Abdominal Nodes Research Articles

Thoracoscopic laparoscopy-assisted Ivor-Lewis resection of esophagogastric junction cancer

Objective: To investigate the outcome of patients with esophagogastric junction cancer undergoing thoracoscopic laparoscopy-assisted Ivor-Lewis resection. Methods: Eighty-four patients who were diagnosed with esophagogastric junction cancer and underwent Ivor-Lewis resection assisted by thoracoscopic laparoscopy at the National Cancer Center from October 2019 to April 2022 were collected. The neoadjuvant treatment mode, surgical safety and clinicopathological characteristics were analyzed. Results: Siewert type Ⅱ (92.8%) and adenocarcinoma (95.2%) were predominant in the cases. A total of 2 774 lymph nodes were dissected in 84 patients. The average number was 33 per case, and the median was 31. Lymph node metastasis was found in 45 patients, and the lymph node metastasis rate was 53.6% (45/84). The total number of lymph node metastasis was 294, and the degree of lymph node metastasis was 10.6%(294/2 774). Among them, abdominal lymph nodes (100%, 45/45) were more likely to metastasize than thoracic lymph nodes (13.3%, 6/45). Sixty-eight patients received neoadjuvant therapy before surgery, and nine patients achieved pathological complete remission (pCR) (13.2%, 9/68). Eighty-three patients had negative surgical margins and underwent R0 resection (98.8%, 83/84). One patient, the intraoperative frozen pathology suggested resection margin was negative, while vascular tumor thrombus was seen on the postoperative pathological margin, R1 resection was performed (1.2%, 1/84). The average operation time of the 84 patients was 234.5 (199.3, 275.0) minutes, and the intraoperative blood loss was 90 (80, 100) ml. One case of intraoperative blood transfusion, one case of postoperative transfer to ICU ward, two cases of postoperative anastomotic leakage, one case of pleural effusion requiring catheter drainage, one case of small intestinal hernia with 12mm poke hole, no postoperative intestinal obstruction, chyle leakage and other complications were observed. The number of deaths within 30 days after surgery was 0. Number of lymph nodes dissection, operation duration, and intraoperative blood loss were not related to whether neoadjuvant therapy was performed (P>0.05). Preoperative neoadjuvant chemotherapy combined with radiotherapy or immunotherapy was not related to whether postoperative pathology achieved pCR (P>0.05). Conclusion: Laparoscopic-assisted Ivor-Lewis surgery for esophagogastric junction cancer has a low incidence of intraoperative and postoperative complications, high safety, wide range of lymph node dissection, and sufficient margin length, which is worthy of clinical promotion.

Autoimmune encephalitis after surgery for appendiceal cancer: A case report

Primary cancer of the appendix is rare and often difficult to diagnose preoperatively due to the lack of specific clinical symptoms. Autoimmune encephalitis (AIE) is the most common cause of non-infectious encephalitis. The etiologies of AIE include tumors (paraneoplastic), infections (parainfections), or recessive infections. The tumors that have been reported to cause AIE include thymomas, ovarian teratomas, lung cancers, and breast cancers. However, there are no reports of AIE occurring after surgery for appendiceal cancer. This report describes the diagnosis and treatment of a patient with an appendiceal cancer and postoperative AIE. We report the case of a 47-year-old man who was transferred to our hospital due to a recurrent low intestinal obstruction. Abdominal enhanced computed tomography was used to consider the possibility of a terminal ileal tumor with serous infiltration and lymph node metastasis. A right hemi-colectomy was performed under general anesthesia with an ileo-transcolon anastomosis and laparoscopic exploration. The postoperative pathologic evaluation revealed a high-grade goblet cell carcinoma of the appendix, accompanied by mesangial and abdominal lymph node metastases, and neural tube and vascular infiltration. The operation was completed without complication. The patient developed restlessness on postoperative day 4, and gradually developed a disturbance of consciousness on postoperative day 6. He was transferred to West China Hospital of Sichuan University and diagnosed with AIE. Albeit rare, the occurrence of neurologic and psychiatric symptoms in patients with an appendiceal cancer postoperatively suggests the possibility of AIE.

