Huge Tumor Research Articles

Giant anogenital tumor of Buschke\u2013L\xf6wenstein in a patient living with human immunodeficiency virus/acquired immunodeficiency syndrome: a case report

BackgroundBuschke–Löwenstein tumor is a giant condyloma acuminata infection that is characterized by degeneration, invasion, and recurrence. It is associated with human papilloma virus infection. It develops around the genital and perineal area, sometimes causing a large budding ulcerated lesion. Although human immunodeficiency virus infection is frequent in Africa, there are few descriptions of Buschke–Löwenstein tumor diagnosis and its management. Screening for other sexually transmitted infections must be systematic among these patients.Case presentationWe report herein the case of a 21-year-old African origin male patient who developed a perineal swelling. Physical examination showed evidence of a huge exophytic tumor made up of budding pinkish vegetations, with serrated crests, a ‘’butterfly wing’’ structure, and a cauliflower-like appearance crowned with centrifugal circinate lesions. Multiple condylomatous lesions of the anal margin were also present. The patient tested positive for human immunodeficiency virus (cluster of differentiation 4 count of 119 cells/mm3) and hepatitis B infections. Real-time polymerase chain reaction revealed human papilloma virus-16 and other high-risk human papilloma virus deoxyribonucleic acid. The diagnosis of Buschke–Löwenstein tumor was made on mass biopsy, and the patient underwent multidisciplinary intervention (surgery, podophyllin application, and antiretroviral therapy). Medium-term evolution was, however, fatal due to opportunistic infection.ConclusionBuschke–Löwenstein tumor is a rare tumor associated with human immunodeficiency virus infection. It is more frequent in male human immunodeficiency virus-positive patients. There is a need to screen for other sexually transmitted infections. In most cases, the treatment is surgical, in association with local therapies. However, recurrences are common.

RETRACTED ARTICLE: Neonatal congenital mesoblastic nephroma that caused respiratory oncologic emergency early after birth: a case report

BackgroundCongenital mesoblastic nephromas mainly present as asymptomatic abdominal masses, but some present hematuria, hypertension or hypercalcemia. Neonatal dyspnea in an early-birth neonate due to rapid tumor growth is reported here for the first time.Case presentationA renal tumor and polyhydramnios were detected by ultrasonography of a male fetus at 32 weeks and 3 days of gestation. The mother had abdominal distension due to the polyhydramnios and signs of imminent premature birth. Amniocentesis was performed and the signs of imminent preterm birth subsided, but growth of the renal tumor was noted as a potential cause of respiratory dysfunction. Cesarean section was performed at 36 weeks and 2 days of gestation. His birthweight was 2638 g and his 1 and 5 min APGAR scores were 2 and 4 points, respectively. There was no spontaneous breathing at birth and he had remarkable abdominal distention. He underwent cardiopulmonary resuscitation. After circulation stabilized, emergency surgery was performed because of progressive hypoxemia and respiratory acidosis. Laparotomy revealed a huge tumor arising from the right kidney and right nephrectomy was performed. Histopathological examination led to diagnosis of congenital mesoblastic nephroma. The respiratory condition and circulatory dynamics stabilized after the pressure on the thorax from the tumor was relieved by surgery. The postoperative course was uneventful. No recurrence or complications have been observed in the 36 months since the surgery.ConclusionsCongenital mesoblastic nephroma can rapidly increase in size from the fetal period and may cause respiratory oncologic emergency, although there is relatively good prognosis.

Clinical survey of a pedigree with hereditary multiple exostoses and identification of EXT‑2 gene deletion mutation.

The aim of the present study was to report a clinical survey of hereditary multiple exostoses (HME) in a large Chinese pedigree, and the identification of a novel deletion mutation of exostosin glycosyltransferase 2 (EXT-2) gene. A patient with multiple exostoses with huge cartilage-capped tumors in scapula, knees and ankles received surgery in Department of Orthopedics (Shanghai Changhai Hospital). A total of 20 family members were recruited to the study, with seven members (five male; two female) diagnosed as HME. The family members of the patients with HME were examined, clinical data and peripheral blood samples were collected, and their DNA was sequenced. The incidence of HME in this family pedigree was 35%. Exostoses were most frequently in the tibiae with occurrence in six patients, followed by ribs, femurs, radii, fibulae, scapulae and humeri. DNA sequencing of peripheral blood revealed a novel deletion mutation, c.824–826delGCA, in exon 5 of the EXT-2 gene, which was observed in all the patients with HME, but not in the healthy family members. Several characteristics of HME in the pedigree were observed, such as susceptibility of male gender, decreased average age of onset and height and increased severity of clinical symptoms with generations.

