Tumor Thrombus as a Rare Presentation of Lymphoma: A Case Series of 14 Patients

2015 ◽  
Vol 204 (4) ◽  
pp. W398-W404 ◽  
Author(s):  
Anil Chauhan ◽  
Naveen Garg ◽  
Christine O. Menias ◽  
Catherine E. Devine ◽  
Priya R. Bhosale ◽  
...  
Keyword(s):  
Tumor Thrombus ◽  
Case Series ◽  
Rare Presentation

Pharmacological treatment of hepatocellular carcinoma with cavoatrial tumor thrombus – case series and literature review

2019 ◽  
Vol 57 (04) ◽  
pp. 501-507 ◽  
Author(s):  
Tianzuo Zhan ◽  
Janina Sollors ◽  
Niels Steinebrunner ◽  
Hans Schlitt ◽  
Christian Stroszczynski ◽  
...  
Keyword(s):  
Tumor Thrombus ◽  
Systemic Treatment ◽  
Treatment Options ◽  
Survival Rates ◽  
Vena Cava ◽  
Case Series ◽  
Surgical Approaches ◽  
Surgical Interventions ◽  
Advanced Hcc ◽  
Multimodal Therapy Concept

AbstractHepatocellular carcinomas (HCC) that extend into the vena cava and the right atrium have a poor prognosis. Surgical approaches including partial hepatectomy and thrombectomy are the most frequently reported treatment options. However, most patients with advanced HCC are not eligible for complex surgical interventions due to reduced liver function, comorbidities, and metastases. At the same time, systemic treatment options of HCC have expanded in recent years. Here, we report 3 cases of patients with advanced HCC who developed a cavoatrial tumor thrombus (CATT) after initial surgical or interventional therapy. The patients were consequently treated with sorafenib or nivolumab. In all cases, the tumor responded to systemic treatment with disease stabilization or partial regression. Overall survival after diagnosis of CATT was 3 and 17 months for sorafenib and 7 + months for nivolumab. Compared to survival rates of alternative treatment options, systemic therapies demonstrated comparable outcomes. In summary, pharmacotherapy is an efficient and well worth option to treat patients with HCC and CATT and should be an integral part of a multimodal therapy concept.

scholarly journals Combination of Sorafenib, Camrelizumab, Transcatheter Arterial Chemoembolization, and Stereotactic Body Radiation Therapy as a Novel Downstaging Strategy in Advanced Hepatocellular Carcinoma With Portal Vein Tumor Thrombus: A Case Series Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Yun Huang ◽  
Zeyu Zhang ◽  
Weijun Liao ◽  
Kuan Hu ◽  
Zhiming Wang
Keyword(s):  
Hepatocellular Carcinoma ◽  
Combination Therapy ◽  
Adverse Events ◽  
Tumor Thrombus ◽  
Stereotactic Body Radiation Therapy ◽  
Transcatheter Arterial Chemoembolization ◽  
Case Series ◽  
Advanced Hepatocellular Carcinoma ◽  
Advanced Hcc ◽  
Arterial Chemoembolization

Background and AimAlthough the treatment effect and availability of therapeutic options for advanced hepatocellular carcinoma (HCC) are limited, the downstaging strategy may improve patient prognosis. This study aimed to investigate the potential of combination therapy as a downstaging strategy for treating advanced HCC with portal vein tumor thrombus (PVTT).MethodsThis retrospective case series included patients having advanced HCC with PVTT, who received the combination therapy of sorafenib, camrelizumab, transcatheter arterial chemoembolization (TACE), and stereotactic body radiation therapy (SBRT) from January 2019 to December 2019 in Xiangya Hospital, Central South University. The downstaging rate, treatment responses, progression-free survival (PFS), overall survival (OS), disease control rate, and toxicities were evaluated.ResultsOf the 13 patients, HCC downstaging was achieved in 4 (33.3%) patients who later received hepatectomy. The overall response rate was 41.7%, and the disease control rate was 50.0%. The median PFS time was 15.7 months, with a 1-year PFS rate of 58.3%, whereas the median OS was not reached after 1 year (1-year OS, 83.3%). No severe adverse events or grade 3–4 adverse effect was observed in 12 of the 13 enrolled patients; therapy had to be discontinued in only one patient due to adverse events, who was excluded from the study. The most common adverse effect was fever (n = 4, 33.3%), followed by skin reaction (n = 3, 25%).ConclusionA combination therapy comprising sorafenib, camrelizumab, TACE, and SBRT is an effective downstaging strategy for advanced HCC with PVTT and is associated with few adverse events.

