Wall Mass Research Articles

Primary Chest Wall Ewing Sarcoma with Indolent Behavior in an Elderly Male

Abstract Introduction/Objective Ewing sarcoma (ES) is the second most common primary malignant bone tumor, primarily affecting children and young adults within the first two decades of life. Over 80% of cases are positive for CD99 and exhibit a characteristic t(11;22) translocation resulting in an EWSR1::FLI1 fusion. Extraosseous ES is extremely rare and most reported cases occur in patients less than 50 years old. We report an unusual case of extraosseous ES arising from the chest wall in an elderly male that showed slow interval progression on imaging studies. Methods/Case Report An 83-year-old male with a past medical history of COPD and tobacco use presented to the emergency department for a mechanical ground level fall and a worsening cough over the prior week. Of note, he was found to have a 6.1 cm pleural based mass seven years prior. The patient was ultimately discharged home with recommended oncologic follow-up for this long-standing chest wall mass due to an increase in size on imaging. A PET scan showed a hypermetabolic subpleural mass in the right lower chest wall measuring 7.6 cm with invasion through the adjacent ribs and intercostal spaces into the adjacent soft tissue. A core biopsy was performed, which demonstrated a small round blue cell tumor diffusely positive for CD99 and Bcl-2, lacking significant mitotic activity and necrosis. Given the unusual clinical features, a next generation sequencing (NGS) panel for sarcoma fusions was performed and identified an EWSR1::FLI1 fusion, supporting the diagnosis of ES/primitive neuroectodermal tumor (PNET). Results (if a Case Study enter NA) NA Conclusion ES is relatively common as a primary bone tumor in children and young adults, but is rare in the chest wall and pleura and is extremely rare in the elderly. The clinical course for ES is typically aggressive. Diagnosis of ES can be challenging as CD99 positivity is nonspecific. The characteristic t(11;22) EWSR1::FLI1 fusion can be identified through FISH or NGS. At 83 years old, this is, to our knowledge, the oldest patient reported in the literature with this diagnosis. The slow interval growth of this mass over a period of seven years is also unusual. These combined clinicopathologic features are exceedingly unique and expand upon the reported spectrum and behavior of the Ewing’s family of sarcomas. The use of broad NGS panels among pathologists may result in increased identification of ES in unusual clinical settings in the future, while also providing more confident pathologic classification in challenging situations.

Targeting BCMA in Plasmablastic Lymphoma: Two Cases of Therapeutic Response to Teclistamab

Plasmablastic lymphoma (PBL) is an aggressive subtype of B-cell Non-Hodgkin lymphoma (B-NHL) with poor outcomes. PBL occurs more commonly in HIV-positive or immunocompromised patients, but it can also occur in immunocompetent patients. Despite anthracycline-based induction therapy, PBL is associated with chemotherapy resistance and early disease relapse, yielding a median overall survival of 7 to 15 months (Castillo JJ, et al. Blood. 2015). The advent of novel therapies altered the therapeutic landscape for many common subtypes of B-NHL, but progress in PBL is lacking due to the rarity of this disease and the lack of effective therapeutic targets. While PBL does not express many common B-NHL markers (e.g. CD19 or CD20), it does highly express B-cell maturation antigen (BCMA). However, data regarding the efficacy of therapies targeting BCMA in PBL is limited. Herein, we report two cases of relapsed/refractory PBL treated with the BCMA-targeting bispecific antibody teclistamab. Patient 1 was a 33 year old male without significant comorbidities when he was diagnosed with Stage IIE PBL after presenting with a chest wall mass. He was treated with six cycles of dose-adjusted EPOCH-V, followed by radiation to the involved region and a BEAM autologous hematopoietic stem cell transplant. Post-transplant imaging showed him to be in a CR on day 30 PET, but he developed recurrent PBL on his day 100 PET exam with osseus lesions. He was then treated with daratumumab and ICE chemotherapy for four cycles, with an initial resolution of osseus lesions. However, he developed relapsed disease with perilymphatic lung nodules. His PBL was confirmed to express BCMA and he was started on teclistamab monotherapy. Following one cycle of weekly teclistamab (1.5mg/kg), his post-treatment PET imaging demonstrated a complete response. He then underwent a consolidative allogeneic hematopoietic stem cell transplant from a matched unrelated donor. As of this report, he remains in a complete response based on his 30 day PET restaging imaging after transplant and without clinical evidence of disease more than 90 days after transplant. Patient 2 was a 60 year old male with medical history of comorbid CAD, stage IV chronic kidney disease, chronic back pain requiring opioid treatment, and peripheral arterial disease when he was diagnosed with Stage IV PBL after he was found to have mass-like thickening of his descending colon on a CT scan. He underwent partial colectomy, with pathology revealing PBL and his post-operative staging PET/CT scan noting osseus, splenic, and hepatic lesions consistent with advanced stage disease. He was initially treated with DA-EPOCH for six cycles with intrathecal methotrexate, which yielded an initial complete response, though he relapsed four months after completing therapy. He was then treated with gemcitabine, oxaliplatin, and daratumumab but progressed after eight cycles on treatment with abdominal and perisplenic masses confirmed on biopsy to be PBL He was then initiated on teclistamab, which was continued weekly. His treatment course was complicated by a viral pneumonia from which he recovered with IVIG and supportive measures. Following 2 total cycles of therapy, his repeat PET/CT imaging was consistent with a complete response (Figure 1), and he remains on weekly teclistamab therapy with no evidence of disease to date. The encouraging responses noted in our two cases illustrate the therapeutic potential of targeting BCMA using teclistamab in PBL. In our cases, teclistamab was a well tolerated therapy, even in our patient with significant comorbidities. This report provides a foundation for future prospective, multicenter clinical trials to evaluate the efficacy and safety of teclistamab in the treatment of relapsed and refractory PBL.