Abstract 831: Selective targeting of pediatric rhabdoid tumor using G401-CLENs: Cytotoxicity studies

Abstract Background: Rhabdoid tumor is an aggressive soft tissue sarcoma that arises in the kidney, liver, peripheral nerves, and miscellaneous soft parts throughout the body. Rhabdoid tumors usually occur in infancy or during early childhood and the most common sites for metastasis are lungs, abdominal lymph nodes, liver, and brain. Current treatment options include surgery, radiation therapy, high-dose chemotherapy, and stem cell transplant but the overall survival rate is approximately 23%. Nano-sized liposomes are drug-delivery vehicles used to enhance the delivery of drugs to target cells. The composition, size, and overall charge of nanoliposomes determine targeting and influence the degree of drug uptake. The objective of this study was to develop G401-CLENs prepared from lipid extracts derived from rhabdoid tumor cells and conventional lipid components, and to evaluate the optimized drug loaded preparations of rhabdoid-CLENs in vitro. Methods: Rhabdoid tumor cell line, G401, was the chosen model for this study. G401 cells were cultured and expanded in vitro for cellular extraction purposes. The G401 cell membrane lipid extract (LE) was included in the preparation of G401-CLENs. Additional conventional lipid ingredients include DOPC, DOTAP, and DPPE-PEG5000. DPPE-rhodamine lipids were employed for fluorescence studies only. Chemo agents' doxorubicin and vinblastine were used in cell viability and cytotoxicity assays to evaluate formulation efficacy. Phase I of evaluation included physiochemical characterization and cellular uptake studies of preparations of CLENs, including 0 to 20 mol% of G401 LE content. Phase II of evaluation included the use of Hoechst33342/propidium iodide cell viability and cytotoxicity assays with varied amounts of doxorubicin and vinblastine loaded CLENs added to the G401 cells. The control cell line used in the study represents another solid tumor, SK-N-DZ (neuroblastoma). Results: The optimal composition for G401-CLENs was DOPC/DPPE-PEG5000/LE (93/2/5). The average size and zeta potential was 198 ± 16 nm (n=5) and -12 ± 1.2 mV (n=5), respectively. Cell selectivity studies revealed an increase in the uptake of the optimized G401-CLENs by G401 cells when compared to SK-N-DZ control cells. In general, the inclusion of DOTAP increased overall cellular uptake, but diminished selective uptake of G401-CLENs. Results support a significant cellular uptake of preparations consisting of 5 mol% LE compared to 0, 10, and 20 mol% G401 LE content. Doxorubicin loaded in G401-CLENs decreased rhabdoid tumor cell viability in a dose-dependent manner compared to doxorubicin loaded in conventional liposome preparations. Additional cytotoxicity studies are currently underway. Conclusion: To this date, G401-CLENs represents a promising selective drug-targeting vehicle for the treatment of rhabdoid tumors. Citation Format: Varun Kudchadker, Dongxiao Chen, Yeji Seo, Robert Campbell. Selective targeting of pediatric rhabdoid tumor using G401-CLENs: Cytotoxicity studies [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 831.

Role of Lower Esophageal Squamous Cell Carcinoma Margin Location on Abdominal Lymph Node Metastasis Risk

Different sites of esophageal cancer are accompanied by different regional lymph node metastasis (LNM) risks. We aimed to investigate the impact of a lower tumor margin on abdominal LNM risk. We enrolled patients who underwent esophagectomy for esophageal squamous carcinoma (ESCC) from 2014 to 2017 in West China Hospital. Overall survival (OS) analysis was performed. We measured the distance between the lower tumor margin and esophagogastric junction (LED) with upper gastrointestinal contrast-enhanced X-ray (UGCXR). Multivariate logistic regression analysis and propensity score matching (PSM) were performed to explore the relationship between LED and the risk of abdominal LNM. Abdominal LNM risk in ESCC was stratified based on the location of the lower tumor margin. A model predicting abdominal LNM risk was constructed and presented with a nomogram. The included patients had an abdominal LNM rate of 48.29%. In multivariate logistic regression analysis, LED was identified as a risk factor for abdominal LNM. Subgroup analysis of middle ESCC showed that patients with an LED less than 10 cm had a significantly higher rate of abdominal LNM than those with an LED greater than 10 cm. The abdominal LNM rate in middle ESCC patients with an LED less than 10 cm was 32.2%, while it was 35.1% in lower ESCC patients whose lower tumor margin did not invade the esophagogastric junction (EGJ), which was comparable after PSM. LED could help surgeons evaluate the risk of abdominal LNM preoperatively and better guide dissection of abdominal lymph nodes according to risk level.

