scholarly journals Advance MR evaluation of synchronous multifocal osteosarcoma with pathologic fracture : A case report

2021 ◽  
pp. 20210015
Author(s):  
Rosy Setiawati ◽  
Eveline Stephanie Lay ◽  
Valentina Testini ◽  
Paulus Rahardjo ◽  
Mouli Edward ◽  
...  
Keyword(s):  
Family History ◽  
Primary Tumor ◽  
Plain Radiograph ◽  
Pathologic Fracture ◽  
Pelvic Bone ◽  
Bone Lesions ◽  
Mr Images ◽  
Multiple Lesions ◽  
First Case ◽  
Response To Chemotherapy

Objective: Synchronous multifocal osteosarcoma is a rare condition in which the osteosarcoma presents with multiple bone lesions at the time of diagnosis, usually without any visceral metastases. The first case was described in early 1930s by Silverman. To report a case of synchronous multifocal osteosarcoma in adolescent with pathologic fracture. Methods: An 18-year-old girl presented with a painful mass in the right thigh of 4 months’ duration and a history of thigh bone fracture a month ago. Patient’s medical records and family history was unremarkable. Physical examination showed angulation and shortening at right femoral region with tenderness and swelling. Initial radiograph and magnetic resonance (MR) images showed multiple lesions in right femoral shaft and pelvic bone with primary tumor in right distal femur with pathologic fracture and multiple bone marrow lesions found in the contralateral bones. Imaging and histopathologic results supported the diagnosis of synchronous multifocal osteosarcoma. After following the chemotherapy as the treatment of choice, the radiograph and MRI evaluation were done and showed reduction of the mass size with union of the destructed part with the formation of callus. The advance MRI revealed reduction of the overall mass and the composition of the viable area compared to previous study. The patient had satisfying response to chemotherapy series and a better functional outcome on subsequent visits. Results: Diagnosis of synchronous multifocal osteosarcoma was based on patient and family history and finding of multiple lesions in the MR images, meanwhile the plain radiograph only revealed the primary tumor. Amstutz described multifocal osteosarcoma as presence of one primary tumor and several smaller lesions. Most recent reviews concluded that multifocal osteosarcoma is bone-to-bone metastatic process rather than multicentric origin. The limitation in this case was absence of thoracic CT which is suggested to rule out any pulmonary metastases instead of routine chest radiograph. Conclusions: Although satisfying improvement was clinically achieved, further advanced MRI would be indicated to evaluate the progression of tumor and its respond to therapy.

Solitary Peutz-Jeghers Type Polyp of Jejunum with Gastric Fundic and Antral Gland Lining Mucosa: A Case Report and Review of Literature

2021 ◽  
pp. 106689692110677
Author(s):  
Bella Lingjia Liu ◽  
Huifang Zhou ◽  
Martina Risech ◽  
Alex Ky ◽  
Jane Houldsworth ◽  
...  
Keyword(s):  
Family History ◽  
Small Bowel ◽  
Smooth Muscles ◽  
Fundic Gland ◽  
Muscularis Mucosa ◽  
Hamartomatous Polyp ◽  
Gi Tract ◽  
First Case ◽  
Mucocutaneous Pigmentation ◽  
Peutz Jeghers Syndrome