Dual solutions of unsteady flow of copper-alumina/water based hybrid nanofluid with acute magnetic force and slip condition

Suspending particles of tiny solid in a fluid used to transport energy can enhance its thermal conductivity and heat transport properties. Our main goal of this examination is to study the radiative unsteady two-dimensional (2D) flow on a continuously diminishing, horizontal sheet. with suction for the hybrid water-based nanofluid and an aligned field of magnetic, including the combined suction, magnetic, and velocity slip conditions effect. The Tiwari & Das model of nanofluid equations is used, which takes into consideration the solid volume percentage. Equations of similarity are derived by employing the transformations of similarity, and the associated equations have been simplified numerically by employing the bvp4c method in MATLAB software for a variety of values of the nanoparticle volume fraction, the unsteadiness, and the wall mass suction in water. It is discovered that, within the given the unsteadiness parameter range, two solutions exist. Moreover, it is found that the fluid velocity slows down in 1st solution as volume fraction of copper nanoparticles rises but speeds up in the second solution at first before slowing down again. Using a temporal stability analysis, it is found that only one of the dual branches is stable over the long run, while the other is unstable.

A rare and challenging case of intrapericardial hydatidosis

BackgroundHydatid cysts are most frequently located in the liver and lungs and very rarely can be found in the pericardium. Diagnosis and treatment are quite challenging, as the disease can present itself in many forms depending to the location and the complications that it might cause.Case presentationA 22-year-old man presented to our hospital with ongoing dry cough for more than 1 month prior to admission. Other symptoms included chest pain, fatigue, low grade fever, and night sweats, which have worsened in the past 2 weeks. Physical examination revealed normal respiratory and heart function. Chest X-ray demonstrated mediastinal enlargement and left pleural effusion. Contrast-enhanced computed tomography images showed a walled cystic mass lesion measuring up to 56 × 50 mm in close proximity to the upper left atrium, ascending aorta and pulmonary artery, potentially localized in the pericardium, with a 10 mm endoatrial filling defect, findings were compatible with hydatid cyst, left pleural effusion and peripheral pulmonary upper left lobe consolidation. Cardiac involvement was excluded on magnetic resonance imaging and trans-esophageal ultrasound. The patient underwent fine needle aspiration of the affected lung and thoracocentesis. No malignancy was found, meanwhile the biopsy confirmed the presence of pulmonary infarction. In view of the imaging findings were highly suspicious of a hydatid cyst, we performed a test of antibody titers that was negative. The patient underwent left anterolateral thoracotomy, and after the opening of the pericardium, a cystic mass of 5 cm in diameter was found next to the left atrium and in close proximity with the left pulmonary veins. The content of the cyst was completely removed after the surgical area was isolated with gauze impregnated with hypertonic solution (NaCl 10%). The mass resulted to be an echinococcal cyst with multiple daughter cysts within it that did not penetrate/involve (perforate) the cardiac wall.ConclusionPericardial echinococcosis is a very rare pathology in which a high expertise multidisciplinary approach is required. The compression mass effect caused by the cyst can lead to complications, such as in our case where the pulmonary vein was compressed, leading to pulmonary infarction. The value of radiology studies and transoesophageal ultrasound are very important in the diagnosis. Surgery in these cases is always recommended, but preferred surgical approach is questionable. In cases such as ours, we recommend anterolateral thoracotomy.

