Management of giant osteoma in the mandible associated with minor trauma: a case report

Background Osteoma is a benign tumor of the bones, which can be classified as central or peripheral. The occurrence in the jawbones is uncommon, but when it occurs, there is a greater prevalence of the mandible. The etiology is still unknown, and the hypothesis of its development is debated. Case presentation A 35-year-old Caucasian man presenting a tumor lesion in the right jawbone that had been growing for 8 years sought medical service complaining of speaking impairment. According to the patient, the tumor appeared shortly after a minor trauma caused by tooth extraction. The diagnosis of the lesion was made through clinical, radiographic, and histological methods, and the surgical treatment was successful and satisfactory for the patient as well as the surgical team, despite a short follow-up. Conclusion Etiopathogenesis of osteoma is not determined in the majority of cases. In the present report, it was possible to hypothesize the association between a minor trauma and the development of the tumor, reinforcing the reactive theory of tumor development. The uncommon location of the osteoma, as well the possibility of identifying the possible cause of the lesion, makes this case particularly interesting.

Diagnostic assertiveness of cerebellar pilocytic astrocytoma in the pediatric age

Pilocytic astrocytoma of the cerebellum in the pediatric age is the most frequent benign tumor lesion of the nervous system in children according to the WHO. International literature mentions that being low-grade tumors they have a high curative capacity. If the entire tumor is resected, when it is completely removed, survival increases with a high quality of life for children who presented this pathology and was treated on time. However, the delay in diagnosis and therefore in its treatment could generate the possibility of tumor transformation, the malignant nature of the transformed injuries has a very high morbidity and mortality, without mentioning that the degree of cognitive sequelae greatly affects the quality of life of the survivors. That is why the training of pediatric and non-pediatric first contact doctors imply a great responsibility since it gives the population and patients suffering from this nosology the possibility to improve their future life, as well as reduce the cost of the impact caused by the injuries they suffer. On the other hand, these tumors can transform generating devastating prognoses, without taking into account the economic and social repercussions of patients suffering from a low-grade tumor. When it is detected and treated assertively in a timely manner, it offers them greater opportunities than those who did not have such a timely diagnosis.

Differences in Distribution and Detection Rate of the [68Ga]Ga-PSMA Ligands PSMA-617, -I&T and -11—Inter-Individual Comparison in Patients with Biochemical Relapse of Prostate Cancer

The biochemical relapse of prostate cancer is diagnostically challenging but of high clinical impact for subsequent patient treatment. PET/CT with radiolabeled PSMA ligands outperforms conventional diagnostic methods in the detection of tumor recurrence. Several radiopharmaceuticals were and are available for use. The aim of this study was to investigate whether the routinely applied [68Ga]Ga-PSMA ligands PSMA-617, -I&T and -11 (HBED-CC) differ in physiological and pathological distribution, or in tumor detection rate. A retrospective evaluation of 190 patients (39 patients received PSMA-617, 68 patients PSMA-I&T and 83 patients PSMA-11) showed significant differences in tracer accumulation within all organs examined. The low retention within the compartments blood pool, bone and muscle tissue is a theoretical advantage of PSMA-11. Evaluation of tumor lesion uptake and detection rate did not reveal superiority of one of the three radiopharmaceuticals, neither in the whole population, nor in particularly challenging subgroups like patients with very low PSA levels. We conclude that all three [68Ga]Ga-PSMA ligands are equally feasible in this clinically important scenario, and may replace each other in case of unavailability or production restrictions.

Accurate Total-Body Ki Parametric Imaging with Shortened Dynamic 18F-FDG PET Scan Durations via Effective Data Processing

Background: Total-body dynamic PET (dPET) imaging using 18F-fluorodeoxyglucose (18F-FDG) has received widespread attention in clinical oncology. However, the conventionally required scan duration of approximately one hour seriously limits the application and promotion of this imaging technique. In this study, using Patlak analysis-based Ki parametric imaging as the evaluation standard, we investigated the possibility and feasibility of shortening the total-body dynamic scan duration to 30 mins post-injection (PI) with the help of a novel Patlak data processing algorithm.Methods: Total-body dPET images acquired by uEXPLORER (United Imaging Healthcare Inc.) using 18F-FDG of 15 patients with different types of tumors were analyzed in this study. Dynamic images were reconstructed into 25 frames with a specific temporal dividing protocol for the scan data acquired one hour PI. Patlak analysis-based Ki parametric imaging was carried out based on the imaging data corresponding to the first 30 mins PI, during which a Patlak data processing method based on third-order Hermite interpolation (THI) was applied. The resulting Ki images and standard Ki images were compared in terms of visual imaging effect and Ki estimation accuracy to evaluate the performance of the proposed data processing algorithm for parametric imaging with dPET with a shortened scan duration.Results: With the help of Patlak data processing, acceptable Ki parametric images were obtained from dPET data acquired with a shortened scan duration. Compared to Ki images obtained from unprocessed Patlak data, the resulting images from the proposed method contained less image noise, leading to remarkably improved imaging quality. Moreover, box plot analysis showed that that 30-min Ki images obtained from processed Patlak data have higher accuracy regarding tumor lesion Ki values.Conclusion: Acceptable Ki parametric images can be acquired from dynamic imaging data corresponding to the first 30 mins PI. Patlak data processing can help achieve higher Ki imaging quality and higher accuracy regarding tumor lesion Ki values. Clinically, it is possible to shorten the dynamic scan duration of 18F-FDG PET to 30 mins to facilitate the usage of such imaging techniques on uEXPLORER scanners.