The clinical outcome of hemicortical resection in extremity malignant bone tumors.

Hemicortical resection is challenging when a huge fungating tumor is covering the osteotomy site. We report the clinical outcome of hemicortical resection and reconstruction for primary bone tumors, especially with high-grade histology and extensive circumferential involvement. We retrospectively reviewed 44 patients (males, n = 18; females, n = 26) who underwent hemicortical resection from 2005 to 2014. The median follow-up period was 46.0 (23-178) months. Disease-specific, local recurrence-free, and metastasis-free survival rates of patients in the malignant group at 5 years were 96.6%, 84.5%, and 93.6%, respectively. Among 42 patients, there were local recurrences (n = 6), metastasis (n = 2), and death (n = 1). Surgical margin was an independent prognostic factor for local recurrence (hazard ratio = 5.7; p = 0.038). The recycled autograft and strut allograft groups did not show statistical difference in bone union. Failure rate was 31.8% and local recurrence was the most frequent, followed by infection. Hemicortical resection can be a feasible option for extremity malignant bone tumors. Regarding reconstruction, there were no difference between autograft and allograft in bone union rate. Surgical margin was an independent prognostic factor for local recurrence.

Huge chest wall tumor detected incidentally owing to upper airway symptoms.

Huge chest wall tumor detected incidentally owing to upper airway symptoms.

Primary Serous Cystadenocarcinoma of Broad Ligament: A Case Report with Laparoscopic, Histopathologic and Immunohistochemical Findings

An 86-year-old Japanese woman underwent an examining laparoscopy for removing the huge pelvic tumor. At laparoscope examination, the cystic tumor was found within the left broad ligament, while the ovaries, fallopian tubes and uterus showed almost normal appearance. The tumor was removed together by total laparoscopic hysterectomy and bilateral salpingo-oophorectomies after the suction of serous content in the broad ligament. Cytological findings of the ascites suggested serous carcinoma. The resected ovaries and fallopian tubes were grossly and histologically normal. Histological examination of the solid part of broad ligament tumor, closely next to the fallopian tube, revealed a serous adenocarcinoma. Immunohistochemically, the tumor cells were strongly positive for CK7, WT-1, estrogen receptor, AE1/AE3 and EMA, and negative for CK20, D2-40 and calretinin. Also, they were negative for progesterone receptor and p53. The authors diagnosed the primary tumor as being a serous cystadenocarcinoma of the broad ligament [pTIC3NxM0, as modified and adapted to post-surgical staging of ovarian cancer (FIGO 2014)]. The patient has been receiving 6 cycles of adjuvant chemotherapies with one course with paclitaxel (PTX) and carboplatin (CBDCA) and five with PTX, CBDCA and Bevacizumab, and has no signs of recurrence and metastasis six months after the operation.

A Case of Folliculitis Keloidalis Revealing a Huge Tumor Successfully Treated with Surgical Therapy

A Case of Folliculitis Keloidalis Revealing a Huge Tumor Successfully Treated with Surgical Therapy

Malignant Transformation of an Aneurysmal Bone Cyst to Huge Fibroblastic Osteosarcoma without Radiation Exposure: Proper Surgical Management is More than a Challenge

In this study, we present a case of aneurysmal bone cyst presenting as pathologic fracture of the left proximal femur. The patient, who had history of multiple surgeries, was referred to us with a giant mass. The patient was found to develop osteosarcoma without radiation exposure. External hemipelvectomy was performed.Appropriate surgical management of a huge tumor that repeatedly operated is more than a challenge like this case. Aneurysmal bone cysts rarely present as pathologic fractures initially. In addition, to the best of our knowledge, the number of aneurysmal bone cysts (ABCs) exhibiting malignant transformation to osteosarcoma without radiation exposure is less than ten in the literature.Keywords: aneurysmal bone cyst, osteosarcoma, malignant transformation, hemipelvectomy

Complete internal carotid artery coil after huge carotid body tumor resection.

In this brief article, we present an 82-year-old female who came to our care due to a carotid body tumor of the right side of the neck. After an uneventful removal of the tumor, we discovered a 360-degree coil in the internal carotid artery which was not observed in the preoperative imaging. After resection, we believe that the free space left by the large tumor and prior mass effect of the tumor on the internal carotid artery have led to carotid coiling.

