Necrotic Components Research Articles

TREATMENT OF TROPHIC COMPLICATIONS IN DECOMPENSATED FORMS OF IMPAIRED ARTERIAL BLOOD CIRCULATION OF THE LOWER EXTREMITIES

Summary. The aim of the study was to study the clinical effectiveness of using the developed method of cryopreservation on wound surfaces using a cryopreservation device. Materials and methods. 87 patients with ulcerative-necrotic defects of the lower legs and feet were selected for the study. The condition for inclusion in the study was Phase I of the wound process. Patients were divided into the main and comparison groups. The main group included 41 patients who had their wounds cleaned according to the proposed method, and the comparison group consisted of 46 patients who underwent surgical treatment. Results. The use of cryodestruction of the surface of trophic ulcers of arterial etiology led to rapid cleaning of necrotic masses, fibrin, a decrease in exudation and pain intensity, and the disappearance of unpleasant odors. The effectiveness of the methods lies in the fact that not only necrotic components of the wound surface, fibrin films, as well as the surface layers of ulcer surface cells are destroyed, that is, phenotypically altered cells of the wound edge and base are removed, leading to a violation of regeneration processes. Conclusions. Debridment methods based on the use of controlled cryodestruction of pathological tissues on the surface of trophic ulcers accelerate the transition of the wound process to phase II by 25% in patients with trophic ulcers with critical ischemia of the lower extremities.

Role of Advanced Magnetic Resonance Imaging in Differentiating among Glioma Subtypes and Predicting Tumor-Proliferative Behavior

Abstract Objective Gliomas are a devastating and heterogeneous group of primary brain tumors. Previously, the source of glioma was undetermined. Recent literature indicates that neural stem cells, or progenitors, are proposed to be the source of glioma. The prognosis of different types of gliomas differs due to their various biological tissue types. Besides the histological grade, the two useful immunohistochemistry markers that show the tumor's biological behavior are isocitrate dehydrogenase (IDH) labeling and the Ki-67 labeling index. We sought to determine the magnetic resonance imaging (MRI) characteristics associated with IDH mutational status and ascertain whether MRI combined with IDH mutational status, can better predict the clinical outcomes of gliomas. Materials and Methods This period study was conducted in the Department of Radiology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India for 5 years (May 2016–May 2021). The study cohort included 30 patients diagnosed with gliomas who underwent preoperative MRI followed by surgical resection and histopathological examination. Preoperative MRI images were done to assess qualitative tumor characteristics such as location, margin of tumor, extent, cortical involvement, cystic component, mineralization or hemorrhage, and contrast enhancement. Discussion Differences in MRI features between IDH-mutant (MT) and IDH-wild-type (WT) groups were analyzed using the chi-square test for categorical variables and the Mann–Whitney U test for continuous variables. Statistical analysis was conducted using SPSS software. Results Among the 30 patients evaluated, 18 had IDH-WT and 12 had IDH-MT type gliomas. Male predominance (73.33%) was noted in our study. Brainstem location, indistinct borders (83.33%), less cortical involvement (72.22%), less cystic changes (88.89%), more area of necrotic component (44.44%), significantly increased choline/creatine (Cho/Cr) ratio, and choline/N-acetyl aspartate (Cho/NAA) ratio favors IDH-WT tumors. Positive T2-fluid-attenuated inversion recovery mismatch sign is more frequently seen in IDH-MT (7/12; 58.33%) tumors than in IDH-WT (4/18; 22.22%) tumors. Whereas well-defined contours (66.67%), more cortical involvement (83.33%), more cystic changes (58.33%), and less area of necrotic component favor IDH-MT type tumors. Conclusion MRI is a very promising and valuable tool for differentiating among glioma subtypes and predicting tumor-proliferative behavior in glioma cases. The combination of MRI characteristics with IDH mutation status enhances the predictive accuracy for clinical outcomes in glioma patients. This approach could potentially guide treatment planning and improve prognostic assessments.