Efficacy and Dose-Response Relationship of Stereotactic Body Radiotherapy for Abdominal Lymph Node Metastases from Hepatocellular Carcinoma.

The objective of this study was to investigate the treatment efficacy of stereotactic body radiotherapy (SBRT) and evaluate the influence of radiation dose on local control and survival in patients with abdominal lymph node metastases (LNM) from hepatocellular carcinoma (HCC). Between 2010 and 2020, data of 148 patients with HCC with abdominal LNM, including 114 who underwent SBRT and 34 who received conventional fractionation radiation therapy (CFRT), were collected. A total radiation dose of 28-60 Gy was delivered in 3-30 fractions, with a median biologic effective dose (BED) of 60 Gy (range, 39-105 Gy). Freedom from local progression (FFLP) and overall survival (OS) rates were analyzed. With a median follow-up of 13.6 months (range, 0.4-96.0 months), the 2-year FFLP and OS rates of the entire cohort were 70.6% and 49.7%, respectively. Median OS of the SBRT group was longer than the CFRT group (29.7 vs. 9.9 months, P = .007). A dose-response relationship was observed between local control and BED in either the entire cohort or the SBRT subgroup. Patients who received SBRT with a BED ≥60 Gy had significantly higher 2-year FFLP and OS rates than those who received a BED <60 Gy (80.1% vs. 63.4%, P = .004; 68.3% vs. 33.0%, P < .001). On multivariate analysis, BED was an independent prognostic factor for both FFLP and OS. SBRT achieved satisfactory local control and survival with feasible toxicities in patients with HCC with abdominal LNM. Moreover, the findings of this large series suggest a dose-response relationship between local control and BED.

Abscopal effect of radiation in metastatic esophageal carcinoma: fourth reported case.

Abscopal or bystander effect of radiotherapy is a rare and unpredictable outcome encountered during treatment of metastatic cancer where tumor regression is observed distant from irradiated volume. While it has been more frequently reported with malignancies like melanoma, lymphoma, and renal cell carcinoma, data regarding metastatic esophageal cancers are sparse. We describe a case of abscopal regression of distant mediastinal and upper abdominal lymph nodes in a 65-year-old gentleman whose primary esophageal tumor was irradiated with hypo-fractionated radiotherapy in an attempt to achieve local palliation. Our case study emphasizes the systemic benefit of local radiotherapy and the need for future research to investigate its utility as this clinical event poses widespread response in an otherwise dismal Stage-IV cancer with minimal treatment-related side effects.

Primary tuberculosis with miliary hematogenous generalization in old age

Currently, the problems of the mechanisms of immune and inflammatory response aging, which determine the mechanisms of the development of the inflammatory process in the elderly, are being actively studied. A sectional observation of senile tuberculosis in a patient K., 78 years old, who had been treated for 4 months in the University Clinical Hospital No. 4 of the First Sechenov Moscow State Medical University in 2018 is presented. After autopsy, histological, histochemical and PCR examination, the following pathoanatomical diagnosis was made: primary (senile) tuberculosis with hematogenous and lympho-vascular generalization, with a focus of caseous pneumonia in the III segment of the right lung; caseous lymphadenitis of bifurcation, thoracic and abdominal paraaortic lymph nodes; miliary and large-focal generalization in the lungs, parietal and visceral pleura on the left, spleen and liver (acid fast stain; PCR study No. 18-5935 dated 08/13/2018 (Central Research Institute of Tuberculosis) detected DNA of mycobacterium tuberculosis complex). A feature of senile tuberculosis is the course of primary tuberculosis with hematogenic generalization and predominantly exudative-necrotic tissue reaction. Its pathogenesis is mainly due to the phenomenon of "aging immune system" (immunosenescence), as well as inflammaging — features of the inflammatory response in old age. Their main characteristics are the preactivated status of the immune system even before the recognition of the antigen, characterized by a basal level of circulating cytokines, as well as a sharp weakening of the adaptive immune response in the presence of an antigen associated with impaired functioning of the immune system with a large number of memory T cells lacking naive T-cells.

