186Re内放射治疗颅咽管瘤的临床疗效

目的 评价应用立体定向肿瘤囊腔内注射186Re治疗颅咽管瘤的临床效果.方法 应用立体定向穿刺置管注射186Re方法治疗囊性或囊实性颅咽管瘤19例,其中男性12例,女性7例.年龄5～58岁,平均37.2岁.肿瘤呈囊性者12例,囊实性者7例.注射核素186Re前,颅咽管瘤囊性部分的平均体积为8390 mm3.结果 随访6个月至3年,有7例患者囊腔完全消失,囊腔体积缩小>50%以上者5例,囊腔体积缩小≤50%者7例.治疗前视力减退的8例患者中,5例患者治疗后视力显著改善.治疗前垂体功能正常者无一例出现垂体功能低下;而治疗前垂体功能低下的4例患者中,1例治疗后垂体功能改善.治疗前表现为尿崩症的5例患者中,3例治疗后尿崩症状改善.结论 立体定向肿瘤囊腔内注射186Re是治疗囊性或囊实性颅咽管瘤简单、安全、有效的方法.     

囊性颅咽管瘤立体定向囊腔内放疗的临床研究

目的　探讨囊性颅咽管瘤囊腔内放疗的有效性和安全性。方法　对 5 6例囊性颅咽管瘤行CT引导立体定向囊腔内放疗 ,根据个体化剂量设计分别置入 1～ 3次、2 .4～ 14 .8MBq不等胶体磷酸铬 (Cr3 2 Po4) ,并进行临床随访观察。结果　 5 6例患者术后神经功能均很快出现不同程度的改善。随访 6个月至 9年 ,49例视力、视野障碍中 ,45例获得逐渐改善 ,4例恶化 ,偏瘫 3例恢复正常 ,所有内分泌功能障碍者均获得稳定或不同程度好转 ,复查CT或MR示 :5例瘤实质增大 (9% ) ,2例新的囊腔形成 ,1例导管在脑室内囊腔略缩小 ,囊腔完全消失 2 4例 (4 3 % ) ,囊腔明显缩小 (>80 % )2 4例 (86% )。无手术死亡及严重并发症。结论　立体定向囊腔内放疗是一种治疗囊性颅咽管瘤的安全而有效方法 ,放射剂量设计的个体化是提高治疗有效率的关键。     

磁共振成像-弥散加权成像诊断良恶性卵巢肿瘤的临床价值

目的 探讨磁共振成像-弥散加权成像(MRI-DWI)诊断良恶性卵巢肿瘤的临床价值.方法 对经手术病理确诊为卵巢占位性病变的100例患者的MRI常规扫描参数及DWI图像表现进行分析.比较良恶性病变的病变最大径、表观扩散系数(ADC)值、肿瘤位置、边界、囊实性、囊壁/分隔、T1及T2信号均匀性,并进行Logis-tic回归...     

Solitary true cyst of the pancreas in an adult

Background: Solitary true cyst of the pancreas is rare in adults, and the differential diagnosis of cystic lesions of the pancreas is challenging. Aim of the Study: To describe a solitary true cyst of the pancreas in an adult and discuss the differential diagnosis. Methods: A 50 yr old woman presented with a mass lesion in the right upper quadrant of the abdomen. Abdominal computed tomography showed a cystic lesion, with a maximum diameter of 12 cm, between the inferior surface of the liver and the ascending colon. The cyst was homogenous and had smooth edges. On magnetic resonance imaging, a unilocular cyst was seen that was low intensity on T1-weighted images and very high intensity on T2-weighted images. No connection between the cyst and the pancreatic ductal system was demonstrated on endoscopic retrograde cholangiopancreatography. Laparotmy was performed with a presumptive diagnosis of cystic tumor of the pancreas. Results: On pathologic examination, the cyst was serous and was lined with a single layer of normal cuboidal epithelium that was periodic acid Schiff stain negative. Meticulous examination failed to identify honeycomb-like microcysts characteristic of serous cystadenoma. The final diagnosis was a solitary true cyst of the pancreas. Conclusion: The differential diagnosis of solitary true cyst from other cystic lesion of the pancreas usually is based on histology. Particular care must be taken to distinguish this lesion from macrocystic serous cystadenoma.     