Differentiating between Lymphoma and Metastasis Presenting as Solid Cerebellar Mass Lacking Necrosis

Objectives: This study aimed to identify radiologic features that differentiate lymphoma from metastasis manifesting as a solid enhancing mass lacking necrosis in the cerebellum. Methods: Pathologically confirmed 24 primary central nervous system lymphoma (PCNSL) and 32 metastasis patients with solid enhancing cerebellar masses without necrotic or hemorrhagic components were retrospectively analyzed. We evaluated the imaging characteristics using contrast-enhanced magnetic resonance imaging (MRI). The serrate sign was defined as a tumor spreading along white matter with branch-like enhancement or outward spikes. Results: The serrate sign was exclusively identified in the PCNSL group, showing a significant difference compared to the metastasis group (75.0% vs. 0%, p < 0.001). Homogeneous enhancement occurred more frequently in PCNSL than in metastasis (91.7% vs. 21.9%, p < 0.001). Conversely, bulging contour (62.5% vs. 4.2%, p < 0.001) and surface involvement (71.9% vs. 29.2%, p = 0.003) were more prevalent in metastasis than PCNSL. For predicting PCNSL, the serrate sign demonstrated 75.0% sensitivity, 100% specificity, 100% positive predictive value, 84.2% negative predictive value, and 89.3% accuracy. Conclusions: This study found that the serrate sign and homogeneous enhancement are reliable MRI features for differentiating cerebellar PCNSL from metastasis, whereas a bulging contour and surface involvement suggest metastasis. The serrate sign demonstrated diagnostic significance in differentiating PCNSL from metastasis.

Schwann cell-secreted frizzled-related protein 1 dictates neuroinflammation and peripheral nerve degeneration after neurotrauma.

Neurotrauma in limbs can induce sustained neuroinflammation, resulting in persistent disruption of nerve tissue architecture and retardation of axon regrowth. Despite macrophage-mediated inflammation promoting the removal of necrotic neural components and stimulating neo-vessel ingrowth, detrimental shifts in macrophage phenotype exacerbate nerve degeneration. Herein, we find that peripheral nerve injuries (PNIs) result in abundant secreted frizzled-related protein 1 (sFRP1) expression, particularly by Schwann cells (SCs). Heat shock protein 90 (HSP90) in macrophages recognizes sFRP1 and triggers a dysregulated secretion of inflammatory mediators. Single-cell atlas of human injured peripheral nerves reveals the appearance of sFRP1-expressing SCs with mesenchymal traits and macrophages with a proinflammatory genetic profile. Deletion of either SC-specific sFRP1 or macrophage-specific HSP90 alleviates neuroinflammation and prevents the progression of nerve degeneration. Together, our findings implicate the response of macrophages to SC-derived sFRP1 in exacerbating nerve damage following PNIs.

The Role of Amide Proton Transfer (APT)-Weighted Imaging in Glioma: Assessment of Tumor Grading, Molecular Profile and Survival in Different Tumor Components.

Amide Proton Transfer-weighted (APTw) imaging is a molecular MRI technique used to quantify protein concentrations in gliomas, which have heterogeneous components with varying cellularity and metabolic activity. This study aimed to assess the correlation between the component-specific APT signal of the neoplasm and WHO grade, molecular profile and survival status. Sixty-one patients with adult-type diffuse gliomas were retrospectively analyzed. APT values were semi-automatically extracted from tumor solid and, whenever present, necrotic components. APT values were compared between groups stratified by WHO grade, IDH-mutation, MGMT promoter methylation and 1- and 2-year survival status using Wilcoxon rank-sum test, adjusting for multiple comparisons. Overall survival (OS) was analyzed in the subgroup of 48 patients with grade 4 tumors using Cox proportional-hazards models. Random-effects models were used to assess inter-subject heterogeneity of the mean APT values in each tumor component. APT values of the solid component significantly differed between patients with grades 2-3 and 4 tumors (mean 1.58 ± 0.50 vs. 2.04 ± 0.56, p = 0.028) and correlated with OS after 1 year (1.81 ± 0.58 in survivors vs. 2.17 ± 0.51 in deceased patients, p = 0.030). APT values did not differ by IDH-mutation, MGMT methylation, and 2-year survival status. Within grade 4 glioma patients, higher APT kurtosis of the solid component was a negative prognostic factor (hazard ratio = 1.60, p = 0.040). Mean APT values of the necrosis showed high inter-subject variability, although most necrotic tumors were grade 4 and IDH wildtype. In conclusion, APTw imaging in the solid component provided metrics associated with glioma grade and survival status but showed weak correlation with IDH-mutation and MGMT promoter methylation status, in contrast to previous works. Further research is needed to understand APT signal variability within the necrotic component of high-grade gliomas.