Giant benign intrathoracic schwannoma: a decade-long progression towards fatality

BackgroundIntrathoracic neurogenic tumors arise from sympathetic nerve trunks and intercostal nerves; more than 90% are benign. Schwannomas are the most common histological variety, but fatalities due to giant schwannomas are rare.Case presentationWe report a case of a 65-year-old woman who presented with chest pain and cough. Computed tomography (CT) revealed a large left chest wall mass of 130-mm in size, and the patient was referred to our department. Tumor biopsy was performed under local anesthesia, and a diagnosis of schwannoma was made. Ten years previously, a 30-mm tumor had been noted in the left third intercostal space by a previous doctor, but follow-up had been interrupted owing to depressive disorder. Although we planned to perform intercostal artery embolization followed by chest wall tumor resection, the patient did not consent to surgery due to uncontrolled depression. After four months, she developed respiratory failure caused by compression due to an enlarged tumor and died. Autopsy also revealed a benign schwannoma with no malignant findings.ConclusionsAlthough schwannomas are benign tumors, there are some very rare cases in which they can become huge and life-threatening. Therefore, a benign tumor should not be neglected, and if surgery is not possible at the time of diagnosis, a regular follow up is necessary, in order not to miss the right timing for surgery.

Exercise-induced cardiac remodelling in elite athletes is characterized by a stronger ventricular mass-volume association in females as compared with males: MRI results from the ELITE cohort

Abstract Background Differentiation between exercise-induced cardiac remodelling (EICR) and cardiac pathology constitutes a central challenge in sports cardiology. To assist clinicians, theoretical frameworks have been developed: i.e. dynamic sports are associated with ventricular dilatation, static sports with hypertrophy, and sports containing both components with both dilatation and hypertrophy. However, EICR frameworks have been almost exclusively based on findings in male athletes, and whether these associations are found in female athletes is to date unclear. Purpose We aimed to investigate intersex differences in left ventricular (LV) remodelling in the extreme phenotypes of elite athletes. Methods We included 227 healthy, elite athletes from the ELITE cohort who underwent cardiac magnetic resonance imaging (CMR). Our outcomes of interest were absolute and body surface area (BSA) indexed LV end-diastolic volume, LV end-diastolic wall mass, LV end-diastolic mass-volume ratio to express cardiac remodelling (LV end-diastolic wall mass / LV end-diastolic volume) and correlations of BSA-indexed LV mass with LV end-diastolic volume to compare LV remodelling between sexes. Results A total of 122 male and 105 female elite athletes (age 26±6 years) were included. The age and division in sports categories according to the ESC classification were similar between the sexes. Male athletes showed larger indexed LV end-diastolic volumes (127±19 versus 108±14 ml, p <0.001) and indexed LV wall mass (66±12 versus 50±11 grams, p <0.001) compared to female athletes. Male athletes had a proportionally larger LV mass-volume ratio than women (0.53±0.12 versus 0.46±0.09 g/ml, p <0.001). Female elite athletes showed a moderate association between indexed LV mass increase with indexed LV end-diastolic volume increase (Spearman’s rho 0.45, p <0.001), whereas male athletes showed a weak association (Spearman’s rho 0.25, p =0.006). Conclusions Elite male athletes have larger left ventricular volumes and wall mass, with a greater mass-volume ratio, than their female counterparts. However, female athletes demonstrate a stronger mass-volume association than males. Our findings suggest the presence of distinct sex-dependent features of EICR.

Sport-specific cardiac adaptation in 104 female elite athletes: MRI findings from the ELITE cohort