scholarly journals Venous Ulcers as a Rare Presentation of Bilateral May-Thurner Syndrome in Male Patients. Case Series

2019 ◽  
Vol 58 (6) ◽  
pp. e377-e378
Author(s):  
Osman M.A. Mahmoud ◽  
Ashraf Taha ◽  
Ashraf Hosny ◽  
Hesham Aboloyoun ◽  
Ayman Hasaballah
Keyword(s):  
Case Series ◽  
Rare Presentation ◽  
Venous Ulcers ◽  
Male Patients

Malignancy of a Horseshoe Kidney: A Case Series with a Rare Presentation

2012 ◽  
Vol 05 (06) ◽  
Author(s):  
Navin Ram ◽  
Bharat Behera ◽  
Sudheer Rathi ◽  
Sameer Trivedi ◽  
Uday Shankar Dwivedi
Keyword(s):  
Case Series ◽  
Horseshoe Kidney ◽  
Rare Presentation

Vision Deterioration and Hydrocephalus: Rare Presentations of Vestibular Schwannoma and Evolution of Management

2021 ◽  
Author(s):  
Marte van Keulen ◽  
Jonathan Pace ◽  
Christopher J. Burant ◽  
David L. Penn ◽  
Betsy Wilson ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Surgical Resection ◽  
Vestibular Schwannoma ◽  
Clinical Evidence ◽  
Tumor Resection ◽  
Case Series ◽  
Rare Presentation ◽  
Visual Symptoms ◽  
Younger Age ◽  
Csf Diversion

Abstract Introduction The incidence of vestibular schwannoma is reported as 12 to 54 new cases per million per year, increasing over time. These patients usually present with unilateral sensorineural hearing loss, tinnitus, or vertigo. Rarely, these patients present with symptoms of hydrocephalus or vision changes. Objective The study aimed to evaluate the surgical management of vestibular schwannoma at a single institution and to identify factors that may contribute to hydrocephalus, papilledema, and the need for pre-resection diversion of cerebrospinal fluid. Patients and Methods A retrospective review examining the data of 203 patients with vestibular schwannoma managed with surgical resection from May 2008 to May 2020. We stratified patients into five different groups to analyze: tumors with a diameter of ≥40 mm, clinical evidence of hydrocephalus, and of papilledema, and patients who underwent pre-resection cerebrospinal fluid (CSF) diversion. Results From May 2008 to May 2020, 203 patients were treated with surgical resection. Patients with tumors ≥40 mm were more likely to present with visual symptoms (p < 0.001). Presentation with hydrocephalus was associated with larger tumor size (p < 0.001) as well as concomitant visual symptoms and papilledema (p < 0.001). Patients with visual symptoms presented at a younger age (p = 0.002) and with larger tumors (p < 0.001). Conclusion This case series highlights the rare presentation of vision changes and hydrocephalus in patients with vestibular schwannoma. We recommend urgent CSF diversion for patients with visual symptoms and hydrocephalus, followed by definitive resection. Further, vision may still deteriorate even after CSF diversion and tumor resection.

scholarly journals Chronic Skull Base Erosion from Temporomandibular Joint Disease Causes Generalized Seizure and Profound Lactic Acidosis

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Mark A. Dobish ◽  
David A. Wyler ◽  
Christopher J. Farrell ◽  
Hermandeep S. Dhami ◽  
Victor M. Romo ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Skull Base ◽  
Temporomandibular Joint ◽  
Case Series ◽  
Type A ◽  
Oxidative Capacity ◽  
Joint Disease ◽  
Rare Presentation ◽  
Cellular Energy ◽  
Ph Range

This report displays a rare presentation of lactic acidosis in the setting of status epilepticus (SE). The differential diagnosis of lactic acidosis is broad and typically originates from states of shock; however, this report highlights an alternative and rare etiology, SE, due to chronic skull base erosion from temporomandibular joint (TMJ) disease. Lactic acidosis is defined by a pH below 7.35 in the setting of lactate values greater than 5 mmol/L. Two broad classifications of lactic acidosis exist: a type A lactic acidosis which stems from global or localized tissue hypoxia or a type B lactic acidosis which occurs once mitochondrial oxidative capacity is unable to match glucose metabolism. SE is an example of a type A lactic acidosis in which oxygen delivery is unable to meet increased cellular energy requirements. This report is consistent with a prior case series that consists of five patients experiencing generalized tonic-clonic (GTC) seizures and lactic acidosis. These patients presented with a pH range of 6.8-7.41 and lactate range of 3.8-22.4 mmol/L. Although severe lactic acidosis following GTC has been described, this is the first report in the literature of chronic skull base erosion from TMJ disease causing SE.

