Tumor Workup Research Articles

Synchronous Breast and Colorectal Malignant Tumors-A Systematic Review.

Our aim is to describe the main diagnostic and therapeutic challenges for synchronous breast and colorectal tumors. We performed a systematic review of the literature for cases or case series, using established keywords (synchronous breast and colon tumor and synonyms) for the period of 1970-2023. Five reviewers independently screened the literature, extracted data, and assessed the quality of the included studies. The results were processed according to the PRISMA 2020 guidelines. A total of 15 cases were included in the study, including 2 males (age 50 and 57) and 13 females (median age 60, with range from 40 to 79). In a vast majority of the cases, the diagnosis of synchronous tumor was prompted by the first tumor's workup. The first diagnosed tumor was colorectal in nine cases and a breast tumor in six cases. The most common histopathological type of breast tumor was invasive ductal carcinoma, and the colon tumors were exclusively adenocarcinomas. All cases had a surgical indication for both breast and colorectal tumor, except one case, in which the breast tumor had multiple metastasis. In four cases, the surgery was performed concomitantly (colectomy and mastectomy). In three cases, surgery was initially carried out for the breast tumor, followed by colon surgery. Oncological treatment was indicated depending on the tumor stage. For the treatment of synchronous tumors, the Tumor Board (T.B) decision is mandatory and must be personalized for each patient. Developing new methods of treatment and investigation may play an important role in the future for understanding synchronous tumor development, incidence, and outcome.

A comparative study of INSM1 (clone MRQ70) immunoreactivity on CytoLyt® pretreated cytology and resection specimens of pancreatic neuroendocrine tumors.

Insulinoma-associated protein 1 (INSM1) is a newly characterized sensitive and specific immunohistochemical marker for neuroendocrine (NE) tumors. Whereas more traditional NE markers, such as chromogranin A and synaptophysin, are cytoplasmic, INSM1 is uniquely nuclear and thus could serve as a useful addition to NE tumor workup. While application of immunohistochemical studies to cytology specimens is becoming increasingly relevant, knowledge of the effects of the certain fixatives as well as the pattern and intensity of immunoexpression are important considerations. Sixteen cases of pancreatic neuroendocrine tumor (PanNET) diagnosed between 2015 and 2021 underwent both fine-needle aspiration, which was subsequently prepared in CytoLyt®-fixed cytology cell block (CCB), and surgical resection, in which specimens were prepared into formalin-fixed paraffin embedded blocks (FFPE). For all samples, INSM1 immunoreactivity was classified according to staining intensity and extent, then compared between CCBs and matched FFPEs. All 16 FFPE specimens demonstrated strong and diffuse INSM1 immunoreactivity, while only 10/16 (62.5%) CCBs were positive. Of those 10, only 2/10 (20%) demonstrated strong and diffuse reactivity. The choice of fixative has a demonstrable effect on the immunoreactivity of INSM1 in PanNET. Even though the sensitivity is lower in CytoLyt®-fixed cell block specimens, the addition of INSM1 is useful, especially in challenging cases that may be negative for one or more of the traditional NE markers.

P11.49.B MOG antibody positive paraneoplastic brain stem encephalitis associated with cervical cancer: a rare case report