Abstract Background The overlap between exercise-induced cardiac remodelling (EICR) and cardiac pathology is a key challenge in sports cardiology. Mainly based on findings in male athletes, EICR is thought to be sport-specific, and varyingly characterised by increased ventricular volumes, cardiac mass and/or wall thickness. However, no large cardiac magnetic resonance imaging (CMR) study in female elite athletes has extensively examined sport-specific cardiac adaptations. Purpose To investigate sport-specific EICR on CMR in a large cohort of female elite athletes. Methods We performed a cross-sectional CMR analysis in female elite athletes (Para-/Olympic or professional athletes competing ≥10 hours per week at a national/international level) aged ≥16 years, included in the ELITE cohort (1). We excluded athletes with known cardiovascular disease, and classified athletes according to the ESC sports disciplines classification. Our outcomes of interest were sport-specific EICR, defined as BSA-indexed LV and RV end-diastolic volume (EDVi), LV wall mass (LVMi), and maximal LV wall thickness (LVWdmax), LV remodelling index (LVMi/LVEDVi), and LV/RV ratio (LVEDi/RVEDVi). CMR was performed according to a uniform protocol, preferentially on 1.5T. A dedicated core-lab analysed all CMRs in Circle Cardiovascular Imaging. Results We included 104 female elite athletes, 96% Caucasian, mean age of 26.1 ±5 years, BSA 1.8 ±0.1 m2, and mean professional (≥10 hours/week) athlete years of 11.6 ±5. The athletes were classified as skill (n=8), power (n=9), mixed (n=39) and endurance (n=48) sports. Endurance athletes had markedly increased left- and right ventricular volumes compared to power (LVEDVi 111.2 ±15 vs 98.7 ±11 ml/m2, p=0.009; RVEDVi 114.8 ±18 vs 101.7 ±10 ml/m2, p=0.006) and mixed athletes (LVEDVi 111.2 ±15 vs 107.3 ±13 ml/m2, p=0.058; RVEDVi 114.8 ±18 vs 107.8 ±12 ml/m2, p=0.031) (Figure 1). No differences were found between endurance, mixed, power and skill athletes in LVEDVi/RVEDVi ratios (0.97 vs 0.99 vs 0.97 vs 0.99), LVMi (52.6 ±12 vs 46.9 ±10 vs 48.7 ±10 vs 50.4 ±11 g/m2) (Figure 2), LVWdmax (8.1 ±1 vs 7.9 ±1 vs 7.9 ±1 vs 8.9 ±1 mm), LV remodelling index (LVMi/LVEDVi 0.47 vs 0.44 vs 0.49 vs 0.48), LV ejection fraction (56.3 ±4 vs 56.7 ±5 vs 58.2 ±3 vs 57.7 ±3 %), and RV ejection fraction (54.6 ±4 vs 55.7 ±4 vs 55.4 ±3 vs 56.7 ±4). Conclusion In female elite athletes, EICR according to sport categories is mainly characterised by balanced increases in ventricular volumes in endurance athletes, but not in increases in left ventricular wall-mass and thickness, even in sport categories with high static demands. Our findings constitute a first step towards the understanding of sport-specific EICR in female elite athletes.Figure 1.Figure 2.

Biventricular dysfunction and lung congestion in post-COVID patients: a speckle tracking and stress lung echocardiography analysis

Abstract Background Cardiovascular abnormalities have been observed in half of all COVID-19 patients in the acute phase of the infection. Additionally, 10-35% of these patients have various long-term symptoms diagnosed with post-acute sequelae of COVID-19 (PASC). Aim of this study was to evaluate the role of exercise stress echocardiography (ESE) with an integrated approach, inclusive of Speckle-Tracking Echocardiography (STE) with Myocardial Work (MW) analysis in the evaluation of patients after COVID infection. Methods We prospectively recruited a population of 370 post-COVID 19 patients (Group 1) (225 males; 55.8 ±8.3 years), and of 250 age- and sex-comparable healthy controls (Group 2). In Standard Doppler echocardiography, STE and MW analyses and lung ultrasound at rest and at peak supine-bicycle ESE were performed. Results Left ventricular (LV) wall thickness, diameters and mass index were comparable between the two groups. Both LV ejection fraction (EF) and right ventricular (RV) functional indexes (TAPSE and Tissue Doppler S’ wave) at rest did not show differences between the two groups. Conversely, baseline LV GLS (-16.2±2.8 vs. –20.4±3.3 %; p<0.01), MW efficiency (88.8±3.2 vs. 93.2±3.3 %; p<0.001), and RV strain (-16.4±2.8 vs. –20.4±4.3 %; p<0.01), were significantly reduced in Group 1. Also pulmonary artery systolic pressures (PASP) (33.5±3.8 vs. 24.6±3.1 mmHg; p<0.001), and LV E/e’ ratio were significantly increased in COVID group, while B-lines ( ≥ 2) at rest were found in 25.3% of Group 1 and 5.1% of Group 2 (p < 0.001). During effort, COVID patients showed reduced exercise time and exercise capacity (<0.001). Values of LVEF, RV strain and LV GLS (all with p value <0.01) and MWE (p<0001) were much lower in COVID patients when compared to Group 2. Additionally, COVID patients showed at peak effort an increased LV E/e’ ratio, pulmonary pressures and B-lines by lung ultrasound (all p <0.001). Multivariable analysis detected independent associations of baseline GLS and MWE with maximal workload (watts reached), LV E/e’ ratio and B-lines during effort (p<0.001), stronger than the association of LVEF with the same functional parameters (p<0.01). What’s more, RV strain (p<0.001) was significantly associated with PASP levels at peak effort. Conclusions In post-COVID patients, biventricular involvement with impairment of LV and RV systolic function is frequent, missed by conventional indices such as EF or TAPSE, and detected by more sensitive STE indices such as LV-GLS, ME, and RV-strain. These alterations are functionally significant and associated with shorter exercise -time, more pulmonary hypertension, and greater pulmonary congestion during stress.

