MON-919 Primary Neuroendocrine Tumor of the Central Nervous Sistem, a Case Report and Literature Review

Abstract Introduction Neuroendocrine Neoplasms are rare, with an incidence of 5 to 100,000 inhabitants, constituting 1% of all malignancies, presenting high survival rates in general, even in metastatic diseases. However, in those poorly differentiated, as in the following case, survival is around 4% in 5 years. We will describe a case of primary neuroendocrine tumor in the brain, of which is uncommon in the literature. Clinical case A 26 years women was referred to the ER of Santa Casa de São Paulo, in January 2019, to be evaluated by neurosurgery, due to progressive left hemiparesis and headache for 3 months, which got worse in 4 days. On CT scan, there was a 6 x 6 cm solid-cystic, expansive, lesion in the right frontal lobe, with perilesional edema and contralateral midline 1.3cm deviation and subfalcine herniation. Thus, the tumor was resected soon, with anatomopathological analysis showing poorly differentiated tumor of cells with scarce cytoplasm, hyperchromatic nuclei and high mitotic activity. Immunohistochemical analysis finds 50% Ki67, with focal p53, TTF1, CD99, CD 56 and synaptophysin positivity. The main hypotheses, then, consisted of Neuroendocrine Carcinoma. Four months after surgery, the patient reported worsening deficit, headache, pain, weight loss, being referred to the Emergency Room, once more. In RM an expansive lesion was found 6.6 x 4.4 cm, in the right frontoparietal surgical cavity, edema, compression and 0,4 cm midline deviation. The patient was once again submitted to emergency neurosurgery, with microsurgical resection. The pathology was identical to the previous one. We proceed with hormonal evaluation, regarding to Medular Thyroid carcinoma, Gastrinoma, Insulinoma, Pheochromocytoma, Carcinoid tumor and others. Imaging exams were also performed to investigate other primary sites: no changes in CT scan of the chest and abdomen and PET CT FDG. However, this one showed recurrence of the intracranial lesion, with three sites of involvement, all hypermetabolic: one of 4.1 x 2.9 cm (SUV 4.9) and another of 3.9 x 3.3 cm (SUV 8, 4) in the right frontoparietal region and medial nodule to the right thalamus of 1.2 cm (SUV 6.1). Patient currently maintain left hemiparesis, frequent pain, taking carbamazepine due to epileptic seizures, and considerable weight loss. She has an important limitation of daily activities and basic self-care, with 50% Karnofsky scale. Due to relapse, palliative radiotherapy was initiated in the region of the tumors. Conclusion The patient had a poor outcome in relation to cancer, with little possibility of treatment due to poor tumor differentiation and poor performance status.

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Abdominal actinomycosis after reparative surgery for cholecystogastric fistula in an immunosuppressed patient

BMJ Case Reports ◽

10.1136/bcr-2021-243445 ◽

2021 ◽

Vol 14 (7) ◽

pp. e243445

Author(s):

Maria Carolina Fra ◽

Massimo Brenna ◽

Caroline Di Benedetto ◽

Marco De Monti

Keyword(s):

Ct Scan ◽

Laboratory Tests ◽

Needle Aspiration ◽

Immunosuppressed Patient ◽

Ct Guided ◽

Abdominal Actinomycosis ◽

Patient Reported ◽

Daily Dose ◽

The Right ◽

Ultrasound Features

A male patient, aged over 75 years, was referred to the emergency room for pain in his right hypochondrium. This pain, which persisted for approximately 3 days, radiated to his right flank and right iliac quadrant and worsened after meals. The patient reported no nausea, vomiting, diarrhoea, fever or recent traumatic events. Blood laboratory tests, ultrasonography, an MRI and a CT scan were performed, leading to the diagnosis of a mass in the Morrison’s pouch with ultrasound features of adipose tissue compatible with a liposarcoma, infiltrating the liver and the right kidney. Subsequent CT-guided needle aspiration and a histological examination led to the diagnosis of actinomycosis. The patient was initially treated with a daily dose of 18 million IU of benzylpenicillin for 4 weeks and subsequently prescribed the oral administration of 3 g/day of amoxicillin for 11 months. A monitoring CT scan was performed after 1, 5, 8 and 12 months, and a CT scan re-evaluation confirmed that the mass had completely healed.