Solitary Peutz-Jeghers type polyps are characterized by a hamartomatous polyp of the gastrointestinal (GI) tract in a patient without mucocutaneous pigmentation, family history of Peutz-Jeghers syndrome, or STK11/LKB1 mutations. Histologically identical to the polyps in Peutz-Jeghers syndrome, these sporadic polyps can arise anywhere along the GI tract, with typical arborizing smooth muscles extending from the muscularis mucosa. While the lining mucosa is generally the same as the organ in which it arises, gastric pyloric and osseous metaplasia have been reported in intestinal polyps in Peutz-Jeghers syndrome. Herein, the authors report the first case of a small intestinal solitary Peutz-Jeghers type polyp with gastric antral and fundic gland lining mucosa. A 43-year-old male was admitted for small bowel obstruction. Diagnostic laparoscopy revealed jejuno-jejunal intussusception with an associated polyp measuring 7.2 cm. Histological examination showed a hamartomatous polyp with arborizing smooth muscle bundles extending from the muscularis mucosae. The polyp was lined by non-dysplastic gastric antral and fundic gland mucosa, and was sharply demarcated from the adjacent non-polypoid intestinal mucosa. Colonoscopy, esophagogastroduodenoscopy and small bowel enteroscopy revealed no additional polyps or masses. Thorough investigation of the patient's family history was negative for Peutz-Jeghers syndrome or mucocutaneous pigmentation. Molecular analysis of the lesion was negative for STK11/LKB1 mutations. A diagnosis of solitary Peutz-Jeghers type polyp of the small bowel with gastric antral and fundic gland mucosal lining was rendered.

Imaging HER2-positive metastatic esophagogastric cancer with 89Zr-trastuzumab PET and 18F-FDG PET.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 4068-4068
Author(s):  
Melissa Amy Lumish ◽  
Steven Brad Maron ◽  
Viktoriya Paroder ◽  
Steven Philemond ◽  
Joseph A. O' Donoghue ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Fdg Pet ◽  
Median Number ◽  
Whole Body ◽  
Bone Lesions ◽  
Whole Body Imaging ◽  
Her2 Expression ◽  
Her2 Positive ◽  
Recist 1.1 ◽  
Esophagogastric Cancer

4068 Background: Variations in HER2 expression between primary tumor and metastases may contribute to drug resistance in HER2-positive mEG cancer. Whole body imaging with 89Zr-trastuzumab PET has a potential advantage over single site biopsies as it can non-invasively assess variations in HER2 expression and target engagement. 89Zr-trastuzumab PK, biodistribution and dosimetry in mEG cancer were previously published by our group (O’Donoghue, JNM 2018). We now present lesion level analysis of baseline 18F-FDG-PET and CT in comparison with baseline 89Zr-trastuzumab imaging. Methods: Patients with metastatic HER2-positive (IHC 3+, IHC 2+/FISH > 2.0) mEG cancer and RECIST 1.1 measurable disease were consented and imaged with 89Zr-trastuzumab PET, 18F-FDG-PET and CT. All visualized lesions (maximum 5 per organ) were annotated in detail using RECIST 1.1 measurements (CT) and maximum standard uptake values (SUVmax) on 89Zr-trastuzumab and 18F-FDG PET scans. Correlation of visualized disease burden between imaging modalities with clinical and pathologic characteristics was performed. Results: 33 patients with mEG adenocarcinoma were imaged with 89Zr-trastuzumab PET, 18F-FDG-PET and CT (12% esophageal, 64% GEJ, 24% gastric). HER2 status (IHC 3+ 70%; IHC2+/FISH+ 27%, NGS 3%) was assessed from biopsy of primary (66.7%) or metastasis (33.3%). Median time from diagnosis to 89Zr-trastuzumab PET was 12.6 months. At the time of 89Zr-trastuzumab PET, 39% were treatment naive, while 61% had received prior therapy including trastuzumab (58%) and afatinib (median lines 2, range 0-6). 82% of patients had the primary tumor in place and all patients had metastatic disease at the time of enrollment with metastases to lymph nodes (70%) peritoneum (24%), liver (58%), lung (33%), and/or bone (9%). Median number of RECIST 1.1 lesions measured on baseline CT was 6 (range 1-15). PET analysis is complete in 18 of 33 patients. Median number of 89Zr-trastuzumab PET positive (SUV > 3) lesions was 5.5 (range 1-11) with 5 patients having at least 1 (max 3) very intense lesion (SUV > 15). Median number of 18F-FDG-PET-positive lesions was 8 (range 1-14). Three patients had at least 1 lesion positive on 89Zr-trastuzumab-PET and negative on 8F-FDG-PET (range 0-5), and 8 patients had at least 1 lesion positive on 18F-FDG-PET and negative on 89Zr-trastuzumab-PET (range 0-7). Of the total lesions identified on 89Zr-PET but not CT, 40% were in bone. Of those identified on 89Zr but not 8F-FDG-PET, 40% were in bone, and of those on 18F-FDG- but not 89Zr-PET, 6% were in bone. Conclusions: 89Zr-trastuzumab PET effectively identifies heterogeneity of HER2 expression and allows assessment of lesions throughout the whole body. Bone lesions were better identified and appeared earlier on 89Zr-trastuzumab PET compared with CT. Additional analyses including correlation of baseline HER2 heterogeneity with overall and disease-free survival will be presented. Clinical trial information: NCT02023996.