Abstract 17602: Cardiac Structure and Function and Renal Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: Insights From the PARAGON-HF Trial

Introduction: Chronic kidney disease is common and associated with a worse prognosis in patients with heart failure (HF). However, the association of cardiac structure and function with renal outcomes in patients with HF with preserved ejection fraction (HFpEF) is not known. Goal: Identify cardiac structural and functional correlates of renal outcomes in HFpEF. Methods: Patients enrolled in the echocardiographic sub-study of the PARAGON-HF trial were included. The endpoint of interest was a composite renal endpoint: a ≥50% decline in estimated glomerular filtration rate (eGFR) relative to baseline, development of end-stage renal disease, or death attributable to renal causes. Multivariable Cox proportional hazards models were used to identify measures of cardiac structural and functional parameters associated with the composite renal endpoint, adjusting for baseline eGFR, systolic blood pressure, NT-proBNP, treatment arm (sacubitril-valsartan or valsartan) and diabetes. Results: In 1,097 patients (53% women, mean age 74±8 years), over a median follow-up of 2.9 years (IQR 2.6-3.4 years) there were 28 composite renal events (0.9 per 100 patient-years). After multivariable adjustment, higher left ventricular (LV) posterior wall thickness and mass index, right ventricular (RV) end-diastolic and end-systolic areas as well as impaired RV function (lower fractional area change and lower absolute RV free wall longitudinal strain), but not LV systolic function (LVEF and global longitudinal strain) were each associated with a significantly higher risk for the composite renal endpoint ( Figure ). Conclusions: In the PARAGON-HF echocardiographic sub-study, evidence of cardiac biventricular remodeling and deterioration of RV function were associated with an increased risk of renal events. These results underscore the close relationship between the heart and kidneys in patients with HF even when LVEF is preserved.

Design and optimisation of an Intra-Aortic Shrouded rotor axial pump

Undesirable side effects in patients with a LVAD (Left Ventricular Assist Device) pump fitted include blood damage, thrombosis, blood traumatisation, and End-Organ Disfunctions. These side effects have generally been attributed to the high wall shear stresses and the induced turbulent flow. In this study, we introduce a novel design to address these effects by lowering the rotational speed and providing an optimum flow path design to minimise blood damage. We present an initial scheme for a new Intra-Aortic Shrouded Rotary Axial Pump and develop a sequence of pump geometries, for which the Taguchi Design Optimisation Method has been applied. We apply CFD tools to simulate the pressure rise, pump performance, hydraulic efficiency, wall shear stress, exposure time and mass flow rate. A prototype pump has been tested in a mock cardiovascular circuit using a water-glycerol solution. The optimum design delivered the desired pressure/mass flow rate characteristics at a significantly low rpm (2900 rpm). As a result, the estimated blood damage index is low, matching the design requirements. The theoretical performance was matched by experimental results.

Esophageal tumors: The keys to diagnosis by pneumo-computed tomography

ObjectiveTo review and describe the most characteristic radiological findings of the most frequent esophageal tumor lesions, with emphasis on the esophago-gastric distention technique pneumo-computed tomography performed in our institution. To know the main advantage of this distension technique. ConclusionMalignant tumor lesions (predominantly squamous cell carcinoma in the mid esophagus and adenocarcinoma in the distal esophagus) present as asymmetric wall thickening, mucosal irregularity, or mass extending into adjacent organs with lymph node involvement. Benign tumors (mainly leiomyoma being the most frequent and others such as lipoma) present as endoluminal growth, with defined borders and homogeneous attenuation. Post-contrast enhancement is scarce or moderate. The technique of computed tomography pneumotomography technique achieves an additional distension of the esophageal lumen in all cases. It allows delimiting the superior and inferior borders of the lesions, helping the surgeon to define the therapeutic strategy.

Numerical simulation of the particle wall mass transfer rates on rough surfaces confining turbulent natural convection flows

We performed numerical simulations of the particle mass transfer rates on the horizontal and vertical thermally active rough walls confining a turbulent natural convection flow. We considered the air flow conditions in a cubical cavity (L=1.22m, Ra=5.4·108, Pr=0.71) with two opposed pairs of consecutive walls at different temperatures, for which measurements of the particle deposition velocities are reported in the literature. The simulations were carried out by solving the momentum, thermal energy and particle mass transfer equations using a series of two-dimensional computational cell units to determine spatial evolution and development of the particle concentration boundary layer in the vicinity of hot and cold rough walls. Different flow conditions, wall orientations, sizes of roughness elements, particle diameters and temperature increments between the wall and the bulk fluid, typically found in indoor environments, have been considered and consequently, results can be used to estimate the particle deposition rates in real scenarios. At large mass transfer particle Péclet numbers, corresponding to spherical particles with diameters of 0.5–1 μm, the wall mass transfer rates of particles on rough textures typically increase by a factor of about 3 in comparison with the deposition on smooth surfaces. The thermophoretic effect significantly decreases the particle deposition on hot surfaces and increases it on cold surfaces, especially at large particle Péclet numbers. The numerical predictions of the deposition velocities are in good agreement with the measurements reported in the literature for the same flow conditions considered.

