment of choice.

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May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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Successful radiation therapy for primary cutaneous follicle center lymphoma

Journal of Case Reports in Medicine ◽

10.25149/jcrm.v8i2.198 ◽

2019 ◽

Vol 8 (2) ◽

Author(s):

Takashi Matsushita ◽

Tomoyasu Kumano ◽

Kazuhiko Takehara

Keyword(s):

Radiation Therapy ◽

Skin Biopsy ◽

B Cell ◽

B Cell Lymphomas ◽

Solitary Lesion ◽

Lower Jaw ◽

First Choice ◽

The Right

Primary cutaneous follicle center lymphoma (PCFCL) accounts for the majority of primary cutaneous B-cell lymphomas. We report a 60-year-old womanwith PCFCL. She had a red nodule (25 × 25 mm) on the right side of the lower jaw. She was diagnosed with PCFCL by skin biopsy. And then, she was treated with radiation therapy (total 30.6 Gy), which completely eliminated the nodule. Our case suggests that radiation therapy may be a first choice for PCFCL patients with a solitary lesion or localized lesions.

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Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

BMC Infectious Diseases ◽

10.1186/s12879-020-05733-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Takehiro Hashimoto ◽

Ryuichi Takenaka ◽

Haruka Fukuda ◽

Kazuhiko Hashinaga ◽

Shin-ichi Nureki ◽

...

Keyword(s):

Septic Shock ◽

Therapeutic Strategy ◽

Yersinia Pseudotuberculosis ◽

Immunocompromised Host ◽

Immunocompetent Patient ◽

Case Presentation ◽

Gram Negative ◽

Old Japanese ◽

The Right ◽

Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

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Lung autotransplantation for bronchial necrosis after radiotherapy: a case report

Surgical Case Reports ◽

10.1186/s40792-021-01164-0 ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuya Nobori ◽

Masaaki Sato ◽

Mizuki Morota ◽

Yoshikazu Shinohara ◽

Daisuke Yoshida ◽

...

Keyword(s):

Radiation Therapy ◽

Pulmonary Function ◽

Treatment Success ◽

Locally Advanced ◽

Fistula Formation ◽

Bronchial Anastomosis ◽

Silicone Stent ◽

Feasible Option ◽

Malignant Germ Cell Tumor ◽

The Right

Abstract Background Bronchial necrosis is a rare but fatal complication after radiation therapy. Because of the anatomical complexity and rarity of this condition, determining the most appropriate management for individual patients is extremely challenging. Lung autotransplantation is a surgical technique that has been applied to hilar neoplastic lesions to preserve pulmonary function and avoid pneumonectomy. We herein report a case of bronchial necrosis secondary to radiotherapy that was treated with lung autotransplantation. Case presentation A 46-year-old man developed broad necrosis and infection of the right bronchus secondary to previous stereotactic body-radiation therapy. This treatment was supplied close to a right hilar metastatic pulmonary tumor derived from a mediastinal malignant germ cell tumor that had been surgically resected with the left phrenic nerve. The bronchial necrosis accompanied by infection with Aspergillus fumigatus was progressive despite antibiotics and repetitive bronchoscopic debridement. Because of the patient’s critical condition and limited pulmonary function, right lung autotransplantation with preservation of the right basal segment was selected. An omental flap was placed around the bronchial anastomosis to prevent later complications. The postoperative course involved multiple complications including contralateral pneumonia and delayed wound healing at the bronchial anastomosis with resultant stenosis, the latter of which was overcome by placement of a silicone stent. The patient was discharged 5 months postoperatively. Three months after discharge, however, the patient developed hemoptysis and died of bronchopulmonary arterial fistula formation. Conclusions We experienced an extremely challenging case of bronchial necrosis secondary to radiotherapy. The condition was managed with lung autotransplantation and omental wrapping; however, the treatment success was temporary and the patient eventually died of bronchopulmonary arterial fistula formation. This technique seems to be a feasible option for locally advanced refractory bronchial necrosis, although later complications can still be fatal.

