Patients Underwent Tumor Resection Research Articles

Prevention of lung cancer recurrence using cisplatin-loaded superhydrophobic nanofiber meshes

For early stage lung cancer patients, local cancer recurrence after surgical resection is a significant concern and stems from microscopic disease left behind after surgery. Here we apply a local drug delivery strategy to combat local lung cancer recurrence after resection using non-woven, biodegradable nanofiber meshes loaded with cisplatin. The meshes are fabricated using a scalable electrospinning process from two biocompatible polymers—polycaprolactone and poly(glycerol monostearate-co-caprolactone)—to afford favorable mechanical properties for use in a dynamic tissue such as the lung. Owing to their rough nanostructure and hydrophobic polymer composition, these meshes exhibit superhydrophobicity, and it is this non-wetting nature that sustains the release of cisplatin in a linear fashion over ∼90 days, with anti-cancer efficacy demonstrated using an in vitro Lewis Lung carcinoma (LLC) cell assay. The in vivo evaluation of cisplatin-loaded superhydrophobic meshes in the prevention of local cancer recurrence in a murine model of LLC surgical resection demonstrated a statistically significant increase (p = 0.0006) in median recurrence-free survival to >23 days, compared to standard intraperitoneal cisplatin therapy of equivalent dose. These results emphasize the importance of supplementing cytoreductive surgery with local drug delivery strategies to improve prognosis for lung cancer patients undergoing tumor resection.

Association between [18F]-fluoro-2-deoxyglucose uptake and expressions of hypoxia-induced factor 1α and glucose transporter 1 in non-small cell lung cancer.

High maximum standardized uptake values on [(18)F]-fluoro-2-deoxyglucose positron emission tomography are associated with inferior survival in non-small cell lung cancer. Here, we investigated the biological mechanisms underlying [(18)F]-fluoro-2-deoxyglucose uptake in non-small cell lung cancer. This study included 133 patients with non-small cell lung cancer (109 with adenocarcinoma and 24 with squamous cell carcinoma). The patients underwent tumour resection, at the latest, 4 weeks after [(18)F]-fluoro-2-deoxyglucose positron emission tomography. The maximum standardized uptake values for primary lesions were calculated based on [(18)F]-fluoro-2-deoxyglucose uptake. The expression of hypoxia-inducible factor 1α and glucose transporter 1 was evaluated on immunostained tumour sections using six-point grading scales. Maximum standardized uptake values and the expression of hypoxia-inducible factor 1α and glucose transporter 1 were significantly higher in squamous cell carcinoma than in adenocarcinoma (P < 0.001, P = 0.034 and P < 0.001, respectively). In adenocarcinoma, but not squamous cell carcinoma, maximum standardized uptake values, hypoxia-inducible factor 1α and glucose transporter 1 correlated with various clinicopathological factors relating to malignancy, and maximum standardized uptake values and glucose transporter 1 were associated with disease-free survival (P < 0.001 and P = 0.029) and overall survival (P < 0.001 and P = 0.033, respectively). Patients with high expression of hypoxia-inducible factor 1α tended to exhibit shorter disease-free survival and overall survival than those with low expression, but the differences were not significant (P = 0.32 and P = 0.15, respectively). And then in adenocarcinoma, hypoxia-inducible factor 1α and glucose transporter 1, glucose transporter 1 and maximum standardized uptake values, and hypoxia-inducible factor 1α and maximum standardized uptake values were significantly correlated (P < 0.001 for all), suggesting that hypoxia-inducible factor 1α-induced glucose transporter 1 might influence maximum standardized uptake values on [(18)F]-fluoro-2-deoxyglucose positron emission tomography. In lung adenocarcinoma, but not squamous cell carcinoma, hypoxia-inducible factor 1α and glucose transporter 1 expressions indicate tumour aggressiveness pathologically and might explain high [(18)F]-fluoro-2-deoxyglucose uptake on positron emission tomography and correlate with poor prognosis.

