Complete Response in Metastatic Hepatocellular Carcinoma with Cardiac and Lung Involvement via Multimodality Treatment

Background: Until recently, advanced HCC patients with major vessel and cardiac involvement have had an extremely poor prognosis without satisfactory treatment. Case presentation: A 63-year-old Taiwanese male presented with metastatic HCC with RA and IVC thrombi, as well as pulmonary metastases that were successfully treated by multimodal management, encompassed by surgical thrombectomy, concurrent systemic sorafenib and locoregional therapies, and immunotherapy. The patient has achieved a complete response over the past 33 months. Conclusion: Through this case report, which shows a successful outcome via multimodal management, a more aggressive approach should be considered when a patient is expected to tolerate the risks and side effects of various treatments.

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Three-stage approach to resection of left pancoast tumour with spinal and major vessel involvement

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa384 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Alison M Wallace ◽

George D Oreopoulos ◽

Yoga R Rampersaud ◽

Thomas K Waddell

Keyword(s):

Quality Of Life ◽

Left Subclavian Artery ◽

Neoadjuvant Chemoradiotherapy ◽

Oncologic Outcome ◽

Successful Outcome ◽

Team Collaboration ◽

Major Vessel ◽

Vertebral Bodies ◽

Vessel Involvement

Abstract Here we describe the successful outcome of a complex and challenging resection of a left-sided pancoast tumour involving the left subclavian artery and vertebral bodies. The resection was performed following neoadjuvant chemoradiotherapy in a multi-staged fashion involving multiple teams including thoracic surgery, plastic surgery, neurosurgery and vascular surgery. Each operation was less than 6 h, without complication, and the patient was discharged within 1 week of each procedure. This case report highlights the importance of multidisciplinary team collaboration and planning in order to achieve a successful oncologic outcome and a good quality of life following treatment of these challenging tumours. The patient had a good functional outcome and no evidence of recurrence 1.5 years later.

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Successful Multimodality Management of Atypical Teratoid/Rhabdoid Tumour of the Lower Dorsal Spine with Spinal Drop Metastasis: Illustrated Review

Pediatric Neurosurgery ◽

10.1159/000513936 ◽

2021 ◽

pp. 1-13

Author(s):

Ahitagni Biswas ◽

Umesh Velu ◽

Seema Sharma ◽

Kalpana Kumari ◽

Mehar Chand Sharma ◽

...

Keyword(s):

Smooth Muscle Actin ◽

Primary Tumour ◽

Complete Response ◽

Malignant Cell ◽

Conus Medullaris ◽

Successful Outcome ◽

Rhabdoid Tumour ◽

Drop Metastasis ◽

Atypical Teratoid ◽

Atypical Teratoid Rhabdoid Tumour

Introduction: Spinal atypical teratoid/rhabdoid tumour (AT/RT) is exquisitely rare and constitutes 2% of all AT/RTs. Case Presentation: A 6-year-old boy presented with low backache for the last 5 months. MRI of the spine showed a 1.5 × 1.5 × 4.7 cm intradural extramedullary mass extending from D10 to D12, causing compression of the conus medullaris. With a preoperative diagnosis of ependymoma, a gross total resection (GTR) of tumour was performed. Post-operative histopathology showed AT/RT. The tumour cells were immunopositive for cytokeratin, epithelial membrane antigen, smooth muscle actin, and p53 and immunonegative for MIC2, desmin, glial fibrillary acidic protein, and INI1. Post-operative neuraxis MRI revealed post-operative changes (D10–D12) with a 9 mm enhancing lesion at L5-S1 junction suggesting drop metastasis. There was no lesion in brain. Cerebrospinal fluid cytology did not show any malignant cell. The metastatic work-up was normal. He received 3 cycles of chemotherapy with ICE regimen (ifosfamide, carboplatin, and etoposide). Subsequently, he received craniospinal irradiation (CSI)-36 Gy/20 fractions/4 weeks followed by focal boost to primary tumour bed and spinal drop metastasis-14.4 Gy/8 fractions/1.5 weeks. Thereafter, he received 3 more cycles of ICE regimen. End-of-treatment MRI spine showed post-op changes (D10–D12) and 38.9% reduction of the L5-S1 lesion suggesting partial response. Six monthly spinal MRI showed serial reduction of the metastatic lesion leading to complete response (CR) 1 year after completion of treatment. On last follow-up (30 months from the initial diagnosis), he was neurologically intact and in CR. Conclusion: Multimodality management comprising GTR of tumour, CSI followed by focal boost, and multiagent chemotherapy (ICE) can lead to successful outcome in patients with this rare and aggressive spinal tumour.