Phosphorus-32 therapy for cystic craniopharyngiomas

Background and purpose

To examine control rates for predominantly cystic craniopharyngiomas treated with intracavitary phosphorus-32 (P-32).

Material and methods

22 patients with predominantly cystic craniopharyngiomas were treated at Indiana University between October 1997 and December 2006. Nineteen patients with follow-up of at least 6 months were evaluated. The median patient age was 11 years, median cyst volume was 9 ml, a median dose of 300 Gy was prescribed to the cyst wall, and median follow-up was 62 months.

Results

Overall cyst control rate after the initial P-32 treatment was 67%. Complete tumor control after P-32 was 42%. Kaplan-Meier 1-, 3-, and 5-year initial freedom-from-progression rates were 68%, 49%, and 31%, respectively. Following salvage therapy, the Kaplan-Meier 1-, 3-, and 5-year ultimate freedom-from-progression rates were 95%, 95%, and 86%, respectively. All patients were alive at the last follow-up. Visual function was stable or improved in 81% when compared prior to P-32 therapy. Pituitary function remained stable in 74% of patients following P-32 therapy.

Conclusions

Intracystic P-32 can be an effective and tolerable treatment for controlling cystic components of craniopharyngiomas as a primary treatment or after prior therapies, but frequently allows for progression of solid tumor components. Disease progression in the form of solid tumor progression, re-accumulation of cystic fluid, or development of new cysts may require further radiotherapy or surgical intervention for optimal long-term disease control.     

Incidental cystic endocrine tumor of the pancreas: A case report with immunohistochemical study

A large cystic lesion in the pancreatic tail was found incidentally in a 20-year-old female during laparoscopic cholecystectomy. Pre-operative work up had revealed calculi in gall bladder and in addition, a cystic lesion in pancreas suggesting the possibility of a pseudocyst. A laparoscopic enucleation of the cyst was performed along with the removal of gallbladder. Microscopic examination of the resected specimen revealed a pancreatic cystic endocrine tumor; however, this tumor had produced no symptoms. Immunohistochemical studies of the tumor cells showed positivity for neuron-specific enolase, chromogranin A, and synaptophysin indicating their neuroendocrine nature. Prognostic markers (CK19, CD10 and Ki67) indicated good prognosis. Although endocrine tumors of the pancreas are usually solid, cystic change occurs only rarely and such tumors should be considered in the differential diagnosis of patients who have a cystic lesion in the pancreas in view of their rare transformation into a malignant tumor.     

Optimizing the multimodal approach to pancreatic cyst fluid diagnosis

BACKGROUND

The objective of this study was to develop a triage algorithm to optimize diagnostic yield from cytology, carcinoembryonic antigen (CEA), and v‐Ki‐ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) testing on different components of a single pancreatic cyst fluid specimen. The authors also sought to determine whether cell block supernatant was suitable for CEA and KRAS testing.

METHODS

Fifty‐four pancreatic cysts were triaged according to a volume‐dependent protocol to generate fluid (neat and supernatant) and cell block specimens for cytology, comparative CEA, and KRAS testing. Follow‐up histology, diagnostic cytology, or a combined clinicopathologic interpretation was recorded as the final diagnosis.

RESULTS

There were 26 mucinous cystic lesions and 28 nonmucinous cystic lesions with volumes ranging from 0.3 mL to 55 mL. Testing different components of the specimens (cell block, neat, and/or supernatant) enabled all laboratory investigations to be performed on 50 of 54 cyst fluids (92.6%). Interpretive concordance was observed in 17 of 17 cases (100%) and in 35 of 40 cases (87.5%) that had multiple components tested for CEA and KRAS mutations, respectively. An elevated CEA level (>192 ng/mL) was the most sensitive test for the detection of a mucinous cystic lesion (62.5%) versus KRAS mutation (56%) and “positive” cytology (61.5%). KRAS mutations were identified in 2 of 25 mucinous cystic lesions (8%) in which cytology and CEA levels were not contributory.