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Psoas Muscle Infiltration Masquerading Distant Adenocarcinoma

Case Reports in Gastrointestinal Medicine ◽

10.1155/2014/986453 ◽

2014 ◽

Vol 2014 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Kamel A. Gharaibeh ◽

Arnaldo Lopez-Ruiz ◽

Tauqeer Yousuf

Keyword(s):

Ct Scan ◽

Psoas Abscess ◽

Psoas Muscle ◽

Needle Aspiration ◽

Imaging Studies ◽

Lower Quadrant ◽

History Of ◽

Undifferentiated Adenocarcinoma ◽

Poorly Differentiated ◽

The Right

Malignant metastasis to the psoas muscle is rare. We report a case that clinically mimicked psoas abscess that was subsequently proven to be from metastatic disease secondary to adenocarcinoma of the duodenum. A 62-year-old male presented with a seven-month history of right lower quadrant abdominal pain and progressive dysphagia. CT scan of abdomen-pelvis revealed a right psoas infiltration not amenable to surgical drainage. Patient was treated with two courses of oral antibiotics without improvement. Repeated CT scan showed ill-defined low-density area with inflammatory changes involving the right psoas muscle. Using CT guidance, a fine needle aspiration biopsy of the right psoas was performed that reported metastatic undifferentiated adenocarcinoma. Patient underwent upper endoscopy, which showed a duodenal mass that was biopsied which also reported poorly differentiated adenocarcinoma. In this case, unresponsiveness to medical therapy or lack of improvement in imaging studies warrants consideration of differential diagnosis such as malignancy. Iliopsoas metastases have shown to mimic psoas abscess on their clinical presentation and in imaging studies. To facilitate early diagnosis and improve prognosis, patients who embody strong risk factors and symptoms compatible with underlying malignancies who present with psoas imaging concerning for abscess should have further investigations.

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Reduction en masse of inguinal hernia after self-reduction: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-02845-y ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Khosrow Najjari ◽

Hossein zabihi Mahmoudabadi ◽

Seyed Zeynab Seyedjavadeyn ◽

Reza Hajebi

Keyword(s):

Case Report ◽

Inguinal Hernia ◽

Ct Scan ◽

Lower Quadrant ◽

Case Presentation ◽

Delay In Diagnosis ◽

Patient Reported ◽

History Of ◽

Old Persian ◽

The Right

Abstract Background Reduction en mass (REM) is one of the rare complications of inguinal hernia reduction. Although REM can be detected on the basis of specific computed tomography (CT) scan findings, many radiologists are not familiar with its radiological appearance because of the scarcity of this complication, which may cause a delay in diagnosis. Case presentation The patient reported in this article was a 50-year-old Persian man with a history of inguinal hernia, who had been referred with the periumbilical pain that radiated to the right lower quadrant and developed following hernia replacement by the patient himself. REM diagnosis was based on clinical examination and CT scan findings, and surgical treatment was performed by the Lichtenstein repair and mesh implantation. Conclusions Although REM usually occurs after reduction with compression in the inguinal hernia, this unique case report highlighted the possibility of REM after self-reduction. Surgeons and radiologists should consider REM in patients with a history of inguinal hernia presenting with intestinal obstruction symptoms, even without any apparent signs of hernia in the physical examination.

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Rare finding of a large cell poorly differentiated neuroendocrine tumor in the colon

International Surgery Journal ◽

10.18203/2349-2902.isj20202418 ◽

2020 ◽

Vol 7 (6) ◽

pp. 1999

Author(s):

Stephanie A. Luster ◽

Daniel K. Kakish ◽

Manroop Gill ◽

Narendra Kumthekar

Keyword(s):

Neuroendocrine Tumor ◽

Bowel Obstruction ◽

Exploratory Laparotomy ◽

Large Cell ◽

Ascending Colon ◽

Liver Mass ◽

Poorly Differentiated ◽

Right Lobe ◽

Rare Malignancy ◽

The Right

A 43 year old female presented to the emergency department for nausea, vomiting and abdominal pain secondary to a bowel obstruction subsequently revealed to be a poorly differentiated large cell neuroendocrine tumor of the colon. After a CT scan showed a mass in the ascending colon with possible metastasis to the right lobe of the liver, an exploratory laparotomy was performed. A hemicolectomy was performed with biopsy of the liver mass. Pathology was consistent with large cell neuroendocrine tumor in all specimens including the liver biopsy, ascending colon, and transverse colon. Although large cell neuroendocrine tumors of the colon are a rare malignancy, they are an important consideration in the workup of multiple colonic masses with metastases, especially in patients presenting with bowel obstruction. The literature on poorly differentiated large cell neuroendocrine cancer and treatment is reviewed. Poorly differentiated large cell neuroendocrine tumor is a rare pathology but should be included in the differential diagnosis in patients presenting with a colon mass and bowel obstruction.