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Traumatic Arterio-Enteric Fistula—A Report of 2 Cases With Review of Literature

Vascular and Endovascular Surgery ◽

10.1177/1538574421994413 ◽

2021 ◽

pp. 153857442199441

Author(s):

Joses Dany James ◽

Harshit Agarwal ◽

Vignesh Kumar ◽

Atin Kumar ◽

Naren Hemachandran ◽

...

Keyword(s):

Penetrating Trauma ◽

Gluteal Region ◽

Successful Outcome ◽

Enteric Fistula ◽

Gastrointestinal Bleed ◽

The Past ◽

Bleeding Per Rectum ◽

Lower Gastrointestinal Bleed ◽

High Index Of Suspicion ◽

Rare Phenomena

Background: Traumatic arterio-enteric fistula is predominantly seen after penetrating trauma with only 21 reported cases documented in the past 25 years. They may present in an acute or delayed manner with upper or lower gastrointestinal bleed. A detailed clinical examination with requisite imaging can help in detecting such injuries. Case Description: Case 1: A 20-year-old gentleman, presented with penetrating stab injury to the gluteal region with bleeding per rectum. Imaging revealed evidence of injury to the inferior rectal artery which was found to be communicating with the extraperitoneal portion of the rectum. He was managed with a combination of endovascular and open surgery with a successful outcome. Case 2: A 29-year-old gentleman, presented in a delayed manner 2 weeks after a gunshot wound to the gluteal region, which was managed operatively in another hospital. He developed a massive lower gastrointestinal bleed 2 weeks after presentation. Imaging revealed evidence of a pseudoaneurysm of the inferior gluteal artery which had a fistulous communication with the gastrointestinal tract leading to bleeding. It was managed by endovascular techniques successfully. Conclusion: Arterio-enteric fistulas following trauma are rare phenomena and they need a high index of suspicion for diagnosis. Once diagnosed, they can be managed based on their location and patient physiology by interventional techniques, surgery, or a combination of the two.

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What are dental professionals posting on Facebook? A cross-sectional content analysis

Journal of Orthodontics ◽

10.1177/14653125211033302 ◽

2021 ◽

pp. 146531252110333

Author(s):

Keelin Fox ◽

Parmjit Singh

Keyword(s):

Content Analysis ◽

Communication Strategies ◽

Median Number ◽

Cross Sectional ◽

Case Presentation ◽

Plain Text ◽

The Past ◽

Group Members ◽

Group Characteristics ◽

Product Promotion

Objective: To profile the posts on open orthodontic Facebook groups and identify which communication strategies and media modalities generate the most engagement from users. Design: A cross-sectional content analysis. Setting: Facebook Internet-based search. Methods: Post data were collected over a one-month period from the 10 largest public orthodontic Facebook groups. Evaluation of group characteristics included membership levels, number of administrators, time each group had been in existence and growth rate of each group. The number of posts, the numbers and types of engagement (likes, emojis, comments, shares) and engagement rate were calculated. The communication strategies (e.g. case presentation, course promotion, etc.) and media modalities (e.g. plain text, photograph, etc.) were recorded. Results: The study identified 190,268 Facebook members from the 10 largest orthodontic Facebook groups (median 17,811; interquartile range [IQR] 11,977). The median time the groups had existed was six years (median 2175 days; IQR 2311 days) and the median number of new group members in the past month was 1257 (IQR 2773). The median number of new group members in the past month was 1257 (IQR 2773). There were 227 postings during the study period with 2546 engagements. The overall median number of engagements was 196 (IQR 445) and the engagement rate of posts was 1.3% overall. Posts relating to course promotion (n = 63, 28%) followed by product promotion (n = 42, 19%) were the most common. Case presentation style posts accounted for 15% (n = 35). The level of engagement was greater for posts that had a clinical component compared to posts that did not ( P < 0.001). For media modality, posts that included a photograph had greater engagement ( P < 0.001). Conclusion: There are frequent posts on course and product promotion in orthodontic Facebook groups; however, these are associated with low levels of engagement. Posts that are clinically orientated and include photographs have higher levels of engagement.

