Markers of tumor invasion are major predictive factors for the long-term outcome of corticotroph microadenomas treated by transsphenoidal adenomectomy

OBJECTIVE: To assess the postsurgical outcome of patients with corticotroph microadenomas and to define predictors of the long-term outcome, with special emphasis on markers of tumor extension. DESIGN: Prospective study of 53 corticotroph microadenomas treated by enlarged adenomectomy. Patients followed for at least 2 years were classified into two groups: those in long-term remission and uncured patients (immediate failures and recurrences). Pre-, per- and postoperative parameters were analyzed as predictors of the long-term outcome. METHODS: Baseline hormone assessments were performed preoperatively, 8 days after surgery and every 6-12 months thereafter. Pituitary magnetic resonance imaging (MRI) allowed analysis of possible tumor extension to adjacent structures. Apparent completeness of the surgical removal was determined, and fragments labeled either 'tumor' or 'surrounding pituitary tissue' were submitted to serial sectioning. RESULTS: Immediate control of hypercortisolism was achieved in 43/53 patients (81%). However, later recurrences were observed in five patients (9%). Preoperative MRI showed tumor extension into adjacent structures with good specificity (91%) for prediction of surgical failure. Evidence of local invasion at surgery was also significantly predictive of the long-term outcome. A corticotroph adenoma was found at histological examination in 96% of the patients, and 26% had irregular limits, a feature significantly correlated with a poor outcome. Immediate postoperative plasma cortisol did not allow discrimination between long-term remissions and recurrences. CONCLUSION: Surgical failure was best predicted by signs of tumor 'invasiveness' at MRI, confirmed by peroperative examination and histology.

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The Long-term Outcome of CyberKnife-Based Stereotactic Radiotherapy for Intra/ Extracranial Non-Vestibular Schwannomas: A Single-Center Experience

10.21203/rs.3.rs-1078736/v1 ◽

2021 ◽

Author(s):

Sukwoo Hong ◽

Kenji Kagawa ◽

Kengo Sato ◽

Ryutaro Nomura ◽

Shunsuke Ichi

Keyword(s):

Stereotactic Radiotherapy ◽

Significant Risk ◽

Progression Free Survival ◽

Target Volume ◽

Vestibular Schwannomas ◽

P Value ◽

Tumor Extension ◽

Term Outcome ◽

Long Term Outcome

Abstract Background The long-term outcomes of CyberKnife-based hypofractionated stereotactic radiotherapy (SRT) for intra/ extracranial non-vestibular schwannomas (nVS) need to be accumulated. Method Patients who received SRT by CyberKnife for nVS from 2010 to 2019 were retrospectively reviewed. Results A total of 45 patients with nVS were identified. The mean age was 53 (± 18) years old, and 23 patients (51%) were female. Twenty-nine patients (64%) had previous procedures. As for the tumor extension, 22 (49%) nVS were classified as primary intracranial, five (11%) were classified as intra/ extracranial (dumbbell shape), and 18 (40%) were classified as primary extracranial. The median prescribed dose, covering 95% of the planning target volume, was 21 (IQR 21 – 25) Gy, and the median target volume was 7 (IQR 3.6-13.1) cm3. The local control rate of nVS for patients without neurofibromatosis type 2 (NF2) was 100%. Old age (OR 0.92, p-value 0.03) and previous surgery (OR 0.02, p-value 0.02) were significant risk factors for no symptomatic improvement. The progression-free survival was 74 (±33) months clinically and 69 (IQR 36 – 94) months radiologically. During follow-up, two cases (4%) with NF2 resulted in treatment failure, 13 cases (41%) resulted in transient tumor expansion (TTE), 10 (22%) suffered from transient adverse radiation effect (ARE), and two (4%) resulted in permanent ARE. Conclusions Hypofractionated SRT for head, neck, and spine nVS was an effective treatment regardless of tumor extension relative to the cranium. Although the risk of permanent ARE was low, some patients experienced transient clinical worsening due to TTE.