Primary Retroperitoneal DOG-1 Positive & P16 Negative Squamous Cell Carcinoma in a Male – A Rare Case Report

Retroperitoneal neoplasms represent a rare subset of tumors, accounting for only 0.1–0.2% of all cancers. Among them, squamous cell carcinoma (SCC) arising in the retroperitoneal cavity is exceedingly rare, with limited understanding of its pathogenesis and clinical features. Here, a case of primary retroperitoneal squamous cell carcinoma is reported in a male patient who presented with complains of abdominal pain and recurrent diarrhea. On radiological imaging, a large, heteroechoic mass with necrotic components enveloping the celiac trunk in the retroperitoneal region was noted. Histopathological assessment of a core biopsy confirmed a malignant tumor with large atypical cells in clusters with moderate to marked nuclear pleomorphism, prominent nucleoli and abundant eosinophilic to clear cytoplasm. An immunohistochemical (IHC) panel, including markers such as Epithelial Membranous Antigen (EMA), PanCK, CK7, CK20, DOG-1, CD117, β-Catenin, SOX10, CD10, SMA, S100, CEA, TTF-1, CDX2, HMB45, p16, p53, p40 and p63 was systematically conducted for further characterization. Based on the Immunohistochemical (IHC) results, a myriad of differentials were ruled out and the diagnosis of primary retroperitoneal squamous cell carcinoma with DOG1 positivity and P16 negativity was established. Based on extensive research conducted on PubMed, Scopus, and Google Scholar, it appears that this case could potentially be the first documented instance of a male patient with primary retroperitoneal squamous cell carcinoma exhibiting positive DOG1 and negative p16.

Radiomics Based Differentiation of Glioblastoma and Metastatic Disease: Impact of Different T1-Contrast Enhanced Sequences on Radiomic Features and Model Performance.

To evaluate the radiomics-based model performance for differentiation between glioblastoma (GB) and brain metastases (BM) using magnetization prepared rapid gradient echo (MPRAGE) and volumetric interpolated breath-hold examination (VIBE) T1-contrast enhanced sequences. T1-CE MPRAGE and VIBE sequences acquired in 108 patients (31 GBs and 77 BM) during the same MRI session were retrospectively evaluated. Post standardized image pre-processing and segmentation, radiomics features were extracted from necrotic and enhancing tumor components. Pearson correlation analysis of radiomics features from tumor subcomponents was also performed. A total of 90 machine learning (ML) pipelines were evaluated using a five-fold cross validation. Performance was measured by mean AUC-ROC, Log-loss and Brier scores. A feature-wise comparison showed that the radiomic features between sequences were strongly correlated, with the highest correlation for shape-based features. The mean AUC across the top-ten pipelines ranged between 0.851-0.890 with T1-CE MPRAGE and between 0.869-0.907 with T1-CE VIBE sequence. Top performing models for the MPRAGE sequence commonly used support vector machines, while those for VIBE sequence used either support vector machines or random forest. Common feature reduction methods for top-performing models included linear combination filter and least absolute shrinkage and selection operator (LASSO) for both sequences. For the same ML-feature reduction pipeline, model performances were comparable (AUC-ROC difference range: [-0.078, 0.046]). Radiomic features derived from T1-CE MPRAGE and VIBE sequences are strongly correlated and may have similar overall classification performance for differentiating GB from BM. BM: Brain metastases, GB: glioblastoma, T1-CE: T1 contrast enhanced sequence, MPRAGE: magnetization prepared rapid gradient echo, ML: machine learning, RF: random forest, VIBE: volumetric interpolated breath-hold examination.

Unusual manifestation of pancreatic cancer in a young patient

Pancreatic cancer, often described as the most devastating among cancers, characterized by a malignant tumor with a grim prognosis and a limited response to systemic therapy. Its characterization is common in old age and very rare and unusual in the young age. We present an unusual case of a male patient, 35 years old. A case of diabetes and of pancreatic cancer in the head of the pancreas with stomach and bone metastases, highlighting its diagnostic challenges and management. The patient presented with changed bowel habits for a month, generalized body aches for a week, hip joint pain with decreased mobility for a week, decreased oral intake for three to four days, and hematuria for two days. The patient complained of irregular bowel habits, which included fatty and oily feces, minor abdominal discomfort, and intermittent constipation. According to the patient, he developed generalized bone pain in upper as well as lower back unlike usually present in pancreatic cancer. A contrast-enhanced CT scan of the abdomen and pelvis revealed indications of a heterogeneously enhancing lesion in the pancreatic head, with an interior necrotic component measuring 32x31 mm and generating a substantial dilatation of the pancreatic duct and CBD. A tentative diagnosis of pancreatic cancer in the head of the pancreas with stomach and bone metastases was made based on clinical history and testing. Given the poor prognosis associated with pancreatic cancer patients, the patient was admitted for conservative and palliative care. This case emphasizes the rarity of pancreatic cancer in young patients and that further research is needed to understand its epidemiology and etiology.

