Manifestation Of Tumor Research Articles

Primary extradural tumors of the spinal column: A comprehensive treatment guide for the spine surgeon based on the 5th Edition of the World Health Organization bone and soft-tissue tumor classification.

Background:In 2020, the World Health Organization (WHO) published the 5th version of the soft tissue and bone tumor classification. Based on this novel classification system, we reviewed the current knowledge on all tumor entities with spinal manifestations, their biologic behavior, and most importantly the appropriate treatment options as well as surgical approaches.Methods:All tumor entities were extracted from the WHO Soft-Tissue and Bone Tumor Classification (5th Edition). PubMed and Google Scholar were searched for the published cases of spinal tumor manifestations for each entity, and the following characteristics were extracted: Growth pattern, ability to metastasize, peak age, incidence, treatment, type of surgical resection indicated, recurrence rate, risk factors, 5-year survival rate, key molecular or genetic alterations, and possible associated tumor syndromes. Surgical treatment strategies as well as nonsurgical treatment recommendations are presented based on the biologic behavior of each lesion.Results:Out of 163 primary tumor entities of bone and soft tissue, 92 lesions have been reported along the spinal axis. Of these 92 entities, 54 have the potential to metastasize. The peak age ranges from conatal lesions to 72 years. For each tumor entity, we present recommended surgical treatment strategies based on the ability to locally destruct tissue, to grow, recur after resection, undergo malignant transformation as well as survival rates. In addition, potential systemic treatment recommendations for each tumor entity are outlined.Conclusion:Based on the 5th Edition of the WHO bone and soft tumor classification, we identified 92 out of 163 tumor entities, which potentially can have spinal manifestations. Exact preoperative tissue diagnosis and interdisciplinary case discussions are crucial. Surgical resection is indicated in a significant subset of patients and has to be tailored to the specific biologic behavior of the targeted tumor entity based on the considerations outlined in detail in this article.

Targeted therapy in the treatment of HER-2 positive breast cancer with brain metastases

Metastatic damage to the brain is a frequent manifestation in tumors of various localizations, including breast cancer. Until recently, systemic therapy of metastatic brain damage was of limited use; however, with the advent of targeted drugs that are better understood in terms of the specific molecular targets and biological characteristics of metastases, it is now possible to improve treatment results. In an analysis of the results of studies on the problem of metastasis of breast cancer in the brain, a comparison of the use of various targeted drugs in the treatment of metastatic HER2 + breast cancer is presented. The results of a comparison of the degrees of effectiveness of targeted drugs, both in monotherapy and in combination with chemotherapy, were obtained and analyzed.

Tumor carcinoide primario de ovario que se presenta como enfermedad cardiaca carcinoide

El tumor carcinoide primario de ovario es una entidad poco frecuente que se caracteriza por la producción de sustancias vasoactivas que pasan directamente al torrente circulatorio y producen el llamado síndrome carcinoide. Estas sustancias también son las causantes de la formación de placas de fibrosis en las válvulas cardiacas, principalmente las derechas. Presentamos un caso de tumor carcinoide primario de ovario con afectación de la válvula tricúspide, que fue diagnosticado a partir de la lesión cardiaca. En la literatura están descritos casos clínicos aislados y revisiones de casos que nos pueden ayudar en el diagnóstico y en la toma de decisiones terapéuticas. Debemos conocer la existencia de estos tumores; la clínica debe alertarnos sobre su presencia. Es primordial un manejo multidisciplinar junto con endocrinólogos, cardiólogos, oncólogos, anatomo-patólogos, anestesistas, ginecólogos y cirujanos cardiacos, para ofrecer un tratamiento completo.

RNA-Binding Motif Protein 38 as a Potential Biomarker and Therapeutic Target in Cancer.

RNA-binding proteins (RBPs) act as a key factor in gene regulation by governing RNA metabolism. They contribute to the expression and functions of most RNAs by binding to them and forming complexes. RNA-binding motif protein 38 (RBM38), a member of the RBP family, alters the stability and translation of targeted mRNAs to affect various biological processes, such as cell proliferation, cell cycle arrest, and myogenic differentiation. RBM38 contains a highly conserved RNA recognition motif (RRM) consisting of two subunits, RNP1 and RNP2, which specifically bind to RNAs. Recent studies have revealed that RBM38 regulates the mRNA stability of several tumor-related genes, such as p53, mdm2, p63, p73, p21, and c-Myc, by binding to their 3′ untranslated regions (3′ UTRs); thus, RBM38 modulates targeted gene expression and affects the biological processes of tumors. In addition, abnormal RBM38 expression in some malignant tumors and its correlation with prognosis have been documented in many studies, indicating its value for potential clinical applications. In this review, we present an overview of RBM38, specifically highlighting its relationship with tumor manifestation and development. A brief overview of the potential use of RBM38 in cancer therapy is also included to provide ideas for further research on RBM38.