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Lung Cancer Presenting as Skin Metastasis of the Back and Hand: A Case Series and Literature Review

Case Reports in Oncology ◽

10.1159/000501363 ◽

2019 ◽

Vol 12 (2) ◽

pp. 480-487 ◽

Cited By ~ 4

Author(s):

Misbahuddin Khaja ◽

Daniel Mundt ◽

Rizwan Ahmed Dudekula ◽

Umair Ashraf ◽

Shehriyar Mehershahi ◽

...

Keyword(s):

Lung Cancer ◽

Ct Scan ◽

Left Lung ◽

Case Series ◽

The United States ◽

Middle Lobe ◽

Skin Metastasis ◽

Smoking History ◽

Poorly Differentiated ◽

The Right

Lung cancer has the highest mortality of all cancers in the United States. The incidence of lung cancer with metastases to the skin varies between 1–12%, with the highest incidence seen in men. Here, we present two cases of lung cancer presenting as skin metastasis. The first patient was an 80-year-old African American male who presented to the hospital for evaluation of a right upper back mass. A few months prior to admission, he was found to have a left lung mass on CT scan of the chest, he underwent biopsy which showed poorly differentiated SCC of the lung. He also had a skin biopsy which showed poorly differentiated carcinoma in the dermis consistent with metastatic SCC. He was started on chemotherapy, but could not tolerate it. He was accepted to hospice. The second patient was a 78-year-old Hispanic female who presented to the hospital with dyspnea, and a dry cough. Upon physical examination, a 2 × 2 cm ulcerated, wart-like nodule on the right palm was noted. Subsequent CT scan of the chest showed a partial collapse of the right middle lobe. A biopsy of the hand mass revealed well-to-moderately differentiated metastatic SCC favoring lung origin. A bronchoscopy biopsy showed invasive SCC. Subsequently her condition worsened and she passed away. Metastasis to the skin is an unusual presenting symptom of lung cancer. It is therefore essential to consider metastasis as a diagnosis in a patient with both a skin lesion and a smoking history.

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Bilateral carcinomas of the maxillary sinus

The Journal of Laryngology & Otology ◽

10.1017/s0022215100122108 ◽

1993 ◽

Vol 107 (1) ◽

pp. 42-43 ◽

Cited By ~ 2

Author(s):

Masanori Sakaguchi ◽

Kumiko Moriya ◽

Kiichiro Taguchi ◽

Satoshi Katsuno

Keyword(s):

Squamous Cell Carcinoma ◽

Ct Scan ◽

Cell Carcinoma ◽

Maxillary Sinus ◽

Rare Case ◽

Tumour Mass ◽

Large Tumour ◽

Poorly Differentiated ◽

Left Maxillary Sinus ◽

The Right

AbstractWe report a 68-year-old male with a rare case of synchronous bilateral carcinomas of the maxillary sinus. A CT scan revealed a large tumour mass that extruded from the left maxillary sinus; tissue of soft density filled the right antrum which had intact bony walls. A probe antrostomy on the right side disclosed a tumour which was diagnosed histologically as the same poorly differentiated squamous cell carcinoma as that in the left antrum. The incidence and aetiology of this disorder are presented, and its diagnosis and management are discussed.

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Individualized cancer follow-up supported by electronic Patient-Reported Outcomes: Development and evaluation (Preprint)

10.2196/preprints.18397 ◽

2020 ◽

Author(s):

Sissel Ravn ◽

Henriette Vind Thaysen ◽

Lene Seibaek ◽

Victor Jilbert Verwaal ◽

Lene Hjerrild Iversen

Keyword(s):