Abstract Background Paraneoplastic neurological syndromes are a rare complication of malignant tumors. Myelin oligodendrocyte glycoprotein (MOG) is an important marker on the surface of oligodendrocytes and is associated with many demyelinating diseases. There are only few reports of MOG antibody positive paraneoplastic syndromes. Here we present the first case of MOG-antibody positive brain stem encephalitis associated with cervical cancer. Material and Methods: Case report. Results A 58-year-old female presented with headache, fever and acute cerebellar signs. 13 months earlier she was diagnosed with cervical cancer and ovarian metastases. Adnexectomy was performed and she received adjuvant chemo- and radiotherapy. At admission cerebrospinal fluid (CSF) analysis showed pleocytosis (90 cells/µl) with a mixed cell profile but no malignant cells could be detected. Protein and lactate were highly elevated. The patient was treated with aciclovir and ceftriaxone until serology and liquor PCR showed no evidence of systemic or cerebral infections. Initial magnetic resonance imaging (MRI) of the brain was unremarkable. The patient was symptomatically treated. CSF two weeks later showed 53 cells/µl, protein and lactate almost normal. Contrary to the mild improvement of CSF parameters, cerebellar symptoms worsened, and the patient complained about impaired vision and diplopia. MRI revealed gadolinium enhancing lesions of the left mesencephalon and the right N. opticus. Visual evoked potentials confirmed a demyelinating lesion of the right N. opticus. We then assumed paraneoplastic brain stem encephalitis and the patient received high dose methylprednisolone and immunoglobulins. Ultimately, lab results came back positive for anti-MOG-antibodies, while paraneoplastic panels were negative. At follow-up three weeks later, CSF analysis showed normal cell count and brain MRI was unremarkable again. MOG-antibodies however remained positive. Since then, the patient has received monthly immunoglobulins leading to a stable neurological status. Unfortunately, the cancer itself is progressive with a local relapse and metastases of liver, lung and bones. Conclusion Our patient had an acute presentation of a rare brain stem encephalitis. However, infectious workup as well as all well-known onconeural antibodies showed negative results. This shows that pleocytosis in patients with a history of malignant disease is highly suggestive for paraneoplastic neurological syndromes even if common antibodies show negative results. Clinicians should be aware of other autoimmune antibodies like anti-MOG-antibodies and should extend workup if necessary. Vice versa it is worth considering tumor workup in patients with neurological symptoms and anti-MOG-positivity. Furthermore, the appearance of paraneoplastic neurological syndromes is always suspicious for progressive disease.

55P The impact of liquid next-generation testing timing on treatment-naïve advanced non-small cell lung cancer: A prospective observational study

Liquid next-generation sequencing (NGS) of plasma cell-free DNA (cfDNA) has become a promising tool for the identification of driver mutations in non-small cell lung cancer (NSCLC). Whether liquid NGS performed immediately at the start of tumor workup could further enhance NSCLC patient survival is unclear.

A 15-Year Change of an Adrenal Endothelial Cyst

Patient: Male, 61-year-old Final Diagnosis: Adrenal endothelial cyst Symptoms: No obvious self-conscious symptoms Medication:— Clinical Procedure: Laparoscopic adenectomy Specialty: Urology Objective: Rare disease Background:Adrenal gland cysts are rare and often occur without any symptoms. Even with advanced imaging modalities, it is still difficult to differentiate a benign adrenal neoplasm from a malignant one. Therefore, it is difficult to arrive at a definitive diagnosis and provide treatment.Case Report:We describe a patient with asymptomatic adrenal incidentaloma. The patient was lost to follow-up until 7 years later. On resuming follow-up, an enlarged suprarenal tumor was noted on ultrasound imaging. Magnetic resonance imaging revealed a 6×4 cm tumor mass, and the peripheral part expressed progressive enhancement on dynamic contrast-enhanced images. Laboratory data showed slight hypokalemia, and a complete endocrine assessment was performed, which showed no abnormality. Because malignancy of the adrenal gland remained suspected, a laparoscopic adenectomy was performed. The pathological result showed an adrenal endothelial (vascular) cyst with the formation of thrombi and calcification, without any evidence of malignancy.Conclusions:Adrenal cystic lesions can change with time. Routine imaging studies during follow-up are recommended, and endocrine evaluations should be performed as an initial adrenal tumor work-up. Surgery is the treatment of choice when the cyst is >6 cm in size, malignancy is suspected, or abnormal endocrine activity is present.

Role of biogenetic markers in differentiation and prognosis of giant cell tumor: A systemic review.