scholarly journals Langerhans Cell Histiocytosis with Isolated Central Diabetes Insipidus, Low Grade Fever and Sellar Erosion

2021 ◽  
Author(s):  
İclal Okur ◽  
Hasan Ari ◽  
Semra Çetinkaya ◽  
Betül Emine Derinkuyu ◽  
Gizem Çağlar ◽  
...  
Keyword(s):  
Diabetes Insipidus ◽  
Langerhans Cell Histiocytosis ◽  
Bone Structure ◽  
Sella Turcica ◽  
Langerhans Cell ◽  
Central Diabetes Insipidus ◽  
Bone Lesions ◽  
Warning Sign ◽  
Low Grade ◽  
First Case

Langerhans cell histiocytosis (LCH) is a rare disease of the monocyte-macrophage system. Although it is known that bone involvement is seen very frequently in cases with LCH, our case is the first case with a lytic-destructive lesion in the bone structure forming sella turcica. A 4-year-old, 5-month-old male patient who applied to our outpatient clinic was diagnosed with Langerhans cell histiocytosis in further examination after the diagnosis of central diabetes insipidus (CDI) was made. On cranial magnetic resonance imaging (MRI), widespread lytic-destructive bone lesions were observed in the bone structure forming the sella (sphenoid bone), sellar destruction not previously described in the literature. Sellar erosion has not been reported before in cases diagnosed with LCH in the literature. The presence of low-grade fever in a patient presenting with isolated CDI is a warning sign for the diagnosis of LCH.

scholarly journals A Rare Case of Left Ventricular Non-Compaction with Coronary Artery Anomaly Complicated by ST-Elevation Myocardial Infarction and Subcutaneous Defibrillator Implantation

2022 ◽  
Vol 19 (2) ◽  
pp. 791
Author(s):  
Francesca Romana Prandi ◽  
Federica Illuminato ◽  
Chiara Galluccio ◽  
Marialucia Milite ◽  
Massimiliano Macrini ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Family History ◽  
Lateral Wall ◽  
Coronary Intervention ◽  
Left Ventricular ◽  
Cardiac Resynchronization ◽  
Congenital Defects ◽  
Circumflex Artery ◽  
First Case ◽  
The Right

Left ventricular non-compaction (LVNC) is a rare congenital cardiomyopathy caused by arrest of normal endomyocardial embryogenesis and characterized by the persistence of ventricular hypertrabeculation, isolated or associated to other congenital defects. A 33-year-old male, with family history of sudden cardiac death (SCD), presented to our ER with typical chest pain and was diagnosed with anterior STEMI. Coronary angiography showed an anomalous origin of the circumflex artery from the right coronary artery and a critical stenosis on the proximal left anterior descending artery, treated with primary percutaneous coronary intervention. The echocardiogram documented left ventricular severe dysfunction with lateral wall hypertrabeculation, strongly suggestive for non-compaction, confirmed by cardiac MRI. At 3 months follow up, for the persistence of the severely depressed EF (30%) and the family history for SCD, the patient underwent subcutaneous ICD (sICD) implantation for primary prevention. To the best of our knowledge, this is the first case of LVNC associated with anomalous coronary artery origin and STEMI reported in the literature. Arrhythmias are common in LVNC due to endocardial hypoperfusion and fibrosis. sICD overcomes the risks of transvenous ICD, and it is a valuable option when there is no need for pacing therapy for bradycardia, cardiac resynchronization therapy and anti-tachycardia pacing.

