A case of primary breast angiosarcoma with multiple discontinuous small lesions

Abstract Background Angiosarcoma of the breast is rare. It carries a poor prognosis because of its high risk of local recurrence and distant metastases. Presently, there are still no established systemic therapies. Thus, the main treatment strategy for breast angiosarcoma is complete resection. This underscores the importance of closely monitoring the spread of the tumor lesion, particularly for multifocal angiosarcoma, and to plan an optimal operative procedure. We herein present the successful surgical treatment of a rare case of multifocal primary breast angiosarcoma. Case presentation A 43-year-old woman visited our hospital with a growing lump on her right breast accompanied by pain. Clinical and radiological examinations revealed a well-circumscribed 40-mm-diameter tumor at the inner lower quadrant of her right breast. Histological examination of a needle biopsy specimen revealed angiosarcoma. Based on a precise evaluation of the tumor by contrast-enhanced MRI and contrast-enhanced CT scan, a wide local excision with sufficient margins was performed. In the resected specimen, three discontinuous small lesions of angiosarcoma were observed around the main tumor. Therefore, total mastectomy was additionally performed. Pathological examination revealed two other small nodules of angiosarcoma in the remnant right breast, which appeared to be close but not continuous to the defective part of the initial resection. Postoperative follow-up at 1 year showed no signs of recurrence or distant metastasis. Multifocal primary breast angiosarcoma is extremely rare with only two previous reports describing its multifocality. Conclusions Owing to its rarity, a standardized surgical treatment for breast angiosarcoma remains controversial. Our case suggests that primary breast angiosarcoma may occasionally present with multifocal tumor. Thus, it is important to keep in mind the multifocality of breast angiosarcoma when assessing its spread by diagnostic imaging and when planning the surgical strategy.

Download Full-text

18F-Fluorocholine-PET combined with contrast-enhanced CT for localizing hyperfunctioning parathyroid glands and optimizing surgical treatment in patients with hyperparathyroidism

Endocrine ◽

10.1007/s12020-021-02877-w ◽

2021 ◽

Author(s):

Jörn-Markus Gass ◽

Corinna Wicke ◽

Caroline Mona ◽

Klaus Strobel ◽

Werner Müller ◽

...

Keyword(s):

Surgical Treatment ◽

Parathyroid Glands ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Download Full-text

Prospective Study on the Performance of 18F-DOPA Positron Emission Tomography/Computed Tomography in Patients with Medullary Thyroid Carcinoma

10.21203/rs.3.rs-1251733/v1 ◽

2022 ◽

Author(s):

Inés Califano ◽

Fabian Pitoia ◽

Roxana Chirico ◽

Alejandra de Salazar ◽

Maria Bastianello

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Distant Metastases ◽

Emission Tomography ◽

Medullary Thyroid ◽

Contrast Enhanced Ct ◽

Positron Emission ◽

Contrast Enhanced ◽

Pet Ct ◽

Enhanced Ct

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.

Download Full-text

Detection of distant metastases in rectal cancer: contrast-enhanced CT vs whole body MRI

European Radiology ◽

10.1007/s00330-020-07149-1 ◽

2020 ◽

Vol 31 (1) ◽

pp. 104-111

Author(s):

Jeong Hee Yoon ◽

Mi Hye Yu ◽

Bo Yun Hur ◽

Chang Min Park ◽

Jeong Min Lee

Keyword(s):

Rectal Cancer ◽

Distant Metastases ◽

Whole Body ◽

Whole Body Mri ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

Download Full-text

Acute Appendicitis Caused by Previous Endoscopic Submucosal Dissection for an Adenoma Adjacent to the Appendiceal Orifice

Case Reports in Gastroenterology ◽

10.1159/000475753 ◽

2017 ◽

Vol 11 (2) ◽

pp. 271-276 ◽

Cited By ~ 4

Author(s):

Ryo Kato ◽

Keita Harada ◽

Kei Harada ◽

Daisuke Takei ◽

Yuusaku Sugihara ◽

...

Keyword(s):

Acute Appendicitis ◽

Endoscopic Submucosal Dissection ◽

Residual Tumor ◽

Screening Colonoscopy ◽

Pathological Examination ◽

Resected Specimen ◽

Tubular Adenoma ◽

Lower Quadrant ◽

Submucosal Dissection ◽

Additional Surgery

Endoscopic submucosal dissection (ESD) is a groundbreaking treatment for tumors adjacent to the appendiceal orifice that are difficult to remove by conventional endoscopic mucosal resection, and successful cases are increasingly reported. However, little is known about the subsequent complications, especially long-term complications. A female in her early 70s with a 15-mm cecal tumor adjacent to the appendiceal orifice – discovered incidentally during a screening colonoscopy – underwent hybrid ESD of the lesion. We completely resected the tumor, and she was discharged 5 days later with a pathological diagnosis of high-grade tubular adenoma. Ten months postoperatively, she experienced sudden-onset right lower quadrant pain and was diagnosed with acute appendicitis at another hospital. Due to suspicion that her condition was the result of residual tumor, her surgeon performed an emergency laparoscopic cecectomy. The pathological examination of the resected specimen showed thick scarring adjacent to the appendiceal orifice and no residual tumor. The previous ESD was identified as the cause of the scar, and the scar was the only finding to account for the patient’s appendicitis. This case is significant because the patient required additional surgery due to a complication of ESD. Further, it indicates that acute appendicitis may be a late complication of submucosal dissection near the appendiceal orifice. As ESD becomes more widely used, it is likely that more cecal tumors will be treated endoscopically. It is important to be aware of the late complications of ESD for these tumors.