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ATRT-31. SUCCESSFUL MULTIMODALITY MANAGEMENT OF ATRT OF THE LOWER DORSAL SPINE WITH SPINAL DROP METASTASIS

Neuro-Oncology ◽

10.1093/neuonc/noaa222.029 ◽

2020 ◽

Vol 22 (Supplement_3) ◽

pp. iii282-iii282

Author(s):

Ahitagni Biswas ◽

Umesh Velu ◽

Kalpana Kumari ◽

Deepali Jain ◽

Sameer Bakhshi

Keyword(s):

Primary Tumour ◽

Brain Lesion ◽

Complete Response ◽

Malignant Tumour ◽

Malignant Cell ◽

Metastatic Lesion ◽

Conus Medullaris ◽

Successful Outcome ◽

Rhabdoid Tumour ◽

Drop Metastasis

Abstract A 6 year old boy presented with low backache for the last 5 months. MRI of the spine showed a 1.5x1.5x4.7cm intradural mass extending from D10-D12, causing compression of the conus medullaris. With a preoperative diagnosis of intradural ependymoma, a gross total resection (GTR) of tumour was performed. Post-operative histopathology showed a markedly cellular, malignant tumour with frequent mitotic figures. Cells were round to polygonal with vesicular nuclei, prominent nucleoli and were immunopositive for CK,EMA,p53 and immunonegative for MIC2,desmin,SMA,GFAP,INI-1(MIB1 labeling index-35–40%). The overall impression was spinal atypical teratoid rhabdoid tumour(ATRT). Post-operative neuraxis MRI revealed post-operative changes(D10-D12) with a 9 mm enhancing lesion at L5-S1 junction suggesting drop metastasis. There was no brain lesion. CSF cytology did not show any malignant cell. The metastatic work-up was normal. He was started on chemotherapy with ICE regimen (Ifosfamide-2g/m2IVD1–D3,Carboplatin-500mg/m2IVD3,Etoposide-100mg/m2IVD1–D3q3weeks). Subsequently he received craniospinal irradiation (CSI)-36Gray/20fractions/4weeks→ focal boost to primary tumour bed and spinal drop metastasis-14.4Gray/8fractions/1.5 weeks. Thereafter he received 3 more cycles of ICE regimen. End-of-treatment MRI spine showed post-op changes(D10-D12) and 38.9%reduction of the L5-S1 lesion suggesting partial response. Six monthly spinal MRI showed serial reduction of the metastatic lesion leading to complete response (CR) 1 year after completion of treatment. On last follow-up (30 months from initial diagnosis), he was neurologically intact and in CR. Multimodality management comprising GTR,CSI followed by focal boost and multiagent chemotherapy(ICE) can lead to successful outcome in patients with this rare and aggressive spinal tumour.

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Therapy of Brain Arteriovenous Malformations: Multimodality Treatment from a Balanced Standpoint

Neurosurgery ◽

10.1227/01.neu.0000237408.95785.64 ◽

2006 ◽

Vol 59 (suppl_5) ◽

pp. S3-148-S3-157 ◽

Cited By ~ 15

Author(s):

Bernd Richling ◽

Monika Killer ◽

Abdul R. Al-Schameri ◽

Lutz Ritter ◽

Rada Agic ◽

...

Keyword(s):

Arteriovenous Malformation ◽

Arteriovenous Malformations ◽

Multimodality Treatment ◽

Great Variability ◽

Treatment Algorithms ◽

Risk Levels ◽

Therapeutic Modalities ◽

The Past ◽

Surgical Extirpation ◽

Treatment Surgery

Abstract THE THREE THERAPEUTIC modalities for arteriovenous malformation (AVM) treatment (surgery, embolization, and radiotherapy) developed in the past years with specific tools, each tool with its own qualities. Soon after the implementation of embolization for treatment of AVMs, this technique was used in combination with microsurgery; since the development of radiosurgery, treatment algorithms combining embolization with surgery and eventual subsequent radiosurgery, embolization with radiosurgery, or surgery with subsequent radiosurgery have been reported. These different combinations have been in use under the term multimodality treatment for many years, but the algorithms regarding the combination of tools, which tool has priority, and how the risk levels of each tool are assessed shows great variability among institutions. Centers with a surgical background see embolization as a technique to increase surgical feasibility and radiosurgery as a tool to complete subtotal AVM excision. Institutions with an endovascular background embolize AVMs with the aim of maximal occlusion rates and view surgery or radiosurgery as a technique to be used if the goal of total endovascular occlusion cannot be achieved. Radiosurgeons receive patients after incomplete embolization or surgical extirpation or a combination of both.

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Successful Management of Rhabdomyolysis with Acute Infection Resulting from Chronic Sacrococcygeal Pressure Ulcers in a Paraplegic Patient: A Case Report

10.21203/rs.3.rs-89467/v1 ◽

2020 ◽

Author(s):

Kai Huang ◽

Yansheng Zhu

Keyword(s):