Quantification of Tc-99m macroaggregated albumin liver perfusion as a predictor of tumor response to intra-arterial therapy with yttrium 90 spheres

Objectives: It remains unclear whether quantifying the pre-therapy tumor Technetium 99m macro aggregated albumin (Tc 99m MAA) localization can accurately predict the response to Yttrium 90 (Y-90) spheres therapy. Present studies are limited and with contradictory results. The aim of this study is to determine if quantification of Tc-99m MAA in hepatic tumor lesion(s) on pretherapy planning nuclear scan can predict the degree of tumor response after radioembolization using Y-90 Spheres. Material and Methods: We retrospectively included patients with primary liver cancers or metastases who were treated with SirSpheres or TheraSpheres. All patients had a Tc-99m MAA scan with an average dose of 5.0mCi injected aseptically in either the right, left, or common hepatic artery. The patients were subsequently transferred for imaging using planar and single-photon emission computed tomography (SPECT) of the abdomen and planar images of the chest. We calculated geometric mean of radiotracer counts in the largest lesion in the lobe to be treated by placing same size region of interest (ROI) around the largest lesion on the anterior and posterior planar images. Subsequently, an irregular ROI around the liver or lobe to be treated were drawn to calculate the geometric mean of counts in the liver. The percent tracer accumulation in the largest lesion was calculated by dividing the geometric mean of counts in the largest lesion by the geometric mean of counts in the liver or lobe and multiplying by 100%. The size of this largest lesion was obtained on the most recent CT or magnetic resonance imaging (MRI) in cm in 2 directions prior to treatment with Y-90 Spheres. The extent of the response to Y-90 Spheres therapy was re-evaluated with 3 months follow-up MRI or CT by measuring the decrease in the largest lesion size. Comparison of the percent Tc-99 MAA count accumulation in the largest lesion on the pre-therapy scan with the reduction in size using anatomic imaging was performed. Results: A total of 30 patients were included (16 hepatocellular carcinoma, eight colorectal, three breast, one neuroendocrine, one cholangiocarcinoma, and one cervical metastases). There were 14 patients in stable disease or progressive disease group (SD/PD gp) and 16 patients in partial response or complete response group (PR/CR gp). The median lesion size was 3.5 cm in the PD/SD gp versus 2.8 cm in the PR/CR gp (P = 0.31). Additionally, the median delivered Y90 Spheres treatment dose was 51.3 mCi in the PD/SD versus 43.2 mCi in the PR/CR gp (P = 0.22). The percent median largest lesion to liver concentration was 21.9% in the PR/CR gp versus 23.3% in the PR/CR gp (P = 0.74). There was no significant difference in percent Tc-99m MAA distribution in the largest liver lesion between the SD/PD gp and the PR/CR gp. Conclusion: The degree of Tc-99m MAA localization in the largest tumor lesion in the liver compared to the remainder of the liver as quantified from planar images does not predict the response to Y-90 spheres therapy.

The Clinical Characteristics and Outcomes of Incidentally Discovered Glioblastoma

Objective With an increase in the number of imaging examinations and the development of imaging technology, a small number of glioblastomas (GBMs) are identified by incidental radiological images. These incidentally discovered glioblastomas (iGBMs) are rare, and their clinical features are not well understood. Here, we investigated the clinical characteristics and outcomes of iGBM. Methods Data of newly diagnosed iGBM patients who were treated at our institution between August 2005 and October 2019 were reviewed. An iGBM was defined as a GBM without a focal sign, discovered on radiological images obtained for reasons unrelated to the tumor. Kaplan-Meier analysis was performed to calculate progression-free survival (PFS) and overall survival (OS). Results Of 234 patients with newly diagnosed GBM, four (1.7%) were classified as having iGBM. Health screening was the most common reason for tumor discovery (75.0%). The preoperative Karnofsky performance status score was 100 in three patients. Tumors were found on the right side in three cases. The mean volume of preoperative enhanced tumor lesion was 16.8 cm3. The median duration from confirmation of an enhanced lesion to surgery was 13.5 days. In all cases, either total (100%) or subtotal (95–99%) resections were achieved. The median PFS and OS were 11.5 and 20.0 months, respectively. Conclusions The iGBMs were often small and in the right non-eloquent area, and the patients had good performance status. We found that timely therapeutic intervention provided iGBM patients with favorable outcomes. This report suggests that early detection of GBM may lead to a better prognosis.

