Case Report: Vasculitis Triggered by SIRT in a Patient With Previously Untreated Cholangiocarcinoma

Arising from the biliary tract, cholangiocarcinoma is a rare and aggressive epithelial cancer. According to the primary site, it can be further classified into intrahepatic, perihilar and distal types. Due to the lack of symptoms early in the disease course, most patients are diagnosed at advanced stages. Being not candidates for curative surgical management, these patients are treated with palliative systemic chemotherapy, and their prognosis remains poor. Using radioisotopes like yttrium-90 -labeled microspheres (90Y), radioembolization represents a local approach to treat primary and secondary liver tumors. In the case of intrahepatic cholangiocarcinoma, radioembolization can be used as a primary treatment, as an adjunct to chemotherapy or after failing chemotherapy. An 88-year-old man underwent radioembolization for a previously untreated stage II intrahepatic cholangiocarcinoma. One week later, he presented to our clinic with a non-pruritic maculopapular rash of the lower extremities and abdomen, worsening fatigue and low-grade fever. Laboratory exams, including hepatitis screening, were within normal limits. Showing positive immunofluorescence staining for immunoglobulin M (IgM) and complement 3 (C3) in vessel walls without IgA involvement, the skin biopsy results were compatible with leukocytoclastic vasculitis. Apart from the anticancer intervention, there have been no recent medication changes which could explain this complication. Notably, we did not observe any side effects during or after the perfusion scan with technetium-99m macroaggregated albumin (MAA) performed prior to radioembolization. The symptoms resolved quickly after a short course of colchicine and did not reappear at cholangiocarcinoma progression. In the absence of other evident causes, we conclude that the onset of leukocytoclastic vasculitis in our patient was directly linked to the administration of yttrium-90 -labeled microspheres. Our report therefore demonstrates that this condition can be a rare but manageable complication of 90Y liver radioembolization.

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Management of Recurrent or Progressing Skull Base Chondrosarcomas: Predictors of Long-Term Outcomes

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1701523 ◽

2020 ◽

Cited By ~ 1

Author(s):

Jonathan D. Breshears ◽

Franco DeMonte ◽

Ahmed Habib ◽

Paul W. Gidley ◽

Shaan M. Raza

Keyword(s):

Natural History ◽

Skull Base ◽

Radiation Treatment ◽

Systemic Disease ◽

Primary Treatment ◽

Salvage Treatment ◽

Low Grade ◽

Related Factors ◽

Factors Associated ◽

Initial Recurrence

Abstract Background Skull base chondrosarcomas (CSA) are difficult tumors to cure and there is little data regarding salvage therapy. Objective This study aims to identify presentation and treatment-related factors which impact the progression free survival (PFS) and disease specific survival (DSS) for recurrent CSA, and to identify salvage treatment factors associated with successful restoration to the natural history following primary treatment. Methods This single-institution retrospective review included patients with recurrent/progressive CSA over a 25-year period. Survival analysis for factors impacting PFS and DSS was performed. Salvage treatment factors associated with achieving PFS ≥newly diagnosed median PFS were identified using univariate statistics. Analysis was performed on first recurrences and all recurrences combined. Results A total of 47 recurrence/progression events were analyzed from 17 patients (median two events/patient, range = 1–8). The overall PFS and DSS for the initial recurrence was 32 (range = 3–267) and 79 (range = 3–285) months, respectively. Conventional grade III or mesenchymal histology significantly predicted shorter PFS and DSS (p < 0.0001). After stratification by histology, previous radiation predicted shorter PFS for low-grade tumors (p = 0.009). Gross total resection (GTR) after a first time recurrence was significantly associated with successful salvage treatment (p < 0.05); however, this was rare. Conclusion In this series, high grade histology and prior radiation treatment negatively impacted salvage treatment outcomes, while GTR was associated with restoration to natural history following primary treatment. Careful consideration of histology, systemic disease status, previous treatments, and the anatomic extent of the skull base disease can optimize the outcomes of salvage intervention.

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Pediatric and Adult Low-Grade Gliomas: Where Do the Differences Lie?

