Nodal Mass Research Articles

РОЗРАХУНОК НАПРУЖЕНО-ДЕФОРМОВАНОГО СТАНУ ПЛАКУЮЧОГО ШАРУ ПРИ ПЛАКУВАННІ (ЗВАРЮВАННІ) ВИБУХОМ

Purpose. Development of a mathematical model of the process of elastoplastic deformation of the cladding layer of a layered workpiece during welding (cladding) by explosion with the formation of the objective function of optimal deformation and establishing a relationship between the parameters of welding (cladding) by explosion and the shear bond strength of the layers and the wear resistance of the cladding layer. Methodology. The solution to the problem of elastoplastic deformation is carried out using the equations of the flow theory and the nodal calculation scheme. The required deformation values are determined at the nodal mass points of the computational grid. At each moment of time, the positions of the nodes of the cladding workpiece, thrown under loading by a traveling pressure wave, are de-termined. Deformations and their intensity are determined by the position of the nodes. The task of determining the re-quired parameters of explosion welding (cladding) is reduced to the task of mathematical programming. The objective function is minimized on a family of curves, the arguments of which are the explosion welding (cladding) parameter and the welding gap. The interaction of the cladding workpiece with the pressure wave generated during the detonation of the explosive is determined by the dependences of the pressure of the detonation products, the mass velocity of the cladding workpiece and the shock wave velocity at the moment the shock wave reaches the free surface on the parame-ters of the explosion cladding (welding) with subsequent calculation of the stress-strain state of the workpieces. Accord-ing to the optimal parameters of explosion welding (cladding), a probabilistic assessment of the shear bond strength of the layers is carried out. If the strength is insufficient, the parameters are adjusted. Findings. As a result of numerical modeling, the calculation of the deformed state of the projectile is carried out. The parameters of explosion welding (cladding) are determined, at which the intensity of deformations of the cladding layer corresponds to the limit uniform ones. Based on the obtained parameters of explosion welding (cladding), the calculation of the shear strength of the layer joint was performed. Originality. For the first time, a model has been developed for the optimal deformation of the cladding layer during explosion welding (cladding) of wear-resistant compositions. The target function and the optimal process parameters have been established. A method is proposed for calculating the weighting coefficients of the objective function for multi-criteria multilevel optimization. Practical value. Recommendations for industrial application were developed and modes of explosion welding (cladding) were tested to obtain wear-resistant compositions of aluminum alloy with carbon steel.

Prognostic importance of radiologic extranodal extension in nasopharyngeal carcinoma treated in a Canadian cohort

To confirm the prognostic value of radiologic extranodal extension (rENE) and its role in clinical-N classification in nasopharyngeal carcinoma (NPC) treated in a western institution. NPC treated between 2010 and 2017 were included. Pre-treatment MRI were reviewed for unequivocal rENE and its grade: grade-1: tumour invading through any nodal capsule but confined to perinodal fat; grade-2: ≥2 adjacent nodes forming a coalescent nodal mass; grade-3: tumour extending beyond perinodal fat to invade/encase adjacent structures. Overall survival (OS) and disease-free survival (DFS) were compared between rENE-positive (rENE+) and rENE-negative (rENE-) patients. Multivariable analysis (MVA) confirmed the prognostic importance of rENE and its grade. Staging schemas including rENE in N-classification were proposed and their performance evaluated. A total of 274 patients were eligible (43 cN0; 231 cN-positive). rENE was identified in 83/231 (36%) cN-positive, including grade 1/2/3 rENE in 14/58/11 cases. Compared to rENE-, rENE+ patients had a lower OS (68% vs 89%, p<0.001) and DFS (58% vs 80%, p<0.001). MVA confirmed the prognostic importance of grade-2 [HR: OS: 2.85 (p=0.005); DFS: 2.89 (p<0.001)] and grade-3 rENE [HR: OS 5.28 (p=0.004); DFS 3.86 (p=0.005)], with a trend for grade-1 vs rENE- [HR: OS 2.63 (p=0.13); DFS 1.49 (p=0.520)]. We evaluated classifying any rENE as cN3 (Proposal-I) or any grade-2/grade-3 rENE as cN3 (Proposal-II). The stage schema with Proposal-I cN-classification ranked the highest in the performance evaluation. rENE is an important prognostic factor in this western NPC cohort. We propose classifying any unequivocal rENE as cN3.