Triple liver hanging maneuver for hepatic central bisectionectomy with caudate lobectomy for resection of huge hepatocellular carcinoma (with video).

Resection of huge hepatocellular carcinomas occupying the central portion of the liver is challenging. Exposure of an adequate liver transection plane using an anterior approach is likely to be difficult because of compression by the tumor. We herein propose a "triple liver hanging maneuver" technique for central bisectionectomy with caudate lobectomy for huge hepatocellular carcinomas stretching the hilar plate and the right and left hepatic veins. In this technique, the first tape is introduced for the transection plane along the right side of the umbilical portion to the anterior surface of the inferior vena cava. The second tape is introduced to lift the paracaval caudate Glissonean pedicles from the hilar plate. The third tape is introduced for the transection plane along the right hepatic vein to the anterior surface of the inferior vena cava. The triple liver hanging maneuver could be effective for huge tumors compressing major hepatic vessels.

Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate.

Case of giant chondroma of the shoulder

Tumors reaching gigantic sizes usually belong to the group of benign neoplasms, they are found mainly in the genital area (Kedrova, etc.) and are quite rare in other areas of the body. These tumors grow slowly and in some cases, as a result of long-term growth, reach gigantic proportions. Among the huge connective tissue tumors are fibromas, lipomas, chondromas, epithelial - cystomas (Kedrova). An example of a giant chondroma that did not develop from the genital sphere is a tumor that we met at a section in 1931.

Minimally invasive liver resection for huge (≥10 cm) tumors: an international multicenter matched cohort study with regression discontinuity analyses.

The application and feasibility of minimally invasive liver resection (MILR) for huge liver tumours (≥10 cm) has not been well documented. Retrospective analysis of data on 6,617 patients who had MILR for liver tumours were gathered from 21 international centers between 2009-2019. Huge tumors and large tumors were defined as tumors with a size ≥10.0 cm and 3.0-9.9 cm based on histology, respectively. 1:1 coarsened exact-matching (CEM) and 1:2 Mahalanobis distance-matching (MDM) was performed according to clinically-selected variables. Regression discontinuity analyses were performed as an additional line of sensitivity analysis to estimate local treatment effects at the 10-cm tumor size cutoff. Of 2,890 patients with tumours ≥3 cm, there were 205 huge tumors. After 1:1 CEM, 174 huge tumors were matched to 174 large tumors; and after 1:2 MDM, 190 huge tumours were matched to 380 large tumours. There was significantly and consistently increased intraoperative blood loss, frequency in the application of Pringle maneuver, major morbidity and postoperative stay in the huge tumour group compared to the large tumour group after both 1:1 CEM and 1:2 MDM. These findings were reinforced in RD analyses. Intraoperative blood transfusion rate and open conversion rate were significantly higher in the huge tumor group after only 1:2 MDM but not 1:1 CEM. MILR for huge tumours can be safely performed in expert centers It is an operation with substantial complexity and high technical requirement, with worse perioperative outcomes compared to MILR for large tumors, therefore judicious patient selection is pivotal.

A huge recurrent retroperitoneal inflammatory myofibroblastic tumor implicating renal and ureter: a case report

Inflammatory myofibroblastic tumor (IMT) is a rare sarcoma with unique molecular characteristics. It also has typical fasciitis-like, dense spindle cells and hypocellular fibrous histologic patterns and can occur at any age. The etiology of IMT is unknown and a complete treatment and monitoring plan for IMT have not been developed. We have found a rare case about a huge recurrent IMT implicating renal and ureter. The patient was accompanied by a history of a lesion sized 15.5 cm × 11.5 cm × 10.5 cm as a retroperitoneal IMT, and the first tumor resection was performed 12 months ago. The patient, who suffered from tumor recurrence within 1 year and whose recurrent tumor also invaded into the renal parenchymal was given a retroperitoneal neoplasm resection plus right nephrectomy. In order to clarify the pathological features, the histological specimens of recurrent retroperitoneal IMT were examined as well as primary retroperitoneal IMT, and immunohistochemical (IHC) stains showed that the spindle cells were positive for vimentin and negative for anaplastic lymphoma kinase (ALK). At 24 months follow-up, the patient recovered well and there was no evidence of tumor recurrence. This case report is conducive to understanding this rare tumor. When conditions permit, complete surgical resection is the recommended treatment for primary and recurrent IMT.

