CT-based radiomics analysis for differentiation between thymoma and thymic carcinoma.

Background: The purpose of our study was to differentiate between thymoma and thymic carcinoma using a radiomics analysis based on the computed tomography (CT) image features. Methods: The CT images of 61 patients with thymic epithelial tumors (TETs) who underwent contrast-enhanced CT with slice thickness <1 mm were analyzed. Pathological examination of the surgical specimens revealed thymoma in 45 and thymic carcinoma in 16. Tumor volume and the ratio of major axis to minor axis were calculated using a computer-aided diagnostic software. Sixty-one different radiomics features in the segmented CT images were extracted, then filtered and minimized by least absolute shrinkage and selection operator (LASSO) regression to select the optimal radiomics features for predicting thymic carcinoma. The association between the quantitative values and a diagnosis of thymic carcinoma were analyzed with logistic regression models. Parameters identified as significant in univariate analysis were included in multiple analyses. Receiver-operating characteristic (ROC) curves were assessed to evaluate the diagnostic performance. Results: Thymic carcinoma was significantly predominant in men (P=0.001). Optimal radiomics features for predicting thymic carcinoma were as follows: gray-level co-occurrence matrix (GLCM)-homogeneity, GLCM-energy, compactness, large zone high gray-level emphasis (LZHGE), solidity, size of minor axis, and kurtosis. Multiple logistic regression analysis of these features revealed solidity and GLCM-energy as independent indicators associated with thymic carcinoma [odds ratio, 14.7 and 14.3; 95% confidence interval (CI): 1.6-139.0 and 3.0-68.7; and P=0.045 and 0.002, respectively]. Area under the curve (AUC) for diagnosing thymic carcinoma was 0.882 (sensitivity, 81.2%; specificity, 91.1%). Multivariate analysis adjusted for sex similarly revealed two features (solidity and GLCM-energy) as independent indicators associated with thymic carcinoma (odds ratio, 14.6 and 23.9; 95% CI: 2.4-89.2 and 1.9-302.8; P=0.004 and 0.014, respectively). Adjusted AUC for diagnosing thymic carcinoma was 0.921 (95% CI: 0.82-0.97): sensitivity, 62.5% and specificity, 100%. Conclusions: Two texture features (GLCM-energy and solidity) were significant predictors of thymic carcinoma.

Transarterial chemoembolization for pulmonary or mediastinal metastases from hepatocellular carcinoma.

OBJECTIVE: To evaluate the feasibility, efficacy and safety of transcatheter arterial chemoembolization (TACE) with HepaSphere for patients with pulmonary or mediastinal metastases from hepatocellular carcinoma (HCC). METHODS: Between June 2009 and January 2018, 14 patients with pulmonary or mediastinal metastases from HCC were treated with TACE with a combination of 1-3 chemotherapeutic drugs followed by HepaSphere embolization. As first end point, local tumor response and adverse events were evaluated after the first session of TACE, with Response Evaluation Criteria In Solid Tumors v. 1.1 and Common Terminology Criteria for Adverse Events v. 4 criteria, respectively. Overall survival was evaluated as secondary end point. TACE was repeated on-demand. RESULTS: TACE with HepaSphere was well tolerated with acceptable safety profile and no 30 day mortality. 1 month objective response and disease control rate were calculated to be 7.1 and 100%, respectively. Mean tumor size reduction rate was 15.6±9.5% at the first month. Two Grade 3 cytopenia events were seen (14.3 %), however none of the Grade 2 or more post-embolization syndrome was observed. The median overall survival time was 15.0 months and the 1 year, 3 year and 5 year survival rate were, 57.1%, 28.6%, 19.1%, respectively. CONCLUSION: Early experience showed that the transarterial treatment with HepaSphere is safe and effective treatment for patients with pulmonary or mediastinal metastases from HCC. ADVANCES IN KNOWLEDGE: Currently, the effects of molecular targeted drugs on HCC metastases are limited and side-effects are relatively frequent. In the present study, transarterial treatment might be a promising treatment for HCC metastasis.

[Trans-Arterial Chemoembolization Therapy for Giant Cholangiocellular Carcinoma - A Single Case Report].

Here, we report a case of cholangiocellular carcinoma that was successfully treated with chemotherapy using a selective intra-arterial infusion technique. A 65-year-old man presented to our hospital to obtain a second opinion regarding his disease. The patient was diagnosed with cholangiocellular carcinoma. The giant tumor was located in the porta hepatis. Some small nodules that were considered to be metastatic lesions were also observed in the surroundingarea. The tumor was judged by the primary physician to be too large for surgical treatment. Consequently, it was decided to treat the patient with trans-arterial chemoembolization(TACE)by selectingintra -arterial infusion of 5-FU, epirubicin(EPI), and mitomycin C prior to EPI-loaded HepaSphere(super-absorbent polymer microsphere)embolization, combined with concurrent systemic gemcitabine chemotherapy. After 5 sessions of the above treatment, the primary lesion reduced dramatically in size. In addition, the levels of CEA and CA19-9 decreased from 34.2 to 2.6 ng/mL and 1,540 to 149 U/mL, respectively. Although the patient's initial life expectancy was only 3 to 6 months, his life expectancy was extended to as longas 26 months followingthe initiation of TACE. This case suggests that treatment with TACE together with systemic chemotherapy can be a powerful therapeutic option for patients with inoperable cholangiocellular carcinoma.