Comparison of radiomics models and dual-energy material decomposition to decipher abdominal lymphoma in contrast-enhanced CT.

The radiologists' workload is increasing, and computational imaging techniques may have the potential to identify visually unequivocal lesions, so that the radiologist can focus on equivocal and critical cases. The purpose of this study was to assess radiomics versus dual-energy CT (DECT) material decomposition to objectively distinguish visually unequivocal abdominal lymphoma and benign lymph nodes. Retrospectively, 72 patients [m, 47; age, 63.5 (27-87) years] with nodal lymphoma (n = 27) or benign abdominal lymph nodes (n = 45) who had contrast-enhanced abdominal DECT between 06/2015 and 07/2019 were included. Three lymph nodes per patient were manually segmented to extract radiomics features and DECT material decomposition values. We used intra-class correlation analysis, Pearson correlation and LASSO to stratify a robust and non-redundant feature subset. Independent train and test data were applied on a pool of four machine learning models. Performance and permutation-based feature importance was assessed to increase the interpretability and allow for comparison of the models. Top performing models were compared by the DeLong test. About 38% (19/50) and 36% (8/22) of the train and test set patients had abdominal lymphoma. Clearer entity clusters were seen in t-SNE plots using a combination of DECT and radiomics features compared to DECT features only. Top model performances of AUC = 0.763 (CI = 0.435-0.923) were achieved for the DECT cohort and AUC = 1.000 (CI = 1.000-1.000) for the radiomics feature cohort to stratify visually unequivocal lymphomatous lymph nodes. The performance of the radiomics model was significantly (p = 0.011, DeLong) superior to the DECT model. Radiomics may have the potential to objectively stratify visually unequivocal nodal lymphoma versus benign lymph nodes. Radiomics seems superior to spectral DECT material decomposition in this use case. Therefore, artificial intelligence methodologies may not be restricted to centers with DECT equipment.

Laryngeal Anaplastic Lymphoma Kinase-Positive B-cell Lymphoma: Case Report and Review.

Larynx is an uncommon extranodal site for non-Hodgkin lymphoma (NHL). Anaplastic lymphoma kinase (ALK)-positive B-cell lymphoma is a rare and aggressive form of NHL. A 19-year-old male presented to the ENT department with globus sensation, hoarseness, cervical lymphadenopathy and weight loss. A 70-degree rigid endoscopic examination of the larynx showed a vascular, irregular, submucosal mass arising from the right aryepiglottic fold causing near complete obstruction of the laryngeal airway. PET-CT showed hypermetabolic lesions in the supraglottis, cervical lymph nodes, cervical spine, ribs and abdominal lymph nodes. Biopsy was taken from the supraglottic mass as well as the enlarged cervical lymph nodes, which revealed ALK-positive large B-cell NHL. In this report, we present a rare case of ALK-positive large B-cell NHL of the larynx, discussing its clinical, radiological and pathological features. A limited review of literature is also presented. There is a need to develop a database for the description of lymphomas affecting the larynx and this case report adds to the existing knowledge of this rare entity.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

The Journal of Urology® Home Study Course 2023 Volume 209/210.

DIAGNOSTIC VALUE OF SONOGRAPHY IN MESENTERIC ADENITIS IN PEADATRIC AGE GROUP AND ITS CLINICAL SIGNIFICANCE.

Background: Acute abdominal pain is one of the most common yet challenging complaints in children, often presenting as a diagnostic dilemma. Most patients with abdominal pain have self-limited conditions.The most common medical cause is mesenteric lymphadenitis and the most common surgical problem is appendicitis. Mesenteric adenitis is usually viral in origin and has self limiting course. Our aim was to establish a criteria for diagnosis of mesenteric adenitis in symptomatic patients. Material and Method; Cross sectional study performed on 130 patients and 100 controls group case. Presence of enlarged lymph nodes of 5 -8mm in the shortest dia Results; meter were noted in 80% (n=64) of the patients and in 78% (n=78) of control group. Enlarged abdominal lymph nodes of 8-10mm mm were detected in 40% (n=32) of the patients and 48% (n=48) of controls. Nodes larger than 10 mm were detected in 30% (n=24) of the patients and 11% (n=11) in controls . Differences between the groups were statistically signicant only for lymph nodes of 10 mm and larger in the shortest diameter (P &lt; 0.05). The absolute Conclusion; generalization of enlarged mesenteric nodes should only be taken clinically signicant in a symptomatic patient with nodes greater than 10 mm in short axis diameter favoring more towards mesenteric lymphadenitis