994 Prolonged Survival in N3 Penile Cancer with Contralateral Inguinal Relapse - Outcome of A Multimodal Therapeutic Approach

Abstract Case Report Penile squamous cell cancer (PSCC) is rare in the Western world, although higher in many developing countries. This has hindered comparative studies of therapeutic options, with ongoing uncertainty regarding best treatment options. However, greater centralisation of services in recent years is allowing some inroads into improving the management of these patients. Presentation with advanced inguinal lymphadenopathy has traditionally been associated with very poor prognosis. A multimodal approach has been advocated but benefits not yet proven in randomised series. We describe a case of PSCC presenting with a fixed nodal mass, treated with a multimodal approach, combining neo-adjuvant chemotherapy with surgery and then external beam radiotherapy (DXT) at contralateral relapse, resulting in long-term disease-free survival(&amp;gt;12 years) and good quality of life.

TB MASQUERADING AS LUNG MALIGNANCY

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Radiological manifestations of pulmonary tuberculosis (TB) tend to be heterogeneous. [1] In this report, we highlight one such atypical manifestation that posed a diagnostic dilemma and necessitated a biopsy. CASE PRESENTATION: A 67 year old male with no known medical illness presented with a 3 month history of dry cough to a hospital in southern India. The cough was associated with night sweats, appetite loss, fatigue and intermittent fever. He reported no episodes of breathlessness or hemoptysis. He denied any sick contacts, was a non smoker and had no family history of malignancy. On examination, his vital signs were stable and he was not in respiratory distress. There were no palpable lymph nodes Cardiopulmonary examination revealed no abnormal findings. Blood examination showed hemoglobin of 11.9 g/dL and ESR of 54 mm/hr, with normal blood cell counts. Chest radiograph revealed opacities in the right middle zone. A high resolution computed tomography (HRCT) of the thorax was done, and findings raised suspicion of neoplastic changes.HRCT revealed a patchy consolidation with necrotic areas and irregular margins in the superior segment of the right lower lobe, extending up to the costal pleura. Multiple ground glass opacities with nodular thickening of the oblique fissure were noted in the right lower lobe as well. Due to their typical appearance, these features were attributed to a neoplastic etiology. Interestingly, a homogenously enhancing lobulated mass was noted in the prevascular compartment of the superior mediastinum. It was also seen abutting the SVC posteriorly, where it caused a focal compression on the left brachiocephalic vein. This was thought to be a lymph nodal mass. Computed Tomography (CT) guided biopsy of the right lower lobe lesion was conducted. Histopathology revealed granulomatous inflammation with epitheloid and giant cells surrounding areas of caseous necrosis. The patient was started on Anti Tuberculous Treatment and responded well. Follow up imaging six months later revealed fibrotic changes with calcified granulomas. DISCUSSION: Clinical and radiological manifestations of TB are heterogeneous and include a variety of benign and malignant diseases. [1] Diagnostic dilemmas can delay appropriate treatment, favoring Mycobacterium tuberculosis transmission. Up to one third of TB cases have an atypical appearance on radiograph or CT imaging. [2] Thus, despite demographic features and symptoms typical of TB, our patient's HRCT posed a diagnostic dilemma. The consolidation with necrotic areas and superior mediastinal mass raised suspicion for lung malignancy. CONCLUSIONS: An extensive workup is required to differentiate TB from lung malignancy. HRCT and biopsy can be critical. Comprehensive awareness and knowledge of atypical TB manifestations can help in early diagnosis and start of therapy, increasing the probability of clinical and microbiological cure. REFERENCE #1: Collu C, Fois A, Crivelli P, Tidore G, Fozza C, Sotgiu G, Pirina P. A case-report of a pulmonary tuberculosis with lymphadenopathy mimicking a lymphoma. Int J Infect Dis. 2018 May;70:38-41. doi: 10.1016/j.ijid.2018.02.011. Epub 2018 Mar 1. PMID: 29477363. REFERENCE #2: Jeon KN, Bae K, Park MJ. Atypical radiologic appearances of pulmonarytuberculosis in non-HIV adult patients. In Proceedings: The RoyalAustralian and New Zealand College of Radiologists (RANZCR) 63rdAnnual Scientific Meeting, and Asian Oceanian Congress of Radiology(AOCR), 30 August–2 September 2012, Sydney, Australia;http://dx.doi.org/10.1594/ranzcraocr2012/R-0200 DISCLOSURES: No relevant relationships by Arup Ganguly, source=Web Response No relevant relationships by Vinayak Jain, source=Web Response No relevant relationships by Adithya Shetty, source=Web Response