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The Long-Term Outcome of CyberKnife-Based Stereotactic Radiotherapy for Intra/ Extracranial Non-Vestibular Schwannomas: A Single-Center Experience

10.21203/rs.3.rs-1078736/v2 ◽

2022 ◽

Author(s):

Sukwoo Hong ◽

Kenji Kagawa ◽

Kengo Sato ◽

Ryutaro Nomura ◽

Shunsuke Ichi

Keyword(s):

Stereotactic Radiotherapy ◽

Significant Risk ◽

Progression Free Survival ◽

Target Volume ◽

Vestibular Schwannomas ◽

P Value ◽

Tumor Extension ◽

Term Outcome ◽

Long Term Outcome

Abstract The long-term outcomes of CyberKnife-based hypofractionated stereotactic radiotherapy (SRT) for intra/ extracranial non-vestibular schwannomas (nVS) need to be accumulated. Patients who received SRT by CyberKnife for nVS from 2010 to 2019 were retrospectively reviewed. A total of 45 patients with nVS were identified. The mean age was 53 (± 18) years old, and 23 patients (51%) were female. Twenty-nine patients (64%) had previous procedures. As for the tumor extension, 22 (49%) nVS were classified as primary intracranial, five (11%) were classified as intra/ extracranial (dumbbell shape), and 18 (40%) were classified as primary extracranial. The median prescribed dose, covering 95% of the planning target volume, was 21 (IQR 21 – 25) Gy, and the median target volume was 7 (IQR 3.6-13.1) cm3. The local control rate of nVS for patients without neurofibromatosis type 2 (NF2) was 100%. Old age (OR 0.92, p-value 0.03) and previous surgery (OR 0.02, p-value 0.02) were significant risk factors for no symptomatic improvement. The progression-free survival was 74 (±33) months clinically and 69 (IQR 36 – 94) months radiologically. During follow-up, two cases (4%) with NF2 resulted in treatment failure, 13 cases (41%) resulted in transient tumor expansion (TTE), 10 (22%) suffered from transient adverse radiation effect (ARE), and two (4%) resulted in permanent ARE. Hypofractionated SRT by CyberKnife for head, neck, and spine nVS was an effective treatment regardless of tumor extension relative to the cranium. Although the risk of permanent ARE was low, some patients experienced transient clinical worsening due to TTE.

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Cannabis and Cognition: Connecting the Dots towards the Understanding of the Relationship

Brain Sciences ◽

10.3390/brainsci10030133 ◽

2020 ◽

Vol 10 (3) ◽

pp. 133 ◽

Cited By ~ 2

Author(s):

Marco Colizzi ◽

Sarah Tosato ◽

Mirella Ruggeri

Keyword(s):

Cognitive Rehabilitation ◽

Synthetic Cannabinoids ◽

Endocannabinoid System ◽

Cannabis Use ◽

Term Outcome ◽

Long Term Outcome ◽

Potential Risks ◽

Magnetic Resonance Imaging Mri ◽

Connecting The Dots

Several studies have advanced the understanding of the effects of cannabis on cognitive function. A comprehensive reappraisal of such literature may help in drawing conclusions about the potential risks associated with cannabis use. In summary, the evidence suggests that earlier age of use, high-frequency and high-potency cannabis use, as well as sustained use over time and use of synthetic cannabinoids, are all correlated with a higher likelihood of developing potentially severe and persistent executive function impairments. While the exact mechanisms underlying the adverse effects of cannabis on cognition are not completely clear, Magnetic Resonance Imaging (MRI) studies support the presence of both structural and functional alterations associated with cannabis use. Cognitive dysfunction is also a core feature of many neuropsychiatric disorders and care must be taken regarding the effects of cannabis use in these patient populations. Cognitive impairments affect patients’ daily functions, sociability, and long-term outcome, posing elevated economic, social, and clinical burdens. There is, thus, a compelling case for implementing behavioral and cognitive rehabilitation therapies for these patients, as well as investigating the endocannabinoid system in the development of new psychopharmacological treatments.