CONCLUSIONS

A volume‐based protocol using different components of the specimen was able to optimize diagnostic yield in pancreatic cyst fluids. KRAS mutation testing increased diagnostic yield when combined with cytology and CEA analysis. The current results demonstrated that supernatant is comparable to neat fluid and cell block material for CEA and KRAS testing. Cancer (Cancer Cytopathol) 2013. © 2012 American Cancer Society.     

Cystic lymph node metastases of squamous cell carcinoma of Waldeyer's ring origin

We analysed in a retrospective study the frequency of cystic lymph node (LN) metastases in neck dissection specimens of 123 patients with primary squamous cell carcinoma (SCC) arising in the palatine tonsils (62 M/14 F), the base of the tongue (38 M/5 F) and the nasopharynx (2 M/2 F). Eighty-two per cent of patients had metastases (64 tonsillar SCC, 33 base of tongue SCC and all four nasopharynx SCC) in 368 LN of a total 2298 sampled LN. Thirty-nine per cent of patients had exclusively solid metastases and 37% of patients had exclusively cystic metastases. A total of 62 patients had some signs of cyst formation in one or more metastatically affected LN (27 with only histological evidence of cyst formation with luminal diameters < 5 mm, 35 with clinically detectable cyst with luminal diameter > 5 mm). Cystic metastases were more common in patients with SCC of the base of the tongue (P = 0.005), while solitary clinically evident cystic metastasis with lumina > 5 mm were found exclusively in tonsillar carcinoma (P = 0.024). In comparison with solid metastases, cyst formation was associated with N-categories (N2b and N3, P = 0.005) in SCC of the base of the tongue origin. No such association was observed for tonsillar SCC (P = 0.65). The primary mechanism of cyst formation was cystic degeneration.     

An analysis of the severe complications of irradiation of carcinoma of the uterine cervix: treatment with intracavitary radium and parametrial irradiation

Between January 1967 and December 1974, 254 patients with carcinoma of the uterine cervix were treated with either intracavitary radium and parametrial irradiation or 2000 rad whole pelvis irradiation followed by intracavitary radium and parametrial irradiation. In general, these patients had tumors of relatively limited volume and vaginal and uterine anatomy that was favorable for intracavitary radium. Not all patients had a lymphangiogram performed prior to irradiation. Of those who did, only patients with negative lymphangiograms are included in this analysis. All patient had a minimum follow-up of four years. The absolute four year survival rate for this group of patients was 86%. Only 6.3% of patients died of disease. The incidence of severe complications was 7.5%. Complications were associated with a high number of milligram hours of radium plus a high dose of external irradiation, in combination with either asymmetry of the radium system and/or history of previous pelvic inflammatory disease, pelvic surgery, or diverticulosis.     

Periampullary localized pancreatic intraepithelial neoplasia-3 (PanIN-3): evaluation with contrast-enhanced MR cholangiography (MRCP)

Background

The early determination of premalignant lesions of pancreas can prevent unnecessary excessive surgical procedures and can reduce morbidity and mortality. Pancreatic intraepithelial neoplasia-3 (PanIN-3) is a preinvasive form of adenocarcinoma (carcinoma in situ). PanINs have not taken place in the literature of radiology yet, it should be considered in differential diagnosis of pancreatic cystic lesions.

Case report

A patient with preliminary diagnosis of chronic cholecystitis who had choledocolithiasis and periampullary pancreatic cyst detected by noncontrast-enhanced (NCE) and contrast-enhanced (CE) magnetic resonance cholangiography (MRCP) is presented. Pathological examination results of gallbladder and pancreatic cyst were reported as gallbladder adenocarcinoma and PanIN-3, respectively.

Conclusions

Pancreatic cystic lesions with thin septa which enhances slightly with the administration of contrast material may represent PanIN-3. In patients with cystic pancreatic lesion localized at periampullary region, using CE-MRCP together with NCE-MRCP could be useful in the evaluation of pancreatic cystic masses as well as other abdominal pathologies.     