PORCELAIN PLEURA: A RARE CASE OF METASTATIC CHONDROSARCOMA WITH EXTENSIVE PLEURAL CALCIFICATION

TOPIC: Disorders of the Pleura TYPE: Fellow Case Reports INTRODUCTION: Calcified pleural lesions have both benign and malignant etiologies. Benign lesions can originate from previous trauma, prior pleural infections, hemothorax, or asbestos exposures, and are often focal and limited1,2. Malignant lesions often involve metastatic disease from mesenchymal tumor origin, such as osteosarcoma, chondrosarcoma, or mesothelioma1,3. We describe a case of a patient with metastatic chondrosarcoma manifesting with extensive calcification of the parietal and visceral pleura. CASE PRESENTATION: A 67 year old man was referred to pulmonary for a new subcarinal soft tissue mass on chest CT. He had been previously diagnosed with chondrosarcoma in 2016 and underwent treatment via a radical right proximal humerus excision and shoulder arthroplasty, with final pathology revealing grade 2 conventional chondrosarcoma, mixed hyaline and myxoid, without metastatic foci.Screening chest CT in 2020 noted a new, partially calcified subcarinal soft tissue mass and adjacent lymphadenopathy with moderate hypermetabolism on a positron emission tomography scan (PET/CT). Bronchoscopy with endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) subcarinal lymph node and adjacent posterior mass confirmed metastatic disease.He subsequently developed rapidly progressive dyspnea on exertion over the following month. Repeat chest CT revealed extensive development of circumferential nodularity and calcification of the right visceral and parietal pleura with a large pleural effusion. Thoracentesis improved dyspnea despite limited reexpansion of the lung and noted loculation of the effusion. Pleuroscopic evaluation of the complicated space was undertaken to remove loculations and optimize placement of an indwelling pleural catheter (IPC) for his malignant effusion. Despite difficulty with trocar insertion into the calcified pleural space, placement of the IPC was successful with improvement in his dyspnea. DISCUSSION: Metastatic pleural involvement of chondrosarcoma is rare, and can occur in the setting of direct extension in locoregional disease or hematogenous spread from other sites of primary involvement. Metastatic disease has been noted to be more prevalent in the dedifferentiated and mesenchymal subtypes4. Manifestations of metastatic pleural involvement are typically pleural calcifications that can be profound in the rapid evolution and extent of calcified involvement. Management is often palliative, as in this case, with drainage of any associated pleural effusions and attempts to mitigate accompanying dyspnea. CONCLUSIONS: This case of metastatic chondrosarcoma with extensive visceral and parietal pleural involvement is rare and infrequently noted in the literature. Palliative management with thoracentesis and IPC placement was complicated by the pervasive pleural calcification that prevented ultrasound imaging and made access to the pleural space difficult and dangerous. REFERENCE #1: Sureka B, Thukral BB, Mittal MK, Mittal A, Sinha M. Radiological review of pleural tumors. Indian J Radiol Imaging. 2013;23(4):313-320 DISCLOSURES: No relevant relationships by Robert Browning, source=Web Response, value=Grant/Research Support Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Robert Browning, source=Web Response, value=Consulting fee Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Robert Browning, source=Web Response, value=Consulting fee Removed 04/29/2021 by Robert Browning, source=Web Response No relevant relationships by Sean McKay, source=Web Response No relevant relationships by Philip Mullenix, source=Web Response No relevant relationships by Caitlin Nickens, source=Web Response No relevant relationships by John Shumar, source=Web Response

UNUSUAL DIAGNOSIS OF A MEDIASTINAL MASS

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Paragangliomas are rare neoplasms with an annual incidence of 0.8 per 100,000-person years [1]. Mediastinal paragangliomas represent only 2% of paragangliomas [2]. However, with increased availability of imaging, the number of these neoplasms found incidentally in asymptomatic individuals is increasing. This case report presents an asymptomatic paraganglioma in the mediastinum. CASE PRESENTATION: 51-year-old white female with a history of hypertension and anxiety who presented with worsening shortness of breath, weakness, fever, chills and nonproductive cough. The patient was admitted because she failed outpatient treatment with amoxicillin/clavulanate. CT chest revealed basilar consolidation and a bulky centrally necrotic subcarinal nodal mass. She was discharged 5 days later after one dose of dexamethasone as well as a course of IV azithromycin and ceftriaxone. Repeat CT chest 6 weeks later showed a persistent enhancing soft tissue mass in the mediastinum measuring 4.8 x 2.9 cm. Pulmonology was consulted and performed an endoscopic bronchial ultrasound biopsy with fine-needle aspiration that revealed mediastinal lymphadenopathy as well as a partial narrowing from mass effect in the left main bronchus, left lower lobe and the lingula. Histologic sections and immunohistochemistry confirmed the diagnosis of paraganglioma. The patient was sent to thoracic surgery to consider resection and is currently awaiting workup with endocrinology. DISCUSSION: Mediastinal paraganglioma is a rare tumor and often because of their location biopsy to confirm diagnosis is often delayed. Half of patient's are asymptomatic [3] and may only be diagnosed incidentally or once mass effect produces clinical symptoms to initiate workup. Clinical symptoms in symptomatic patients are often from catecholamine hypersecretion causing palpitations, sweating, headaches and most commonly hypertension. Non-catecholamine symptoms may include hoarseness, shortness of breath or dysphagia depending on the location of the tumor. Surgical tumor removal remains the cornerstone of treatment. However, resection may not be feasible due to these tumors being highly vascular and neighboring critical vascular structures. CONCLUSIONS: Paraganglioma is a rare tumor in the mediastinum that is usually asymptomatic and found incidentally. Surgical resection can be curative. REFERENCE #1: Beard CM, Sheps SG, Kurland LT, Carney JA, Lie JT. Occurrence of pheochromocytoma in Rochester, Minnesota, 1950 through 1979. Mayo Clin Proc. 1983 Dec;58(12):802-4. PMID: 6645626. REFERENCE #2: Ghayee HK, Havekes B, Corssmit EP, et al. Mediastinal paragangliomas: association with mutations in the succinate dehydrogenase genes and aggressive behavior. Endocr Relat Cancer 2009; 16:291. REFERENCE #3: Sutton MG, Sheps SG, Lie JT. Prevalence of clinically unsuspected pheochromocytoma. Review of a 50-year autopsy series. Mayo Clin Proc. 1981 Jun;56(6):354-60. PMID: 6453259. DISCLOSURES: No relevant relationships by Haytham Adada, source=Web Response No relevant relationships by Mahmoud Amarna, source=Web Response No relevant relationships by Camelia Chirculescu, source=Web Response No relevant relationships by Trevor Elswick, source=Web Response