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Conservatively Treated Femoral Intertrochanteric Fracture With Early Asymptomatic Novel Coronavirus Disease 2019 (COVID-19): A Case Report

Geriatric Orthopaedic Surgery & Rehabilitation ◽

10.1177/2151459320969380 ◽

2020 ◽

Vol 11 ◽

pp. 215145932096938

Author(s):

Yuki Suzuki ◽

Toshihiko Kasashima ◽

Kazutoshi Hontani ◽

Yasuhiro Yamamoto ◽

Kanako Ito ◽

...

Keyword(s):

Intertrochanteric Fracture ◽

Screening Method ◽

Oxygen Demand ◽

Japanese Woman ◽

Trauma Patients ◽

Lung Field ◽

Old Japanese ◽

Femoral Intertrochanteric Fracture ◽

Novel Coronavirus ◽

The Right

Introduction: The ongoing outbreak of novel coronavirus disease 2019 (COVID-19) is a worldwide problem. Although diagnosing COVID-19 in fracture patients is important for selecting treatment, diagnosing early asymptomatic COVID-19 is difficult. We describe herein a rare case of femoral intertrochanteric fracture concomitant with early asymptomatic novel COVID-19. Case presentation: An 87-year-old Japanese woman was transferred to our emergency room with a right hip pain after she fell. She had no fever, fatigue, or respiratory symptoms on admission and within the 14 days before presenting to our hospital, and no specific shadow was detected in chest X-ray. However, chest computed tomography (CT) was performed considering COVID-19 pandemic, and showed ground-glass opacities with consolidation in the dorsal segment of the right lower lung field. Then, qualitative real-time reverse-transcriptase-polymerase-chain-reaction (RT-PCR) was carried out and turned out to be positive. She was diagnosed right femoral intertrochanteric fracture with concomitant COVID-19 infection. Conservative treatment was applied to the fracture due to infection. After admission, fever and oxygen demand occurred but she recovered from COVID-19. Throughout the treatment period, no cross-infection from the patient was identified in our hospital. Conclusion: This case highlights the importance of considering chest CT as an effective screening method for infection on hospital admission in COVID-19-affected areas, especially in trauma patients with early asymptomatic novel COVID-19.

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Rapid Deterioration of Latent HBV Hepatitis during Cushing Disease and Posttraumatic Stress Disorder after Earthquake

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0037-1598052 ◽

2017 ◽

Vol 78 (04) ◽

pp. 407-411 ◽

Cited By ~ 1

Author(s):

Ryosuke Tashiro ◽

Teiji Tominaga ◽

Yoshikazu Ogawa

Keyword(s):

Hepatic Dysfunction ◽

Residual Tumor ◽

Optic Chiasm ◽

Japanese Woman ◽

Hbv Reactivation ◽

Cushing Disease ◽

Old Japanese ◽

Threatening Condition ◽

The Right ◽

Subtotal Removal

AbstractReactivation of the hepatitis B virus (HBV) is a risk in the 350 million HBV carriers worldwide. HBV reactivation may cause hepatocellular carcinoma, cirrhosis, and fulminant hepatitis, and HBV reactivation accompanied with malignant tumor and/or chemotherapy is a critical problem for patients with chronic HBV infection. Multiple risk factors causing an immunosuppressive state can also induce HBV reactivation.We present a case of HBV reactivation during an immunosuppressive state caused by Cushing disease and physical and psychological stress after a disaster. A 47-year-old Japanese woman was an inactive HBV carrier until the Great East Japan Earthquake occurred and follow-up was discontinued. One year after the earthquake she had intractable hypertension, and her visual acuity gradually worsened. Head magnetic resonance imaging showed a sellar tumor compressing the optic chiasm, and hepatic dysfunction with HBV reactivation was identified. Endocrinologic examination established the diagnosis as Cushing disease. After normalization of hepatic dysfunction with antiviral therapy, transsphenoidal tumor removal was performed that resulted in subtotal removal except the right cavernous portion. Steroid hormone supplementation was discontinued after 3 days of administration, and gamma knife therapy was performed for the residual tumor. Eighteen months after the operation, adrenocorticotropic hormone and cortisol values returned to normal. The patient has been free from tumor regrowth and HBV reactivation throughout the postoperative course.Accomplishment of normalization with intrinsic steroid value with minimization of steroid supplementation should be established. Precise operative procedures and careful treatment planning are essential to avoid HBV reactivation in patients with this threatening condition.