Imaging characterization of paediatric tumours with the neurotrophic tyrosine receptor kinase fusion transcript.

The neurotrophic tyrosine receptor kinase (NTRK) fusion transcript (FT) is a major genetic landmark of infantile fibrosarcoma (IFS) and cellular congenital mesoblastic nephroma (cCMN) but is also described in other tumours. The recent availability of NTRK-targeted drugs enhances the need for better identification. We aimed to describe the anatomic locations and imaging features of tumours with NTRK-FT in children. Imaging characteristics of NTRK-FT tumours of 41 children (median age: 4 months; 63% <1 year old; range: 0-188) managed between 2001 and 2019 were retrospectively analysed. The tumours were located in the soft tissues (n = 24, including 19 IFS), kidneys (n = 9, including 8 cCMN), central nervous system (CNS) (n = 5), lung (n = 2), and bone (n = 1). The tumours were frequently deep-located (93%) and heterogeneous (71%) with necrotic (53%) or haemorrhagic components (29%). Although inconstant, enlarged intratumoural vessels were a recurrent finding (70%) with an irregular distribution (63%) in the most frequent anatomical locations. Paediatric NTRK-FT tumours mainly occur in infants with very variable histotypes and locations. Rich and irregular intra-tumoural vascularization are recurrent findings. Apart from IFS of soft tissues and cCMN of the kidneys, others NTRK-FT tumours locations have to be known, as CNS tumours. Better knowledge of the imaging characteristics may help guide the pathological and biological identification.

НЕ НЕОПЛАСТИЧНІ ОДИНОЧНІ ВОГНИЩЕВІ УРАЖЕННЯ ЛЕГЕНЬ: ПОРІВНЯЛЬНИЙ АНАЛІЗ КЛІНІКО-МОРФОЛОГІЧНИХ ПРОЯВІВ

Non-neoplastic solitary focal lesions of the lungs are a fairly common finding during radiological examination. The primary task in the medical management of such patients is to establish the nature of such formations, both in order to rule out a malignant process and for further treatment if necessary. The aim of the work was to conduct a comparative analysis of clinical, radiological data and the results of morphological diagnostics of non-neoplastic solitary focal lesions of the lungs, taking into account one of the important histological features, namely the absence or presence of a necrotic component in the pathological focus. Materials and methods. The study was cohort, retrospective and included all clinical observations for the period 2017-2021 years. 126 patients with solitary lung foci of a non-neoplastic nature with morphological diagnosis of these formations were selected. Patients were divided into two groups depending on the presence or absence of necrotic changes in the composition of the tumor, according to histological examination. The available history, clinical, general laboratory data for each patient, the results of a microbiological examination of the lung tissue for the presence of mycobacteria and non-specific microorganisms, the results of molecular genetic analysis for tuberculosis mycobacteria were evaluated. A number of clinical chemistry and immunology were also considered. Results. Study data are presented in tables. Differences between groups were analyzed. It was established that, in general, females predominate, and formations without necrotic lesions were observed more. common in older women. The main differences were related to the diagnostic procedure - in the group without necrotic changes only minimally invasive interventions were performed (47.6 % of cases); in the group with necrotic formations in most cases (83.4 %) the lung surgery was performed. In both groups, the average size of foci was almost the same (16-17 mm), no significant differences were found by radiological signs. The preliminary clinical diagnosis in most patients of both groups was “lesion of unknown origin”. Based on the results of morphological examination, it was found that cytology was not very informative in 18-50 % of cases. In 23.8 % of cases a specific inflammatory process was established or suspected when necrotic foci. In other cases an inflammation was determined. Histological examination made it possible to establish the etiology of the pulmonary focus in 91.3 % of cases. Moreover, a significantly larger spectrum of various pathological processes was established in cases of necrotized foci. Conclusion. A number of significant differences were objectively determined, mainly at the level of morphological diagnosis, between solitary non-neoplastic focal lesions with and without a necrotic component. Key words: non-neoplastic single lung foci, diagnostics.