PWE-333 Rectal cancer resection specimen quality and pathological response at 6 vs. 12 weeks after long-course chemoradiotherapy: data from a pilot randomised controlled trial

Introduction Long-course chemoradiotherapy (CRT) is often delivered to down-stage locally-advanced rectal cancer prior to surgical resection. Surgery is performed after an interval period to allow time for radiation-induced tumour shrinkage and to facilitate more accurate surgery. The optimal time interval remains unclear, with little high-quality evidence to guide clinical decisions about when to operate. Method This study explores pathological outcomes from a pilot Randomised Controlled Trial (RCT) comparing an interval of six weeks versus an interval of 12 weeks between CRT and rectal cancer resection surgery. Thirty one patients requiring CRT for locally-advanced rectal cancer were recruited from seven UK centres between June 2012 and May 2014 and randomised to an interval of either 6 or 12 weeks. Photographs were taken of the intact mesorectal surfaces, and of the serial slices of resected specimens. These were assessed by an, blinded histopathologist to describe the quality of mesorectal dissection using a three-point scale. Rates of complete response, down-staging, and circumferential resection margin (CRM) involvement were assessed according to Royal College of Pathology guidelines. For tumour cell density (TCD) assessment, slides from the resected specimen and baseline biopsy were scanned at x40 magnification. For each patient, the slide with the greatest amount of residual tumour was selected and between 285 and 315 data-points were analysed by a blinded expert to describe the percentage of different tissue components for the whole tumour area. Results Twenty three patients underwent tumour resection within the trial (10 patients from the 6-week arm and 13 patients from the 12-week arm). A mesorectal specimen score of 3/3 (mesorectal fascia plane) was assigned to seven specimens from the 6-week arm (70%) and eight from the 12-week arm (62%). Three patients at 6-weeks and two patients at 12-weeks had a complete pathological response to CRT. Only one patient (from the 12-week arm) had an involved CRM. TCD was 0.3% (IQR 0.7) for the 6-week arm and 4.3% (IQR 8) for the 12 week arm (p = 0.12) Conclusion In this small randomised study, rates of mesorectal specimen quality, complete pathological response, and TCD were broadly similar when rectal cancer was resected after either a 6 or 12 week interval following CRT. Further studies are needed to further clarify whether a longer interval actually does facilitate ongoing down-staging. Disclosure of interest None Declared.

A comparison of the prognostic value of preoperative inflammation-based scores and TNM stage in patients with gastric cancer.

BackgroundPeople’s Republic of China is one of the countries with the highest incidence of gastric cancer, accounting for 45% of all new gastric cancer cases in the world. Therefore, strong prognostic markers are critical for the diagnosis and survival of Chinese patients suffering from gastric cancer. Recent studies have begun to unravel the mechanisms linking the host inflammatory response to tumor growth, invasion and metastasis in gastric cancers. Based on this relationship between inflammation and cancer progression, several inflammation-based scores have been demonstrated to have prognostic value in many types of malignant solid tumors.ObjectiveTo compare the prognostic value of inflammation-based prognostic scores and tumor node metastasis (TNM) stage in patients undergoing gastric cancer resection.MethodsThe inflammation-based prognostic scores were calculated for 207 patients with gastric cancer who underwent surgery. Glasgow prognostic score (GPS), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), prognostic nutritional index (PNI), and prognostic index (PI) were analyzed. Linear trend chi-square test, likelihood ratio chi-square test, and receiver operating characteristic were performed to compare the prognostic value of the selected scores and TNM stage.ResultsIn univariate analysis, preoperative serum C-reactive protein (P<0.001), serum albumin (P<0.001), GPS (P<0.001), PLR (P=0.002), NLR (P<0.001), PI (P<0.001), PNI (P<0.001), and TNM stage (P<0.001) were significantly associated with both overall survival and disease-free survival of patients with gastric cancer. In multivariate analysis, GPS (P=0.024), NLR (P=0.012), PI (P=0.001), TNM stage (P<0.001), and degree of differentiation (P=0.002) were independent predictors of gastric cancer survival. GPS and TNM stage had a comparable prognostic value and higher linear trend chi-square value, likelihood ratio chi-square value, and larger area under the receiver operating characteristic curve as compared to other inflammation-based prognostic scores.ConclusionThe present study indicates that preoperative GPS and TNM stage are robust predictors of gastric cancer survival as compared to NLR, PLR, PI, and PNI in patients undergoing tumor resection.

