Edematous Tumor Research Articles

Case Report: Pott's Edematous Tumor: Complicated Frontal Sinusitis - An Unremembered Diagnosis

Pott’s Puffy tumor, also called Pott’s edematous tumor (PET), is a subperiosteal abscess of the frontal bone, associated with osteomyelitis of the frontal bone. In this paper, we report the case of a 16-year-old patient who presented with headache associated with progressive forehead swelling and fever. Clinical and imaging exams pointed to the hypothesis of PET associated with brain abscess. Patient was submitted to surgical excision of the abscess and treatment of osteomyelitis, with intraoperative findings corroborating the condition. There was a good clinical-radiological recovery associated with prolonged antibiotic therapy and satisfactory follow-up after hospital. PET, which often results from an underdiagnosed or partially treated frontal sinusitis, is a condition that must be promptly recognized and directed to an adequate therapeutic approach due to the risk of serious complications that it entails.

LEFT-SIDED PLEURAL EFFUSION, ASCITES AND LEIOMYOMATA: AN UNUSUAL CASE OF PSEUDO-MEIGS' SYNDROME

TOPIC: Disorders of the Pleura TYPE: Medical Student/Resident Case Reports INTRODUCTION: Meigs' Syndrome has been described as the development of ovarian fibroma or fibroma-like mass with pleural effusion and ascitic fluid. It is present in approximately 1% of all ovarian fibroma, thecoma and granulosa cell tumors. Pseudo-Meigs' Syndrome is secondary to benign etiologies and reported to be more uncommon. These syndromes should be considered in women with the clinical triad of pleural effusion, ascites and a pelvic mass and can mimic more serious malignant tumors [1]. A thorough evaluation including biopsy and peritoneal and pleural fluid analyses need to be performed. CASE PRESENTATION: A G0P0 29-year-old female presents with chills and fatigue since the start of her menstrual cycle. She was found to be tachycardic, tachypneic and hypoxemic to 85% with moderate abdominal distention. CT of the chest, abdomen and pelvis showed a large left-sided pleural effusion, multiple abdominal masses with compressive effect and large-volume abdominal ascites. CA-125 level was elevated at 295 U/ml. Biopsy showed small muscle proliferation with bland spindle cells and no malignant features. Thoracentesis was consistent with exudative effusion and negative cytology. Left-sided pleural effusion continued to reaccumulate requiring multiple thoracenteses. Patient underwent left pleuroscopy with pleural biopsies showing fibrotic pleura and reactive mesothelial proliferation, negative for malignancy. There was an active ascitic fluid leak into the left hemithorax through a small, thinned-out region in the dome of the left hemidiaphragm. She underwent abdominal myomectomy several months later with resolution of symptoms. Final pathology was consistent with leiomyomata. DISCUSSION: We describe a case of abdominal leiomyomatosis resulting in ascites and leak into the left hemithorax with recurrent exudative pleural effusions and resolution after surgical myomectomy, consistent with Pseudo-Meigs' Syndrome [2]. Right-sided pleural effusions are most common as pleural fluid collects due to fluid leakage from edematous tumor resulting in translocation via diaphragmatic pores into the right hemidiaphragm [3]. Effusions are exudative in nature, although in previous studies only 1.6% of patients underwent pleural fluid analysis [4]. CA-125 are typically found to be elevated, with normalization post-surgery [5]. CA-125 levels were not re-checked post-myomectomy in our case. Surgical tumor removal results in resolution of ascites and pleural effusion [5]. Therefore, in patients presenting with pleural effusion and ascites in the setting of abdominal leiomyomata, Pseudo-Meigs' Syndrome should be suspected, and pleural fluid analysis and cytology play an important role in aiding diagnosis and further management. CONCLUSIONS: The prompt evaluation of patients with leiomyomatosis presenting with ascites and large pleural effusion can be vital in guiding future interventional management. REFERENCE #1: 1. Cowan M, Crantz J, Welsh S, Nahhas W, Lindheim SR. A rare case of acute pseudo-Meigs' Syndrome presenting with pleural effusion and ascites and a ruptured leiomyoma and hemorrhagic shock. Obstet Gynecol Cases Rev. 2016. 3:070. REFERENCE #2: 2. Peparini N, Chirletti P. Ovarian malignancies with cytologically negative pleural and peritoneal effusions: demons' or meigs' pseudo-syndromes? Int J Surg Pathol. 2009 Oct; 15(5):396-7.3. Meyers MA. The spread and localization of acute intraperitoneal effusions. Radiology. 1970 Jun;95(3):547-54. REFERENCE #3: 4. Krenke R, Maskey-Warzechowska M, Korczynski P et al. Pleural effusion in Meig's syndrome - transudate or exudate? Systematic review of the literature. Medicine (Baltimore). 2015 Dec; 94(49): e2114.5. Nguyen P, Yazdanpanah O, Schumaker B. Meigs' versus Pseudo-Meigs' Syndrome: A case of pleural effusion, ascites, and ovarian mass. Cureus. 2020 Aug; 12(8): e9704. DISCLOSURES: No relevant relationships by Sally Askar, source=Web Response No relevant relationships by Patrick Bradley, source=Web Response No relevant relationships by Labib Debiane, source=Web Response No relevant relationships by Shaikh Husnain, source=Web Response