A pregnant lady (G3P2A0) with fetal distress and brain tumor

Intracranial tumors or brain tumors are one of the most feared diseases because the brain is an important central organ. Brain tumors share several pathophysiologic features and may present with a variety of signs and symptom.&#x0D; A 39-year-old female patient, G3P2A0 of 28 weeks gestation complained of frequent throbbing headaches for the last 2 y. On physical examination, she had decreased consciousness, fever and anisocor pupil. Laboratory tests found leukocytosis. Cerebral multi-slice computed tomography (MSCT) found heterodense lesion at intraaxial supratentorial region with irregular border, necrotic components and bleeding in the right basal ganglia to the right temporal lobe. There were signs of fetal distress on cardiotocography (CTG).&#x0D; Management during pregnancy depends on the nature of the tumor. There may be some conflict between maternal and fetal interests in the patient with increased ICP. The patient was diagnosed with brain tumor in the right basal ganglia and undergoing treatment in the ICU. As a 28-week pregnant patient with fetal distress diagnosed with brain tumor, she needed to be observed and periodically evaluated. However, the patient's prognosis was dubia ad malam.&#x0D; Key words: Brain Tumor; Fetal Distress; Pregnancy&#x0D; Citation: Arianto AT, Heryadi MI. A pregnant lady (G3P2A0) with fetal distress and brain tumor. Anaesth. pain intensive care 2023;27(6):772−775; DOI: 10.35975/apic.v27i6.2233&#x0D; Received: May 22, 2923; Revised: August 08, 2023; Accepted: October 22, 2023

Diagnostic value of computed tomography myocardial perfusion imaging to detect coexisting microvascular dysfunction in patients with obstructive epicardial coronary artery disease.

Computed tomography myocardial perfusion (CT-MP) has reported usefulness in assessing hemodynamically significant epicardial coronary artery lesions. However, the diagnostic ability of the absolute coronary flow using CT-MP to detect coronary microvascular dysfunction (CMD) remains elusive. This prospective cohort study aimed to assess the diagnostic value of CT-MP in evaluating coexisting CMD in patients with functionally significant epicardial coronary stenosis and to analyze the predictive factors of lesions with CMD. Sixty-eight patients with chronic coronary syndrome (CCS) and de novo single functionally significant stenosis [fractional flow reserve (FFR) ≤0.80] were studied. CMD was defined as an index of microcirculatory resistance ≥25. We compare clinical background and CT-MP findings between patients with and without CMD (CMD, n=29; non-CMD, n=39). CT-MP, and quantitative and qualitative plaque assessments were included in computed tomography angiography assessment. Logistic regression analysis was performed to predict CMD. FFR, invasive wire-derived coronary flow reserve (CFRwire) and index of microcirculatory resistance were 0.68 [interquartile range (IQR), 0.59-0.74], 1.71 (IQR, 1.24-2.88), and 22.6 (IQR, 15.1-34.5), respectively. The rest and hyperemic-myocardial blood flow (MBF) and CT-MP-derived CFR (CFRCT-MP) were 0.83 (0.64-1.03) mL/min/g, 2.14 (1.30-2.92) mL/min/g, and 2.19 (1.44-3.37), respectively. In the territories with CMD, hyperemic-MBF was significantly lower than in those without [1.68 (IQR, 0.84-2.44) vs. 2.31 (IQR, 1.67-3.34) mL/min/g, P=0.015] and the prevalence of CFRCT-MP <2.0 was higher in the lesions with CMD than in those without (62.1% vs. 28.2%, P=0.011), while FFR values were similar. Fibrofatty and necrotic core component volume was greater in the vessels with CMD than in those without [31.8 (IQR, 19.0-48.9) vs. 25.1 (IQR, 17.2-32.1) mm3, P=0.045]. Multivariable logistic regression analysis showed that hyperemic-MBF and fibrofatty and necrotic core component volume were independent predictors of CMD territories [odds ratio (OR) =0.583; 95% confidence interval (CI): 0.355-0.958; P=0.033 and OR =1.040; 95% CI: 1.010-1.070; P=0.011]. Quantitative assessment of absolute coronary flow using pre-percutaneous coronary intervention (PCI) CT-MP, and comprehensive plaque analysis using computed tomography angiography may help detect coexisting subtended microvascular dysfunction in territories with functionally significant epicardial coronary lesions. Further studies are required to elucidate the clinical significance of coexisting CMD in patients with CCS undergoing PCI.