P36.01 Primary Acinic Cell Carcinoma of Bronchial Ground Origin: A Case Report

Primary acinic cell carcinoma of the lung is an extremely rare disease. Also known as Fechner’s tumor, this condition was first reported by Fechner et al. in 1972. The accurate diagnosis of primary pulmonary acinic cell carcinoma is difficult and relies on comprehensive evaluation of clinical, histological and immunohistochemical features. A 49-year-old male patient was referred to our hospital because of an abnormal infiltration shadow in the left lower lung field detected on a chest radiograph during a medical check-up. Chest computed tomography revealed a nodal mass shadow 10mm in size, in segment 8 of the left lower lobe. Bronchoscopic examination revealed a polypoid tumor at B8. Transbronchial biopsy was performed and the tumor was diagnosed as a bronchial gland adenoma. The patient underwent video-assisted thoracic segmentectomy to achieve complete resection of the tumor. Macroscopically, the tumor was a solitary mass measuring 14×10×8 mm in size with substantial cut surface and showed no intraparenchimal growth. Histopathological examination revealed a polypoid projection in the bronchial space. Adeno-type cancer cells with monomorphous nuclei invade the bronchial wall tissue in association with tubule or acinus-like space formation. The cytoplasm of the tumor cells is plump and eosinophilic with granularity or clear. No direct invasion into the lung parenchyma was observed. Immunohistochemical staining revealed that the tumor cells were positive for PAS, lactoferrin, and HMG-45MI. The features are consistent with acinic cell carcinoma of bronchial gland origin. Electron microscopy showed that the acinus-forming tumor cell possess well-developed mitochondria and round-surfaced endoplasmic reticulum, in association with active luminal secretion. Rounded, electron-dense secretory exocrine granules, ranging from 150 to 340 nm in size, are noted mainly in the apical cytoplasm. Fat vacuoles are noted in some tumor cells. Microvillous intracytoplasmic lumina are occasionally noted. Bundles of intermediate filaments and desmosomal attachments are also seen. These features are consistent with acinar cell nature of the cells. Fourteen years since the surgical resection, no apparent recurrence or metastasis has been detected. We experienced an extremely rare case of primary bronchial acinic cell carcinoma diagnosed based on clinical information, histopathological features, immunogistopathological staining profile, and electron microscopy features. The limited number of reports on this type of tumor have revealed that the outcome after surgical resection is favorable due to its low-grade malignant potential. Likewise in this case, the patient remained free of recurrence for over 14 years after surgery.

