Case Report: Hematoma Formation After Spontaneous Coronary Artery Rupture

We report a case of hematoma formation in the right coronary artery after spontaneous rupture. A 48-year-old female patient was admitted with a suspected right cardiac mass. Despite diagnostic work-up, the dignity of the mass could not be determined. Due to acute clinical symptoms, explorative surgery was decided and performed. Hereby, the mass was partially incised, and thrombus-like tissue was detected without active bleeding. We described the challenges during the diagnostic process, and the diagnosis was finally made according to a multimodality approach. For further assessment, we reviewed related literature and highlighted the importance of coronary angiography in the preoperative evaluation of such patients. The therapy may vary according to the location and size of such lesions.

Gender Representation in Perpustakaan Intan

There is little research on gender-related children's picture books in Indonesia. In this article, we discuss the disclosure of gender representation in a picture book entitled Perpustakaan Intan. The high number appearances of women, the actions pinned on women, and the clothes displayed in both text and images are materials for visualizing women and men. Previous studies have revealed that men dominate the number of appearances in books. However, this book displays women more often than men. On the one hand, this raises the question of whether this means women are in power, and on the other hand, men are portrayed as powerless. Utilizing the multimodality approach, the results show that although women appear more in the narrative, women are still represented as less powerful.

Giant Soft Tissue Sarcoma of Scalp with Skull and Cerebral Invasion

Scalp soft tissue sarcomas (STS) are very rare accounting for less than 0.1% of all malignancies. We report a rare clinical image of advanced stage soft tissue sarcoma of the scalp. A 65 year woman had presented to the surgical department with complaints of a rapidly growing swelling over the scalp for three months. On examination there was huge 20 x 20 cm swelling over the scalp in the left temporoparietal region with variegated consistency. Computed tomography of head revealed a large soft tissue mass with necrosis invading the bone and underlying brain parenchyma. Histopathological finding from core needle biopsy revealed pleomorphic sarcoma. STS are highly malignant tumors which should be diagnosed and treated using multimodality approach. Recurrences are common even after complete resection and prognosis is poor.

The development of breast radiology: the Acta Radiologica perspective

The encouraging results of modern breast cancer care builds on tremendous improvements in diagnostics and therapy during the 20th century. Scandinavian countries have made important footprints in the development of breast diagnostics regarding technical development of imaging, cell and tissue sampling methods and, not least, population screening with mammography. The multimodality approach in combination with multidisciplinary clinical work in breast cancer serve as a role model for the management of many cancer types worldwide. The development of breast radiology is well represented in the research published in this journal and this historical review will describe the most important steps.

ADULT JOKES IN SAUSAGE PARTY MOVIE: A STUDY OF MULTIMODALITY

The Sausage Party Movie is a comedy film directed by Conrad Vernon and Greg Tiernan (2016) which is sensational. The theme brings some controversy among people about how vulgar it is. The story exposed some sensitive themes such as intercourse, orgy, homosexuality, bisexuality, foreplay, torturing, murderer, annihilation, genocide, colonial domination, and other aspects as well. The contested scenes in the movie which manifest adult jokes are being analyzed by investigating the visual and linguistic elements related to the particular scenes. Thus, this study analyzed the adult jokes in “Sausage Party” by using multimodality approach which combines types of metafunction from Systemic Functional Linguistic (SFL) and visual elements of Gunther Kress and Theo van Leeuwen framework. The data were all scenes which contain adult jokes in this movie. The result reveals that some scenes may construct the meaning which related with the adult jokes. Despite the fact that this film is a comedy cartoon which associated with children, many adult jokes are being displayed to entertain the audiences which not suitable for underage communities. Likewise, the adult jokes are displayed as implicitly as possible to entertain either the underage who thinks it is only a usual joke or the adulthood who socially and practically understood the meaning behind it. In addition, the data is occupied by an intercourse activity between sausage and bun, torturing and murdered ideas, and also the idea of how human had intercourse from another perspective.

Neuroendocrine Tumours of Extrahepatic Biliary Tract: Series of Four Cases with Literature Review

Neuroendocrine tumours (NETs) originating from extrahepatic bile duct are an extremely rare entity. They are typically slow growing tumours with malignant potential. Commonly presenting as obstructive jaundice, preoperative clinico-radiologic differentiation between extrahepatic biliary tract neuroendocrine tumours and cholangiocarcinoma is difficult and the final diagnosis is usually established after surgical histopathology and immunohistochemistry examination. R0 resection offers the only curative option with good long term outcomes for Well differentiated NETs (grade1, grade2 and grade3) whilst the aggressive poorly differentiated Neuroendocrine Carcinoma (NEC) needs multimodality approach. We present our experience of management of four cases including three cases of grade II NET and one case of NEC undergoing surgical resection at a single centre with a short review of available literature.