Cysts or necrotic components in pancreatic ductal adenocarcinoma is associated with the risk of EUS-FNA/B complications including needle tract seeding

BackgroundEUS-FNA/B for pancreatic ductal adenocarcinoma (PDAC) is generally considered to be safe; however, while the incidence is low, there are occurrences of complications. Among these complications, there are serious ones like needle tract seeding (NTS), and it is not known than which types of tumors have the risks of EUS-FNA/B complications. This study aimed to evaluate the risk of EUS-FNA/B complications in patients with PDAC, focusing on morphological features. MethodsOverall, 442 patients who underwent EUS-FNA/B for solid pancreatic masses between January 2018 and May 2022 in four institutions were retrospectively surveyed. Finally, 361 patients histopathologically diagnosed with PDAC were analyzed. Among these patients, 79 tumors with cysts or necrotic components were compared with 282 tumors without cysts or necrotic components. The incidence and risk of EUS-FNA/B complications including NTS were evaluated. ResultsThere were 9 (2.4 %) of total EUS-FNA/B complications and 3 (0.8 %) of NTS. The incidence of total complication rate and NTS in tumors with cysts or necrotic components were significantly higher than in those without cysts or necrotic components (total complication 6.3 % vs. 1.4 %, p = 0.026, NTS 3.7 % vs. 0 %, p = 0.01). The transgastric route of puncture (OR: 93.3, 95 % CI: 3.81–2284.23) and the existence of cysts or necrotic components (OR: 7.3, 95 % CI: 1.47–36.19) were risk factors for EUS-FNA/B complications identified by the multivariate analysis. ConclusionsWe should pay attention to the risks of EUS-FNA/B complications, including NTS, when the tumor has cysts or necrotic components.

FRI351 Pituitary Stalk Epidermoid Cyst: A Rare Cause Of Diabetes Insipidus

Abstract Disclosure: J.T. Batch: None. F. Warda: None. P. Natter: None. R. Makary: None. G.Y. Gandhi: None. Introduction: Epidermoid cysts are benign squamous epithelial cysts filled with keratin. They are rarely found in the central nervous system, constituting 0.2-1.8% of intracranial masses, with the majority located in the cerebellopontine angle. Case Report: A 34-year-old female presented with blurred vision, debilitating headaches, milky breast discharge, and no menstrual periods for three years. Prolactin was mildly high on two occasions at 40.3 and 52.8 ng/mL (3.0-30.0 ng/mL). Estradiol was low at 15 pg/ml in the setting of inappropriately normal FSH (10.1 mIU/mL) and LH (5.8 mIU/mL). ACTH, cortisol, TSH, free thyroxine, and IGF-1 were in the normal range. A pregnancy test was negative. A 1:100 diluted prolactin did not detect the hook effect. MRI revealed a 1.8 x 1.4 x 1.4 cm suprasellar mass centered along the pituitary stalk with peripheral enhancement and central cystic vs. necrotic components. It caused a mass effect on the optic chiasm. Formal visual field testing revealed a left inferior temporal defect. Subsequently, the patient reported increased thirst (consuming 4-5 L of water daily) and urination (confirmed with a 24-hour urine output of 4 L). Following 12 hours of overnight water deprivation, morning labs confirmed diabetes insipidus with high serum sodium of 146 mmol/L, high serum osmolality of 306 mOsm/kg, and low urine osmolality of 204 mOsm/Kg. Initiation of oral DDAVP 0.1 mg nightly resulted in a resolution of nocturia and dramatic improvement in thirst. The patient underwent transsphenoidal resection, during which the neurosurgeon identified a suprasellar cystic lesion with classic epidermoid pearl white material. The lesion and capsule were resected, and patient started on dexamethasone 6 mg IV every 6 hours to prevent chemical meningitis. Pathology was consistent with an epidermoid cyst. Prolactin stained several cells, possibly from compression of the pituitary stalk by the epidermoid cyst. Postoperatively, the patient had severe headaches, and photophobia thought to be associated with chemical meningitis. Lumbar puncture revealed elevated CSF neutrophils and aseptic culture. The patient was continued on dexamethasone with slow taper upon discharge. DDAVP was increased to 0.1 mg twice daily as polyuria and polydipsia worsened. Discussion: There have been six reported cases of epidermoid cysts involving the pituitary stalk. Visual disturbance and headaches are common, while galactorrhea and amenorrhea are uncommon. Preoperative polyuria can be a frequent presenting symptom that can evolve into permanent postoperative diabetes insipidus. Surgical resection is the treatment of choice. It may be difficult to achieve complete excision due to the adherence of the cyst wall to the adjacent structures. The most common complications after resection include chemical meningitis (noted in our patient), hydrocephalus, infectious meningitis, and cranial nerve palsies. Presentation: Friday, June 16, 2023

Nephrometry scores to predict oncological outcomes following partial nephrectomy (UroCCR Study 70).