Research for clinical, biological and endoscopic ultrasound characteristics of pancreatic tumors

Background: Pancreatic tumor disease often has clinical symptoms ambiguously which is leading to late detection and poor prognosis. Currently, there are many imaging methods to use for the early detection, and diagnosis of pancreatic tumors. Endoscopic ultrasound (EUS) with the strength of a high-frequency probe, approaching directly the pancreas which is improving the diagnosis of the tumor, especially small lesions &lt; 2 cm. This study was aimed at: (1) To describe some clinical, biological, and endoscopic ultrasound characteristics of pancreatic tumors. (2) To evaluate the relationship between clinical and biological characteristics and pancreatic tumor characteristics on endoscopic ultrasound. Subject and methods: Cross-sectional study in 41 patients diagnosed with pancreatic tumor on endoscopic ultrasound. Results: Common history was smoking, high intake of alcohol and diabetes. Almost half of the patients 48.5% had a CA 19.9 ≤ 37 U/ml. Lesions in the pancreatic head accounted for 80.5%, hypoechoic lesions 97.6%, solid tumor 80.5%. Common extra-tumoral findings were abdominal lymph nodes accounting for 51.2%, common bile duct dilatation 46.3% and pancreatic duct dilatation 39.0%. There was no relationship between levels of CA 19.9 and endoscopic ultrasound features such as vascular invasion, and lymph node metastasis (p &gt; 0.05). There was a statistically significant relationship of tumors in the head of the pancreas and jaundice, and dilation of the common bile duct (p &lt; 0.05). Conclusion: Smoking, high intake of alcohol and diabetes were the most common history. Common findings of tumor were hypoechoic, solid tumor and pancreatic head position. There is a relationship of pancreatic head tumors and jaundice as well as dilation of the common bile duct. Key words: endoscopic ultrasound, pancreatic tumor, clinical features, biochemical characteristics.

Oncologic significance of lymphovascular invasion in patients with superficial esophageal squamous cell carcinoma reaching the muscularis mucosae or with slight invasion of the submucosa

BackgroundThe clinicopathological features and the distribution of lymph node metastasis in patients with T1a-MM and T1b-SM1 superficial esophageal squamous cell carcinoma remain unclear; therefore, the optimal treatment strategy is still controversial. MethodsOne hundred and ninety-one patients who had undergone a thoracic esophagectomy with 3-field lymphadenectomy and who were pathologically confirmed to have thoracic superficial esophageal squamous cell carcinoma that had reached the T1a-MM or T1b-SM1 stage were retrospectively reviewed. Risk factors of lymph node metastasis, the distribution of lymph node metastasis, and long-term outcomes were evaluated. ResultsA multivariate analysis revealed that lymphovascular invasion was the only independent risk factor of lymph node metastasis (odds ratio: 6.410, P < .001). Patients with primary tumors in the middle thoracic region had lymph node metastasis in all 3 fields, whereas patients with primary tumors in the upper or lower thoracic region did not have distant lymph node metastasis. The frequencies of neck (P = .045) and abdominal (P < .001) lymph node metastasis were significantly higher in lymphovascular invasion–positive patients than those in lymphovascular invasion–negative patients in all cohort. MM/lymphovascular invasion–positive patients with middle thoracic tumors had lymph node metastasis spread from the neck to the abdomen. SM1/lymphovascular invasion–negative patients with middle thoracic tumors did not have lymph node metastasis in the abdominal region. The SM1/pN+ group had a significantly poorer overall survival and relapse-free survival than the other groups. ConclusionThe present study revealed that lymphovascular invasion was associated with not only the frequency of lymph node metastasis, but also the distribution of lymph node metastasis. It also suggested that superficial esophageal squamous cell carcinoma patients with T1b-SM1 and lymph node metastasis had a significantly poorer outcome than those with T1a-MM and lymph node metastasis.