Download Full-text

Intraductal papillary neoplasm of bile duct with invasive carcinoma as an intrahepatic cystic lesion, with successful preoperative diagnosis

BMJ Case Reports ◽

10.1136/bcr-2021-245918 ◽

2022 ◽

Vol 15 (1) ◽

pp. e245918

Author(s):

Tetsuro Takasaki ◽

Takashi Sakamoto ◽

Akira Saito ◽

Yasuaki Motomura

Keyword(s):

Bile Duct ◽

Cystic Lesion ◽

Invasive Carcinoma ◽

Pathological Examination ◽

Mucus Production ◽

Intraductal Papillary Neoplasm ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Elevated Liver Enzymes ◽

Papillary Neoplasm

An 82-year-old man presented to the emergency department with abdominal pain and febrile symptoms that had been present for 4 days. Blood tests showed elevated liver enzymes and white blood cell count, and abdominal contrast-enhanced CT revealed a 35 mm cystic lesion in the left lateral liver lobe. On closer examination, the cystic lesion was found to have contiguous bile duct dilatation and internal nodules. Furthermore, mucus production was observed during endoscopic retrograde cholangiopancreatography, which led to the diagnosis of intraductal papillary neoplasm of the bile duct (IPNB), with cystic infection. Although the patient was an older adult, there was no background disease that would have prevented surgery, and resection was performed. Pathological examination revealed type 1 IPNB, with invasive carcinoma. The number of reports of IPNB is expected to increase with an increasing older population in Asia, and we report the findings of this case.

Download Full-text

Association of Contrast-Enhanced CT Findings with Etiology and Outcome in Patients with Portal Venous Gas and Pneumatosis Intestinalis: A Single Center Case Series Study

10.21203/rs.3.rs-533515/v1 ◽

2021 ◽

Author(s):

Naohiro Yoshida ◽

Yoshihiko Sadakari ◽

Kazuhito Tamehiro ◽

Kazuma Ohkawara ◽

Hiroyuki Nakane ◽

...

Keyword(s):

Surgical Treatment ◽

Pneumatosis Intestinalis ◽

Bowel Ischemia ◽

Portal Venous Gas ◽

Ct Findings ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct ◽

The Relationship ◽

Group 1

Abstract Background: Contrast-enhanced computed tomography (CT) is a reliable diagnostic tool often used to investigate the etiology of portal venous gas (PVG) and pneumatosis intestinalis (PI). However, there are few reports that offer an analysis of the relationship between particular CT findings and clinical outcomes. In this paper, we sought to close that gap and present the results of our analyses that reveal which CT findings are correlated with life-threatening cases.Methods: 39 patients were diagnosed with PVG or PI from contrast-enhanced CT scans and underwent treatment at St. Mary’s Hospital from January 2009 to December 2018. We reviewed patients’ medical charts, laboratory data, and CT scan images retrospectively. We defined cases resulting in operation or death as group 1, and patients with conservative treatment who survived as group 2. We then analyzed the relationship between each CT finding and clinical feature.Results: The primary underlying diseases identified for PVG and PI were bowel ischemia (13/39), enteritis (9/39), constipation (5/39), iatrogenic disease (4/39), and hemodialysis (3/39). Poor enhancement of the intestinal wall and extrahepatic venous gas were correlated with bowel ischemia (p=0.0002 and p=0.0003, respectively). Free air was less correlated with bowel ischemia (p=0.02). Wall thickness was correlated with enteritis (p=0.02). Mortality in cases with bowel ischemia and perforation was quite high (60%) even if patients underwent surgery (33.3%). Conversely, patients with enteritis, constipation, hemodialysis and gastric dilatation who did not require surgery resulted in more favorable outcomes with conservative treatment. In the multivariate analysis, extra hepatic venous gas was the only solitary factor correlated with group 1 (p=0.0008).Conclusions: Extra hepatic venous gas was the strongest predictive factor of clinical outcome in contrast-enhanced CT findings correlated with bowel ischemia and required surgical treatment. The other CT findings were useful in diagnosing the underlying disease, but were not correlated with clinical outcomes. The necessity for surgical treatment remains dependent on the root cause.

Download Full-text

Role of fused PET/CT compared to the standard contrast-enhanced CT in the follow-up assessment of the treated gastric malignancy

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-019-0093-9 ◽

2019 ◽

Vol 50 (1) ◽

Author(s):

Ahmed A. Baz ◽

Talaat A. Hassan

Keyword(s):

Computed Tomography ◽

Distant Metastases ◽

Treatment Method ◽

Nodal Metastasis ◽

Diagnostic Modality ◽

Malignant Carcinoid ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Pet Ct

Abstract Background To investigate the use of fused positron emission tomography/computed tomography (PET/CT) compared to contrast-enhanced computed tomography (CECT) in the follow-up of treated gastric malignancies, all data were collected and analyzed retrospectively, enrolling 68 patients (18 females and 50 males) (their age range = 34–73 years). The patients had been referred to a private imaging center for their assessment by PET/CT. Results Adenocarcinoma was present in 73.5%, lymphoma was present in 23.5%, and malignant carcinoid was found in 3% of cases. All patients had received at least one treatment method including endoscopic/surgical resection, chemotherapy, and radiotherapy. By PET/CT, gastric recurrence/residual was depicted in 30 patients (47.0%) compared 46 patients (67.5%) as detected by CECT, and this was statistically significant (P value = 0.006), nodal metastasis was present in 18 patients (26.5%) compared to 26 patients (38%) as detected by CECT (P value = 0.143), and distant metastasis was present in 18 patients (26.5%) compared to 24 patients (35%) as depicted by CECT (P value = 0.265). Conclusion PET/CT offered a useful diagnostic modality as compared to CECT for follow-up evaluation of cases with treated gastric malignancies through a precise detection of the gastric lesions but it had rather comparable results in the detection of nodal and distant metastases.

Download Full-text