Lipid-associated sialic acid levels in human breast cyst fluids

Summary Benign mammary gross cystic disease is the most common breast lesion. Women with apocrine changes of epithelium lining the cysts are at higher risk for developing breast cancer than the normal female population. Sialic acid has drawn considerable interest because of carbohydrate aberrations in malignant cells. The current investigation determined the concentrations of lipid-associated sialic acid (LASA) in 62 breast cyst fluids and sera. Data analyses show a significant increase in the mean values of LASA in metabolically active apocrine cysts when compared to the cysts with Na⁺/K⁺>3 (flattened cysts) (p<0.001). The greater LASA levels in cyst fluids with lower intracystic Na⁺/K⁺ ratios could represent an altered expression of biosynthetic activity of the surrounding apocrine cell surface sialoglycolipid metabolism, providing a possible explanation of why women with apocrine cysts may be at greater cancer risk and being useful in further studies on functional stage changes in the cysts and their relationship to breast cancer.     

Intracavitary brachytherapy using stereotactically applied phosphorus-32 colloid for treatment of cystic craniopharyngiomas in 53 patients

This paper summarizes outcomes of a single-center study of intracavitary brachytherapy (IBT) with stereotactically applied phosphorus-32 ((32)P) colloid for treatment of cystic craniopharyngiomas. We assessed its efficacy and safety, on the basis of clinical and radiological outcomes in one of the largest reported patient series. Between 1992 and 2011, 53 patients were treated with IBT, 14 without previous treatment and 39 who had previously been treated for recurrent cysts. Intervention was performed by applying 200?Gy to the internal cyst wall (median volume 6.1?ml). Median clinical and radiological follow-up were 60.2 and 53.0?months, respectively. Actuarial tumor cyst control was 86.0?±?5.3?% at 12, 24, and 60?months. Actuarial out-of-field control (development of new cysts or progression of solid tumor parts) was 90.9?±?4.3, 84.0?±?5.6, and 54.5?±?8.8?% after 12, 24, and 60?months, respectively. Corresponding actuarial overall progression-free survival was 79.4?±?6.1, 72.4?±?6.8, and 45.6?±?8.7?% at 12, 24, and 60?months, respectively. Visual function improved for 12 patients (23.5?%), remained unchanged for 34 patients (66.7?%), and worsened for five patients (9.8?%), correlating with tumor progression in each case. Endocrinological deterioration occurred for ten patients (19.6?%); for nine patients this was a result of tumor progression or after tumor resection and for one it was attributed to irradiation. Within six months of IBT seven patients (13.7?%) experienced transient neurological deficits and two patients (3.9?%) deteriorated permanently (hemiparesis and third nerve palsy). Stereotactically applied (32)P is highly efficacious for control of cystic components of craniopharyngiomas and is associated with a low risk of permanent morbidity. The procedure does not, however affect the development of new cysts or the progression of solid tumor parts.     

Abdominal desmoid in familial adenomatous polyposis presenting as a pancreatic cystic lesion

A 17-year-old male with familial adenomatous polyposis (FAP) presented with chest pain and significant weight loss. An abdominal CT scan detected a cystic pancreatic lesion of unknown etiology. The patient therefore underwent surgical resection of the distal pancreas, which included the lesion, because of the known association of pancreatic cancer with FAP. Histopathological examination of the resected specimen showed a benign pancreatic cyst and fibrous plaque with desmoid fibromatosis adherent to the surface of the pancreas, serosa of the stomach, and colon. The fibrous plaque was histologically identical to the fibrous mesenteric plaque known to occur in FAP and associated mesenteric fibromatosis. We present pathologic evidence that the pancreatic cyst formation was induced by FAP-associated desmoid invasion. Desmoid growth should be considered in the differential diagnosis of a pancreatic cystic mass lesion in patients with FAP or its Gardner syndrome variant. This case report provides the first pathologic evidence for benign epithelial cyst formation in the pancreas caused by fibromatosis invasion of that organ as a part of FAP.     