Surgical Management of Medial Tentorial Meningioma: Falcotentorial and Torcular

Falcotentorial meningiomas (FTM) stand out for their rarity, inconsistent definition, and surgical complexity. It is appropriate to deal with them in the context of medial tentorial meningiomas (TMs). Clinical and radiologic characteristics of medial TMs, comprising the typical features of FTM and TM, along with surgical management and short-term and long-term outcomes, are reported. FTM (n= 16) were typically supratentorial, large, edematous tumors that caused mainly headache and hemianopia; TM (n= 12) were infratentorial, smaller not edematous tumors that caused mainly headache and gait ataxia. The most frequent venous pattern was straight sinus infiltration in one third of cases of FTM and occlusion in one half of cases of TM. Total removal (Simpson grade I-II) was obtained in 46.4% of cases and subtotal removal (Simpson grade III-IV) in 53.6%. Suprainfratentorial extension in FTM and incomplete venous invasion in TM were the factors most likely opposing complete removal. The overall acute complications rate was 32.1% (higher for FTM), transient for most cases. Patients with supratentorial meningiomas performed significantly worse preoperatively (Karnofsky Performance Status ≤70 in 75% of cases); patients with infratentorial symptoms/signs recovered worse postoperatively. Stereotactic radiosurgery with subtotal removal was used as adjuvant treatment in 8 cases. Only 2 recurrences, both atypical tumors, occurred at 57.6 months (mean) follow-up. As a general rule, careful venous management, tailored surgical approach for FTM, and cautious tumor removal for TM can yield good and stable results. Total removal accounts for half the cases in both groups, whereas FTM was associated with worse postoperative complications.

拡散強調MR画像にて高信号を呈した膀胱炎症性病変の1例；組織学的所見との比較による考察

A 66-year-old woman was referred to our department for thickening bladder wall incidentally found during postoperative follow-up of transverse colon cancer. Cystoscopy showed edematous tumor with a diameter of 5 cm on the right wall. Deep portion of the tumor showed high intensity on diffusion-weighted magnetic resonance imaging (DW-MRI). Transurethral resection and transvaginal needle biopsy was performed, and pathological examination revealed granulation tissues mainly consisted of inflammatory cells and fibrosis. DW-MRI is a functional imaging constructed by quantifying the diffusion of water molecules. Recently, the feasibility of this imaging in the diagnosis of bladder cancer has been reported. However, we should keep in mind that granulation tissues consisted of inflammatory cells and fibrosis is also possible to be positive for DW-MRI.