Unconventional radiotherapy to enhance immunotherapy efficacy in bulky tumors: a case report

Determining the most appropriate management strategy for patients with large tumor masses is a very challenging issue. Unconventional radiotherapy modalities, such as spatially fractionated radiation therapy (SFRT), are associated with dramatic responses. Recent studies have suggested that systemic immune activation may be triggered by SFRT delivery to primary tumor lesion. This report describes the case of a patient treated with a novel form of immune-sparing partially ablative irradiation (ISPART) for a bulky peritoneal metastasis from renal cell cancer, refractory to anti-PD-1 therapy (nivolumab) as third-line therapy after sequential therapy with sunitinib and cabozantinib. The observed response suggests that there may be a synergistic effect between ISPART and immunotherapy. This case report supports the inclusion of ISPART in patients presenting with bulky lesions treated with checkpoint inhibitors .

The Association of Propranolol with 2DG Reduces the Metabolism and the Proliferation of Cutaneous Squamous Cell Carcinoma A431 Cell Line

The non-selective β-blocking (±)-Propranolol Hydrochloride was demonstrated to improve the progression-free survival of patients and to reduce the incidence of different cancer types. Since the expression of β-adrenoceptors (β-AR) in the A431 squamous cell carcinoma (cSCC) human cells was described, we had suggested that cSCC proliferation may be controlled by using β-AR-blockers. Thus, we hypothesized that the topical application of a β-AR-blocker over the tumor lesion may decrease/restrain its extension before the surgical excision becoming an adjuvant\therapy against cSCC. However, it is known that β-AR-blocker anti-cancer activity as a single agent is limited. Hence, we suggested that the combination of Propranolol with the glucose analog 2-Deoxy-D-glucose (2-DG) could improve its antiproliferative effect through the induction of metabolic stress. Our results have demonstrated that the addition of 2DG to (±)-Propranolol Hydrochloride therapy can improve its effect on A431 cells metabolism and proliferation, suggesting that the combination of (±)-Propranolol Hydrochloride with low dose of 2DG could be a promising treatment to be topically applied as an adjuvant pre-surgical therapy against cSCC, aiming to decrease the size of the injury before the surgical procedure, avoiding systemic adverse effects to the patient.

Active targeting of orthotopic glioma using biomimetic liposomes co-loaded elemene and cabazitaxel modified by transferritin

Background Effective treatment of glioma requires a nanocarrier that can cross the blood–brain barrier (BBB) to target the tumor lesion. In the current study, elemene (ELE) and cabazitaxel (CTX) liposomes were prepared by conjugating liposomes with transferrin (Tf) and embedding the cell membrane proteins of RG2 glioma cells into liposomes (active-targeting biomimetic liposomes, Tf-ELE/CTX@BLIP), which exhibited effective BBB infiltration to target glioma. Results The findings showed that Tf-ELE/CTX@BLIP was highly stable. The liposomes exhibited highly significant homologous targeting and immune evasion in vitro and a 5.83-fold intake rate compared with classical liposome (ELE/CTX@LIP). Bioluminescence imaging showed increased drug accumulation in the brain and increased tumor penetration of Tf-ELE/CTX@BLIP in orthotopic glioma model nude mice. Findings from in vivo studies indicated that the antitumor effect of the Tf-ELE/CTX@BLIP led to increased survival time and decreased tumor volume in mice. The average tumor fluorescence intensity after intravenous administration of Tf-ELE/CTX@BLIP was 65.2, 12.5, 22.1, 6.6, 2.6, 1.5 times less compared with that of the control, CTX solution, ELE solution, ELE/CTX@LIP, ELE/CTX@BLIP, Tf-ELE/CTX@LIP groups, respectively. Histopathological analysis showed that Tf-ELE/CTX@BLIP were less toxic compared with administration of the CTX solution. Conclusion These findings indicate that the active-targeting biomimetic liposome, Tf-ELE/CTX@BLIP, is a promising nanoplatform for delivery of drugs to gliomas. Graphic Abstract