Sector Irradiation vs. Whole Brain Irradiation After Resection of Singular Brain Metastasis-A Prospective Randomized Monocentric Trial.

To minimize recurrence following resection of a cerebral metastasis, whole-brain irradiation therapy (WBRT) has been established as the adjuvant standard of care. With prolonged overall survival in cancer patients, deleterious effects of WBRT gain relevance. Sector irradiation (SR) aims to spare uninvolved brain tissue by applying the irradiation to the resection cavity and the tumor bed. 40 were randomized to receive either WBRT (n = 18) or SR (n = 22) following resection of a singular brain metastasis. Local tumor control was satisfactory in both groups. Recurrence was observed earlier in the SR (median 3 months, 1–6) than in the WBRT cohort (median 8 months, 7–9) (HR, 0.63; 95% CI, 0.03–10.62). Seventeen patients experienced a distant intracranial recurrence. Most relapses (n = 15) occurred in the SR cohort, whereas only two patients in the WBRT group had new distant tumor manifestation (HR, 6.59; 95% CI, 1.71–11.49; p = 0.002). Median overall survival (OS) was 15.5 months (range: 1–61) with longer OS in the SR group (16 months, 1–61) than in the WBRT group (13 months, 3–52), without statistical significance (HR, 0.55; 95% CI, 0.69–3.64). Concerning neurocognition, patients in the SR group improved in the follow-up assessments, while this was not observed in the WBRT group. There were positive signals in terms of QOL within the SR group, but no significant differences in the global QLQ and QLQ-C30 summary scores were found. Our results indicate comparable efficacy of SR in terms of local control, with better maintenance of neurocognitive function. Unsurprisingly, more distant intracranial relapses occurred. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT01667640.

Orbital decompressive effect of endoscopic transorbital surgery for sphenoorbital meningioma.

This study was aimed at evaluating the orbital decompressive effect of endoscopic transorbital approach (TOA) in the management of sphenoorbital meningioma involving the orbit. Patients treated with TOA for this tumor from December 2016 to December 2019 were included, and the data were reviewed. Pre- and postoperative clinical and imaging findings were compared with a volumetric study. Eighteen patients (two men and 16 women) were included. Lateral wall hyperostosis (13 patients), extraconal tumor infiltration (18 patients), intraconal tumor infiltration (seven patients), and superior and lateral rectus encasement (nine patients) were found. Intraconal tumor infiltration in the posterior orbit affected compressive optic neuropathy (CON) more often than other tumor manifestations. The orbital soft tissue volume decreased to 91.18% ± 8.19% compared to that in the contralateral side preoperatively. The postoperative volume increased to 113.73% ± 12.92% compared to the preoperative volume. The average values of LogMAR visual acuity and visual field index score of ten patients with CON improved from 0.80 to 0.42 and 48.9 to 65.9%, respectively. All 17 patients with proptosis showed improvement after surgery. There were no significant complications associated with the surgery. Additional treatment, including gamma knife surgery, was applied to 12 cases for the remaining tumor. This minimally invasive surgical debulking procedure was successful in treating sphenoorbital meningioma without significant adverse events. Lateral orbital wall decompression and limited intraorbital tumor resection were effective for compressive orbitopathy from the tumor.

Tumors of the orofacial zone in children and adolescents (literature review)