Physical Examination ◽

Laboratory Tests ◽

Pressure Ulcers ◽

Acute Infection ◽

Case Presentation ◽

The Past ◽

Sacrococcygeal Region ◽

Skin Sensation ◽

Life Threatening ◽

Paraplegic Patient

Abstract Background: Rhabdomyolysis, a potentially life-threatening syndrome, is caused by the breakdown of skeletal muscle cells and leakage of intramyocellular contents into the bloodstream. The treatment of cases with rhabdomyolysis resulting from chronic sacrococcygeal pressure ulcers have been rarely reported.Case presentation: A 62-year-old man suffered from high fever and dark-colored urine. For the past 30 years, the patient has lived with paraplegia, which led to his immobility. According to his physical examination, the wound on his sacrococcygeal region was dehisced and exuded repeatedly with loss of skin sensation. Upon corroboration of a physical examination and laboratory tests, the patient was diagnosed with rhabdomyolysis with an acute infection resulting from sacrococcygeal pressure ulcers. We first debrided the necrotic tissue, and then the chronic ulcer was repaired. The wound dressing was changed frequently, and antimicrobial therapy and nutritional support were included in the treatment. The fever and dark-colored urine were gradually relieved post-operatively. Renal function was also improved according to the typical indicators in laboratory tests. Additionally, the size of the pressure ulcers was reduced, to some extent. The patient was discharged after one month of hospitalization.Conclusions: Accurate diagnosis is critical for clinicians to administer precise treatment to paraplegic patients with progressive rhabdomyolysis.

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Simultaneous Coexistence of Thyrotropin-Prolactin-Secreting Adenoma and Papillary Thyroid Carcinoma

Case Reports in Endocrinology ◽

10.1155/2021/6564765 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Somaya Safi ◽

Yousra Benabdelfedil ◽

Sara Derrou ◽

Faycal El Guendouz

Keyword(s):

Papillary Thyroid Carcinoma ◽

Thyroid Carcinoma ◽

Complete Response ◽

Thyroid Stimulating Hormone ◽

Suppressive Therapy ◽

Papillary Thyroid ◽

Case Presentation ◽

Moroccan Woman ◽

Potential Link ◽

Concurrent Case

Background. The thyrotropin-secreting adenomas are very rare and even more rare when they simultaneously coexist with thyroid carcinoma. So far, only sixteen cases have been reported in the literature. Here, we present a unique case of successful management of a concurrent case of thyrotropin-prolactinoma with papillary thyroid carcinoma. Case Presentation. A 50-year-old Moroccan woman underwent a total thyroidectomy and complementary totalization by iratherapy for papillary thyroid carcinoma, who presented persistence of an inappropriate secretion of the thyroid-stimulating hormone (TSH > 4 mUI/L) despite of levothyroxine suppressive therapy (300 μg/d). After eliminating noncompliance, interfering medicines, and thyroid malabsorption, a pituitary adenoma (12 mm) was documented at magnetic resonance imaging. The patient has had transsphenoidal pituitary adenomectomy with histology confirming a thyrotropin-prolactin-secreting adenoma. After surgery and lanreotide treatment failures, we noted a complete response (TSH < 0.5) with cabergoline treatment (3 mg/week). Conclusion. The unusual association of thyroid adenocarcinoma and TSHoma enriches the hypothesis of a potential link between thyrotropic hypersecretion and thyroid carcinogenesis. Our case also illustrates the difficulty of monitoring thyroid carcinoma in nonremission of a TSHoma.

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An Ectopic Breast Tissue Presenting with Fibroadenoma in Axilla

Case Reports in Surgery ◽

10.1155/2013/947295 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Anandhi Amaranathan ◽

Kanchana Balaguruswamy ◽

Ramachandra V. Bhat ◽

Manash Kumar Bora

Keyword(s):

Breast Tissue ◽

Cardiac Anomaly ◽

Excision Biopsy ◽

Rare Entity ◽

Renal Anomalies ◽

Case Presentation ◽

The Past ◽

Ectopic Breast Tissue ◽

The Right ◽

Ectopic Breast

Introduction. The congenital anomalies of breast, especially the polymastia (supernumerary breast) and polythelia (supernumerary nipple), always do not fail to amuse the clinicians because of their varied presentations, associated renal anomalies, and pathologies arising from them. The axillary polymastia is a variant of ectopic breast tissue (EBT). Ectopic breast tissue can undergo the same physiological and pathological processes as the normally located breast. The incidence of fibroadenoma developing in ectopic breast is reported as a rare entity, the most common being the carcinoma.Case Presentation. A 31-year-old Dravidian female presented with a lump of 4 cm in the right axilla for the past year which gradually increased in size, giving discomfort. Our initial differential diagnosis was fibroadenoma, lipoma, and lymphadenopathy. Further investigation and histopathological report of excision biopsy confirmed it as a fibroadenoma on ectopic breast tissue in the axilla. Patient has no associated urological or cardiac anomaly.Conclusion. This case has been reported for its rarity and to reemphasise the importance of screening of EBT for any pathology during routine screening of breast.

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