Outcome of Sellar and Suprasellar Brain Tumors with Retractorless Modified Subfrontal Approach

Aim: To determine the outcome of sellar and suprasellar brain tumors with retractorless modified subfrontal approach. Study design: Descriptive/observational study Place and duration of study: Department of Neurosurgery, Liaquat University Hospital Hyderabad/Jamshoro from 1st March 2020 to 28th February 2021. Methodology: Fifty patients of sellar and suprasellar brain tumors age between 15-70 years were enrolled. Patients details demographics age, sex and body mass index were recorded after taking written consent. The inter-hemispheric front-basal technique was used for all patients and the average follow-up time was 6 months. Postoperatively, magnetic resonance imaging (MRI) and computerized tomography (CT) scans in all patients were performed. After 12 hours, the postoperative CT scan was performed to monitor for persistent tumor and hemorrhage cerebral edema following an operation. Results: There were 30 (60%) male patients and 20 (40%) female patients. Mean age of the patients were 28.36±14.88 years with mean BMI 23.16±7.54 kg/m2. Most of the patients 20(40%) were from age group 15-30 years, followed by 31-40 years in 12 (24%) patients. Frequency of pituitary adenoma was found in 22 (44%) cases, craniopharyngioma found in 19 (38.7%) cases, arachnoid cyst found in 4 (8%), keratin flakes in 2 (4%) cases, benign giant cell tumor found in 2 (4%)olfactory groove meningioma in 1 (2%) and epidermoid in 1 (2%) cases. Post operatively 35 (70%) patients were completely recovered, complications found in 13 (26%) patients who were recovered later and frequency of not recovered patients was 2 (4%). According to Karnofsky performance, 16 (32%) patients had scale 30, scale 60 was in 2 (4%) cases, scale 70 in 4 (8%) patients, scale 80 in 19 (38%) and scale 90 in 9 (18%). Conclusion: This retractorless method is very effective and safe in the sellar and suprasellar region for excision of big tumors. This method allows the huge tumor to be removed without serious complication. Keywords: Sub-frontal approach, Sellar, Suprasellar, Brain tumor, Retractorless method

Modified liver hanging maneuvers to facilitate various difficult types of hepatectomy: A single center experience

The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach. Since the first time described by Belghiti, it has been modified many times by different surgeons to be more effective. Thus, we aim to evaluate the short term results of using some modified liver hanging maneuvers (mLHM) for difficult types of hepatectomy. From February 1 to September 30, 2020, we perform 3 modified techniques of LHM for 4 patients with liver's tumors. mLHM 1: A tape was placed upon the fossa ductus venosi, its cranial tip was passed to the right behind the common trunk of left hepatic vein and middle heptic vein, and its caudal tip passed behind the left Glissonean pedicle to the hepatic hilum. mLHM 2: After transect the caudal part of S1R about 2 cm, a tape was passed through the hepatic hilum and the right hepatic vein - middle hepatic vein pocket along the right border of the paracaval portion. mLHM 3: Instead of a tape, we used 2 fingers to create the tunnel and push the liver forward. Among 4 patients, there were 2 right hepatectomy and caudate lobectomy, 1 left hepatectomy and caudate lobectomy, 1 right anterior sectionectomy with reconstruction right hepatic vein for huge tumor. The modified LHMs were performed successfully in all patients, provide adequate cut planes without complications. The LHM is a safe and effective technique which can be modified to adapt with many types of hepatectomy.

Cervical Dumbbell Ganglioneuroma Causing Quadriplegia

Ganglioneuroma is a rare benign tumour that originates from the ganglion cells of the sympathetic nervous system. They are rare in cervical spine region and only 8 % of ganglioneuromas occur in the neck. The common sites of occurrence are in the posterior mediastinum, retroperitoneum and adrenal medulla, and as such, a cervical occurrence presenting with quadriplegia is a reportable event. We present a 26-year old young male with a two-year history of neck pain and progressive quadriplegia. He later became wheelchair-bound. Musculoskeletal examination revealed multiple generalized nodular skin swellings with café au lait macules. Magnetic resonance imaging showed a huge dumbbell tumour of the first two cervical vertebrae, to the right side of the spinal canal causing significant spinal cord compression. He had surgical intervention, aimed at complete tumour resection, postoperatively, power of the limbs improved to normal. Histological examination was consistent with ganglioneuroma. We present this report because the occurrence of ganglioneuroma is rare, secondly a cervical presentation is unusual and thirdly it presented as a rare cause of quadriplegia.