Relevance.The relevance of the literature review presented by the authors is due to the diversity and complexity of the differential diagnosis of tumors of the orofacial zone in children and adolescents. Against the background of the absolute predominance of benign neoplasms, about 10-20% falls on the share of malignant neoplasms in this area. In this regard, polyclinic specialists often do not show sufficient oncological alertness, which leads to an unjustified lengthening of the diagnostic period and late diagnosis of malignant neoplasms.The purposeof the literature review is to discuss the results of studies on the epidemiological, clinical and therapeutic features of the tumor process in the orofacial zone in children and adolescents.Materials and methods.The searching of publications on the subject of the review were performed in the databases: https://www.ncbi.nlm.nih.gov/, https://elibrary.ru/cit_title_items.asp, https://www.researchgate.net/, https://elibrary.ru/. The authors describe the clinical manifestations of tumors depending on the location of the lesion and histological affiliation. The initial symptoms of both malignant and benign neoplasms are often nonspecific. Prevailing benign neoplasms can only be treated by surgery. Much less often in children and adolescents, malignant neoplasms are also found: squamous cell carcinoma of the oral cavity, Langerhans cell histiocytosis and others, which are treated in accordance with the principles of complex / combined anticancer therapy, including courses to minimize the amount of rehabilitation. Results.Timely diagnosis and prevention of the development of neoplasms in the orofacial area can reduce the severity of morphological and functional disorders in children and adolescents. Despite the use of effective methods of surgical or combination therapy, many need rehabilitation measures.Conclusions.The optimal position of a pediatrician, therapist, dentist, or surgeon at the stage of tumor diagnosis should be the implementation of oncological alertness, which implies an active approach without long-term "dynamic observation" of patients. Oncological alertness, especially among dentists, will improve the results of antitumor therapy in patients with Orofacial tumors.

Endocrine manifestations of central nervous system germ cell tumors in children

IntroductionCentral nervous system germ cell tumors need to be adequately diagnosed because their treatment is usually effective and they do not always require surgery. The study objectives are to describe the endocrine manifestations of these tumors and to compare the time of their onset to that of the occurrence of neurological and visual changes. Patients and methodsThe medical histories of patients under 14 years of age seen at a pediatric endocrinology unit between 2000 and 2018 were reviewed. Wilcoxon and Fisher statistical tests were performed. ResultsWe found 12 patients (10 females) with an age at diagnosis of 9.4±1.7 years and a follow-up time of 5.5±3.0 years, 10 with tumors in the sellar region, and each one with a pineal gland and a bifocal tumor. Clinical changes leading to diagnosis were neurological and/or visual in nine patients and hormonal in three. Seven patients diagnosed on the basis of neurological or visual symptoms had previously reported hormonal changes, giving us a total of 10 children at diagnosis (the most common diagnosis was central diabetes insipidus, found in 8). Endocrine symptoms had been present before diagnosis for 25.0±26.2 months, considerably longer than neuro-ophthalmological complaints (2.0±2.1 months, p=0.012). ConclusionsAlmost all intracranial germ cell tumors have associated endocrine manifestations at diagnosis, with central diabetes insipidus the most common. Hormonal symptoms usually appear long before neuro-ophthalmological manifestations. Adequate clinical and endocrinological assessment may allow for an earlier diagnosis of these tumors.

Primary Myxoid Liposarcoma of the Lower Back in an Adult Female Patient: An Extremely Rare Presentation

Myxoid liposarcoma is the second most common type of liposarcoma that typically presents in the lower extremities and has a predilection for men. Manifestation of this tumor in the lower back is rare. We report the first known case of an adult woman presenting with a soft tissue mass in her lower back. Following excision and further workup, the mass was positive for rearrangements of the DDIT3 ( CHOP ) gene at the 12q13 locus, consistent with the diagnosis of a myxoid liposarcoma. The tumor was noted to be intramuscular and extended into the margins, requiring re-excision at the previous resection site. Biopsy of the re-excised area was negative for evidence of residual myxoid liposarcoma. We report this case to highlight the importance of considering myxoid liposarcoma as a differential diagnosis in soft tissue masses presenting in the lower back. J Med Cases. 2020;11(11):342-344 doi: https://doi.org/10.14740/jmc3558

Abordaje de la vía aérea difícil en un paciente con ameloblastoma gigante en maxilar inferior

Entre las principales manifestaciones de tumores de cabeza y específicamente de la cavidad oral se encuentran los de tipo odontógenicos, y de estos el más frecuente es el ameloblastoma. Este puede condicionar la presencia de una vía aérea difícil para el anestesiólogo, que debe estar entrenado para todos los escenarios disponibles en su manejo. El objetivo del presente trabajo es presentar y discutir el caso clínico de un paciente con diagnóstico de ameloblastoma gigante con predictores positivos de vía aérea difícil. Se trata de un paciente masculino de 39 años, quien refiere inicio de enfermedad actual hace ocho años, caracterizado por una lesión tumoral a nivel de maxilar inferior de 13 centímetros de largo y 16 centímetros de ancho, unilobulada y de consistencia dura a la palpación. La preparación de la fosa nasal se realizó con la administración de oximetazolina, seguido de lidocaína al 2 % (atomizador 3 push), por catéter nasal; también se le realizó bloqueo del nervio laríngeo superior bilateral, y se le administró atropina como antisialogogo. Se procedió a introducir el broncofibroscopio. El abordaje de la vía aérea difícil con un broncofibroscopio en el paciente estudiado fue realizado eficazmente, a pesar de tener el diagnóstico de un ameloblastoma gigante en maxilar inferior, que condicionó la presencia de predictores de vía aérea difícil. El paciente estudiado presentó una clasificación de Mallampati grado III. El abordaje de vía aérea difícil predecible con el uso del broncofibroscopio es efectivo en manos entrenadas en pacientes con diagnóstico de ameloblastoma gigante.