Clipping of tumour resection margins allows accurate target volume delineation in head and neck cancer adjuvant radiation therapy

BackgroundAccurate tumour bed localisation is a key requirement for adjuvant radiotherapy. A new procedure is described for head and neck cancer treatment that improves tumour bed localisation using titanium clips. Materials and methodsFollowing complete local excision of the primary tumour, the tumour bed was marked with titanium clips. Preoperative gross target volume (GTV) and postoperative tumour bed were examined and the distances between the centres of gravity were evaluated. Results49 patients with squamous cell carcinoma of the oral cavity were prospectively enrolled in this study. All patients underwent tumour resection, neck lymph node dissection and defect reconstruction in one stage. During surgery, 7–49 clips were placed in the resection cavity. Surgical clip insertion was successful in 88% (n=43). Clip identification and tumour bed delineation was successful in all 43 patients. The overall distance between the centres of gravity of the preoperative tumour extension to the tumour bed was 0.9cm. A significant relationship between the preoperative tumour extension and the postoperative tumour bed volume could be demonstrated. ConclusionWe demonstrate a precise delineation of the former tumour cavity. Improvements in tumour bed delineation allow an increase of accuracy for adjuvant treatment.

Cosmetology Incision in Treatment of Benign Tumor of Breast: A Report of 1000 Cases

Objective: To explore the selection of the best incision for operative treatment of benign breast tumor. Methods: The clinical data of 1000 cases of benign breast tumor operated by cosmetology incision were retrospectively analyzed. Results: All patients underwent tumor resection and were satisfied with the incision. Conclusions: Benign breast tumor can be excised through cosmetology incision, and no obvious scar leaves behind, so it can satisfy the cosmetic requirement of many patients.

Low infection rate after tumor hip arthroplasty for metastatic bone disease in a cohort treated with extended antibiotic prophylaxis.

Background. Compared to conventional hip arthroplasty, endoprosthetic reconstruction after tumor resection is associated with a substantially increased risk of periprosthetic joint infection (PJI), with reported rates of around 10% in a recent systematic review. The optimal duration of antibiotic prophylaxis for this patient population remains unknown. Material and Methods. To establish the infection rate associated with prolonged antibiotic prophylaxis in our department, we performed a retrospective review of all adult patients who underwent endoprosthetic reconstruction of the proximal femur after tumor resection for metastatic bone disease during a 4-year period from 2010 to 2013 (n = 105 patients). Results. Intravenous antibiotic prophylaxis was administrated for an extended duration of a mean of 7.4 days. The overall infection rate was 3.6% (4/111 implants), infection free survival was 96% at 2 years, and the risk of amputation associated with infection was 25% (1/4 patients). Discussion. Preemptive eradication of bacterial contamination may be of value in certain clinical situations, where the risk level and consequences of implant-associated infection are unacceptable. Our findings suggest that extended postoperative antibiotic prophylaxis may reduce the risk of PJI in patients undergoing tumor resection and endoprosthetic replacement for metastatic bone disease associated impending or de facto pathologic fractures of the proximal femur.

MR imaging, apparent diffusion coefficient and histopathological features of desmoplastic infantile tumors-own experience and review of the literature.

Desmoplastic infantile tumors are rare supratentorial brain lesions occurring in children under 18 months of age. We report characteristic neuroimaging with DWI and the histopathological features of these neoplasms. Magnetic resonance (MR) examinations of nine patients, aged 0-18 months (median age 3.5 months), were retrospectively analyzed. Analysis of MR images included location and tumor size, signal intensity, contrast enhancement, presence of edema, and hemorrhage. Minimum and mean value of apparent diffusion coefficient (ADC) in the solid component of the tumor and contralateral normal-appearing white matter (NAWM) were measured, and ADC/NAWM ratios were calculated. All patients underwent tumor resection, and diagnosis of grade I desmoplastic tumors was confirmed. The tumors were located in the temporal lobe in seven patients, the parietal lobe in three, and in the frontal lobe in one case (in two children, tumors invaded more than one lobe). Suprasellar localization was observed in two patients; one child had multifocal brain lesions. In five cases, signal intensity of the solid component was hypointense on T2-WI. The measured minimum ADC value of solid tumor varied from 0.606 to 1.020 × 10(-3) mm(2)/s, with a mean value of 0.921 × 10(-3) mm(2)/s. The mean ADC value of NAWM was 1.121 × 10(-3) mm(2)/s. The mean ADC ratio was 0.858 × 10(-3) mm(2)/s. From our series, we can assume that restricted diffusion is observed not only in malignant but also in benign brain tumors. Diffusion signals and ADC values in these neoplasms appear to depend on their cellularity and components of the extracellular matrix.