Paediatric thoracic actinomycosis presenting as back swelling: A case report

Presentation: A seven years old girl presented with a three-day history of cough and fever, and several weeks of back pain, anorexia and weight loss. Examination was significant only for a tender, non-erythematous swelling to the right mid-back measuring ten centimetres in length. Diagnosis and treatment: Investigations on admission included neutrophilia and elevated inflammatory markers. Chest radiograph demonstrated a confluent area of opacification within the right peripheral lower zone with a small pleural effusion. CT reported two large enhancing and infiltrative lesions in the right thorax and the right posterior lower ribs, and disseminated lymphadenopathy. Microbiology and histology of a tissue sample were conclusive for actinomycosis israelii. She had a full recovery following a nine month course of oral amoxicillin. Discussion: Invasive actinomycosis is rare, and a high clinical suspicion and thorough investigation is warranted with invasive pneumonia and atypical associated symptoms. Keywords: Actinomycosis; Pneumonia; Chest wall mass; non-accidental injury.

SAT563 Follicular Thyroid Cancer Masquerading as Chest Wall Mass With an Aggressive Course

Abstract Disclosure: I. Goyal: None. E. Punni: None. L. Adhikari: None. Introduction:Follicular thyroid cancers (FTC) are more aggressive than papillary thyroid cancer and usually have more advanced tumor stage at the time of presentation. Musculoskeletal metastases are rare though, but when present can cause various complications like pathological fractures and nerve compression. Clinical case:A 75-year-old female was seen in orthopedics clinic for a left infraclavicular chest wall mass. MRI chest showed a large destructive mass invading the manubrium. Biopsy showed follicular cells consistent with ectopic thyroid tissue. CT neck/chest showed 2x1.8 cm right thyroid lobe nodule and left sternoclavicular joint metastasis. She underwent total thyroidectomy and resection of portions of manubrium, left clavicle and left 1st and 2nd rib. Pathology showed FTC in right thyroid lobe, measuring 2.6 cm in greatest dimension with angioinvasion, and FTC of manubrium, adjacent connective tissue and sternoclavicular joint and ribs, measuring 6.3 cm in greatest dimension. Pathological TNM staging was pT2N0M1. Her 6-week post-op thyroglobulin (Tg) level was 28.7 ng/mL (Beckman Coulter Immunometric Assay, reference value <0.1 athyrotic). She was started on levothyroxine supplementation to achieve a TSH <0.01 uIu/mL. She was subsequently treated with 200 mCi of radio-active iodine (RAI) as adjuvant therapy. Post-therapy whole body scan showed increased activity in the right strap muscle and iodine-avid osseous metastasis in right hemisacrum. She further received radiation therapy to neck and sternal regions, and the right sacroiliac joint. Following this, patient was monitored with serial Tg panel and neck ultrasound (US). Her initial post-op US neck showed a soft tissue fullness in right thyroidectomy bed, concerning for residual disease but this was no longer seen after 3 months. Her Tg level downtrended from 28.7 ng/mL to 12.6 ng/mL and further to 1.8 ng/mL at 1-year follow-up. However, her course was complicated by development of several oral ulcers resulting from high-dose RAI therapy which were treated symptomatically with hydration, topical analgesics and Listerine mouth washes. The patient reported ongoing bowel incontinence since her initial cancer diagnosis. MRI pelvis showed rim-enhancing 4.5cm lesion centered at right sacral ala and extending into adjacent S1/S2 neural foramina. She was re-referred for palliative radiation therapy.Conclusion:This case of FTC is unique due to its uncommon initial presentation. Skeletal metastases to sacrum resulted in bowel incontinence in our patient. When present, skeletal metastases need treatment with high-dose (200 mCi) RAI. RAI therapy can cause xerostomia, hypogeusia and sialadenitis due to reductions in salivary flow. Clinicians should be aware of the early and late-onset complications of RAI therapy, discuss these with the patient before therapy and manage the complications adequately if these occur. Presentation Date: Saturday, June 17, 2023

RET/PTC rearrangement in papillary thyroid carcinoma arising in malignant struma ovarii with abdominal wall metastasis and cervical thyroid gland: a case report and review of the literature