Children ◽

10.3390/children8111075 ◽

2021 ◽

Vol 8 (11) ◽

pp. 1075

Author(s):

Ladina Greuter ◽

Raphael Guzman ◽

Jehuda Soleman

Keyword(s):

Primary Treatment ◽

The Other ◽

Awake Surgery ◽

Low Grade ◽

Total Excision ◽

Cerebrospinal Fluid Flow ◽

Pilocytic Astrocytomas ◽

The Brain ◽

Initial Results ◽

Infratentorial Tumors

Two thirds of pediatric gliomas are classified as low-grade (LGG), while in adults only around 20% of gliomas are low-grade. However, these tumors do not only differ in their incidence but also in their location, behavior and, subsequently, treatment. Pediatric LGG constitute 65% of pilocytic astrocytomas, while in adults the most commonly found histology is diffuse low-grade glioma (WHO II), which mostly occurs in eloquent regions of the brain, while its pediatric counterpart is frequently found in the infratentorial compartment. The different tumor locations require different skillsets from neurosurgeons. In adult LGG, a common practice is awake surgery, which is rarely performed on children. On the other hand, pediatric neurosurgeons are more commonly confronted with infratentorial tumors causing hydrocephalus, which more often require endoscopic or shunt procedures to restore the cerebrospinal fluid flow. In adult and pediatric LGG surgery, gross total excision is the primary treatment strategy. Only tumor recurrences or progression warrant adjuvant therapy with either chemo- or radiotherapy. In pediatric LGG, MEK inhibitors have shown promising initial results in treating recurrent LGG and several ongoing trials are investigating their role and safety. Moreover, predisposition syndromes, such as neurofibromatosis or tuberous sclerosis complex, can increase the risk of developing LGG in children, while in adults, usually no tumor growth in these syndromes is observed. In this review, we discuss and compare the differences between pediatric and adult LGG, emphasizing that pediatric LGG should not be approached and managed in the same way as adult LCG.

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Selective internal radiation therapy (SIRT) with yttrium-90 microspheres for unresectable intrahepatic cholangiocarcinoma

BMJ Case Reports ◽

10.1136/bcr-2017-223539 ◽

2018 ◽

pp. bcr-2017-223539

Author(s):

Vindya Abeysinghe ◽

Siva Sundararajan ◽

Luc Delriviere ◽

Jonathan Tibballs

Keyword(s):

Radiation Therapy ◽

Intrahepatic Cholangiocarcinoma ◽

Selective Internal Radiation Therapy ◽

Internal Radiation ◽

Selective Internal Radiation ◽

Internal Radiation Therapy ◽

Yttrium 90

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Living-related liver transplant to treat epithelioid hemangioendothelioma – a case report

Brazilian Journal of Transplantation ◽

10.53855/bjt.v8i4.383 ◽

2005 ◽

Vol 8 (4) ◽

pp. 449-451

Author(s):

Marcelo A. F. Ribeiro Jr ◽

Christian Evangelista Garcia ◽

Telma Eugênio dos Santos ◽

Adavio de Oliveira e Silva ◽

Regina Leitão ◽

...

Keyword(s):

Liver Transplantation ◽

Case Report ◽

Liver Transplant ◽

Soft Tissues ◽

Liver Tumors ◽

Epithelioid Hemangioendothelioma ◽

Low Grade ◽

Living Related Liver Transplant ◽

Transplantation Technique ◽

Living Related

Introduction: Epithelioid hemangioendothelioma of liver is a rare, low-grade neoplasm of vascular origin that has an unpredictable malignant potential. It preferentially arises in soft tissues and bones, and seldom in the liver. Biologically, it trends to be multi-focal and often unresectable. Objective: The outcome of a patient submitted to a living-related liver transplant to treat epithelioid hemangioendothelioma of the liver. Case report: The reported case involves a 39-year old female patient with an immense epithelioid hemangioendothelioma of the liver, involving segments III, IV, V, VII, and VIIl. The prognostic to any kind of treatment was considered unfavorable, and the decision of submitting her to a liver transplant was made. It was suggested a living-related liver transplant. The donor was the patient’s 36-year old brother, who donated his right liver lobe (segments V, VI, VII, VIII). The recipient´s original liver was large, presenting very solid consistence and no node evidence. The transplant itself was performed using the conventional living-related liver transplantation technique. The recovery was good, and she was discharged from hospital on the 15th postoperative day using micophenolate mofetil, tacrolimus, and corticoid. Conclusion: Liver transplantation for epithelioid hemangioendothelioma of the liver can be performed with acceptable survival rate. The living related liver transplant opens a great perspective to that group of patients presenting liver tumors and who are unfeasible to wait for an organ on a waiting list.