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Impact of breast magnetic resonance imaging (MRI) on long-term outcome after breast conservation therapy (BCT).

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.15_suppl.1053 ◽

2016 ◽

Vol 34 (15_suppl) ◽

pp. 1053-1053

Author(s):

Carolyn J. Kushner ◽

Neha Vapiwala ◽

Wei-Ting Hwang ◽

Gary M. Freedman ◽

Lawrence J. Solin

Keyword(s):

Magnetic Resonance Imaging ◽

Breast Magnetic Resonance Imaging ◽

Breast Conservation ◽

Breast Conservation Therapy ◽

Resonance Imaging ◽

Term Outcome ◽

Long Term Outcome ◽

Breast Magnetic Resonance ◽

Magnetic Resonance Imaging Mri

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Odontogenic myxoma invading the maxillary sinus – Case presentation

Romanian Journal of Rhinology ◽

10.1515/rjr-2016-0007 ◽

2016 ◽

Vol 6 (21) ◽

pp. 49-51

Author(s):

Dan Cristian Gheorghe ◽

Adina Zamfir-Chiru-Anton

Keyword(s):

Maxillary Sinus ◽

Surgical Excision ◽

Surgical Removal ◽

Odontogenic Myxoma ◽

Term Outcome ◽

Long Term Outcome ◽

Case Presentation ◽

Complete Surgical Excision ◽

Aggressive Tumor

Abstract Tumors of the maxillary sinus pose difficult challenges in a young patient. Our paper presents a very rare case of an odontogenic myxoma extended to the maxillary sinus, in a 14-year-old girl. The clinical picture suggested a malignancy or a local infection. The surgical removal was complete and the diagnosis was confirmed by immunohistochemistry. Discussions are made from the perspective of already published cases. A review of the disease is performed. CONCLUSION. Myxoma is a benign but aggressive tumor, needing complete surgical excision for a good long-term outcome.

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Long-term outcome and mortality after transsphenoidal adenomectomy for acromegaly

Clinical Endocrinology ◽

10.1046/j.1365-2265.2003.01679.x ◽

2003 ◽

Vol 58 (1) ◽

pp. 86-91 ◽

Cited By ~ 206

Author(s):

Catherine Beauregard ◽

Uyen Truong ◽

Jules Hardy ◽

Omar Serri

Keyword(s):

Term Outcome ◽

Long Term Outcome ◽

Transsphenoidal Adenomectomy

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Postsurgical Outcome in Cats with Exocrine Pancreatic Carcinoma: Nine Cases (2007–2016)

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6780 ◽

2018 ◽

Vol 54 (5) ◽

pp. 291-295 ◽

Cited By ~ 3

Author(s):

Ryan Nicoletti ◽

Ruthanne Chun ◽

Kaitlin M. Curran ◽

Louis-Philippe de Lorimier ◽

Michelle A. Morges ◽

...

Keyword(s):

Pancreatic Carcinoma ◽

Surgical Removal ◽

Survival Times ◽

Term Outcome ◽

Long Term Outcome ◽

Localized Disease ◽

Pancreatic Exocrine ◽

Aggressive Tumor

ABSTRACT Feline exocrine pancreatic carcinoma has been reported to be an aggressive tumor with a high metastatic rate and poor prognosis. Studies reporting long-term outcome of cats after surgical removal of solitary pancreatic carcinomas are rare, due to the uncommon diagnosis and paucity of cats who undergo treatment. In this study, nine cases of feline exocrine pancreatic carcinoma from seven academic and private practice veterinary hospitals were reviewed to examine the outcome in cats undergoing surgical removal of the mass. The median postsurgical survival time for the nine cats was 316.5 days (range, 25–964 days), with three cats alive at a median follow-up time of 309 days. This study demonstrates that surgical removal of pancreatic exocrine tumors in cats with localized disease can result in survival times of over 300 days.