BackgroundStruma ovarii refers to rare mature cystic teratomas containing at least 50% of thyroid tissue, and malignant transformation is known to be even rarer. The synchronous development of malignant struma ovarii and cervical thyroid carcinoma are also scarce and poorly understood due to limited data about molecular features. Here, we present the first report of RET/PTC 1 rearrangement in synchronous metastatic malignant struma ovarii to the abdominal wall and cervical thyroid cancer.Case presentationWe described a 47-year-old multigravida woman with bilateral adnexal and lower abdominal wall masses detected during the evaluation of abnormal uterine bleeding. The patient underwent a hysterectomy, bilateral salpingo-oophorectomy, and surgical removal of abdominal wall mass. Then, the pathological evaluation revealed papillary thyroid carcinoma (PTC) within struma ovarii and metastatic PTC in the abdominal wall fibro adipose tissue. Further, cervical thyroid gland physical examination and ultrasound illustrated a nodule within the left lobe. Subsequently, a total thyroidectomy was performed, and a histological examination revealed PTC. Furthermore, all affected tissue, i.e., struma ovarii, abdominal wall metastasis, and cervical thyroid gland tested for BRAF and RAS mutations and RET/PTC 1 rearrangement. RET/PTC 1 rearrangement was identified among all three different sites. Finally, after six years of follow-up, the patient had no evidence of recurrence or distant metastasis.ConclusionsIn light of these findings, malignant struma ovarii might yield a clue to cervical thyroid carcinoma, and the molecular analysis could provide valuable information for understanding the underlying mechanism, tumor clinicopathological behaviors, and prognosis.

Thermal-hydraulic characteristics analysis of steam–air condensation in vertical porous-wall corrugated tubes

In the passive containment cooling systems (PCCS) of Generation III nuclear power plants, the condensation performance of steam containing non-condensable gas (NCG) in condensate tubes is critical for removing heat from the nuclear power plant containment. By applying a novel porous-wall corrugated structure in the condenser tubes of this system, it was found that under certain conditions, a double vortex is formed inside and outside the porous layer, which is conductive to the transportation and condensation of steam to the condensing wall. The VOF multiphase relation and Brinkman–Forchheimerextended Darcy model in combination of local heat balance, condensation and species transport equations are employed to describe the heat and mass transfer in the porous-wall corrugated tube during condensation. The numerical analysis are conducted to investigate the effects of waveform channel, porous layer and its thicknesses, subcooling of cooling wall and inlet air mass fractions on flow and condensation under different inlet velocities, in which simulations agree with the experimental data. The results show that the condensation heat transfer is greatly influenced by the vortex distribution and air accumulation. At inflowing velocity of 1 m/s, the waveform with amplitude of 1 mm and wavelength of 18 mm can achieve the highest performance evaluation factor, φ (about 67.5 % enhancement than the smooth tubes). The ratio of waveform amplitude to wavelength needs to be chosen properly in consideration of convection between solid matrix and steam–air mixture in porous layer, and non-condensation gas distribution near cooling wall of condensation tube.

A 13-Year-Old Boy with Chest Wall Actinomycosis Mimicking Ewing Sarcoma on Imaging.

BACKGROUND Actinomyces, a filamentous, branching, anaerobic gram-positive bacillus, typically found as a commensal organism in the oral cavity, can lead to rare chronic bacterial infections in various anatomical regions. Chest wall involvement represents an uncommon presentation, posing significant diagnostic challenges. This report focuses on the case of a 13-year-old boy presenting with chest wall actinomycetoma that closely resembled Ewing sarcoma on imaging. CASE REPORT We present the case of a 13-year-old male with no previous medical history who presented to the Emergency Department with progressive left-sided chest pain following a sports-related fall. Physical examination revealed mild swelling and tenderness on the left anterior chest wall. A chest computed tomography (CT) scan revealed a large tumor involving the lower left chest wall, suggesting Ewing sarcoma. However, a histopathological examination unexpectedly confirmed actinomycosis of the chest wall. Intravenous penicillin G was promptly initiated for 4 weeks. A follow-up CT scan after 4 weeks of therapy demonstrated a significant response with notable reduction in the size of the chest wall mass. The patient then continued with maintenance therapy using oral amoxicillin for 12 months. Throughout this period, complete resolution of the chest wall mass occurred, with no significant adverse events or complications observed. CONCLUSIONS This case highlights the importance of considering uncommon differential diagnoses like chest wall actinomycosis in patients presenting with chest wall masses. The diagnostic complexities associated with this rare condition emphasize the need for a comprehensive evaluation strategy, incorporating histopathological examination and imaging.