Colonic T-cell-rich, large B-cell lymphoma associated with equid herpesvirus 5 infection and secondary trans-colonic fistula in a horse.

A 17-y-old Rocky Mountain gelding was presented to the Virginia-Maryland Veterinary Teaching Hospital because of a 4-wk history of anorexia, weight loss, lethargy, and fever of unknown origin. Abdominal ultrasound revealed lymphadenomegaly of the abdominal and colonic lymph nodes, thickening of the wall of the large colon, and a mass associated with the large colon. The horse was euthanized given a poor prognosis. On autopsy, an ~20-cm diameter mass was found within the mesocolon between the right ventral and right dorsal colon. The mass had invaded through the colonic walls and formed a fistula between the 2 involved lumina. On histologic evaluation, the mass consisted of small numbers of large neoplastic lymphocytes, numerous small lymphocytes, and many foamy macrophages. A diagnosis of T-cell-rich, large B-cell lymphoma was made based on immunohistochemical staining for CD79a, CD3, and Iba1; concurrent infection with equid herpesvirus 5 was confirmed with in-situ hybridization (ISH). To our knowledge, neither a trans-colonic fistula resulting from alimentary lymphoma in a horse nor detection of intralesional equid herpesvirus 5 in equine alimentary lymphoma by ISH has been reported previously.

Pattern of relapse following three-field lymphadenectomy of esophageal carcinoma and related factors predictive of recurrence

PurposeFor treatment of esophageal carcinoma, the optimal postoperative radiotherapy target volume after three-field lymph node dissection (3-FLD) had not been determined. We analyzed local recurrence pattern of thoracic esophageal carcinoma and risk factors of lymph node recurrence after 3-FLD without prophylactic radiotherapy. Material and methodsWe reviewed 1282 patients with thoracic esophageal squamous cell carcinoma (ESCC) who were treated with 3-FLD without radiotherapy from 2010 to 2018 and analysed local recurrence patterns and risk factors of lymph node recurrence, in order to provide a reference for determination of the radiotherapy target volume for thoracic ESCC. ResultsThe lymph node recurrence accounted for 91.0% of treatment failures. The mediastinal, cervical and abdominal lymph node recurrence accounted for 84.92%, 36.07% and 22.30%, respectively (χ2=264.776, P=0.000). The superior, middle and inferior mediastinal lymph node recurrence rates were 67.54%, 27.87% and 0.98%, respectively (χ2=313.600, P=0.000). Cervical metastases were significantly associated with N stage and Preoperative cervical lymph node status. Abdominal metastases were significantly associated with the number of preoperative abdominal lymph node metastases (LNM), tumor location and N stage. ConclusionsThe main pattern of local-regional recurrence might be lymph node metastasis after radical 3-FLD without radiotherapy in esophageal carcinoma. The dangerous lymph node recurrence regions included neck, superior and middle mediastinum. The abdominal areas might be irradiated for lower TEC patients with preoperative abdominal LNM.

Safety and efficacy of conversion therapy for esophageal squamous cell carcinoma.

362 Background: The increased efficacy of multimodality treatment allows for the consideration of conversion therapy with curative intent for initially unresectable esophageal squamous cell carcinoma (ESCC) after initial treatment. Conversion therapy has been commonly defined as treatment aiming at a curable intention after tumors initially deemed technically or oncologically unresectable or only marginally resectable respond to chemotherapy. In our institute, conversion therapy is considered for patients with para-aortic lymph node-positive advanced ESCC who have no other distant metastasis, if the para-aortic lymph node metastases have disappeared after systemic chemotherapy. Methods: There were 33 patients of unresectable esophageal cancer with positive para-aortic lymph node metastases from 2011 to 2021. Nine of these patients showed disappearance of para-aortic lymph node metastases and underwent conversion therapy, seven patients underwent esophagectomy and two patients underwent chemoradiation therapy (CRT). Characteristics, short-term and long-term results of these nine cases are studied. Results: All of the nine patients who had para-aortic lymph node metastases were treated with induction DCF (Docetaxel + Cisplatin + 5-FU) therapy as initial treatment. After disappearance of para-aortic lymph node metastasis, minimally invasive or open esophagectomy was performed in seven patients and CRT was performed in two patients. In operation group, four patients (57%) had Clavien-Dindo grade 2 or 3 complications, but no perioperative death was observed. In CRT group, there was no toxicity over CTCAE grade 3. Four of nine patients (44%) had recurrence, within mediastinum lymph node, abdominal lymph node or adrenal gland. 3-year DFS was 56% and 3-year OS was 67%. Conclusions: Conversion therapy is safe and feasible in cases that responded to systemic chemotherapy. Some cases showed good prognosis. Long-term survival is expected with conversion therapy. In our study, there was few cases that could led to conversion therapy. It is expected that more aggressive initial chemotherapy will be used in the future for patients with positive para-aortic lymph node metastases with a view to conversion therapy.