Survival of patients treated with radiation therapy for anaplastic astrocytoma.

BackgroundAnaplastic astrocytoma (AA) represents 7% of primary brain tumors in adults. Patient-, tumor-, and treatment-related factors are thought to be predictive of survival. We retrospectively assessed the association of patient-, tumor-, and treatment-related factors with survival in AA treated with radiotherapy (RT) at our institution.Patients and methods.Medical records of patients with AA treated with RT between 1987 and 2007 were reviewed. Patient-, tumor-, and treatment-related variables were recorded and used to assign patients to a Radiation Therapy Oncology Group recursive partitioning analysis (RTOG RPA) classification. First use of chemotherapy was recorded. Log-rank tests and Cox regression models were used to assess for an association of patient-, tumor- and treatment-related factors with survival.ResultsOne-hundred twenty-six patients were eligible for study. Median age, Karnofsky performance status, and duration of symptoms were 43 years, 90, and 8 weeks. Median radiation dose was 59.4 Gy; 61% of patients underwent tumor resection, and 17% and 41% of patients received temozolomide during and after RT. Median survival was 31 months, and 2-year survival was 58%. RTOG RPA class was associated with survival (p < 0.001), but use of temozolomide during or after RT was not (p > 0.05).ConclusionsIn this retrospective study with inherent limitations, RTOG RPA classification was associated with survival. Further studies are necessary to confirm or refute this finding.

SO-06 * SURGICAL STRATEGIES AND OUTCOMES OF SPINAL EPENDYMOMAS OF DIFFERENT LENGTHS: ANALYSIS OF 210 PATIENTS

OBJECTIVE: The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths. METHODS: The authors used data from 210 patients with spinal ependymomas (WHO Grades II and III) in this 10-year retrospective study (January 1999 to December 2008), dividing them into 3 different groups according to length (spinal ependymomas 10 cm). All patients underwent tumor resection. The basic characteristics of the patients were reviewed and the functional status was assessed using the McCormick classification. RESULTS: There were 89, 81, and 40 patients, respectively, in the 3 groups ( 10 cm). Grosstotal resections (GTRs) were performed in 172 patients (81.9% overall, or 86.5%, 79.0%, and 77.5% in the 3 groups, respectively). Subtotal and partial resections were achieved in 38 patients (18.1%). Eight patients with medulla oblongata or upper cervical cord tumors received a tracheotomy postoperatively. The follow-up period ranged from 56 to 176 months. One hundred thirty-five patients (76.7%) experienced improvement, (88.2%, 83.8%, and 34.4% in the 10 cm groups, respectively). Thirty-three patients (18.8%) maintained their pretreatment status, and 8 patients (4.5%) showed deterioration following tumor resection at 6 months. CONCLUSIONS: Radical resection of spinal ependymomas could be performed in most patients, and the rate of GTR was significantly different in the different-length groups Patients with longer tumors had worse surgical results compared with those with small tumors and more postoperative neuropathic pain and proprioceptive deficits could usually be observed in patients harboring larger tumors. Early diagnosis and timely operation are critical to achieving better neurological outcomes. For tumors with dense adhesions, complete removal should be performed cautiously because of the significant incidence of neurological deterioration.

18FDG PET/CT Findings in the Unusual Urachal Adenocarcinoma

A 48-year-old woman presented with a hard, painless mass in the left lower quadrant and no other significant complaint. Laboratory tests, including those for tumor markers, showed no significant abnormal value. CT showed an extraperitoneal mixed solid and cystic mass in the anterior abdominal wall, located anterocranial to and in close contact with the bladder. Percutaneous biopsy findings were compatible with adenocarcinoma of unknown origin. PET/CT showed increased 18FDG uptake on the mass and no evidence of disease at other sites. The patient underwent tumor resection, and the pathological diagnosis was moderately differentiated urachal adenocarcinoma.