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Necrotizing leukocytoclastic vasculitis mimicking necrotizing fasciitis: a case report

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163130 ◽

2016 ◽

Vol 2 (3) ◽

pp. 193

Author(s):

Mehmet Salih Soylemez ◽

Korhan Ozkan ◽

Bulent Kılıc ◽

Samet Erinc ◽

Irfan Esenkaya ◽

...

Keyword(s):

Differential Diagnosis ◽

Case Report ◽

Laboratory Test ◽

Necrotizing Fasciitis ◽

Immunofluorescence Microscopy ◽

Leukocytoclastic Vasculitis ◽

Maculopapular Rash ◽

Skin Manifestation ◽

Biopsy Specimens ◽

Common Skin

<p>There are several subtypes of necrotizing leukocytoclastic vasculitis, which are classified according to their morphological features in biopsy specimens using immunofluorescence microscopy. Necrotizing leukocytoclastic vasculitis is limited to the skin, predominantly that of the lower extremities, and usually spares the palms and soles. The most common skin manifestation is palpable purpura. Other skin manifestations include maculopapular rash, bullae, papules, nodules, ulcers and livedo reticularis. There is no specific laboratory test to determine the diagnosis. There are various diseases presenting with these nonspecific symptoms, and a rapid differential diagnosis must be conducted, because the appropriate differentiation and diagnosis markedly influence the treatment strategy and survival of patients. In this study, we report a case of necrotizing leukocytoclastic vasculitis<strong> </strong>presenting with internal organ involvement and symptoms of necrotizing fasciitis, with emphasis on the clinical differentiation.</p>

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Development of an Enzyme-Linked Immunosorbent Assay for Immunoglobulin M Antibodies against Measles Virus

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.10.3.439-442.2003 ◽

2003 ◽

Vol 10 (3) ◽

pp. 439-442 ◽

Cited By ~ 3

Author(s):

F. Roodbari ◽

M. H. Roustai ◽

A. Mostafaie ◽

H. Soleimanjdahi ◽

R. Sarrami Foroshani ◽

...

Keyword(s):

Immunosorbent Assay ◽

Neutralizing Antibodies ◽

Measles Virus ◽

Clinical Symptoms ◽

Maculopapular Rash ◽

Immunoglobulin M ◽

Enzyme Linked Immunosorbent Assay ◽

Serum Samples ◽

Vaccination Programs ◽

Elisa System

ABSTRACT Measles is a highly contagious respiratory virus infection, with typical clinical symptoms including maculopapular rash, fever, cough, coryza, and conjunctivitis. Despite implementation of widespread vaccination programs throughout the world, the rates of global morbidity and mortality are still considerable. This study was performed to design a reliable indirect enzyme-linked immunosorbent assay (ELISA) to measure measles-specific immunoglobulin M (IgM). First, human IgM was purified, and then an anti-IgM antibody was produced in rabbits and purified in a multistep process. The rabbit IgG against human IgM was conjugated with peroxidase. Measles virus-infected Vero cells produced viral antigen. One hundred serum samples from infants of 9 to 18 months of age, mostly vaccinated, were evaluated for determining the presence of specific IgM antibodies against measles virus. The samples were also evaluated for neutralizing antibodies against measles virus by a microneutralization test (MNT). By comparing the results of the ELISA with those of MNT, it was demonstrated that ELISA had a sensitivity and specificity of 100 and 92%, respectively. On the other hand, when the results obtained by our ELISA system were compared with those of an imported measles virus IgM ELISA kit (EIAgen; Adaltis Italia SPa, Bologna, Italy), a high level of agreement was shown (k = 0.926).

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