Orbital metastasis: Clinical presentation and survival in a series of 11 cases.

Orbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20%-42%. The clinical presentation and survival is presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. Descriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastasis involving the orbit was included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. One-half (50%) of the patients were women. Mean age at diagnosis was 60.9 years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases); followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation, and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8 months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5 months) and in the active treatment group (median 29.2 months), p=.034. In the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

Metástasis orbitarias: presentación clínica y supervivencia en una serie de 11 casos

Background and objectiveOrbital metastases are an uncommon condition. They may be the clinical presentation of a previously unknown malignancy. Depending on the series, the rate of orbital metastasis as a first manifestation of a malignant tumour is 20-42%. The clinical presentation and survival are presented in a series of 11 cases of orbital metastasis corresponding to 10 patients. Material and methodsDescriptive retrospective study of a series of 10 adult patients diagnosed with orbital metastasis from solid tumours during a 9-year period. Metastases involving the orbit were included, and lymphomas and contiguity invasions from adjacent structures were excluded. A note was made on whether the clinical picture was the first sign of tumour onset. Signs and symptoms at clinical debut were registered, as were primary tumour location, distance seeding, orbital structures involved, and survival time since the diagnosis was established. ResultsOne-half (50%) of the patients were women. Mean age at diagnosis was 60.9years (range 42-82). In nine cases (90%), the metastasis was unilateral, while in the remaining one the involvement was bilateral. The most frequent primary tumour location was the breast (36% of the cases), followed by the bladder (27%), lung (18%), and ovary and cavum (9%). Seventy percent of the patients had a previously diagnosed neoplasm; in 3 cases the metastasis was the first malignancy manifestation. Most frequent symptoms were diplopia (60%), visual impairment (40%), and pain (30%). The most common signs were resistance to ocular retropulsion (60%), presence of a mass on orbital palpation and ocular dystopia (50%), and bulbar hyperaemia and proptosis (40%). The most employed management modality was clinical observation (5 patients). In 3 patients radiotherapy was administered, combining chemotherapy plus hormonal therapy in one case, and orbital exenteration in another one. In 2 cases, chemotherapy was administered as an isolated regime. Median survival time was 4.8months since the diagnosis. There was a statistically significant difference between the survival time in the observation group (median 2.5months) and in the active treatment group (median 29.2months), P=.034. ConclusionsIn the series presented, 27% of the cases established the clinical debut of the malignant neoplasm. The ophthalmologist plays an essential role when this condition is suspected, diagnosing it, and proposing its management together with the Oncology Service.

Renal Manifestations of Tuberous Sclerosis Complex

Tuberous sclerosis complex (TSC) is a genetic condition caused by a mutation in either the TSC1 or TSC2 gene. Disruption of either of these genes leads to impaired production of hamartin or tuberin proteins, leading to the manifestation of skin lesions, tumors and seizures. TSC can manifests in multiple organ systems with the cutaneous and renal systems being the most commonly affected. These manifestations can secondarily lead to the development of hypertension, chronic kidney disease, and neurocognitive declines. The renal pathologies most commonly seen in TSC are angiomyolipoma, renal cysts and less commonly, oncocytomas. In this review, we highlight the current understanding on the renal manifestations of TSC along with current diagnosis and treatment guidelines.

Renal Manifestations of Tuberous Sclerosis Complex.

Tuberous sclerosis complex (TSC) is a genetic condition caused by a mutation in either the TSC1 or TSC2 gene. Disruption of either of these genes leads to impaired production of hamartin or tuberin proteins, leading to the manifestation of skin lesions, tumors, and seizures. TSC can manifest in multiple organ systems with the cutaneous and renal systems being the most commonly affected. These manifestations can secondarily lead to the development of hypertension, chronic kidney disease, and neurocognitive declines. The renal pathologies most commonly seen in TSC are angiomyolipoma, renal cysts, and less commonly, oncocytomas. In this review, we highlight the current understanding on the renal manifestations of TSC along with current diagnosis and treatment guidelines.