scholarly journals A Suspected Pelvic Aneurysmal Bone Cyst in Pregnancy

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Rayan Elkattah ◽  
Brooke Foulk
Keyword(s):  
Clinical Outcomes ◽  
Aneurysmal Bone Cyst ◽  
Bone Fractures ◽  
Bone Cyst ◽  
Bone Lesion ◽  
Pelvic Bone ◽  
Bone Lesions ◽  
Bone Changes ◽  
Challenging Situation ◽  
In Pregnancy

Albeit rare, the majority of identified bone lesions in pregnancy spare the pelvis. Once encountered with a pelvic bone lesion in pregnancy, the obstetrician may face a challenging situation as it is difficult to determine and predict the effects that labor and parturition impart on the pelvic bones. Bone changes and pelvic bone fractures have been well documented during childbirth. The data regarding clinical outcomes and management of pregnancies complicated by pelvic ABCs is scant. Highly suspected to represent an aneurysmal bone cyst, the clinical evaluation of a pelvic lesion in the ilium of a pregnant individual is presented, and modes of delivery in such a scenario are discussed.

Practical Input on Bone Tumor Imaging: Pathological Fracture, Risk Features, and When to Contact Orthopaedics

2019 ◽  
Vol 23 (01) ◽  
pp. 019-025 ◽  
Author(s):  
Suzanne Anderson ◽  
Sina Havakeshian ◽  
Andreas Würzburg ◽  
Magdalena Lunkiewicz
Keyword(s):  
Pathological Fracture ◽  
Clinical Presentation ◽  
Tumor Imaging ◽  
Treatment Strategies ◽  
Pathologic Fracture ◽  
Long Bone ◽  
Bone Lesions ◽  
Anatomical Site ◽  
Factors Associated ◽  
Impending Fracture

AbstractAwareness of risk factors associated with impending fracture and its radiologic appearance allows early diagnosis, supports prophylactic surgical treatment, and prevents the multiple complications of a pathologic fracture. Because the femur is the most common long bone affected by metastatic bone lesions, we address this clinically relevant site in this review. The key to early detection of risky bone lesions is familiarity with the possible clinical presentation, biomechanical effects of the anatomical site (femoral head and neck, intertrochanteric zone, proximal diaphysis), and the lesion types (lytic, blastic, or mixed). Awareness of the possible treatment strategies depending on the characteristics just listed allows high-quality targeted reporting.

scholarly journals COVID-19-associated brief psychotic disorder

2020 ◽  
Vol 13 (8) ◽  
pp. e236940 ◽  
Author(s):  
Colin M Smith ◽  
Jonathan R Komisar ◽  
Ahmad Mourad ◽  
Brian R Kincaid
Keyword(s):  
Mental Illness ◽  
Family History ◽  
Psychotic Disorder ◽  
Neuropsychiatric Symptoms ◽  
Healthy Woman ◽  
Psychotic Symptoms ◽  
First Case ◽  
Brief Psychotic Disorder ◽  
History Of ◽  
New Onset

A 36-year-old previously healthy woman with no personal or family history of mental illness presented with new-onset psychosis after a diagnosis of symptomatic COVID-19. Her psychotic symptoms initially improved with antipsychotics and benzodiazepines and further improved with resolution of COVID-19 symptoms. This is the first case of COVID-19-associated psychosis in a patient with no personal or family history of a severe mood or psychotic disorder presenting with symptomatic COVID-19, highlighting the need for vigilant monitoring of neuropsychiatric symptoms in these individuals.