scholarly journals Calcitriol-Mediated Hypercalcemia: Causes and Course in 101 Patients

2013 ◽  
Vol 98 (10) ◽  
pp. 4023-4029 ◽  
Author(s):  
Peter J. Donovan ◽  
Lana Sundac ◽  
Carel J. Pretorius ◽  
Michael C. d'Emden ◽  
Donald S. A. McLeod
Keyword(s):  
Angiotensin Converting Enzyme ◽  
Case Reports ◽  
Elevated Serum ◽  
Case Series ◽  
Lymphocytic Leukemia ◽  
Converting Enzyme ◽  
Retrospective Case ◽  
Rare Presentation ◽  
Hospital System ◽  
Serum Angiotensin Converting Enzyme

Abstract Context: Hypercalcemia mediated by 1,25-dihydroxy vitamin D (calcitriol) is uncommon, with evidence on etiology limited to small case series or case reports. Objective: The objective of the study was to systematically identify a large series of cases of calcitriol-mediated hypercalcemia and document the presentation, demographics, and clinical course across etiologies. Design, Setting, and Patients: The study was a hospital-based, retrospective case series, identifying subjects from 1999 through 2009 across the public hospital system in Queensland, Australia. All patients aged over 18 years were identified that had persistent hypercalcemia associated with elevated or inappropriately normal calcitriol concentration or elevated serum angiotensin-converting enzyme. Results: A total of 101 cases were identified. Sarcoidosis was the most common etiology (49%), followed by hematological malignancy (17%) and infections (8%). Etiologies not previously described include squamous cell carcinoma of the tongue, ovarian cystadenocarcinoma, and chronic lymphocytic leukemia. Median serum angiotensin-converting enzyme was higher in sarcoid patients compared with all other causes [218 U/L (176–277) vs 155 U/L (110–208), P &lt; .001], but a level above the normal range did not discriminate well between cases of sarcoidosis and other causes (specificity at cutoff of 130 U/L was only 31%). However, a value greater than 250 U/L was highly specific (89%) for sarcoidosis but lacked sensitivity (31%). A calcitriol level greater than 300 pmol/L was not seen in sarcoidosis but was seen with other etiologies. Cases with neoplastic etiologies were older (61.4 ± 11.4 y) than all other subjects (51.7 ± 15.0 y, P = .006). Conclusions: Hypercalcemia mediated by calcitriol remains a rare presentation. In almost half the cases, sarcoidosis was the underlying cause, whereas a third of patients had cancer or systemic infections.

Venous line filtration: a novel technique for cases involving inferior vena caval and right atrial tumor and associated thrombus: a two-case series

Perfusion ◽  
2006 ◽  
Vol 21 (6) ◽  
pp. 391-394 ◽  
Author(s):  
Gregory R Smigla ◽  
D Scott Lawson ◽  
David D Kaemmer ◽  
Ian R Shearer
Keyword(s):  
Right Atrium ◽  
Tumor Thrombus ◽  
Inferior Vena ◽  
Venous Return ◽  
Vena Cava ◽  
Case Series ◽  
Venous Drainage ◽  
Right Atrial ◽  
Arterial Line ◽  
First Case

Two patients are presented with right atrial tumors, who were considered to be at risk for tumor thrombus migration down the venous line into the cardiopulmonary bypass (CPB) circuit during surgical excision, which may lead to compromised or interrupted venous drainage. An arterial line filter was placed in the venous line to capture any material that might become dislodged and embolize into the circuit. Vacuum-assisted venous drainage, at approximately -50 mmHg, was used to overcome any resistance caused by the filter in the venous line. In one case, tumor thrombus obstructed the filter, requiring the use of the bypass line around the filter, so venous return could be maintained. In both cases, thrombus was found in the filter. The first case was a 44-year-old female (81 kg, 137 cm, body surface area (BSA) 1.66 m2) who presented with a metastatic pheochromocytoma with associated thrombus arising from the left adrenal gland and extending into the inferior vena cava (IVC) and right atrium. The second case was a 37-year-old male (95 kg, 178 cm, BSA 2.17 m2), who presented with a very large angiosarcoma tumor involving almost the entire right atrium. We have shown that venous line filtration with vacuum-assisted venous drainage can be performed safely, and should be considered in cases where there is tumor thrombus in the vena cava or right atrium, which may threaten venous return.

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