[Transarterial Chemoembolization for Liver Metastasis of Ovarian Malignant Melanoma Resulting in Long-Term Survival].

Melanoma is a potentially aggressive disease, and patients with metastatic melanoma have a poor prognosis, with a median survival of only 6-9 months. There is no effective standard treatment for liver metastasis of malignant melanoma. Primary ovarian malignant melanoma is extremely rare and is usually associated with teratoma. We report a case of malignant melanoma arising in a mature ovarian cystic teratoma that had metastasized to the liver. Six courses of systemic chemotherapy were administered. However, as the liver metastases became enlarged, we performed transarterial chemoembolization(TACE). Following repeated TACE using drug-eluting microspheres for the liver metastasis, the patient survived 80 months from the initial diagnosis.

[Introduction of Hyperthermia Therapy with Low Dose Systemic Chemotherapy and Hepatic Transarterial Chemo-Embolization for a Case of Advanced Prostatic Cancer].

The case of a 78-year-old man with hormone-independent locally advanced prostatic cancer with liver metastases is reported. Standard systemic chemotherapy was not administered due to his poor general condition. At the initial consultation, rapidly growing liver metastases, multiple lymph node metastases, and extensive locally advanced prostatic lesions were found. Transcatheter arterial chemoembolization, low dose systemic chemotherapy, and thermotherapy were administered. After introduction of this combination therapy, marked regression of all of the lesions, including the liver metastases, lymph node metastases, and pelvic extension was observed. The patient's condition and prognosis were markedly improved without serious complications.

Superselective coaxial microballoon-occluded coil embolization for vascular disorders: a preliminary report.

PURPOSE: To evaluate the safety and effectiveness of superselective coil embolization with coaxial microballoon occlusion (B-coiling) for vascular disorders. MATERIALS AND METHODS: Clinical data were retrospectively evaluated for 16 consecutive patients (6 men, 10 women; mean age, 70 y; age range, 57-80 y) with vascular disorders who underwent B-coiling with 0.010-0.014-inch detachable microcoils delivered through a guide-wire lumen of a microballoon catheter. Routine angiographic catheters (4-5 F) were introduced in all cases, including splenic (n = 4) and renal (n = 3) artery aneurysms, pulmonary and renal arteriovenous malformations (AVMs; n = 3 and n = 1, respectively), gastroesophageal varices (GEVs; n = 3), gastroduodenal artery stump pseudoaneurysm (n = 1), and superficial temporal artery aneurysm (n = 1). RESULTS: Complete primary occlusion was achieved in 87.5% of cases (n = 14) without complications. Additional percutaneous transhepatic sclerotherapy by N-butyl cyanoacrylate (NBCA)/iodized oil mixtures without balloon occlusion resulted in successful occlusion of one GEV. Additional balloon-occluded NBCA injection was successfully performed in one renal AVM. CONCLUSIONS: Superselective coaxial microballoon embolization with detachable microcoils is a safe and useful treatment. Selective B-coiling induces tight packing under flow control in the treatment of vascular disorders.

[Liver Metastasis in a Gastric Cancer Patient--A Case of Successful Radiofrequency Ablation Combined with Degradable Starch Microspheres Transcatheter Arterial Chemoembolization].

A 60-year-old male patient underwent curative surgical resection for gastric cancer. After the surgery, the patient was diagnosed with T4b, N3b, ly3, v2, CY0, fStageⅢc gastric cancer, and adjuvant systemic chemotherapy using S-1 and CDDP was administered. However, follow-up computed tomography (CT) scan examination taken 2 months after surgery revealed a pancreatic fistula and retroperitoneal abscess, and percutaneous drainage was performed. After 1 month, the enhanced CT scan detected liver metastasis measuring 25 mm in diameter at segment 7. The CT-guided percutaneous radiofrequency ablation (RFA) combined with transcatheter arterial chemoembolization (TACE) procedure was performed on the liver metastasis using degradable starch microspheres (DSM). Two months after the RFA, a follow-up CT scan revealed local recurrence of the lesion in the medial side of the ablated area in segment 7. A second CT-guided RFA, which was combined with DSM-TACE, was performed on the recurrent lesion. The patient has since survived more than 2 years after the second treatment without any further recurrences. This case report suggests that RFA treatment combined with DSM-TACE might be a safe and feasible treatment for liver metastasis from gastric cancer.