Total neoadjuvant oxaliplatin-based therapy (TNT) before (induction) and after (consolidation) chemoradiation for advanced rectal cancer: MRI correlation on complete response and outcome.

165 Background: Preoperative chemoradiation with fluoropyrimidine, followed by total mesorectal excision (TME) and adjuvant chemotherapy is the standard care for locally advanced rectal cancer (LARC). Studies have shown the potential benefit of oxaliplatin based TNT approach. The benefits of using of both induction and consolidation chemotherapy with chemoradiation prior of TME is not well studied. We investigate whether the use of oxaliplatin based before (induction) and after (consolidation) neoadjuvant chemoradiation will increase the pCR and clinical Complete response (cCR), improve survival and MRI correlation. Methods: Patients treated with curative intent surgery for LARC who received oxaliplatin based induction and consolidation chemotherapy with neoadjuvant capecitabine chemoradiation were identified. Demographics and clinicopathologic data were analyzed. Multiparametric MRI was used for initial staging and restaging before surgery. The primary endpoint will be the complete response (pathological and clinical), recurrent-free survival (RFS), and overall survival (OS). Results: A total of 21 patients have been identified, all patient has T3/T4 and positive nodes N1/N2 on initial MRI staging, 2 (10%) patients had Stage IV disease with abdominal para-aortic nodes. Median age was 63 (range: 26-76); 14 (67%) male. As for the induction regimen, 9 (43%) had CAPOX/FOLFOX, 7 (33%) had short-course capecitabine, 5 (24%) had FOLFIRINOX. All patient received neoadjuvant chemoradiation with capecitabine. As for consolidation, 19 (90%) had CAPOX/FOLFOX, 1 (5%) had capecitabine and 1 (5%) had FOLFIRINOX. Median time for induction and consolidation chemotherapy was 8.5 weeks (range: 1-24) and 8 weeks (range: 2-16) respectively. Median time from starting induction chemotherapy to surgery was 6.8 months (range: 3.2-11). Eight (38%) patients had cCR and pCR. Post-treatment restaging MRI prior of resection has 100% concordant rate with pCR. All (100%) pateints had tumor downstaged after treated with TNT and chemoradiation. The sensitivity of MRI in detecting the residual lymph node post TNT/neoadjuvant chemoradiation was 55% (95% CI: 26-81%), and the negative predictive value was 75% (51-90%); the specificity was 100% (76-100%) and the positive predictive value was 100% (57-100%). There is no death and one patient had recurrence after recurrence free for 2 years. Median RFS and OS are not meet. Median follow up time is 25.7 months (range: 9.1-76.8). Conclusions: Neoadjuvant oxaliplatin based therapy before and after chemoradiation for rectal cancer potentially improves CR rate, and accurately predicted by post-treatment MRI. The use of MRI can potentially help to select candidates who desire organ preservation.