4D Electromagnetic Navigation Bronchoscopy for the Sampling of Pulmonary Lesions: First European Real-Life Experience

Purpose The use of Electromagnetic navigation bronchoscopy (ENB) for the diagnosis of pulmonary peripheral lesions is still debated due to its variable diagnostic yield; a new 4D ENB system, acquiring inspiratory and expiratory computed tomography (CT) scans, overcomes respiratory motion and uses tracked sampling instruments, reaching higher diagnostic yields. We aimed at evaluating diagnostic yield and accuracy of a 4D ENB system in sampling pulmonary lesions and at describing their influencing factors. Methods We conducted a three-year retrospective observational study including all patients with pulmonary lesions who underwent 4D ENB with diagnostic purposes; all the factors potentially influencing diagnosis were recorded. Results 103 ENB procedures were included; diagnostic yield and accuracy were, respectively, 55.3% and 66.3%. We reported a navigation success rate of 80.6% and a diagnosis with ENB was achieved in 68.3% of cases; sensitivity for malignancy was 61.8%. The majority of lesions had a bronchus sign on CT, but only the size of lesions influenced ENB diagnosis (p < 0.05). Transbronchial needle aspiration biopsy was the most used tool (93.2% of times) with the higher diagnostic rate (70.2%). We reported only one case of pneumothorax. Conclusion The diagnostic performance of a 4D ENB system is lower than other previous navigation systems used in research settings. Several factors still influence the reachability of the lesion and therefore diagnostic yield. Patient selection, as well as the multimodality approach of the lesion, is strongly recommended to obtain higher diagnostic yield and accuracy, with a low rate of complications.

Combined Treatment with Laser Ablation and Tyrosine-Kinase Inhibitor as a Novel Multimodality Approach to Locally Advanced Thyroid Cancer: a Case Report

Background: Direct locoregional treatments were recently proposed for the local control of cervical and distant metastasis of thyroid cancer, but data on their use as part of a multimodality approach for primary thyroid tumors are poor. In this feasibility study, laser ablation (LTA) was successfully used for the initial debulking of unresectable radioiodine-refractory thyroid cancer in sequential therapy with tyrosine-kinase inhibitors (TKI). Clinical case: A 69-year-old woman underwent partial resection of papillary thyroid cancer with extensive tracheal infiltration. Post-treatment whole-body scan (131I, 8140 MBq) showed the absence of cervical thyroid uptake. The patient experienced a rapid increase in her cervical mass associated with dysphonia, dyspnea, and dysphagia. Due to a concomitant severe hypertensive state and cardiac failure, the patient was treated with LTA after a multidisciplinary consultation. After local anesthesia, two 300 nm optic fibers were inserted into the lesion through 21G spinal needles. Two illuminations with 4-watt output power and 3600 Joules energy delivery were performed with a diode-laser source. LTA resulted in rapid cancer debulking, and mass volume decreased from 23.9 to 7.5 mL resulting in significant improvement of pressure symptoms. Three months later, the patient was started on lenvatinib due to the initial regrowth of the tumor mass. The cervical tumor burden was controlled by TKI for 20 months when a rapid disease progression occurred, and the patient died. Discussion: Locally advanced, unresectable, and radioiodine-refractory thyroid tumors can be managed with a novel multimodality approach. The initial debulking with LTA of the locally aggressive disease results in rapid control of the tumor burden threatening patients’ life and is effectively followed by long-term control with TKI treatment. Conclusion: Based on this experience, sequential multimodality treatment with an initial locally directed laser ablation procedure followed by TKI therapy may be considered as a salvage option in patients with unresectable and rapidly progressive RR thyroid tumors.

Wilms’ Tumor in Adults—Conventional and Unconventional Presentations of a Rare Entity with a Review of Literature

Wilms’ tumor (WT) in adults is a rare neoplasm. Only a few reports are available in the literature. The tumor often masquerades as renal cell carcinoma (RCC). For accurate reporting, histopathological examination (HPE) plays a vital role in early diagnosis and prompt administration of multimodality treatment helps to improve the prognosis.We comprehensively analyzed five cases of adult WT presenting in the third to fifth decade with flank pain, hematuria, fever, and palpable lump. After complete clinical, biochemical, radiological, and HPE evaluation, tumor was staged and treatment was planned accordingly.Patients with low-stage WT were treated with open radical nephrectomy and chemotherapy. One of the patients diagnosed with inferior vena cava (IVC) thrombus apart from the above treatment also underwent IVC thrombectomy. Another young male presenting with distant metastasis (stage IV) and focal anaplasia on histology received preoperative chemotherapy and then planned for surgery. Unfortunately, the tumor being unresectable, second-line chemotherapy was given but he ultimately succumbed to death. All other patients are on regular follow-up and disease-free.Adult nephroblastoma is a rare clinical entity with hostile behavior. The presence of IVC thrombus is not a contraindication to surgery. Although the management strategy as per pediatric protocol by the inclusion of multimodality approach improves survival, still the overall prognosis in adults is dismal. There is a need for a standardized treatment protocol to encourage a homogenous approach for this rare disease and thereby improve survival.