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PHACE Syndrome: A Rare Case

Journal of Pediatric Genetics ◽

10.1055/s-0039-1694705 ◽

2019 ◽

Vol 09 (01) ◽

pp. 027-031

Author(s):

Ceylan Altintas Taslicay ◽

Elmire Dervisoglu ◽

Ercument Ciftci ◽

Funda Corapcioglu ◽

Yonca Anik

Keyword(s):

Magnetic Resonance ◽

Brain Mri ◽

Vascular Disorder ◽

Resonance Imaging ◽

Term Outcome ◽

Long Term Outcome ◽

Phace Syndrome ◽

Posterior Fossa Malformations ◽

Magnetic Resonance Imaging Mri

AbstractPHACE syndrome (OMIM 606519) is a rare neurocutaneous vascular disorder, characterized by posterior fossa malformations, large cervicofacial infantile hemangiomas, arterial anomalies, aortic coarctation, cardiac abnormalities, and eye abnormalities. The long-term outcome of PHACE syndrome patients is unclear; however, it seems that they are at risk for childhood stroke. The radiologist has an important role on diagnosis of PHACE syndrome and in the assessment of potential complications. Investigation of infants with segmental craniofacial hemangiomas should include cranial magnetic resonance imaging (MRI) and magnetic resonance angiography (MRA) of the cerebral and cervical arteries. Brain MRI and MRA findings of a 5-year-old female patient with PHACE syndrome are presented.

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Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

Fetal Diagnosis and Therapy ◽

10.1159/000515694 ◽

2021 ◽

pp. 1-10

Author(s):

Nimrah Abbasi ◽

Rory Windrim ◽

Johannes Keunen ◽

P.G.R. Seaward ◽

Tim Van Mieghem ◽

...

Keyword(s):

Ventilatory Support ◽

Surgical Removal ◽

Pleural Effusions ◽

Amniotic Cavity ◽

Term Outcome ◽

Long Term Outcome ◽

Significant Difference

Objective: Fetal thoraco-amniotic shunts (TASs) can dislodge in utero, migrating internally into the fetal thorax or externally into the amniotic cavity. Our objective was to evaluate the perinatal and long-term outcome of fetuses with TAS dislodgement and conduct a review of the literature. Methods: This is a retrospective review of all TAS inserted for primary pleural effusions and macrocystic congenital pulmonary airway malformations (CPAMs) in a tertiary fetal medicine center (1991–2020). Antenatal history, procedural factors, and perinatal and long-term outcomes were reviewed in all fetuses with dislodged shunts and compared to fetuses with shunts that did not dislodge. Results: Of 211 TAS inserted at a mean gestational age of 27.8 weeks ± 5.47 (17.4–38.1 weeks), 187 (89%) were inserted for pleural effusions and 24 (11%) for macrocystic CPAMs. Shunts dislodged in 18 fetuses (8.5%), 17 (94%) of which were for pleural effusions. Shunts migrated into the chest wall/amniotic cavity or into the thorax among 7/18 (39%) and 11/18 (61%) fetuses, respectively. Eleven (61%) fetuses were initially hydropic, which resolved in 8 (72%) cases. Effusions were bilateral in 9 (50%), amnioreduction was required in 6 (33%), and fetal rotation in 8 cases (44%). Four (22%) fetuses underwent repeat shunting, 12 (67%) neonates required ventilatory support, and 2 (11%) neonates required chest tubes. There was no significant difference in technical factors or outcomes between infants with shunts that dislodged and those that did not. Among 11 intrathoracic shunts, 2 (18%) were removed postnatally and the remainder are in situ without any shunt-related or respiratory complications over a follow-up period of 9 months to 22 years. Conclusion: TAS dislodged antenatally in 8.5% of fetuses, with 2/3 of shunts migrating into the thorax, and nearly 25% requiring re-shunting. Retained intrathoracic shunts were well tolerated and may not necessarily require surgical removal after birth.

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