S3682 Management of Right-Sided Carcinoid Heart Failure

Introduction: Carcinoid heart disease is a rare disease affecting around 20% of patients with carcinoid syndrome. It is considered a result of high circulating serotonin levels depositing into heart valves. The characterized symptoms of carcinoid syndrome are vasomotor flushing, gastrointestinal hypermotility and cardiac involvement. Right heart valve disorders increase morbidity and mortality due to right heart failure complications of fluid overload. This case presents a 48 year old woman with new findings on echocardiogram compatible with right heart failure. Case Description/Methods: A 48 year old woman with a past medical history of hypothyroidism presented with shortness of breath for the last month. No productive cough, no sick contacts, no fevers or chills. Endorses diffuse redness on her face and right arm. Antistreptolysin A returned positive and completed a 10 day course of cephalexin without relief. Other related symptoms were abdominal distress, nonbloody diarrhea and tachycardia. She lost approximately 30 pounds in the last 2 months due to chronic diarrhea. Recent celiac serology testing has been negative. CT Abdomen and Pelvis with contrast shows a prominent, speculated nodal mass at the root of the mesentery with focal nodular thickening of the duodenal wall. 5-HIAA returned at 40mg/24h (Reference < 30 mg/24hr). Echocardiogram revealed grade 1 diastolic dysfunction, preserved ejection fraction and moderate tricuspid regurgitation. Lasix was started for diuresis along with octreotide to calm down the systemic 5-HIAA surge. She will be followed up outpatient for surgical evaluation. Discussion: Carcinoid heart disease is caused by the deposition of pearly fibrotic plaques into the endocardium of right sided valves leading to multiple patterns of severe valve dysfunction. Plaque formation causes leaflet thickening, and fusion of the valves. Echocardiography remains a reliable method for the definitive diagnosis. Valve replacement is currently the gold standard treatment for symptomatic carcinoid valve disease. However, debates remain in terms of the choice of heart valve prosthesis. The surgical indications of carcinoid heart disease are symptomatic right ventricular failure, severe valvular dysfunction and systemic venous pressure elevation. Contraindications are end-stage metastatic disease poorly controlled carcinoid symptoms despite octreotide therapy medical management. This case highlights the rare syndrome of carcinoid heart disease with follow up surgery in the outpatient..

EUS-Guided Biopsy with a Novel Puncture Biopsy Forceps Needle—Feasibility Study

Endoscopic ultrasound (EUS) with fine needle aspiration (FNA) or biopsy (FNB) to diagnose lesions in the gastrointestinal tract is common. Demand for histology sampling to identify treatment-specific targets is increasing. Various core biopsy FNB needles to obtain tissue for histology are currently available, however, with variable (37–97%) histology yields. In this multicenter study, we evaluated performance, safety, and user experience of a novel device (the puncture biopsy forceps (PBF) needle). Twenty-four procedures with the PBF needle were performed in 24 patients with a suspected pancreatic lesion (n = 10), subepithelial lesion (n = 10), lymph node (n = 3), or pararectal mass (n = 1). In 20/24 (83%) procedures, the PBF needle yielded sufficient material for interpretation (sample adequacy). In 17/24 (71%), a correct diagnosis was made with the material from the PBF needle (diagnostic accuracy). All participating endoscopists experienced a learning curve. (Per)procedural technical issues occurred in four cases (17%), but there were no adverse events. The PBF needle is a safe and potentially useful device to obtain an EUS-guided biopsy specimen. As the design of the PBF needle is different to core biopsy FNB needles, specific training will likely further improve the performance of the PBF needle. Furthermore, the design of the needle needs further improvement to make it more robust in clinical practice.

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BACKGROUND Mediastinal lesions are one of the most common lesions of the chest in children and adults. Multidetector computed tomography (MDCT) is the most common investigation done in patients with suspected abnormalities on X-ray. Crosssectional imaging visualises complex anatomy, helps in predicting the tissue of origin, characterises lesions and depicts the extent of involvement of adjacent structures. Complications of mediastinal lesions and emergent conditions, for example, sealed pneumo-mediastinum, tracheoesophageal / pulmonary fistula, a peri-lesional abscess can be well assessed on CECT. The possibility of the lesion as benign or malignant and can be well predicted. Vascular lesions like aneurysms, dissections, and embolism can be evaluated and stable lesions requiring to follow up and unstable lesions requiring emergent treatment are differentiated using MDCT. The objectives of the study were to characterize and identify features pathognomic of specific mediastinal masses on computed tomography and find out diagnostic accuracy of MDCT in mediastinal masses and compare them with pathological results wherever possible. METHODS A prospective study was done in the Department of Radiodiagnosis, Rohilkhand Medical College and hospital, Bareilly for a span of 1 year from November 2018 to October 2019. Our study included 51 patients. Mediastinal lesions were assessed based on size, compartmental localisation, and attenuation and enhancement patterns. RESULTS In our study with 51 patients, 16 lesions were non-neoplastic and 35 were neoplastic lesions. Anterior mediastinal lesions constituted maximum lesions followed by middle and posterior mediastinal lesions. Lymph nodal masses were the commonest lesions out of which 4 cases were tubercular in origin, 4 were lymphomatous and 4 were metastatic. Neurogenic tumours were most common in the posterior mediastinum consisting of 6 cases. 2 vascular lesions were seen, 1 of aortic aneurysm and 1 aortic dissection. The diagnostic accuracy of MDCT was 93 % compared to histopathological results. Computed tomography (CT) plays a major role in evaluating mediastinal masses by virtue of its excellent multiplanar reconstruction capabilities and demonstration of exact anatomic relationships. However, in many situations, histopathological examination is needed to know the exact tissue of origin and for further management. CONCLUSIONS We conclude that CT has a major role in evaluating mediastinal masses regarding location, extent and tissue characterization. It can display certain features pathognomic for particular masses thus obviates the need for invasive procedures. KEY WORDS Mediastinal Lesions, MDCT, Imaging Modality, Histopathology