Cerebellopontine angle endodermal cyst presenting with hemifacial spasm

Intracranial endodermal cysts presenting with hemifacial spasm (HFS) are extremely rare. We report a right cerebellopontine angle (CPA) endodermal cyst in a 56-year-old man who presented with a 6-month history of right-sided hemifacial spasm. Computed tomography revealed a homogenous, well-demarcated, hyperdense lesion extending from prepontine cistern to right CPA. Magnetic resonance imaging demonstrated a right CPA extra-axial cystic lesion protruding into Meckel’s cave, with compression of cranial nerves VII and VIII. Light brown, creamy cystic content was totally removed, and the thin cyst wall surrounding cranial nerves VII and VIII and the right vertebral artery was subtotally removed through the right lateral suboccipital approach. On microscopic examination, the cyst wall was composed of mono- to multilayered stratified epithelia, which were lined by ciliated or nonciliated cuboidal cells, with cilia showing the characteristic 9 + 2 pattern. Immunohistochemistry showed positive staining of cells composing the cyst wall with carcinoembryonic antigen, epithelial membrane antigen, cytokeratin 8, and negative staining with cytokeratin 20, and S-100, thereby characterizing endodermal cyst. Postoperatively, the patient was free of facial spasm.     

Intracavitary chemotherapy with 5-fluoro-2'-deoxyuridine (FdUrd) in malignant brain tumors.

BACKGROUND: After completing basic research on the anti-tumor effects and neurotoxicity of 5-fluoro-2'-deoxyuridine (FdUrd) and the balance of thymidine kinase and thymidine phosphorylase activities and confirming the safety of intrathecal FdUrd administration in a previous clinical study of meningeal carcinomatosis, intracavitary administration of FdUrd was performed as a second trial in patients with malignant glioma and metastatic brain tumors. METHODS: The study population consisted of 13 patients, six with glioblastoma, one with anaplastic astrocytoma and six with metastatic brain tumors. This treatment was applied for cystic, small-volume residual or recurrent tumors. FdUrd (1-10 microg) was administered every day at least 25 times through an Ommaya device placed in the cyst or closed postoperative cavity reconstructed with a patch of galea aponeurotica. Intracavitary chemotherapy with FdUrd was preceded by radiation therapy in two patients but no other adjuvant therapy was performed. RESULTS: No side effects such as headache, nuchal pain, convulsive attack, bone marrow suppression or liver dysfunction were observed during the course of chemotherapy. Seven of the 13 patients showed responses: complete response six, minor response one, no change two and progressive disease four after the twenty-fifth intracavitary administration of FdUrd when tumor sizes on CT scans and MRI before and after intracavitary chemotherapy were compared. CONCLUSIONS: Intracavitary FdUrd chemotherapy may be useful for the treatment of small-volume tumors.     

Sclerosing hemangioma of the lung with cystic appearance

A case of cystic sclerosing hemangioma of the lung is reported. A chest X-ray of a 55-year-old woman who had been suffering from a cough with sputum for several months revealed an abnormal nodular shadow. A chest CT scan revealed a solitary tumor with cystic appearance occupying S7 of the right lung and the inferior pulmonary ligament. Radiological differential diagnosis for the lesion included bronchogenic cyst, cystic Schwannoma, pulmonary necrotic carcinoid, and lung carcinoma. Right lower lobectomy was carried out and the lesion was pathologically diagnosed as sclerosing hemangioma of the lung with cystic features, expanding into the pulmonary ligament. Differential diagnosis of the cystic lesion of the lung should include cystic sclerosing hemangioma as observed in this case.     

Radioimmunoassayable insulin-like growth factor-I in human breast cyst fluid

Insulin-like growth factor-I (IGF-I) was measured in breast cyst fluid and serum collected at the same time. In addition, epidermal growth factor (EGF) was measured in breast cyst fluid. The radioimmunoassay inhibition curve of cystic IGF-I was parallel to that of authentic IFG-I. Cystic immunoreactive IGF-I had an elution pattern similar to IGF-I from Sep-Pak C₁₈ silica columns and from gel-filtration chromatography using Sephacryl 200. The material from Sephacryl 200 gave a radioimmunoassay curve which was parallel to IGF-I.The median (range) amount of IGF-I in cyst fluid was 9.3 ng/ml (0.8–33.3 ng/ml) and was 5–10% of that found in serum, although there was no significant correlation between the two levels. The median (range) level of cystic EGF was 416 ng/ml (14–1640 ng/ml). There was a weak negative correlation between cystic EGF and cystic IGF-I (P < 0.01).Some women presented with multiple cysts and for these cysts there was a high degree of concordance of levels for both IGF-I or EGF.Unlike serum there was little or no protein present in cyst fluid which bound IGF-I.     