A Single-Arm, Nonrandomized Phase II Trial of Neoadjuvant Gemcitabine and Oxaliplatin in Patients With Resectable Pancreas Adenocarcinoma

The role for neoadjuvant systemic therapy in resectable pancreas adenocarcinoma remains undefined. We evaluated the efficacy of gemcitabine and oxaliplatin administered as preoperative therapy in patients with resectable pancreas adenocarcinoma. Eligible patients were screened using computed tomography-pancreas angiography, laparoscopy, endoscopic ultrasonography, and fine-needle aspiration cytology to identify 38 patients who received 4 cycles of neoadjuvant gemcitabine 1000 mg/m intravenously over 100 minutes and oxaliplatin 80 mg/m intravenously over 2 hours, every 2 weeks. Patients whose tumors remained resectable at restaging proceeded to operation and subsequently received 5 cycles of adjuvant gemcitabine (1000 mg/m intravenously over 30 minutes days 1, 8, and 15 every 4 weeks). The primary endpoint was 18-month overall survival and secondary endpoints included radiological, tumor marker and pathological response to neoadjuvant therapy, time to recurrence, patterns of failure, and feasibility of obtaining preoperative core biopsies. Thirty-five of 38 patients (92%) completed neoadjuvant therapy. Twenty-seven patients underwent tumor resection (resectability rate 71%), of which 26 initiated adjuvant therapy for a total of 23 patients (60.5%) who completed all planned therapy. The 18-month survival was 63% (24 patients alive). The median overall survival for all 38 patients was 27.2 months (95% confidence interval: 17-NA) and the median disease-specific survival was 30.6 months (95% confidence interval: 19-NA). This study met its endpoint and provided a signal suggesting that exploration of neoadjuvant systemic therapy is worthy of further investigation in resectable pancreas adenocarcinoma. Improved patient selection and more active systemic regimens are key. Clinical trials identification: NCT00536874.

Surgical strategies and outcomes of spinal ependymomas of different lengths: analysis of 210 patients: clinical article.

The aim of this study was to investigate the surgical strategies and outcomes for spinal ependymomas of different lengths. The authors used data from 210 patients with spinal ependymomas (WHO Grades II and III) in this 10-year retrospective study (January 1999 to December 2008), dividing them into 3 different groups according to length (spinal ependymomas < 5 cm, 5-10 cm, and > 10 cm). All patients underwent tumor resection. The basic characteristics of the patients were reviewed and the functional status was assessed using the McCormick classification. There were 89, 81, and 40 patients, respectively, in the 3 groups (< 5 cm, 5-10 cm, and > 10 cm). Grosstotal resections (GTRs) were performed in 172 patients (81.9% overall, or 86.5%, 79.0%, and 77.5% in the 3 groups, respectively). Subtotal and partial resections were achieved in 38 patients (18.1%). Eight patients with medulla oblongata or upper cervical cord tumors received a tracheotomy postoperatively. The follow-up period ranged from 56 to 176 months. One hundred thirty-five patients (76.7%) experienced improvement, (88.2%, 83.8%, and 34.4% in the < 5 cm, 5-10 cm, and > 10 cm groups, respectively). Thirty-three patients (18.8%) maintained their pretreatment status, and 8 patients (4.5%) showed deterioration following tumor resection at 6 months. Tumor recurrence or progression was observed in 6 (2.9%) of the 210 patients. Among the 6 patients, recurrent tumors were located in the conus (n = 3), thoracic (n = 1), and medullocervical cord (n = 2). Radical resection of spinal ependymomas could be performed in most patients, and the rate of GTR was significantly different in the different-length groups (< 10 cm vs > 10 cm, p = 0.032). Patients with longer tumors had worse surgical results compared with those with small tumors (p < 0.001), and more postoperative neuropathic pain and proprioceptive deficits could usually be observed in patients harboring larger tumors. Early diagnosis and timely operation are critical to achieving better neurological outcomes. For tumors with dense adhesions, complete removal should be performed cautiously because of the significant incidence of neurological deterioration.

Masseter-to-facial nerve transfer: a novel effective technique for facial functional reconstruction after acoustic neuroma resection