Partial nephrectomy (PN) for large or complex renal tumors can be difficult and associated with a higher risk of recurrence than radical nephrectomy. We aim to evaluate the clinical useful of nephrometry scores for predicting oncological outcomes in a large cohort of patients who underwent PN for renal cell carcinomas. Our analysis included patients who underwent PN for renal cell carcinoma in 21 French academic centers (2010-2020). RENAL, PADUA, and SPARE scores were calculated based on preoperative imaging. Uni- and multivariate cox models were performed to identify predictors of recurrence-free survival and overall survival. The area under the curve (AUC) was used to identify models with the highest discrimination. Decision curve analyses (DCAs) determined the net benefit associated with their use. A total of 1927 patients were analyzed with a median follow-up of 32months (14-45). RENAL score (p = 0.01), age (p = 0.002), histological type (p = 0.001), high nuclear grade (p = 0.001), necrotic component (p < 0.001), and positive margins (p = 0.005) were significantly related to recurrence in multivariate analyses. The discriminative performance of the 3 radiological scores was modest (65, 63, and 63%, respectively). All 3 scores showed good calibration, which, however, deteriorated with time. Decision curve analysis of the three models for the prediction of overall and recurrence-free survival was similar for all three scores and of limited clinical relevance. The association between nephrometry scores and oncological outcomes after NP is very weak. The use of these scores for predicting oncological outcomes in routine practice is therefore of limited clinical value.

Imaging spectrum in rhino-orbito-cerebral mucormycosis: a cross-sectional study.

Rhino-orbital-cerebral mucormycosis (ROCM) is a life-threatening condition caused by a saprophytic fungus that predominately affecting immune-compromised patients. Early diagnosis of ROCM is of utmost importance to start the treatment as early as possible to prevent early and horrible complications of the disease. This retrospective study evaluated the imaging findings of 21 patients with biopsy and KOH mount-based evidence of invasive ROCM. The imaging was obtained from a Siemens Magnetom Amira 1.5T system with a strength of 1.5T or more. The spectrum of findings was evaluated for the sites of involvement, signal intensity, contrast characteristics, necrotic component as well as orbital, infratemporal, and intracranial extensions, especially cavernous sinuses, Meckel's cave, and the brain parenchyma. The mean age of the patients was 55.8±10.9 years and included 71% male. All the patients were positive for COVID-19 and the majority were diabetic. MRI showed predominant involvement of the maxillary sinus (17, 81%) and the ethmoidal sinus (15, 71.4%). The orbital extension was present in 18 cases (86%). T1-weighted imaging showed iso to low signal intensity in involved sinuses in the majority of the patients (9, 42.9%). Heterogeneously high signal intensity was observed in T2-weighted and short tau inversion recovery images in all the patients. Heterogenous contrast enhancement was present in 20 (95.2%) patients. The imaging spectrum of ROCM is variable. Multiplanar MRI with postcontrast images is a very useful complementary tool to the clinical evaluation to assess the extent of disease and its complications, which has a high mortality. Clinicians and radiologists should be aware of the imaging spectrums of ROCM.

A Case Report of Radiation Therapy as Definitive Treatment for Desmoid Tumor in a Young Girl

Introduction: Desmoid tumor is a benign growth that can exhibit aggressiveness and various patterns, resulting in a wide range of management methods. These methods include observation to active interventions, such as surgery, radiation, and systemic therapy. Therefore, this case report aimed to present the role of radiation therapy for desmoid tumors in a young girl who refused limb amputation to preserve the organ.Case Presentation: This study presented the case of a 13-year-old girl with a vast and painful desmoid tumor in the left upper arm. Magnetic resonance imaging (MRI) on the left shoulder showed an 8 x 9 x 17 cm solid soft tissue mass on the left deltoid muscle with the necrotic component that expands to adjacent cutaneous and subcutaneous tissue. In this case, the left humerus attaches to the deep brachial artery and vein. Previous pathological studies with immunohistochemicals showed desmoid fibromatosis. A multidisciplinary team discussion led to the selection of, radiotherapy for treatment because of tumor localization and proximity to the critical structure. Radiation was also selected as the definitive therapy of choice with the aim of local control and organ preservation. Furthermore, the radiation dose was 56 Gy in 2 Gy per fraction over six weeks. After six months of follow-up, the patient reported pain relief, improved range of motion, and reduced tumor size.Conclusion: Radiotherapy reduced desmoid tumor size and improved symptoms without compromising organ function in young girls.

