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PURPOSE: Surgery of deep-seated brain tumors can be challenging. Several methods have been described to facilitate transcortical approaches, including ultrasound-assisted resection. Ultrasound-guided placement of a standard ventricular catheter is a widely reported technique and has been used to approach these lesions via the transcortical route. We describe how we usually perform this useful technique to assist and enhance the transcortical resection of some deep-seated brain tumors. METHODS: Standard electromagnetic frameless navigation (S8 Neuronavigation System, Medtronic, Minneapolis, USA) was employed to focus the craniotomy and to plan the trajectory of the ventricular catheter. After dural opening, an ultrasound device (Arietta 850, Hitachi-Aloka Medical, Tokyo, Japan) was used for intraoperative ultrasound (IOUS) assessment. A ventricular catheter was placed from the cortex to the lateral wall of the tumor under direct real-time IOUS visualization to guide the further transcortical dissection. RESULTS: Transcortical transcatheter ultrasound-assisted technique involved minimal time and infrastructure requirements. There were no major technical difficulties during its use, providing confidence and improving subcortical white matter dissection by guiding the route to the tumor. CONCLUSIONS: Recent improvement of IOUS image-quality devices offers several attractive options for real-time navigation. The combination of conventional neuronavigation systems with real-time IOUS assessment during the intradural step provides a higher degree of control by improving the execution of the surgery. We hope this description may be a useful tool for some selected cases and contribute to the further enhancement and improvement of this widely used technique.
Assuntos
Neoplasias Encefálicas , Humanos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/cirurgia , UltrassonografiaRESUMO
(1) Background: endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy, previously assisted by fine-needle aspiration, is a novel technique of particular interest in the field of lung cancer diagnosis and is of great utility for extrathoracic tumor metastases, lymphomas, and granulomatous diseases. An integrated histological and molecular diagnosis of small samples implies additional difficulty for the pathologist. Additionally, emerging tumor biomarkers create the need to search for new approaches to better manage the tissue sample; (2) Methods: An analytical observational study of 32 mediastinal node cryobiopsies is carried out in 27 patients (n = 27). Statistical analysis using the t-student and Wilcoxon signed-rank tests for paired data is performed with SPSS 26 and R Statistical software. The significance level is established at p < 0.05; (3) Results: cryobiopsies were valid for diagnosis in 25 of 27 patients, with a maximum average size of 3.5 ± 0.7 mm. A total of 18 samples (66.67%) were positive for malignancy and 9 (33.33%) were benign. The tumor percentage measured in all neoplastic samples was greater than 30%. The average DNA and RNA extracted in nine non-small cell lung cancer cases was 97.2 ± 22.4 ng/µL and 26.6 ± 4.9 ng/µL, respectively; (4) Conclusions: the sample size obtained from an endobronchial ultrasound-guided mediastinal transbronchial cryo-node biopsy facilitates the morphological and histo-architectural assessment of inflammatory and neoplastic pathology. It optimizes molecular tests in the latter due to more tumor cells, DNA, and RNA.
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BACKGROUND: Angiomyolipoma is a benign mesenchymal neoplasm of a wide histological heterogeneity belonging to the PEComa "family." The liver, after the kidney, is their second most frequent location. However, inflammatory hepatic AMLs constitute a rare entity, with only fourteen documented cases until 2020. These neoplasms can overlap morphological features of IgG4-related diseases, being of great diagnostic relevance to demonstrating myomelanocytic-lineage differentiation of the neoplastic cells. CASE PRESENTATION: we present a new case of an inflammatory hepatic AML resembling an IgG4-related disease in a 35-year-old woman with a subcapsular 5 cm mass confined to segment VII of the right hepatic lobe. Although having reduced its size along the tumor's natural evolution, complete tumor resection was decided due to its hypermetabolic behavior (max. SUV = 12,6) assessed by PET-CT scan. Finally, the patient underwent a right hepatectomy due to spontaneous rupture and bleeding of the lesion during the intervention. All the diagnostic and therapeutic procedures occurred in the last months of the COVID-19 pandemic. CONCLUSIONS: This review aims to describe inflammatory hepatic AML histological and immunohistochemical features. We further sought to establish a clinicopathological contextualization of this tumoral subtype.
Assuntos
Angiomiolipoma , COVID-19 , Neoplasias Gastrointestinais , Neoplasias Hepáticas , Feminino , Humanos , Adulto , Angiomiolipoma/diagnóstico , Angiomiolipoma/cirurgia , Angiomiolipoma/patologia , Neoplasias Hepáticas/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Pandemias , Teste para COVID-19RESUMO
We present the exceptional case of a 76-year-old woman with an incidental finding of a liver tumor compatible with an epithelioid angiomyolipoma, a rare neoformation about which there is still controversy regarding its management, due to its presumed potential for malignancy.