Unusual manifestation of an endocrine-active testicular tumor

Unusual manifestation of an endocrine-active testicular tumor

Risk of malignancy in Caroli disease and syndrome: A systematic review.

BACKGROUNDCongenital intrahepatic bile duct dilatation without fibrosis is called Caroli disease (CD), and is called Caroli syndrome (CS) when it has fibrotic and cirrhotic liver morphology. The development of intrahepatic carcinoma is described in both conditions, but the reported incidence varies extensively. Potential risk factors for the malignant transformation were not described. Furthermore, conservative or surgical treatment is performed depending on the extent of cystic malformation, hepatic dysfunction and structural hepatic changes, but little is known about which treatment should be offered to patients with CD or CS and cancer.AIMTo further investigate the malignant transformation in these conditions.METHODSA systematic review of the current literature until January 2019 was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A search using Medline (PubMed) was performed using a combination of Medical Subject Headings terms “caroli disease”, “caroli syndrome”, “tumor”, “malignant”, and “cholangiocarcinoma”. Only human studies published in English were used for this systematic review. The following parameters were extracted from each article: year of publication, type of study, number of patients, incidence of malignant tumor, duration of symptoms, age, sex, diagnostics, identification of tumor, surgical therapy, survival and tumor recurrence.RESULTSTwelve retrospective studies reporting the courses of 561 patients (53% females) were included in this systematic review. With a mean age of 41.6 years old (range 23 to 56 years old), patients were younger than other populations undergoing liver surgery. Depending on the size of the study population the incidence of cholangiocarcinoma varied from 2.7% to 37.5% with an overall incidence of 6.6%. There were only few detailed reports about preoperative diagnostic work-up, but a multimodal work-up including ultrasound of the liver, computed tomography, magnetic resonance imaging and endoscopic retrograde cholangiopancreatography was used in most studies. Disease duration was variable with up to several years. Most patients had episodes of cholangitis, sepsis, fever or abdominal pain. Tumor detection was an incidental finding of the surgical specimen in most cases because it is currently often impossible to detect tumor manifestation during preoperative diagnostics. Liver resection or liver transplantation was performed depending on the extent of the biliary pathology and additional alterations of the liver structure or function. No postoperative adjuvant chemotherapy was reported, but chemotherapy was administered in selected cases of tumor recurrence. Overall survival rates after one year were low at 36% and a high recurrence rate of up to 75% during the observation period.CONCLUSIONOnly few retrospective studies reported a low tumor incidence. Despite the high rate of mortality and tumor recurrence, definite surgical treatment should be offered as soon as possible.

A clinical case of central cancer of the lung and infiltrative tuberculosis

The scientific challenge of combining the tuberculosis process and lung cancer has not been fully disclosed in modern literature. This primarily involves the low incidence of these two pathologies at the same time. This may contribute to difficulties in the qualitative and timely diagnosis of these diseases. Tuberculosis hides the radiological manifestations of a malignant tumor for a long time that contributing to its progression and the development of high mortality among patients. Lung cancer facilitates hemato- and lymphogenous spread of a specific pathogen. As an example, a clinical case of simultaneous occurrence of pulmonary tuberculosis and lung cancer which was observed in the patient admitted to the Department for patients with respiratory tuberculosis of Nizhny Novgorod regional clinical tuberculosis dispensary, was presented. We concluded that compliance with the algorithm of the mandatory diagnostic minimum when patients admitted to the general healthcare network, as well as compliance with the rules for population screening, especially among people over 45, will minimize the risks of delayed diagnosis in case of coexistence of respiratory tuberculosis and lung cancer.

Diabetes insipidus after suprasellar tumor surgery: case report

Introduction: Diabetes insipidus (DI) is a rare water and electrolyte imbalance with hypovolemic hypernatremia characteristic (1:25.000) however can be potentially fatal if not well-anticipated and managed adequately. Brain tumors, either operated or not, may lead to DI (25%). Based on anatomical location, the suprasellar tumor may cause hypophyseal hormone dysfunction. Sellar region tumors can be classified into hypophyseal (90%) and non-hypophyseal (10%). Non-hypophyseal tumors with neurological deficits are more often causing hypophyseal hormone hyposecretion including DI. Sellar tubercle meningioma is one of the sellar region non-hypophyseal tumors which is often encountered and surgically managed. Worsening symptoms may become the surgical indication e.g. headache and visual disturbance. Case: We are reporting two meningioma cases in Salatiga local hospital with almost similar tumor characteristics either size and frontal lobe location. Both cases were managed by similar transcranial tumor excision craniotomy. Their differences were in the presence of neurological manifestations and the degree of hypothalamic compression. One patient developed postoperative DI without thirst thus the clinical manifestation was polyuria which was closely monitored in the intensive ward. We were convinced that the DI incidence was affected by the tumor manifestation and location which can be assessed by computed tomography (CT) scans. Conclusion: The clinicians should anticipate the possibility of post craniotomy DI thus may provide adequate monitoring and management in patients developing postoperative DI.