e23514 Background: Giant cell tumor (GCT) is a locally aggressive bone tumor. Early diagnosis and potential for recurrence are often difficult to assess due to a lack of bio-genetic markers and radiographic findings overlap with other osteolytic lesions. The purpose of this study is to explore biological and genetic markers that can be used for detection, differentiation, recurrence, and prognosis of GCT. Methods: We conducted a literature review including 24 articles out of 1568 articles, summarizing the role of biogenetic markers in the prognosis of GCT. Results: P63 is 98.6% sensitive and relatively specific for GCT as compared to other multinucleated giant cells containing neoplasms. MDM2(Mouse double minute 2 homolog), IGF1(Insulin-like growth factor 1), STAT1(Signal transducer and activator of transcription 1), and RAC1(Ras-related C3 botulinum toxin substrate 1) are associated with GCT recurrence. Increased expression of proteins like STAT5B, GRB2, and OXSR1 are related to a higher probability of metastasis. Neutrophil to lymphocyte ratio > 2.70, platelets to lymphocyte > 215.80, lymphocyte to monocyte ≤ 2.80, and AGR albumin to globulin < 1.50 ratio were significantly associated with decreased disease-free survival (DFS) (p < 0.05). Large amounts of osteoclast-related mRNA in GCTs (P < 0.05) are associated with the grade of bone resorption. We propose that subarticular primary malignant bone sarcoma with H3.3 mutations represent true malignant GCTB. IMP3 and IGF2 might be potential biomarkers in regulating the angiogenesis of GCT spine and predicting the patients’ prognosis. Conclusions: This review study has shown serological markers are significant in determining the diagnosis, differentiation, prognosis, and recurrence of GCT, which can be added to tumor work-up for definitive diagnosis and prognosis. [Table: see text]

Research progress on amyopathic dermatomyositis associated with interstitial lung disease.

Research progress on amyopathic dermatomyositis associated with interstitial lung disease.

P883 Hepatocellular carcinoma presenting as a tumor thrombus extending from the inferior vena cava to the right atrium in echocardiography

Abstract Case A 74 year-old white male with COPD, type 2 Diabetes, Atrial Fibrillation and a Pacemaker presented to our hospital for a routine echocardiography follow-up for mild to moderate Aortic Stenosis. His past social history was positive for moderate alcohol consumption but negative for tattoos, recent travel, illicit drug use, blood transfusion or chemical exposure. During evaluation in the echocardiography lab the patient had symptoms of dyspnea, fatigue and abdominal distension. He was hemodynamically stable and physical examination was positive for signs os ascites and inferior limb oedema, but disclosed no scleral icterus, asterixis, spider angiomata or overt hepatomegaly. There was a recent weight gain of 10kg. Cardiac and pulmonary auscultation was unrevealing. The echocardiogram revealed moderate left ventricle dysfunction (EF ∼40%), moderate aortic stenosis and a dilated inferior vena cava (31mm) with an image of a mobile mass in the confluence of the central hepatic vein with the inferior vena cava with extension to the right atrium. Initial blood chemistry and blood count revealed macrocytic anaemia; slight increased y-GT, C-reactive protein and NT-proBNP (6210pg/mL). The patient was admitted and anticoagulation with subcutaneous enoxaparin was initiated with echocardiographic follow-up. An abdominal ultrasound was performed which a hyperecogenic mass (71x47mm) adjacent to the right and left supra-hepatic veins, highly suggestive of hepatocelullar carcinoma. A triple-phase abdominal CT confirmed a nodular lesion 70x50mm on segment VIII, compatible with hepatocellular carcinoma (Fig.1). A cardiac magnetic resonance was performed documenting the tumor extension to the inferior vena cava and right atrium, suggestive of tumor thrombus (Fig.2). Multidisciplinary meeting enrolled the patient in palliative care. The right heart failure picture was refractory to medical treatment and the patient progressed to multi organ failure and a consumptive state. He died approximately 20 days after diagnosis. Discussion Intravascular tumor extension, also known as Tumor thrombus (TT) is a rare complication of some forms of cancer. In the late stages of Hepatocellular carcinoma (HCC) a TT can form in the portal or hepatic vein. These are usually detected during tumor workup or during evaluation of cardiorespiratory symptoms in a patient with a known abdominal carcinoma. Tumor invasion to the portal system is quite common while invasion to the inferior vena cava (IVC) and/or heart without invasion of the portal system is rare. Tumor extension to the RA or IVC, most patients were either symptomatic, had cirrhosis, or both. Our patient presented mainly with signs of right heart failure refractory to medical treatment and had no signs of portal invasion or hypertension in the various image modalities. The prognosis for a HCC with extension to the IVC or RA is grim, with a 1 to 4 months of mean survival regardless of treatment choice. Abstract P883 Figure.

Reduced field of view echo-planar imaging diffusion tensor MRI for pediatric spinal tumors.