Management of giant amoebic liver abscess with severe sepsis by open drainage: a study of 28 cases in 20 years

Background: Presently large amoebic liver abscesses are treated by intravenous antibiotics coupled with less invasive procedure like pigtail drainage. Pigtail drainage may not be adequate enough to drain thick pus and solid necrotic component in good number of large amoebic liver abscesses. In these cases, with severe sepsis, open surgical drainage is a life saver and a game changer. Aim of this study was to determine whether in critically ill patient with large amoebic liver abscesses results in good clinical outcome, by open surgical drainage. Methods: Over a 20-year period, 28 patients with giant amoebic liver abscesses, in severe sepsis, were managed by, an up-front open surgical drainage. In this prospective study we tried to evaluate time to reversal of the toxic features of sepsis, recovery of hemodynamic stability, degree of morbidity and hospital stay. Results: In all 28 patients treated by open surgical drainage (OSD), there was certainly rapid reversal of toxic features of sepsis, decrease in leukocyte count and accelerated recovery of hemodynamic stability in all are cases Three patients had surgical site infection, which were managed accordingly. The average hospital stay was 12 days. No mortality occurred in our study. Conclusions: The results of our study show that for large amoebic liver abscesses with severe sepsis, OSD provides better clinical outcomes in terms of treatment success, rapid recovery, recovery of hemodynamic stability, less morbidity and no mortality.

An unusual finding after adrenal surgery: a case series of adrenal schwannomas.

Adrenal schwannomas are rare benign tumors with no specific imaging and laboratory findings to diagnose preoperatively. Due to the limited number of cases in the literature, clinical, imaging, and pathological findings are presented in this study. Case 1 is a 61-year-old woman patient who has a 31-mm mass in the right adrenal gland. This mass was nonfunctional; in imaging studies, this mass had a cystic necrotic component, and high 18-fluorodeoxyglucose (FDG) uptake was seen. There was no metaiodobenzylguanidine (MIBG) uptake. Laparoscopic transabdominal right adrenalectomy was performed, and the pathology result was consistent with adrenal schwannomas. Case 2 is a 63-year-old man patient who presented with a 38-mm mass in the left adrenal gland. This mass was nonfunctional and similar to that in Case 1; this mass had a cystic component. Laparoscopic transabdominal left adrenalectomy was performed. The diagnosis of adrenal schwannoma with degeneration was revealed. Case 3 was a 72-year-old woman patient admitted to the hospital for a 125-mm left adrenal mass. Similar to Case 1, this mass also had a cystic necrotic component in imaging studies. High FDG uptake was seen, and the patient underwent conventional adrenalectomy due to the suspicion of malignancy. After pathological evaluation, a diagnosis of adrenal schwannoma was made. A main diagnostic challenge in adrenal schwannomas is the preoperative diagnosis. These masses have no pathognomonic finding or specific hormonal function. Imaging findings of these masses may increase the suspicion of malignancy, which may affect decisions for surgery and the surgical technique.

Криобиопсия в морфологической верификации центрального рака легких с некрозом

Background. The diagnostic yield of a standard forceps biopsy for central lung cancer is 74 %. However, the diagnostic value is significantly reduced in the presence of necrosis in the tumor. In Russia, cryobiopsy for central lung cancer diagnosis is currently used only in a few clinical centers.The purpose of this study is to present a series of clinical cases showing the effectiveness of the cryobiopsy method in the morphological verification of central neoplasms with necrosis.Description of clinical cases. The article presents 3 clinical cases of patients with central lung cancer, in which standard forceps biopsy was ineffective due to the presence of severe necrosis in the tumor. The cryobiopsy performed at the second stage made it possible in all cases to obtain a suffcient amount of morphological material for histological and immunohistochemical studies and to reconalize the lumens of the large bronchi.Conclusion. Cryobiopsy is an effective and safe method of morphological verification of central lung cancer, which has an advantage over standard forceps biopsy, especially in the presence of a visible necrotic component in the tumor structure.