Role of 18F-FDG PET-CT Imaging in a Patient with Renal Ewing’s Sarcoma: A Rare Case Report

Ewing's sarcoma (ES) is a bone-related tumor that typically affects young children and adolescents. Primary renal Ewing sarcoma (RES) is extremely rare. Sources of Ewing sarcoma in the kidney include invagination or migration of neural crest cells to the kidney. Here, a case of a young adult male with renal Ewing sarcoma is presented. A 28-year-old male presented with nausea, hematuria, and left flank pain for seven days with an unremarkable previous medical history. An ultrasound and CT scan revealed a massive lobulated mass in the upper and midsection of the left kidney. A radical nephrectomy was done. Histopathology and immunohistochemistry revealed Ewing’s sarcoma/primitive neuroectodermal tumor. The chest X-ray and chest CT scan were negative for metastasis. Initial staging was T2bNxM0. Before starting further treatment, the patient was advised to undergo a fluorine-18 FDG (fluorodeoxyglucose) positron emission tomography (F-18 FDG PET-CT) scan for the detection of occult metastases. A F-18 FDG PET-CT scan revealed peritoneal seeding, skeletal and abdominal lymph node metastases. A multimodality workup is essential for proper management of Ewing sarcoma of the kidney due to its rarity and unusual location. F-18 FDG PET-CT plays a critical role in the detection of occult metastases, staging, restaging, and treatment planning in patients with RES. Bangladesh J. Nuclear Med. 26(1): 54-57, 2023

Features of preoperative diagnosis of chronic lymphoproliferative syndrome of ENT organs in young children

Introduction. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, a comprehensive examination is necessary. Herpesvirus infection (HVI) plays an important role in the etiology of hypertrophy of lymphoid formations of the pharynx.Purpose. To evaluate the results of preoperative diagnosis of chronic lymphoproliferative syndrome in children in early childhood.Materials and methods. In 96 patients aged 1 to 3 years 11 months with lymphoproliferative syndrome more than 3–6 months, endoscopy, otomicroscopy, impedance, ultrasound examination of abdominal organs, cervical and submandibular lymph nodes, serological and molecular genetic analyses of markers of EBV, CMV, HCV-6 in the blood; PCR in pharyngeal tonsil scrapings were performed.Results and discussion. The clinical picture in children with chronic lymphoproliferative syndrome of younger age was dominated by complaints of difficulty in nasal breathing, snoring in 42% of children, recurrent otitis in 58%, manifestations of asthenovegetative and intoxication syndromes and frequent acute respiratory viral infections in 70% of patients. A high degree of infection of children of the younger age group was revealed – HCV-6 in 87%, CMV in 63% of children, 46% – EBV. And high activity of the infectious process in 31% of patients for all three GVI, more often for EBV in 27%. A combination of two or three GVI was detected in 83% of patients. During instrumental examination, a high degree of hypertrophy of the nasopharyngeal tonsils (adenoid vegetations of 2–3 degrees – 67% and 3 degrees – 18%, combined with hypertrophy of the palatine tonsils in 27% of cases), an increase in neck lymph nodes of more than 16mm, including lymph node packs in 28% of younger children and reactive hepatosplenomegaly in 17.7% of patients.Conclusion. To determine the tactics of management of chronic lymphoproliferative syndrome in young children, it is important to assess the severity of lymphoproliferative syndrome according to the clinical picture and instrumental research methods (nasopharyngeal endoscopy, ultrasound examination of neck and abdominal lymph nodes) in combination with laboratory data and characteristics of the stage of activity of the infectious process of herpesvirus etiology.

Epithelioid hemangioendothelioma mimicking aortic intramural haematoma.

A 69-year-old man presented with a dull chest pain for 2 months. He denied history of hypertension or trauma. Computed tomography angiography (CTA) indicated ‘intramural haematoma’ in descending aorta (Panel A). Control blood pressure and heart rate were as follows: target 120/70 mm/Hg, 60 beats/min, and the patient was discharged. One month later, to check the progression of aortic intramural haematoma, CTA was done (Panel B). The intramural haematoma area is larger than before. Positron emission tomography/computed tomography (PET/CT) was done for the enlarged area of intermural haematoma without clinical manifestation. PET/CT revealed abnormal intense high metabolic region around aorta (Panel C) and a similar hypermetabolic mass in right lower kidney (Panel D), as well as abdominal lymph node metastasis. For histologic confirmation, biopsy of the renal mass was obtained, and pathological studies supported the diagnosis of epithelioid haemangioendothelioma. The pathologic finding showed irregular nests of atypical epithelioid cells with intracytoplasmic vacuoles (Panel E, arrow). The tumour cells are immunoreactive to ETS-related gene (Panel F). The final diagnosis was made as epithelioid haemangioendothelioma around aortic with multiple metastasis. Our patient died <6 months after the diagnosis was made.