Benefits of 11C-methionine PET/MRI and intraoperative fluorescence in treating hyperparathyroidism

Multiple endocrine neoplasia 1 (MEN1) is a rare genetic syndrome characterized by the manifestation of tumors in endocrine glands most often in the parathyroid gland (PG). Treatment may involve several parathyroidectomies (PTX), especially in young patients, which increases the risk of postoperative complications. We present a 16-year-old patient with a family history of MEN1 syndrome. The patient started to show biochemical signs of hyperparathyroidism (HPT) and hypercalcemia at the age of 10. One and a half years later a PTX was successfully performed with removal of the two left PGs. However, a rise in plasma parathyroid hormone and ionized calcium was observed 4 years later. Preoperative noninvasive imaging with 99mTc-sestamibi scintigraphy showed no definitive parathyroid adenoma. A 11C-methionine position emission tomography combined with MRI (MET-PET/MRI) was then performed and detected a focus posterior to the lower part of the right thyroid lobe. Intraoperative angiography with fluorescence and indocyanine green dye was used to assess the vascularization of the remaining PGs. The lower right PG was removed. The patient was discharged with normalized biochemical values and without postoperative complications. Recurrence of primary HPT is frequent in MEN1 patients which often necessitates repeated operations. Our case report showed that the use of advanced noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration in selected cases to avoid postoperative complications. To our knowledge, this is the first case where MET-PET/MRI has been used to detect parathyroid pathology.Learning points:MEN1 patients will develop parathyroid disease, which eventually will lead to surgical treatment with removal of the pathological glands.Preoperatively usage of MRI combined with PET tracers such as 11C-methionine and 18F-Fluorocholine are able to detect parathyroid pathology with a higher sensitivity than conventional imaging.Techniques using intraoperatively angiography with fluorescence and florescent dyes allow surgeons to verify the vascularization of each parathyroid gland.Optimization of noninvasive preoperative imaging techniques and intraoperative fluorescent imaging are valuable tools and should be taken into consideration when performing PTX consecutively in the same patient to avoid postoperative complications.

MR-Guided High-Power Microwave Ablation in Hepatic Malignancies: Initial Results in Clinical Routine

PurposeEvaluation of technique effectiveness, patient safety and ablation parameters of MR-guided microwave ablation in hepatic malignancies using an MR-conditional high-power microwave ablation system.Materials and MethodsInstitutional review board approval and informed patient consent were obtained. Patients who underwent MR-guided microwave ablation of hepatic malignancies in a 1.5T wide-bore scanner using a perfusion-cooled high-power microwave ablation system with a maximum generator power of 150 W were included. Ablation parameters comprising procedure durations, net ablation duration, applicator positions and ablation zone dimensions were recorded. Adverse events were classified according to the CIRSE classification system. Technique effectiveness was assessed after 1 month. Follow-up was conducted with contrast-enhanced MRI and ranged from 1 to 20 months (mean: 6.1 ± 5.4 months).ResultsTwenty-one consecutive patients (age: 63.4 ± 10.5 years; 5 female) underwent 22 procedures for 28 tumours (9 hepatocellular carcinomas, 19 metastases) with a mean tumour diameter of 14.6 ± 5.4 mm (range: 6–24 mm). Technique effectiveness was achieved in all lesions. Tumours were treated using 1.7 ± 0.7 applicator positions (range: 1–3). Mean energy and ablation duration per tumour were 75.3 ± 35.4 kJ and 13.3 ± 6.2 min, respectively. Coagulation zone short- and long-axis diameters were 29.1 ± 6.4 mm and 39.9 ± 7.4 mm, respectively. Average procedure duration was 146.4 ± 26.2 min (range: 98–187 min). One minor complication was reported. Five patients developed new tumour manifestations in the untreated liver. Local tumour progression was not observed during initial follow-up.ConclusionMR-guided high-power microwave ablation provides safe and effective treatment of hepatic malignancies with short ablation times and within acceptable procedure durations.