Ct Scan ◽

Advanced Cancer ◽

Patient Reported Outcomes ◽

Cost Benefit Analysis ◽

Cost Benefit ◽

Structured Interviews ◽

European Organization ◽

Individualized Care ◽

Patient Reported

BACKGROUND Cancer survivors experience unmet needs during follow-up. Besides recurrence, a follow-up includes detection of late side effects, rehabilitation, palliation and individualized care. OBJECTIVE We aimed to describe the development and evaluate the feasibility of an intervention providing individualized cancer follow-up supported by electronic patient-reported outcomes (e-PRO). METHODS The study was carried out as an interventional study at a Surgical and a Gynecological Department offering complex cancer surgery and follow-up for advanced cancer. The e-PRO screened for a priori defined clinical important symptoms and needs providing individualized follow-up. We included following questionnaires in the e-PRO; the general European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 and the EORTC validated for colorectal and ovarian cancer patients. To support individualization, we included three prioritized issues of the patient’s preference in each e-PRO. The response-algorithm was aggregated based on the severity of the patient’s response. To ensure the sensitivity of the e-PRO, we performed semi-structured interviews with five patients. All clinicians (surgeons and gynecologists) performing the consultations reviewed the e-PRO. The evaluation was divided in two, 1)The feasibility was assessed by a)Patients’ response rate of the e-PRO, b)Number of follow-up visits documenting the use of e-PRO and c)Patients’ prioritized issues prior to the consultation(‘yes’ / ‘no’), and after the follow-up 2)Patients assessment of a)The need and purpose of the follow-up visit and b)the support provided during the follow-up visit. RESULTS In total, 187 patients were included in the study, of which 73%(n=136/187) patients responded to the e-PRO and were subjected to an individualized follow-up. The e-PRO was documented as applied in 79% of the follow-up visits. In total, 23% of the prioritized issues did not include a response. Stratified by time since surgery, significantly more patients did not fill out a prioritized issue had a follow-up >6 months since surgery. In total, 72 % follow-up visits were evaluated to be necessary in order to discuss the outcome of the CT scan, symptoms, and/or prioritized issues. Contrary, 19% of the follow-up visits were evaluated to be necessary only to discuss the result of the CT scan. A range from 19.3–56.3% of patients assessed the follow-up visit to provide support with respect to physical (42% of patients), mental (56%), sexual (19%) or dietary (27%) issues. Further, a range from 34–60% of the patients reported that they did not need support regarding physical (43% of patients), mental (34%), sexual (63%) or dietary (57%) issues. CONCLUSIONS An individualized follow-up based on e-PRO is feasible, and support most patients surgically treated for advanced cancer. However, results indicate that follow-up based on e-PRO may not be beneficial for all patients and circumstances. A thorough cost-benefit analysis may be warranted before implementation in routine clinic.

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Thyroid Carcinoma on the Side of the Absent Lobe in a Patient with Thyroid Hemiagenesis

Case Reports in Otolaryngology ◽

10.1155/2017/4592783 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5

Author(s):

Hiroki Sato ◽

Kiyoaki Tsukahara ◽

Ray Motohashi ◽

Midori Wakiya ◽

Hiromi Serizawa ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Papillary Carcinoma ◽

Thyroid Tissue ◽

Needle Aspiration ◽

Left Lobe ◽

Thyroid Hemiagenesis ◽

Poorly Differentiated ◽

Node Metastases ◽

Right Lobe ◽

The Right

Background. Thyroid carcinoma complicated by hemiagenesis is very rare, and previous reports have not described this cancer on the side of the absent lobe. Methods and Results. We report the case of a 64-year-old woman in whom left thyroid hemiagenesis was discovered incidentally during investigations of abnormal sensation during swallowing. A tumorous 1.4 cm lesion was also found on the side of the absent lobe, left of the isthmus. Fine-needle aspiration biopsy revealed class V papillary carcinoma, but no lymph node metastases. Total thyroidectomy was performed for stage cT1bN0M0 carcinoma. Histopathology revealed normal thyroid tissues in the right lobe and isthmus, while the left lobe was absent. The mostly papillary carcinoma was adjacent to the truncated thyroid tissue, with a portion histologically consistent with poorly differentiated carcinoma. Conclusions. All previously reported cases of thyroid cancer complicated by hemiagenesis have represented carcinoma occurring within the present lobe. This case is extremely rare.