Not a Huge but Two Tumors

A 73-year-old man presented to the thoracic surgery clinic with progressive difficulty breathing for about 3 months. He had a benign spindle cell tumor (about 3 centimeter in diameter) in right lung upper lobe, which had been resected by thoracotomy surgery 15 years earlier. The physical examination showed weakened right respiratory sounds. Computed tomography of the chest revealed a huge mass closed to the pulmonary vessels and bronchus, which measured more than 13 cm in greatest dimension (Panel A). Thoracotomy surgery was performed for the tumor resection again. Two separated tumors, instead of one huge tumor, originated from visceral pleura were found with well encapsulated (Panel B). And the histopathological analysis revealed solitary fibrous tumor. The immunohistochemical analysis was positive for Desmin-protein and CD34. Just followingup was initiated after surgery, and the patient was doing well after 3 months.

Gigantic parasitic leiomyoma of 19 kg in a postmenopausal woman: A case report and review of the literature

Parasitic leiomyomas are a rare subtype of subserosal uterine leiomyomas and are mostly found incidentally. Diagnosis is challenging and treatment consists out of complete surgical resection. Cases are few in women without history of uterine surgery. In this extraordinary case, a 56-year-old menopausal female suffering from backache and abdominal swelling, was suspected to have a huge malignant ovarian tumor. She underwent a resection of the mass along with hysterectomy and bilateral salpingo-oöphorectomy. Histopathology revealed a gigantic leiomyoma of 19.1 kg in the broad ligament. This unique case suggests taking this diagnosis into account in future clinical cases presenting with large abdominal masses even without previous uterine surgery.

A dual autoencoder and singular value decomposition based feature optimization for the segmentation of brain tumor from MRI images

BackgroundThe brain tumor is the growth of abnormal cells inside the brain. These cells can be grown into malignant or benign tumors. Segmentation of tumor from MRI images using image processing techniques started decades back. Image processing based brain tumor segmentation can be divided in to three categories conventional image processing methods, Machine Learning methods and Deep Learning methods. Conventional methods lacks the accuracy in segmentation due to complex spatial variation of tumor. Machine Learning methods stand as a good alternative to conventional methods. Methods like SVM, KNN, Fuzzy and a combination of either of these provide good accuracy with reasonable processing speed. The difficulty in processing the various feature extraction methods and maintain accuracy as per the medical standards still exist as a limitation for machine learning methods. In Deep Learning features are extracted automatically in various stages of the network and maintain accuracy as per the medical standards. Huge database requirement and high computational time is still poses a problem for deep learning. To overcome the limitations specified above we propose an unsupervised dual autoencoder with latent space optimization here. The model require only normal MRI images for its training thus reducing the huge tumor database requirement. With a set of normal class data, an autoencoder can reproduce the feature vector into an output layer. This trained autoencoder works well with normal data while it fails to reproduce an anomaly to the output layer. But a classical autoencoder suffer due to poor latent space optimization. The Latent space loss of classical autoencoder is reduced using an auxiliary encoder along with the feature optimization based on singular value decomposition (SVD). The patches used for training are not traditional square patches but we took both horizontal and vertical patches to keep both local and global appearance features on the training set. An Autoencoder is applied separately for learning both horizontal and vertical patches. While training a logistic sigmoid transfer function is used for both encoder and decoder parts. SGD optimizer is used for optimization with an initial learning rate of .001 and the maximum epochs used are 4000. The network is trained in MATLAB 2018a with a processor capacity of 3.7 GHz with NVIDIA GPU and 16 GB of RAM.ResultsThe results are obtained using a patch size of 16 × 64, 64 × 16 for horizontal and vertical patches respectively. In Glioma images tumor is not grown from a point rather it spreads randomly. Region filling and connectivity operations are performed to get the final tumor segmentation. Overall the method segments Meningioma better than Gliomas. Three evaluation metrics are considered to measure the performance of the proposed system such as Dice Similarity Coefficient, Positive Predictive Value, and Sensitivity.ConclusionAn unsupervised method for the segmentation of brain tumor from MRI images is proposed here. The proposed dual autoencoder with SVD based feature optimization reduce the latent space loss in the classical autoencoder. The proposed method have advantages in computational efficiency, no need of huge database requirement and better accuracy than machine learning methods. The method is compared Machine Learning methods Like SVM, KNN and supervised deep learning methods like CNN and commentable results are obtained.