Spine MRI is a diagnostic modality for evaluating pediatric CNS tumors. Applying diffusion-weighted MRI (DWI) or diffusion tensor imaging (DTI) to the spine poses challenges due to intrinsic spinal anatomy that exacerbates various image-related artifacts, such as signal dropouts or pileups, geometrical distortions, and incomplete fat suppression. The zonal oblique multislice (ZOOM)-echo-planar imaging (EPI) technique reduces geometric distortion and image blurring by reducing the field of view (FOV) without signal aliasing into the FOV. The authors hypothesized that the ZOOM-EPI method for spine DTI in concert with conventional spinal MRI is an efficient method for augmenting the evaluation of pediatric spinal tumors. Thirty-eight consecutive patients (mean age 8 years) who underwent ZOOM-EPI spine DTI for CNS tumor workup were retrospectively identified. Patients underwent conventional spine MRI and ZOOM-EPI DTI spine MRI. Two blinded radiologists independently reviewed two sets of randomized images: conventional spine MRI without ZOOM-EPI DTI, and conventional spine MRI with ZOOM-EPI DTI. For both image sets, the reviewers scored the findings based on lesion conspicuity and diagnostic confidence using a 5-point Likert scale. The reviewers also recorded presence of tumors. Quantitative apparent diffusion coefficient (ADC) measurements of various spinal tumors were extracted. Tractography was performed in a subset of patients undergoing presurgical evaluation. Sixteen patients demonstrated spinal tumor lesions. The readers were in moderate agreement (kappa = 0.61, 95% CI 0.30-0.91). The mean scores for conventional MRI and combined conventional MRI and DTI were as follows, respectively: 3.0 and 4.0 for lesion conspicuity (p = 0.0039), and 2.8 and 3.9 for diagnostic confidence (p < 0.001). ZOOM-EPI DTI identified new lesions in 3 patients. In 3 patients, tractography used for neurosurgical planning showed characteristic fiber tract projections. The mean weighted ADCs of low- and high-grade tumors were 1201 × 10-6 and 865 × 10-6 mm2/sec (p = 0.002), respectively; the mean minimum weighted ADCs were 823 × 10-6 and 474 × 10-6 mm2/sec (p = 0.0003), respectively. Diffusion MRI with ZOOM-EPI can improve the detection of spinal lesions while providing quantitative diffusion information that helps distinguish low- from high-grade tumors. By adding a 2-minute DTI scan, quantitative diffusion information and tract profiles can reliably be obtained and serve as a useful adjunct to presurgical planning for pediatric spinal tumors.

Microangiopathic Hemolytic Anemia: A Rare Clue to Diagnose Bone Marrow Metastatic Gastric Adenocarcinoma

Microangiopathic Hemolytic Anemia (MAHA) is a hematological condition which is very rare for the primary presentation of a gastric adenocarcinoma with bone marrow metastases. When it emerges as initial findings in a previously undetected case of malignancy, the diagnosis is often missed and results in inappropriate management. Carcinoma stomach associated with MAHA is generally having fulminant course. This is a case report of a 30-year-old male who presented with widespread bone marrow infiltration along with Coomb’s negative haemolytic anemia, thrombocytopenia and schistocytes in peripheral blood typical of MAHA. The combination of MAHA and bone marrow infiltration in gastric adenocarcinoma is a very rare entity. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, Endoscopy of upper GIT, colonoscopy, bone marrow examinations, and PET-CT or bone scans.&#x0D; J MEDICINE JUL 2019; 20 (2) : 102-105

Modular megaprosthesis for proximal femoral tumors

Objectives Limb salvage surgery is the preferred treatment for proximal femoral tumors. The use of modular prosthesis following resection of the tumor is the preferred method, a procedure that is technically demanding. The resection of tumor at the level of proximal femur results in loss of abductors and other musculature necessary for hip stability. This often leads to a higher instability rate. Hip dislocation is a recognized problem after the use of megaprosthesis, with rates of dislocation varying from 1.7% to ∼28%.Patients and methods Between March 2003 and March 2008, 15 patients in our series had resection of the proximal femoral primary malignant tumors and implantation of a modular megaprostheses, using a bipolar acetabular cup. There were seven women and eight men, with a mean age of 37 years (18–68 years). The diagnoses were osteosarcoma (two), chondrosarcoma (eight), malignant fibrous histiocytoma (two), and giant cell tumor (three). All patients had a complete tumor workup before surgery that included routine blood work, bone scan, computed tomography of the chest, and MRI of the femur. All patients had an open biopsy. They were given preoperative radiotherapy and chemotherapy as required.Results The mean follow-up was 5 years (range, 5 months–10 years). Two patients died of causes not related to the prosthesis. The postoperative Musculoskeletal Tumor Society score was 26 (range, 23–30) for the remaining 13 patients. There were one subluxation treated conservatively, and one erosion of the acetabulum that needed conversion into total hip replacement. No infections and local recurrence were encountered.Conclusion Proximal femoral modular megaprosthesis is a good option for reconstruction after resection of proximal femoral tumors.