Mediastinal and neck follicular dendritic cell sarcoma treated with definitive radiation therapy using the volumetric modulated arc therapy technique: a case report

AbstractFollicular dendritic cell sarcoma (FDCS) is a rare malignancy that affects the nodal and extranodal tissues. The mediastinum is a rare site for this tumor, with few published reports and series. Although surgery is the mainstay of treatment for this disease entity, in this report we present a case of mediastinal FDCS treated with definitive radiation therapy (RT) with a near‐total radiological response. A 28‐year‐old woman presented with chest tightness and neck swelling. Radiological findings were suggestive of a conglomerated nodal mass involving the mediastinum and extending superiorly into the anterior neck. Biopsy results led to a diagnosis of FDCS. The tumor was deemed unresectable, and definitive RT was planned as the treatment. The patient was treated with volumetric modulated arc therapy to a total dose of 54 Gy in 30 fractions over 6 weeks. Her symptoms had completely resolved at the first follow‐up visit, 3 months after RT completion, with a near‐total radiological response on a contrast‐enhanced computed tomography scan. Although surgery is the standard of care in FDCS, based on the favorable response of FDCS to RT, as in this case, the role of definitive RT needs to be studied in more patients to determine its efficacy in long‐term tumor control as an alternative to surgery.

Fracture simulations using edge-based smoothed finite element method for isotropic damage model via Delaunay/Voronoi dual tessellations

In this study, an effective numerical framework for fracture simulations is proposed using the edge-based smoothed finite element method (ES-FEM) and isotropic damage model. The duality between the Delaunay triangulation and Voronoi tessellation is utilized for the mesh construction and the compatible use of the finite element solution with the Voronoi-cell lattice geometry. The mesh irregularity is introduced to avoid calculating the biased crack path by adding random variation in the nodal coordinates, and the ES-FEM elements are defined along the Delaunay edges. With the Voronoi tessellation, each nodal mass is calculated and the fractured surfaces are visualized along the Voronoi edges. The rotational degrees of freedom are implemented for each node by introducing the elemental formulation of the Voronoi-cell lattice model, and the accurate visualizations of the rotational motions in the Voronoi diagram are achieved. An isotropic damage model is newly incorporated into the ES-FEM formulation, and the equivalent elemental length is introduced with an additional geometric factor to simulate the consistent softening behaviors with reducing the mesh sensitivity. The full matrix form of the smoothed strain-displacement matrix is constructed for optimal use in the element-wise computations during explicit time integration, and parallel computing is implemented for the enhancement of the computational efficiency. The simulated results are compared with the theoretical solutions or experimental results, which demonstrates the effectiveness of the proposed methodology in the simulations of the quasi-brittle fractures.

Radiological evaluation of metastatic lymph nodes in carcinoma cervix with emphasis on their infiltrative pattern

Background & objectives:Imaging has been added to the International Federation of Gynecology and Obstetrics (FIGO) 2018 staging system of cervical carcinoma. This study was performed to assess the impact of imaging in staging and to ascertain the prevalence and pattern of nodal metastasis on contrast-enhanced computed tomography (CECT) in patients with cervical carcinoma who were treated based on FIGO 2009 staging system.Methods:This retrospective study was conducted to evaluate all patients with biopsy-proven cervical carcinoma who underwent CECT of abdomen at a tertiary cancer centre in north India from April 2017 to April 2019 and for whom either baseline or follow up scans were available. In patients with enlarged or necrotic lymph nodes, the location, size and pattern of infiltration of adjacent organs were recorded.Results:A total of 602 patients of cervical carcinoma had undergone CT during the study period, of whom 138 (22.9%) underwent CT at baseline and 464 (77.1%) patients during follow up. The FIGO (2009) stage distribution at the time of presentation was stage IB: 109 (18.1%); stage IIA: 14 (2.3%), stage IIB: 118 (19.6%), stage IIIA: 12 (2%), stage IIIB: 277 (46%), stage IVA: 20 (3.3%) and stage IVB: 52 (8.6%). Ninety of the 138 (65.22%) patients underwent a stage shift according to the FIGO 2018 because of the presence of enlarged lymph nodes at baseline scan. Sixteen (2.7%) patients had infiltrative nodal masses most commonly involving the blood vessels (n=14) followed by ureter (n=8), bones (n=5), muscle and bowel (n=3, each). The majority (14/16) of these patients presented with vague abdominal pain, discomfort and vomiting, while two had bone pain.Interpretation & conclusions:CECT at baseline helps in accurately assessing the stage in cervical carcinoma. It helps in the identification of lymph node metastasis in cervical carcinoma, which is crucial for guiding accurate management.