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Angiomiolipoma , Neoplasias Renais , Neoplasias Hepáticas , Feminino , Humanos , Idoso , Angiomiolipoma/diagnóstico , Neoplasias Renais/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Tomografia Computadorizada por Raios XRESUMO
The diagnosis of hepatocellular carcinoma (HCC) became easier in relation to the improved radiological examinations; however, the neoplasm may occur under atypical presentations mimicking other benign or malignant processes. Several mechanisms for the cystic changes of HCC have been suggested, including arterial thrombosis, inflammation, and rapid tumor growth. This paper reports an uncommon case of a 74-year-old patient, who presented with pain in the upper right abdomen and large cystic mass involving right lobe of the liver. He was diagnosed as cystic HCC, in the absence of cirrhosis, after surgery.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Idoso , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/patologia , MasculinoRESUMO
A 45-year-old male patient, with no history of interest, consulted in emergency department due to a progressive loss of strength in the lower limbs at the distal level with impossibility for dorsal flexion of the left foot, as well as neurogenic bladder. The MRI revealed a mass at the filum terminale with completed occupation of transverse diameter of the dural sac. The radiological diagnosis was lipoma of filum terminale. The patient underwent surgery with intraoperative neurophysiological monitoring using direct stimulation of nerve roots, which allowed the removal of a tumour composed of sebaceous material, fat and hair. The anatomopathological study classified it as a mature cystic teratoma. Postoperative evolution was favorable.
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The cranial radiation-induced tumors appearance in pediatric patients treated for hematological diseases such as leukemia/T-lymphoblastic lymphoma (T-ALL/LBL) is a known phenomenon that may include lesions of different malignant degrees and require neurosurgical treatment. We present the case of a 38-year-old man referred to our department for a sudden diplopia with 6-month progressive left hemiparesis and frequent falls. After imaging tests, different intra and extraxial lesions with different radiological behavior were observed, performing a single surgical approach for their resection. The pathological anatomy confirms four histological variants: meningioma (grade 1 and 2 [atypical]), subependymoma, and cavernoma. We discuss the teratogenic role of ionizing radiation.
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Dermatofibrosarcoma protuberans is a low-grade sarcoma typically originating in the dermis but with local invasion of subcutaneous cell and muscle tissue. We report a case of perianal dermatofibrosarcoma protuberans in a 41-year-old male complaining of anal pain and constipation. To date, only two cases of perianal dermatofibrosarcoma protuberans have been reported. The unusual location hinders surgical treatment. The characteristic translocation t(17;22)(q22;q13) leading to the formation of COL1A1/PDGFß fusion transcripts is not only of diagnostic value but also enables an alternative imatinib-based therapy in inoperable or metastatic cases. The pertinent literature is reviewed.
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Neoplasias do Ânus/patologia , Dermatofibrossarcoma/patologia , Adulto , Canal Anal/patologia , Neoplasias do Ânus/diagnóstico por imagem , Neoplasias do Ânus/genética , Neoplasias do Ânus/terapia , Dermatofibrossarcoma/diagnóstico por imagem , Dermatofibrossarcoma/genética , Dermatofibrossarcoma/terapia , Humanos , Imageamento por Ressonância Magnética , Masculino , Proteínas de Fusão Oncogênica/genética , Translocação GenéticaAssuntos
Adenocarcinoma/etiologia , Neoplasias do Ânus/etiologia , Doença de Crohn/complicações , Fístula Retal/etiologia , Neoplasias das Glândulas Sudoríparas/etiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Adulto , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias do Ânus/tratamento farmacológico , Neoplasias do Ânus/cirurgia , Biomarcadores Tumorais/análise , Colostomia , Doença de Crohn/cirurgia , Fluoruracila/administração & dosagem , Humanos , Leucovorina/administração & dosagem , Metástase Linfática , Masculino , Terapia Neoadjuvante , Compostos Organoplatínicos/administração & dosagem , Complicações Pós-Operatórias , Neoplasias das Glândulas Sudoríparas/tratamento farmacológico , Neoplasias das Glândulas Sudoríparas/cirurgiaAssuntos
Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Ovarianas/diagnóstico , Neoplasias Peritoneais/diagnóstico , Pseudomixoma Peritoneal/diagnóstico , Teratoma/diagnóstico , Idoso , Feminino , Humanos , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/cirurgia , Pseudomixoma Peritoneal/cirurgia , Teratoma/cirurgiaRESUMO
Adenocarcinoma (ADC) of the anal canal is a rare disease comprising only 5% of all anorectal neoplasias and 1.5% of all gastrointestinal tumours. The World Health Organisation classifies anal ADC into 3 types: the first may arise from the mucosa of the transitional zone in the upper canal, the second from the anal glands (ducts) and the last can develop in the environment of a chronic anorectal fistula. Patients with ADC of the anal canal have high rates of pelvic failure, distant metastasis, and lower overall survival than patients with epidermoid carcinoma. Because of limited case reports about this neoplasia, management strategies have not been well established. Most authors of related studies recommend preoperative chemoradiotherapy (CRT) followed by radical surgery. The aim of the present study is to review clinicopathology features and management of anal canal ADC.