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May-Thurner Syndrome Is Aggravated by Pregnancy

Medicina ◽

10.3390/medicina57030222 ◽

2021 ◽

Vol 57 (3) ◽

pp. 222

Author(s):

Kuntharee Traisrisilp ◽

Manatsawee Manopunya ◽

Tanop Srisuwan ◽

Wisit Chankhunaphas ◽

Theera Tongsong

Keyword(s):

Conservative Treatment ◽

Renal Agenesis ◽

Iliac Vein ◽

Vein Thrombosis ◽

Left Lower Extremity ◽

Asymptomatic Patients ◽

Pregnancy And Postpartum ◽

Anticoagulant Prophylaxis ◽

The Right ◽

Deep Vein

This study aims to emphasize that asymptomatic patients with undiagnosed and asymptomatic May-Thurner syndrome (MTS) may firstly develop severe compression during pregnancy. A 40-year-old woman, G1P0, at 22 weeks of twin gestation presented with left lower extremity edema and pain. One twin was structurally normal while the other had bilateral renal agenesis with oligohydramnios. Magnetic resonance venography (MRV) revealed severe compression of the left iliac vein by the right iliac artery without evidence of deep vein thrombosis (DVT). Conservative treatment with anticoagulant prophylaxis was instituted throughout the rest of pregnancy and postpartum period. She was also complicated with severe pre-eclampsia, a cesarean section was performed due to a prolapsed cord at 27 weeks of gestation, and she gave birth to a surviving baby weighing 1100 g. In conclusion, this case report provides evidence that pregnancy can disclose a subtle May-Thurner anatomy to be symptomatic without DVT. Successful pregnancy outcomes could be achieved with conservative treatment and anticoagulant prophylaxis.

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Republished: Successful treatment of ruptured multiple fusiform middle cerebral artery aneurysms with silk vista baby flow diverter in a 10-months-old infant

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-017554.rep ◽

2021 ◽

pp. neurintsurg-2021-017554.rep

Author(s):

Giovanni Barchetti ◽

Loris Di Clemente ◽

Mauro Mazzetto ◽

Mariano Zanusso ◽

Paola Ferrarese ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Cerebral Artery ◽

Successful Treatment ◽

Expectant Management ◽

Flow Diverter ◽

Artery Occlusion ◽

Parent Artery ◽

Microsurgical Clipping ◽

Parent Artery Occlusion ◽

The Right

We report the successful treatment of multiple ruptured fusiform middle cerebral artery (MCA) aneurysms in a 10-month-old girl. This previously healthy infant presented with subarachnoid haemorrhage and was found to have multiple irregular dilatations of the superior division branch of the right MCA. Cerebral angiography was performed and confirmed the presence of multiple fusiform aneurysms of the MCA. After multidisciplinary team discussion, it was decided to treat the aneurysms with endovascular approach, using a flow-diverter. Microsurgical clipping was deemed risky because of the high likelihood of parent artery occlusion and expectant management was also considered inappropriate because of the risk of re-bleeding. Dual antiplatelet therapy was started, and a flow-diverter was successfully delivered in the superior division branch of the right MCA. The post-operative course was uneventful, MRI at 12 months did not show any sign of recurrence and at 3 years of age the patient had a normal neurological examination.

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