Objective To determine the effects of masseter-to-facial nerve transfer for patients who acquired a proximal injury to the facial nerve and to analyze the associated morbidities after the operation.Methods A total of 16 patients underwent tumor resection in cerebellopontine angle (CPA) received the masseter-to-facial nerve transfer from November 2010 to February 2013 in our center with continuously follow-up.Terzis's smile grading and Metha's synkinetic movements scales were used to evaluate the preoperative and postoperative mimetic muscle function.The periods between the operation and the onset of mimetic muscle contraction were also documented.A questionnaire was introduced to assess the donor-site morbidity and the ability to smile without biting.Results All patients had restored the smile function with biting(P ＜0.05).9 of 16 patients had excellent or good results,5 had moderated results and 2 had poor results.4 patients complained about moderate degree of masseter atrophy and required further revision.The synkinetic movements were observed in all patients and were rated as mild.Conclusions Masseter-facial nerve transfer was a highly efficient technique to reanimate the paralytic muscle in patients who acquired intracranial facial nerve injury with minor deformities.After continued physical therapy,some patients were able to regain a symmetrical and effortless smile with mild synkinetic movements. Key words: Facial nerve; Neuroma,acoustic; Nerve transfer; Masseter nerve

Nephron Sparing Surgery for Unilateral Non-Syndromic Wilms Tumor

The initial therapy for most children with Wilms tumor is radical nephrectomy. Several centers, have explored the role of Nephron-sparing procedures in children with unilateral non-syndromic Wilms tumors. The primary motivation for this approach is concern about late occurrence of renal dysfunction after unilateral nephrectomy. We report our experience with NSS for unilateral non-syndromic Wilms tumor. We reviewed the records of nine children who underwent nephron sparing surgery for unilateral, nonsyndromic Wilms tumors at our Hospital between Jan 2000 through Jan 2012. All patients received preoperative chemotherapy with two drugs (vincristine, and dactinomycin) following which patients underwent tumor resection. Subsequent renal function was assessed by estimating the glomerular filtration rate using creatinine clearance and other measures of long-term renal function assessment included blood pressure evaluation and the need for antihypertensive medications. During the study period nine children with a mean age 19.66 ± 14.37months at diagnosis and presenting with unilateral non-syndromic Wilms tumor underwent nephron sparing surgery. In all the nine children, the renal plane of resection showed a tumor-free margin. Post-operative serum creatinine repeated at the end of 3 months revealed maintenance of good renal function in all children. Nephron sparing surgery is a safe and effective option in the management of early stage unilateral non-syndromic Wilms tumor. It is oncologically safe and does not lead to decreased local tumor control. The function of the kidney remnant remains rather well.

The radiation-induced jaw osteosarcoma: CT imaging features

To evaluate the CT features of radiation-induced jaw osteosarcoma(RIJOS) developed after therapeutic irradiation for a variety of nonosseous lesions. The demographic and CT findings of thirteen patients with RIJOS were reviewed retrospectively.Observation items included location, bone destruction, mineralized tumor matrix, periosteal reaction, soft tissue extension and calcification.Of the thirteen patients, twelve were male and one was female. The mean age was 48 years (range: 29-68 years).Five patients had tumors in the maxilla and eight in the mandible. All the patients underwent tumor resection. The latent period before development of RIJOS ranged from 3.5 to 14 years (mean, 11 years).In all thirteen patients, eight tumors were osteoblastic, with one osteolytic and four mixed lesions.Osteoid tumor matrix mineralization was present in twelve patients. Periosteal reaction was identified in 11 cases.Soft-tissue extension was present in all patients beyond the area of bone destruction. The characteristic CT imaging of RIJOS showed the bone destruction associated with a large number of mineralized tumor matrix and significant soft tissue extension in the original radiation field after radiotherapy. CT findings could play an important role in identifying the tumor and pre-operative assessment.

上顎洞を広範に占拠した内反乳頭腫の1例

Inverted papilloma of the nasal cavity and paranasal sinuses is a relatively uncommon benign tumor. Because of the aggressive nature and risk of recurrence of the tumor, complete resection is essential.We report a patient with a massive inverted papilloma of the maxillary sinus who was surgically treated by a collaborative medical team approach, including otorhinolaryngology specialists and oral surgeons. The patient was a 50-year-old woman who consulted an otorhinolaryngologist at a primary care center in early June 2010 because of left nasal obstruction. A left nasal polyp was resected. The histopathological diagnosis was an inverted papilloma.In early July 2010, she was referred to the Division of Otolaryngology at Ebina General Hospital. Computed tomography revealed a mass of different density in the left maxillary sinus and nasal cavity. The clinical diagnosis was a suspected massive inverted papilloma of the left maxillary sinus.In mid-July 2010, otorhinolaryngology specialists were consulted and resection of the tumor was considered difficult by endoscopic sinus surgery （ESS） alone. In September 2010, the patient underwent tumor resection combined with the Caldwell-Luc operation under general anesthesia in collaboration with our department. The histopathological diagnosis was an inverted papilloma.No recurrence has occurred as of 36 months after the operation.