Chest computed tomography findings among adult Indigenous Australians in the Northern Territory of Australia.

There is sparse evidence in the literature in relation to the chest computed tomography (CT) findings among adult Indigenous Australians with chronic respiratory conditions. In this retrospective study, patients who underwent chest CT between 2012 and 2020 among those referred to undergo lung function tests (spirometry) were assessed for the prevalence of abnormal chest CT radiological findings. Of the 402 patients (59% female) included in this study, 331 (82%) had an abnormality identified on chest CT. Most abnormalities occurred alongside one (25%) or multiple (46%) other CT abnormalities. Airway disease ((AD) (including, emphysema, airway wall thickening and small airway disease) (35%), atelectasis: segmental or lobar collapse (27%), inflammatory opacities (24%) and bronchiectasis (23%) were the most common findings. AD and bronchiectasis were also the most common concurrent abnormalities in 40-50%. Other CT abnormalities noted in isolation or in combination with other CT findings were lung nodules (19%), lymph node enlargement (17%), consolidation or mass (17%), followed by lung cysts, ground-glass opacity, lung parenchymal architectural distortion, cavitating lung lesions and chronic pleural effusion were observed in ≤10%. Predictive models for odds of abnormality and outcomes showed age, smoking and underweight were associated with AD, and male sex and very remote residence were associated with bronchiectasis. This study has illustrated that Indigenous Australian adults have a high prevalence of multiple chest CT abnormalities that may impose unprecedented diagnostic and therapeutic challenges in this population. Further studies are warranted to determine the long-term implications and prognostic significance of the CT findings as demonstrated in this study.

Role of Computed Tomography in the Evaluation of Pediatric Retroperitoneal Masses: A Retrospective Study

Objective: Retroperitoneum is one of the largest spaces in the body. Retroperitoneal (RP) masses are common in paediatric age group and present with vague clinical features. Computed Tomography (CT) is an excellent imaging modality in the evaluation of RP masses. The aim of this study was to evaluate the role of CT in the detection and characterization of RP masses. Materials and Methods: 28 clinically suspected or sonographically detected RP masses formed the material of the study. Detailed clinical history was elicited from the patients/attendants and findings of general physical examination recorded. Non-contrast and Contrast Enhanced CT was performed and masses were evaluated with respect to site of origin, consistency, components and pattern of enhancement. Probable CT diagnosis was made and findings correlated with pathological/laboratory findings wherever possible. The results were subjected to statistical analysis and expressed as percentages and proportions.Results: Majority of patients were seen in 1-5 years age group with M:F ratio of 1.8:1. Lump abdomen was the commonest presenting feature followed by pain abdomen. Lymph nodal masses were the commonest primary RP space mass while renal masses accounted for the majority of secondary RP masses in our study. Pathological/Laboratory correlation was available in 21 cases and CT was able to differentiate benign and malignant lesions in 95.2% cases. Overall diagnostic accuracy of CT in the evaluation of RP masses was 85.7%. Conclusions: CT is a simple and reliable tool in diagnosing pediatric RP masses with a high diagnostic accuracy.

Acute Gastrointestinal Bleeding: A Report of Rare Presentation of Duodenal Metastasis From Cervical Squamous Cell Carcinoma

We report a case of a 42-year-old gravida 3, para 4 woman from Puerto Rico with a history of cervical cancer who presented with dizziness, lethargy, and three days of bright red blood per rectum. Imaging evaluation showed a retroperitoneal lymph node mass with secondary metastasis to the duodenum. After she was stabilized with multiple blood transfusions and to mitigate her ongoing bleeding, she was transferred to a tertiary care hospital for possible embolization by interventional radiologists. However, she was deemed a poor candidate for an interventional procedure and decided to ultimately go home on hospice care. This case highlights the rarity of duodenal metastasis presenting as gastrointestinal bleeding due to cervical squamous cell cancer and further reinforces the need for human papillomavirus vaccination and cervical cancer screening. This case study also illustrates that even though cervical cancer rates are low in the United States, it is still deadly in many countries across the globe. As people continue to travel and migrate across borders, the risk of being lost to follow-up is on the rise.