Rare pulmonary primitive neuroectodermal tumor metastasizing to the right atrium: a case report

A 28-year-old man complained of intermittent irritable dry cough for 2 months with occasional bloody sputum. Positron emission tomography–computed tomography (PET-CT) suggested multiple heterogeneous soft tissue masses in the inferior lobes of both lungs, with heterogeneous increases in ¹⁸F-FDG uptake. No metabolic disorders were found in the rest of the body. CT-guided percutaneous lung puncture and biopsy and immunohistochemical study confirmed pulmonary primitive neuroectodermal tumor (PNET). PNET is characterized by small round blue cells and positive CD99 expression. After six cycles of chemotherapy with ifosfamide, dacarbazine and cisplatin, the lesions diminished substantially. At 2 months after the last cycle of chemotherapy, the patient complained of exertional dyspnea. PET-CT and echocardiogram suggested a space-occupying lesion in the right atrium. Autopsy revealed that this space-occupying lesion had the same pathomorphology and immunophenotype with pulmonary PNET, suggesting metastasis of pulmonary PNET to the right atrium. Here, we reported this rare case of pulmonary PNET metastasizing, instead of direct infiltrating or extending, into the heart.     

Stereotactic radiosurgery for cavernous sinus hemangiomas

We performed this retrospective study to analyze the outcome of patients with cavernous sinus hemangioma (CSH) after stereotactic radiosurgery (SRS). We analyzed 19 patients with CSHs who were treated with SRS between 1998 and 2011. The median age of the patients was 50 years (range, 35–73 years), and 16 (84.2 %) of the patients were female. SRS was performed as a primary treatment for 18 patients and to treat a residual lesion after surgical resection in one patient. Nine (47.4 %) patients had cranial neuropathies in 14 cranial nerves before SRS, whereas five (26.3 %) patients were initially asymptomatic. The mean volume of the CSHs was 6.1 ± 7.2 cm³ (range, 0.3–32.3 cm³), and the median marginal dose at the 50 % isodose line was 14.5 Gy (range, 11.5–16.0 Gy). The mean follow-up period was 37 months (range, 12–85 months). At the last follow-up, the lesion volume had decreased in all patients. The average tumor volume had decreased to 26 % (range, 0–70 %) of the initial volume at the last follow-up MRI. The first follow-up MRI, performed 6.1 ± 1.0 months after the SRS, showed that the tumor volume had decreased to 41 % (range, 0–88 %) of the initial volume. All 14 of the cranial neuropathies observed before SRS had improved, with complete remission in 12 (85.7 %) cranial nerves and partial remission in two (14.3 %). There were no radiation-induced neuropathies or complications during the follow-up period. SRS appears to be an effective and safe treatment modality for the management of CSHs.     

Three Cases of Serous Oligocystic Adenomas of the Pancreas; Evaluation of Cyst Wall Thickness for Preoperative Differentiation from Mucinous Cystic Neoplasms

Background

Serous oligocystic adenoma (SOA), a rare pancreatic neoplasm, is generally a benign lesion without the necessity of surgery. Preoperatively, it is difficult to discriminate SOA from mucinous cystic neoplasm (MCN), which essentially needs surgical treatment. The purpose of this study was to evaluate the cyst wall thickness of SOAs and MCNs for preoperative differential diagnosis.

Methods

We experienced three cases of SOAs with typical histopathological features. The cyst wall thickness of the SOAs was evaluated in the area protruding out of the pancreas and was compared with that of 13 MCNs histopathologically. The same evaluation and comparison were conducted on preoperative computed tomography (CT) images retrospectively.

Results

The SOAs had a uniformly thin cyst wall measuring less than 1 mm. In contrast, the largest area of a cyst wall in MCNs ranged from 2.5 to 10.0 mm. On CT images, all but one of the MCNs showed a detectable cyst wall, while the cyst walls were hardly recognizable in two of the three SOAs.

Conclusions

For preoperative differentiation between SOAs and MCNs, the evaluation of cyst wall thickness may be an important tool and may contribute to the decision of treatment strategy.