The evolution of high complexity companion testing for targeted and immuno-oncology.

The evolution of high complexity companion testing for targeted and immuno-oncology.

Impact of Liver and Whole-Body Diffusion-Weighted MRI for Neuroendocrine Tumors on Patient Management: A Pilot Study

Background: Computed tomography scan is the current standard cross-sectional imaging modality for neuroendocrine tumor (NET) workup. Diffusion-weighted magnetic resonance imaging (DW-MRI) has proven to be more sensitive than standard sequences to diagnose liver metastases; whole-body DW-MRI may be more sensitive than whole-body MRI. Clinical implications have not yet been assessed. Thus, we evaluated radiological and clinical contributions of liver and whole-body DW-MRI to manage NETs. Methods: Twenty-five abnormal liver and 22 abnormal whole-body standard MRIs were first analyzed retrospectively. MR images were then reanalyzed after adding DW sequences. The standard of reference for metastasis confirmation was a combination of radiological follow-up and histological proof. Clinical impact was defined as MRI changes of liver invasion (unilobar to bilobar and/or <50 to >50% of liver) or therapeutic management changes made during a dedicated multidisciplinary meeting after whole-body MRI. Results: Thirty-two patients with mainly small intestine NETs (24/32) were studied. Adding DW to standard liver MRI yielded additional findings for 45% of the patients with 1.78 times more new lesions, mainly infracentimetric; it induced a management change for 18% of the patients. DW sequences added to whole-body MRI yielded additional findings for 71% of the patients, with 1.72 times more lesions, mainly infracentimetric, and induced a change in management for 19% of the patients. Conclusion: Adding DW sequences to standard MRI revealed additional metastases and led to modifications of patient management. Prospective studies are needed to confirm these results.

Lytic Lesion in the Distal Phalanx of the Hand

challenging. Objectives: This study was designed to evaluate the patients who were presented with a lytic lesion in their distal phalangeal bone of the hand. Patients and Methods: In this retrospective study, we reviewed the final diagnosis, clinical presentation, treatment, and outcomes of the lytic lesions in distal phalangeal bones of the hand in 14 patients who were referred to our hospital from 2008 to 2013. Results: The mean age of our patients was 36.14 ± 15.8 years. Thumb and middle finger were the most common involved digits (four cases of each) followed by the index finger (three patients). Enchondroma was the most common final diagnosis (five patients) followed by giant cell tumor and glomus tumor (two cases of each). Painless mass was the chief complaint of most patients with enchondroma, whereas pain and swelling were the chief compliant of others. Enchonromas were located in the proximal part of the distal phalanx and other lytic lesions were seen in the distal part. Conclusions: Because of the diverse diagnosis for the lytic lesions in the distal phalanx of the hand, a complete tumor work-up should be performed to evaluate the condition properly, especially in distally located lesions.

Chondromyxoid fibroma of calcaneus

Chondromyxoid fibroma is a rare benign primary bone tumor composed of immature myxoid mesenchymal and cartilaginous tissue. Its occurrence in calcaneus is very rare and few cases of calcaneal involvement have been reported in literature. We report five cases of CMF in calcaneus. Five cases, with the final diagnosis of chondromyxoid fibroma of the calcaneal bone are included in this report. Preoperative tumor workup was performed for our patients. We reviewed and recorded demographic data and the sign and symptoms of patients at presentation to our center. Mode of treatments, postoperative complications and recurrence were also studied. Curettage, high speed burring and bone grafting was performed in 4 of our patients and in the remaining case we only carried out curettage and burring. Of the five patients, 3 were male and 2 were female. The mean age at presentation was 21. Two of our cases had previous surgery in other centers and had been referred to our clinic because of recurrence. The chief complaint in all of our patients was heel pain. The mean follow up period was 25.2 months. All of our patients had a delay in the diagnosis of tumor. We did not have any recurrence in our patients during follow up period. This case series shows that chondromyxoid fibroma is not necessarily as exceedingly rare as generally reported in the current literature. This tumor should be considered in the differential diagnosis in patients with ankle and heel pain.