Retrospective analysis of 26 cases of pregnancy luteoma.

Pregnancy luteoma is a rare hormone-dependent ovarian tumor-like lesion caused by increased androgenic activity during pregnancy. To explore the clinical history, ultrasound manifestations, and differential diagnosis of pregnancy luteoma. A retrospective analysis was conducted on 26 cases of pregnancy luteoma diagnosed by postoperative pathology, from 2009 to 2022. All cases were from two hospitals: Shanghai First Maternity and Infant Hospital and International Peace Maternity and Child Health Hospital. The clinical history data and ultrasound characteristics were analyzed and the relevant literature was reviewed. Among the 26 cases, five of them had preoperative ultrasound images. Among these five cases, three patients showed hyperechoic masses with less internal uniformity, while two demonstrated loculated anechoic zones, with clear boundary and regular morphology. Color Doppler showed no obvious internal blood flow signals, or that blood flow signals were visible within the cyst wall and hyperechoic mass. Among the cases, 16 had multiple gestations, while two visited the clinic due to sudden abdominal pain and a huge ovarian mass was found by ultrasonography. The ovarian lump was detected during routine obstetric ultrasound in three cases. The remaining were ovarian cysts found incidentally during caesarean section. Four patients presented with hairy manifestations and one patient had a deepened voice. There is no characteristic ultrasound of pregnancy luteoma, and its diagnosis is mainly based on clinical history data and laboratory tests.

Numerical analysis of magnetohydrodynamics in an Eyring–Powell hybrid nanofluid flow on wall jet heat and mass transfer

The customization of hybrid nanofluids to achieve a particular and controlled growth rate of thermal transport is done to meet the needs of applications in heating and cooling systems, aerospace and automotive industries, etc. Due to the extensive applications, the aim of the current paper is to derive a numerical solution to a wall jet flow problem through a stretching surface. To study the flow problem, authors have considered a non-Newtonian Eyring–Powell hybrid nanofluid with water and CoFe2O4 and TiO2 nanoparticles. Furthermore, the impact of a magnetic field and irregular heat sink/source are studied. To comply with the applications of the wall jet flow, the authors have presented the numerical solution for two cases; with and without a magnetic field. The numerical solution is derived with a similarity transformation and MATLAB-based bvp4c solver. The value of skin friction for wall jet flow at the surface decreases by more than 50% when the magnetic field is present. The stream function value is higher for the wall jet flow without the magnetic field. The temperature of the flow rises with the dominant strength of the heat source parameters. The results of this investigation will be beneficial to various applications that utilize the applications of a wall jet, such as in car defrosters, spray paint drying for vehicles or houses, cooling structures for the CPU of high-processor laptops, sluice gate flows, and cooling jets over turbo-machinery components, etc.

Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis.

Bladder cancer is the sixth most common malignancy in the United States (US). Despite its high prevalence and the significant potential benefits of early detection, no reliable, cost-effective screening algorithm exists for asymptomatic patients at risk. Nonetheless, reports of incidentally identified early bladder cancer on CT/MRI scans performed for other indications are emerging in the literature. This represents a new opportunity for early detection, with over 80 million CT scans performed in the US yearly, 40% of which are abdominopelvic CTs. This investigation aims to define the imaging features of early bladder cancer, with the mission of facilitating early diagnosis. Following IRB approval with a waiver of informed consent, a retrospective review was performed, identifying 624 patients with non-muscle-invasive bladder cancer diagnosed at Johns Hopkins Hospital between 2000 and 2019. Of these patients, 99 patients underwent pelvic CT within the 5 years preceding pathologic diagnosis. These imaging studies were reviewed retrospectively to evaluate for the presence and features of any focal bladder wall abnormality. Median age at the time of pathologic diagnosis was 70 years (range: 51-88 years), and 82% (81/99) of patients were male. A total of 226 CT studies were reviewed. The number of studies per patient ranged from 1 to 33. Median time interval between all available imaging and pathologic diagnosis was 14 months. A total of 62% (141/226) of the scans reviewed were performed for indications other than suspected urinary tract cancer (UTC). A bladder wall mass was visualized in 67% (66/99) of patients and on 35% (78/226) of scans performed before diagnosis. The majority (84%, 67/80) of masses were intraluminal. Mean transverse long- and short-axis measurements were 24 mm and 17 mm, respectively, with long dimension measurements ranging between 5 and 59 mm. Early bladder cancer was visualized on CT preceding pathologic diagnosis in more than 2/3 of patients, and the majority of scans were performed for indications other than suspected urinary tract cancer/UTC symptoms. These results suggest that cross-sectional imaging performed for other indications can serve as a resource for opportunistic bladder cancer screening, particularly in high-risk patients.