Surgical strategy for intra- and extra-vertebral dumbbell-shaped tumors

Objective To investigate the clinical features and surgical strategy of intra- and extra-vertebral dumbbell-shaped tumors. Methods Clinical data of 39 patients with intra- and extra-vertebral tumor were retrospectively studied. The tumors were removed via posterior midline approach in 33 patients, and via posterior combined with anterior approach in 6 patients. Thirty patients underwent tumor resection and internal fixation. Lateral mass screw fixation was performed in the level of C3-7, while the pedicular screw fixation was performed in the level of C2 and thoracic and lumbar segment. Results Tumors were totally excised in all the cases. The patients were followed-up for 6 months to 5 years with an average of 18.67 months. Pain relief occured in 29 cases, of whom the average Visual Analogue Scale (VAS) score decreased from (7.51 ± 1.05) before surgery to (3.17 ± 1.17) 24 h after surgery (P < 0.05). The numbness area emerged or enlarged in 12 cases and was unchanged in 3 cases. The average American Spinal Injury Association (ASIA) sensation score decreased from (218.67 ± 2.80) before surgery to (213.33 ± 2.16) 24 h after surgery (P < 0.05), but it increased to (216.78 ± 1.47) 6 months after operation (P < 0.05). The motor function improved in 18 cases, and ASIA motor function score improved from (92.33 ± 1.63) before surgery to (95.05 ± 1.41) 6 months after operation (P < 0.05). No tumor recurrence and secondary spinal deformity were found. Conclusion Most cases of dumbbell-shaped intra- and extra-vertebral tumor can be totally removed with one-session microsurgery. In the cases with bony erosion caused by tumor and facetectomy, concurrent internal fixation and fusion were recommended in order to maintain spinal stability. doi：10.3969/j.issn.1672-6731.2013.12.003 Video: http://www.cjcnn.org/index.php/cjcnn/pages/view/v13n12a3

A Novel Data-Driven Approach to Preoperative Mapping of Functional Cortex Using Resting-State Functional Magnetic Resonance Imaging

Recent findings associated with resting-state cortical networks have provided insight into the brain's organizational structure. In addition to their neuroscientific implications, the networks identified by resting-state functional magnetic resonance imaging (rs-fMRI) may prove useful for clinical brain mapping. To demonstrate that a data-driven approach to analyze resting-state networks (RSNs) is useful in identifying regions classically understood to be eloquent cortex as well as other functional networks. This study included 6 patients undergoing surgical treatment for intractable epilepsy and 7 patients undergoing tumor resection. rs-fMRI data were obtained before surgery and 7 canonical RSNs were identified by an artificial neural network algorithm. Of these 7, the motor and language networks were then compared with electrocortical stimulation (ECS) as the gold standard in the epilepsy patients. The sensitivity and specificity for identifying these eloquent sites were calculated at varying thresholds, which yielded receiver-operating characteristic (ROC) curves and their associated area under the curve (AUC). RSNs were plotted in the tumor patients to observe RSN distortions in altered anatomy. The algorithm robustly identified all networks in all patients, including those with distorted anatomy. When all ECS-positive sites were considered for motor and language, rs-fMRI had AUCs of 0.80 and 0.64, respectively. When the ECS-positive sites were analyzed pairwise, rs-fMRI had AUCs of 0.89 and 0.76 for motor and language, respectively. A data-driven approach to rs-fMRI may be a new and efficient method for preoperative localization of numerous functional brain regions.

18F-FDG PET/CT in a Rare Malignant Extraskeletal Osteosarcoma

Extraskeletal osteosarcoma (EO) is a rare malignancy and its FDG PET/CT imaging is seldom reported. We present staging and restaging images of a FDG PET/CT imaging in an EO originating from paraspinous musculature. Initial staging FDG PET/CT scan showed increased metabolism of a mass in the right paraspinous region without nodal or distant metastasis. The patient underwent tumor resection and radiation therapy with a pathological diagnosis of EO. Restaging FDG PET/CT imaging demonstrated postsurgical changes without nodal or distant metastasis. This case demonstrates the clinical relevance of FDG PET/CT imaging for staging and restaging EO.