Microangiopathic Hemolytic Anemia as the First Manifestation of Metastatic Signet Ring Cell Carcinoma of Unknown Origin: A Case Report and Review of Literature

Microangiopathic hemolytic anemia (MAHA) occurs occasionally as a paraneoplastic syndrome in some solid tumors, but MAHA accompanied by signet ring cell carcinoma of an unknown origin is very rare. In this study, we present the case of an 80-yr-old man who was admitted to the hospital because of a 1-month history of lower back pain and dyspnea. He was diagnosed with MAHA on the basis of the laboratory findings that revealed anemia with schistocytes, decreased haptoglobin levels, and a negative direct Coombs' test. Bone marrow examination, which was performed because of the progression of anemia, revealed bone marrow metastases of signet ring cell carcinoma with extensive bone marrow necrosis. However, the primary origin of this signet ring cell carcinoma was not found. When the cause of progressive MAHA is unknown, the possibility of cancer-associated MAHA must be excluded by performing additional tumor workup, including the detection of tumor markers, gastric and colorectal endoscopic examinations, bone marrow examinations, and positron emission tomography-computed tomography or bone scans.

Role of Intraoperative US in the Decision for Radical or Partial Nephrectomy

To investigate the effect of intraoperative ultrasonographic (US) findings on the decision for the type of nephrectomy to be performed in patients who had renal tumors that were preoperatively evaluated by using magnetic resonance (MR) imaging, with pathologic results as the reference standard. The institutional review board approved the study protocol, and informed consent was obtained. Between June 2008 and September 2009, 44 patients (25 men, 19 women; mean age, 56.6 years; range, 28-76 years) with 46 renal tumors were prospectively assessed by using intraoperative US examinations to demonstrate tumor relationship with the nontumoral intact parenchyma. Findings at preoperative MR examinations were retrospectively evaluated by two radiologists to determine the type of surgery that would be recommended. The reference standard was results of pathologist's review of gross specimens and postoperative reports. The observers assigned their decisions as follows: score group 1, radical nephrectomy should be (should have been) performed; score group 2, partial nephrectomy can be (could have been) attempted; and score group 3, partial nephrectomy should be (should have been) performed. Radical nephrectomy was performed in 36 lesions. In all cases, the intraoperative US observer and the pathologist were concordant in the decision that radical nephrectomy versus partial nephrectomy could or should have been performed. MR observers 1 and 2 overcalled the need for radical nephrectomy in seven and four cases, respectively. Compared with pathologic results, the overall correlation of intraoperative US was 0.991, and the correlation for MR observer 1 was 0.786 and that for MR observer 2 was 0.731. Intraoperative US can be suggested as a valuable examination method in patients with tumors at a central location with suspicious renal sinus extension demonstrated by using MR imaging. The close cooperation of urologist and radiologist in renal tumor work-up could reduce performance of unnecessary radical nephrectomy.

The clinical significance of 18F-FDG-PET/CT in early detection of second primary malignancy in cancer patients

This retrospective study evaluated the diagnostic value of integrated whole-body (18)F-fluorodeoxyglucose positron-emission tomography and computed tomography ((18)F-FDG-PET/CT) in early detection of second primary malignancies in cancer patients. From June 2007 to October 2008, 677 cancer patients who had undergone a whole-body (18)F-FDG-PET/CT imaging for the purpose of initial tumor work-up were included in this study. We retrospectively analyzed the follow-up results of patients with newly detected lesions presented on the (18)F-FDG-PET/CT images, which had not been previously detected by other modalities. We diagnosed suspected second primary malignancies by considering PET/CT images and clinical information as well. With the pathological results as the golden standard and complementary clinical follow-up investigations, the sensitivity and the positive-predictive value (PPV) of diagnosis of a second primary malignancy were calculated. We retrospectively analyzed the follow-up results of 338 patients with newly detected lesions. Twenty-one patients were finally diagnosed with second primary malignancies. In addition, the second primary malignancies of 17 patients were diagnosed at an early stage (P = 0.007). Thirteen patients were without any related symptoms which are indicative of second primary malignancies (P = 0.38). The median Karnofsky performance status scale of these patients in the last follow-up study was 80 points. The sensitivity of (18)F-FDG-PET/CT in detecting a second primary malignancy was 95.24%, the PPV was 74.07%, which was much higher than the PPV of diagnosing with no clinical information. (18)F-FDG-PET/CT is a useful tool in detecting second primary malignancies in an early stage and can improve the therapeutic effects experienced by the patients.