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Delayed Extradural Hematoma after Evacuation of Contralateral Acute Extradural Hematoma

Indian Journal of Neurotrauma ◽

10.1055/s-0040-1713722 ◽

2020 ◽

Author(s):

Majid Anwer ◽

Atique Ur Rehman ◽

Farheen Ahmed ◽

Satyendra Kumar ◽

Md Masleh Uddin

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Postoperative Period ◽

Road Traffic ◽

Case Reports ◽

Mass Effect ◽

Extradural Hematoma ◽

Traumatic Head Injury ◽

Neurologic Deterioration ◽

The Right

Abstract Introduction Traumatic head injury with extradural hematoma (EDH) is seen in 2% of patients. Development of EDH on the contralateral side is an uncommon complication that has been reported in various case reports. Case Report We report here a case of an 18-year-old male who had a road traffic injury. He was diagnosed as a case of left-sided large frontotemporoparietal acute extradural bleed with a mass effect toward the right side. He was managed with urgent craniotomy and evacuation of hematoma. A noncontrast computed tomography (NCCT) scan performed 8 hours after postoperative period showed a large frontotemporoparietal bleed on the right side with a mass effect toward the left side. He was again taken to the operating room and right-sided craniotomy and evacuation of hematoma were performed. A postoperative NCCT scan revealed a resolved hematoma. The patient made a complete recovery in the postoperative period and is doing well. Conclusion Delayed onset epidural hematoma is diagnosed when the initial computed tomography (CT) scan is negative or is performed early and when late CT scan performed to assess clinical or ICP deterioration shows an EDH. The diagnosis of such a condition requires a high index of suspicion based on the mechanism of injury along with fracture patterns. Additionally, change in pupillary size, raised intracranial pressure, and bulging of the brain intraoperatively are additional clues for contralateral bleeding. Neurologic deterioration may or may not be associated with delayed EDH presentation. An early postoperative NCCT scan within 24 hours is recommended to detect this complication with or without any neurologic deterioration.

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US-guided percutaneous microwave ablation (MWA) of submandibular gland: A new minimal invasive and effective treatment for refractory sialorrhea and treatment response evaluation with contrast-enhanced imaging techniques

Clinical Hemorheology and Microcirculation ◽

10.3233/ch-211115 ◽

2021 ◽

pp. 1-12

Author(s):

Hui-Li Zhang ◽

Jing-E Zhu ◽

Jia-Xin Li ◽

Xiao-Long Li ◽

Li-Ping Sun ◽

...

Keyword(s):

Effective Treatment ◽

Submandibular Gland ◽

Microwave Ablation ◽

Imaging Techniques ◽

Symptom Relief ◽

Minimal Invasive ◽

Whole Saliva ◽

Patient Reported ◽

The Right ◽

Percutaneous Microwave Ablation

A 33 years’ old male complained of excessive salivation with frequent swallowing and spitting, which resulted in communication disturbance, reduced quality of life, and social embarrassment for 19 years. He had been diagnosed as sialorrhea and submandibular gland hyperfunction by stomatologist, then had unilateral submandibular gland resection 13 years ago, but the symptom relief was not satisfactory. After that, he had been treated with glycopyrrolate for less than a year, which was withdrawn because of the short duration of symptomatic control after each tablet take-in and intolerable side effects. With the wish to receive a new treatment with long term effectiveness, low re-operation risk and normal preserved saliva secretion function, the patient was subject to MWA for the right submandibular gland. After systematic clinical evaluation, US-guided percutaneous MWA was successfully performed with an uneventful post-operative course. The volume of the right submandibular gland and ablated area were measured precisely by an ablation planning software system with automatic volume measurement function based on three-dimensional reconstruction of the pre-operative and post-operative enhanced magnetic resonance imaging (MRI) raw data. Finally, the ablated volume was calculated as 62.2% of the whole right submandibular gland. The patient was discharged 1 day after the operation, with symptoms relieved significantly, the mean value of whole saliva flow rate (SFR) decreased from 11 ml to 7.5 ml per 15 minutes. During the follow up by phone three months after operation, the patient reported that the treatment effect was satisfactory, whereas the SFR value became stable as 7 ml per 15 minutes, drooling frequency and drooling severity (DFDS) score decreased from 6 to 5, drooling impact scale (DIS) score decreased from 43 to 26. US-guided percutaneous MWA of submandibular gland seems to be an alternative, minimal invasive, and effective treatment for refractory sialorrhea. We described a patient with refractory sialorrhea treated successfully with ultrasound (US) guided percutaneous microwave ablation (MWA).

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