Localized but unresectable neuroblastoma: treatment and outcome of 145 cases. Italian Cooperative Group for Neuroblastoma.

1993 ◽  
Vol 11 (9) ◽  
pp. 1770-1779 ◽  
Author(s):  
A Garaventa ◽  
B De Bernardi ◽  
C Pianca ◽  
A Donfrancesco ◽  
L Cordero di Montezemolo ◽  
...  
Keyword(s):  
Primary Tumor ◽  
Standard Dose ◽  
Serum Lactate ◽  
Response To Therapy ◽  
Serum Lactate Dehydrogenase ◽  
Risk Category ◽  
High Dose ◽  
Tumor Site ◽  
Primary Tumor Site ◽  
Response To Chemotherapy

PURPOSE To define factors that influence outcome in children with localized but unresectable neuroblastoma by retrospective investigation of response to therapy and outcome in 21 Italian institutions. PATIENTS AND METHODS Of 145 assessable children diagnosed between 1979 and 1990, 77 were treated between 1979 and 1984 with three consecutive standard-dose (SD) protocols, and 68 between 1985 and 1990 with a high-dose (HD) protocol. All protocols included chemotherapy, followed by resection of primary tumor if feasible. If at least partial resection was achieved, consolidation therapy followed, except that from 1985 onward, patients considered disease-free following surgery received no further treatment. RESULTS Ninety-four of 145 patients (65%) achieved a complete response (CR) or partial response (PR) with chemotherapy and 75 (52%) subsequently underwent complete resection of the primary tumor. Eighty-one patients are alive (73 without disease, eight with disease), 63 have died, and one is lost to follow-up. The 5-year overall survival (OS) rate is 55% and progression-free survival (PFS) rate 50%. Both OS and PFS correlated with response to chemotherapy, removal of primary tumor, HD therapy, and serum lactate dehydrogenase (LDH) levels. Infants (< 1 year), independent of primary tumor site, and children aged 1 to 15 years with a nonabdominal primary tumor, did better compared with children aged 1 to 15 years with an abdominal primary tumor (PFS, 72% and 64% v 30%; P < .001 and < .01, respectively). Outcome of this last group improved with the HD protocol (PFS, 40% v 23%; P = .01). CONCLUSION In children with unresectable neuroblastoma, risk categories can be defined by age and primary tumor site. HD chemotherapy should be investigated for the poor-risk category age 1 to 15 years with an abdominal primary tumor.

Grade I meningioma with disseminated bone disease: a rare clinical phenomenon

2020 ◽  
Vol 13 (4) ◽  
pp. e233708
Author(s):  
Oriol Mirallas ◽  
David Marmolejo ◽  
Augusto Valdivia ◽  
Maria Vieito
Keyword(s):  
Molecular Subtype ◽  
Primary Tumour ◽  
Growth Potential ◽  
Pelvic Bone ◽  
Bone Lesions ◽  
Clinical Experiences ◽  
Systemic Dissemination ◽  
History Of ◽  
The Central Nervous System ◽  
Disseminated Disease

Meningioma, the second most common primary tumour of the central nervous system, is classified into three different grades based on their characteristics. Each tumour grade includes different molecular subtype, growth potential, and thus, different prognosis. Grade I meningioma is the most common subtype with a benign course, in which systemic dissemination rarely occurs. We present the case of a 48-year-old male patient with a history of grade I meningioma who was referred 3 years after the initial diagnosis to our centre due to pelvic pain. Computed tomography (CT) images showed new pelvic bone lesions whose histopathological report was compatible with a grade I meningioma. Neither hormonal therapy concomitant with octreotide nor hydroxiurea treatments were effective. Very little is known about this entity’s prevalence and treatment when disseminated disease occurs. Thus, we think it is important to increase the positive and negative clinical experiences in this setting.

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