Complementary but Distinct Roles for MRI and18F-Fluoromisonidazole PET in the Assessment of Human Glioblastomas

Glioblastoma multiforme is a primary brain tumor known for its rapid proliferation, diffuse invasion, and prominent neovasculature and necrosis. This study explores the in vivo link between these characteristics and hypoxia by comparing the relative spatial geometry of developing vasculature inferred from gadolinium-enhanced T1-weighted MRI (T1Gd), edematous tumor extent revealed on T2-weighted MRI (T2), and hypoxia assessed by 18F-fluoromisonidazole PET (18F-FMISO). Given the role of hypoxia in upregulating angiogenic factors, we hypothesized that the distribution of hypoxia seen on 18F-FMISO is correlated spatially and quantitatively with the amount of leaky neovasculature seen on T1Gd. A total of 24 patients with glioblastoma underwent T1Gd, T2, and 18F-FMISO-11 studies preceded surgical resection or biopsy, 7 followed surgery and preceded radiation therapy, and 11 followed radiation therapy. Abnormal regions seen on the MRI scan were segmented, including the necrotic center (T0), the region of abnormal blood-brain barrier associated with disrupted vasculature (T1Gd), and infiltrating tumor cells and edema (T2). The 18F-FMISO images were scaled to the blood 18F-FMISO activity to create tumor-to-blood ratio (T/B) images. The hypoxic volume (HV) was defined as the region with T/Bs greater than 1.2, and the maximum T/B (T/Bmax) was determined by the voxel with the greatest T/B value. The HV generally occupied a region straddling the outer edge of the T1Gd abnormality and into the T2. A significant correlation between HV and the volume of the T1Gd abnormality that relied on the existence of a large outlier was observed. However, there was consistent correlation between surface areas of all MRI-defined regions and the surface area of the HV. The T/Bmax, typically located within the T1Gd region, was independent of the MRI-defined tumor size. Univariate survival analysis found the most significant predictors of survival to be HV, surface area of HV, surface area of T1Gd, and T/Bmax. Hypoxia may drive the peripheral growth of glioblastomas. This conclusion supports the spatial link between the volumes and surface areas of the hypoxic and MRI regions; the magnitude of hypoxia, T/Bmax, remains independent of size.

A CASE OF CAVERNOUS HEMANGIOMA OF THE ILEUM

We experienced a rare case of cavrnous hemangioma of the ileum presenting with anal bleeding. A 25-year-old woman who complaining of anal bleeding and abdominal pain received upper gastrointestinal endoscopy and barium enema at another hospital. However, no abnormal findings were pointed out. Ultrasonography revealed an ovarian cyst. Enucleation of the ovarian cyst was performed, in this operation a tumor of the small intestine being recoganized. Without any further operation for the intestinal tract, she was sent to our hospital. The X-ray examination of the small bowel revealed a segmental lesion at the terminal ileum with irregular margin consisting of protruding nodular lesions. Enhanced computed tomography of the abdomen revealed a thicking wall of the small intestine associated with calcification. Superior mesenteric angiography revealed hypervascularity of the ileal artery in the lesion mentioned above; and contrast medium pooled there in the late phase. Laparotomy was carried out and a dark red edematous tumor of about 20cm in length with the dilated serosal vessels on the intestinal wall was found at approximately 40cm oral side from the ileo-cecal end. The tumor of hte intestine was resected. The histological diagnosis was cavernous hemangioma.

Relationship of perfusion to edema in the 9L gliosarcoma.

The relationship between tumor perfusion and edema was analyzed, with edema characterized as tumor wet/dry weight ratio. Perfusion of subcutaneous 9L gliosarcoma was measured by injection of 133Xe in saline into the tumor core, followed by gamma camera imaging of 133Xe washout kinetics. A significant inverse correlation was found between edema and tumor perfusion (p < 0.0002), suggesting that edema can limit tumor perfusion, perhaps through a mechanism of increased interstitial fluid pressure. The perfusion rate of highly edematous tumors was reduced to less than 10% of the perfusion rate of less edematous tumors (p < 0.001). It was also found that tumor edema increased significantly with increasing tumor volume (p < 0.001), which could account for the finding that perfusion declined significantly with increasing tumor volume (p < 0.02). These findings are potentially important because it is possible to quantify tumor edema in vivo, with millimeter resolution, using 1H magnetic resonance imaging (MRI). Thus MRI may provide a non-invasive technique for characterizing tumor perfusion or tumor drug delivery.