Huge Pelvic Mass, Cutaneous and Vaginal Fistulas, and Bilateral Hydronephrosis: A Rare Presentation of Actinomycosis with a Good Response to Conservative Treatment and with Long-Term Sequelae of Renal

Objective: Actinomycosis with an extended pelvic abscess is an uncommon condition, which usually occurs coincident with the presence of an intrauterine contraceptive device (IUD) in the uterine cavity. The clinical picture of pelvic actinomycosis may vary between individuals, is often accompanied by complications, and is frequently misdiagnosed. Here, we report a case of pelvic actinomycosis, presenting as a huge pelvic mass and complicated by a vaginal fistula, a cutaneous fistula, and bilateral hydronephrosis, and we discuss the diagnosis and management of this patient. Case Report: A 35-year-old woman was referred to our hospital with a huge pelvic complex mass and progressively worsening low abdominal pain. The tumor workup, which included a computed tomography (CT) scan, revealed an extended pelvic abscess and bilateral hydronephrosis. Both cutaneous and vaginal fistulas were also noted. Endometrial curettage and biopsies of the skin and vaginal lesions confirmed the diagnosis of actinomycosis. The patient underwent conservative treatment and recovered well, although the skin lesion only healed after 12 weeks of oral antibiotic treatment. At the 1-year follow-up, a CT scan showed sequelae including a mildly atrophic left kidney and left hydronephrosis. Conclusion: In patients presenting with a pelvic mass and an IUD in the uterine cavity, the diagnosis of actinomycosis should be seriously considered. A detailed workup, including a CT scan, endometrial curettage and biopsies where possible, should be performed before surgery. Once diagnosis has been confirmed, conservative medical treatment should be attempted before considering laparotomy, to reduce the risk of complications. Despite successful treatment with antibiotics, long-term sequelae such as hydronephrosis and renal atrophy are possible in cases of extended pelvic actinomycosis.

Huge Pelvic Mass, Cutaneous and Vaginal Fistulas, and Bilateral Hydronephrosis: A Rare Presentation of Actinomycosis with a Good Response to Conservative Treatment and with Long-term Sequelae of Renal Atrophy and Hydronephrosis

Actinomycosis with an extended pelvic abscess is an uncommon condition, which usually occurs coincident with the presence of an intrauterine contraceptive device (IUD) in the uterine cavity. The clinical picture of pelvic actinomycosis may vary between individuals, is often accompanied by complications, and is frequently misdiagnosed. Here, we report a case of pelvic actinomycosis, presenting as a huge pelvic mass and complicated by a vaginal fistula, a cutaneous fistula, and bilateral hydronephrosis, and we discuss the diagnosis and management of this patient. A 35-year-old woman was referred to our hospital with a huge pelvic complex mass and progressively worsening low abdominal pain. The tumor workup, which included a computed tomography (CT) scan, revealed an extended pelvic abscess and bilateral hydronephrosis. Both cutaneous and vaginal fistulas were also noted. Endometrial curettage and biopsies of the skin and vaginal lesions confirmed the diagnosis of actinomycosis. The patient underwent conservative treatment and recovered well, although the skin lesion only healed after 12 weeks of oral antibiotic treatment. At the 1-year follow-up, a CT scan showed sequelae including a mildly atrophic left kidney and left hydronephrosis. In patients presenting with a pelvic mass and an IUD in the uterine cavity, the diagnosis of actinomycosis should be seriously considered. A detailed workup, including a CT scan, endometrial curettage and biopsies where possible, should be performed before surgery. Once diagnosis has been confirmed, conservative medical treatment should be attempted before considering laparotomy, to reduce the risk of complications. Despite successful treatment with antibiotics, long-term sequelae such as hydronephrosis and renal atrophy are possible in cases of extended pelvic actinomycosis.