Eosinophilic interstitial nephritis and cardiac insufficiency in Kimura\u2019s disease: a case report

BackgroundKimura’s disease (KD) is a rare chronic inflammatory disease and the etiology remains uncharacterized. The typical manifestations are painless lymph node or subcutaneous masses. There is currently no report of prominent renal interstitial injury and cardiac insufficiency in KD.Case presentationA 45-year-old man was referred to our hospital with dark urine, subcutaneous masses in forehead and right retroauricular, multiple lymphadenopathy and unexplained cardiac insufficiency. Renal biopsy demonstrated eosinophilic interstitial nephritis. Laboratory tests revealed eosinophilia and a high level of serum IgE. A biopsy of cervical lymph node was performed and KD was diagnosed. Treatment with oral prednisone resulted in a decrease of eosinophil, serum IgE, improvement of cardiac function, and regression of the subcutaneous mass.ConclusionsWe describe an extremely rare KD case presenting with eosinophilic interstitial nephritis, cardiac insufficiency and significant response to prednisone. The clinicians should improve the disease awareness and find optimal treatment.

Follicular Lymphoma Response with CDK4/6 Inhibitor(Palbociclib) Utilized in the Setting of Metastatic Breast Cancer

Follicular Lymphoma Response with CDK4/6 Inhibitor(Palbociclib) Utilized in the Setting of Metastatic Breast Cancer

English

A 53-year-old male presented to our tertiary care center with complaints of palpitation and difficulty in breathing on exertion which was insidious in onset and gradually progressive. He had a history of back ache and significant weight loss. His physical examination and initial laboratory work up revealed no obvious abnormality. His initial radiological investigation involved chest roentgenogram which revealed cardiomegaly with mediastinal widening and haziness in left lower lung zone (Figure 1). His (electrocardiogram) ECG revealed normal sinus rhythm. Later, patient underwent echocardiography which revealed normal systolic flow with a mass extending up to pericardium (measuring 6.9 x 4.1 cm) in left atrium obstructing mitral flow and minimal pericardial effusion. He was sent to our department for contrast enhanced computerised tomography (CT) thorax scan to evaluate the extension of the left intra atrial mass which revealed a heterogeneously enhancing circumferential wall thickening in mid oesophagus extending from T7 - T11 for an approximate length of 8.3 cm with a single wall thickness of 2.3 cm in left lateral wall. There was also a heterogeneously enhancing lobulated soft tissue density mass with hypodense area within measuring 6.4 (CC) x 7.3 (AP) x 7.9 (TR) cm in left paraesophageal region infiltrating into adjacent pulmonary vessels and left atrium forming a large intracavitary mass with collapse of adjacent lung parenchyma and pericardial effusion with a maximum depth of 1.7 cm (Figure 2 &amp; 3). Multiple enlarged lymph nodes were noted in paratracheal, pretracheal precranial and perivascular regions, largest measuring 1.2 cm in SAD in paratracheal regions (Figure 2B). Based on the imaging findings we made the diagnosis of malignant oesophageal growth with metastatic paraesophageal nodal mass infiltrating into adjacent pulmonary vessels and left atrium forming a large intra-cavitary mass. On following up, endoscopic workup revealed a nodular growth in oesophagus extending from 33 to 38 cms with intact overlying mucosa (Figure 4). On histopathological examination of the specimen taken from the oesophageal growth revealed to be squamous cell carcinoma infiltrating to muscle coat.

Perianal Plasmablastic Lymphoma Masquerading as a Buschke-Löwenstein-like Tumour in an HIV-infected Patient with Recurrent Anal Condyloma

Plasmablastic lymphoma (PBL) commonly presents as a primary (de novo) oral or extraoral mucocutaneous or nodal mass lesion in patients with HIV/AIDS. PBL developing as a secondary malignancy at the same location as a pre-existing tumour is extremely rare and has never been reported in association with longstanding or recurrent anal condyloma. A Buschke-Löwenstein tumour is a rare gigantic, locally destructive condyloma that is usually located in the anogenital region. We report a case of a diagnostically and therapeutically challenging PBL that presented as a rapidly enlarging mass underlying a giant condyloma, thereby mimicking a benign Buschke-Löwenstein tumour. Clinical suspicion was further masked by the co-presence of fistulae in ano and adjacent abscess pockets at the time of diagnosis. By the time of final diagnosis, the lymphoma had disseminated to regional lymph nodes, a month later to pleural cavities and 4 months later to the leptomeninges and bilateral kidneys, leading to permanent deferral of chemotherapeutic intervention.LEARNING POINTSPlasmablastic lymphoma presenting as a secondary tumour in a patient with pre-existing giant anal condyloma has not been reported previously in the literature.Unusual clinical presentation of a recurrent giant condyloma, especially rapid growth and significant change in physical appearance, should kindle a high index of suspicion for a secondary aggressive tumour.Plasmablastic lymphoma disseminates early and rapidly, which complicates its response to treatment.