Application of radiomics for preoperative prediction of lymph node metastasis in colorectal cancer: a systematic review and meta-analysis.

BACKGROUND: Colorectal cancer (CRC) stands as the third most prevalent cancer globally, projecting 3.2 million new cases and 1.6 million deaths by 2040. Accurate lymph node metastasis (LNM) detection is critical for determining optimal surgical approaches, including preoperative neoadjuvant chemoradiotherapy and surgery, which significantly influence CRC prognosis. However, conventional imaging lacks adequate precision, prompting exploration into radiomics, which addresses this shortfall by converting medical images into reproducible, quantitative data. METHODS: Following PRISMA, Supplemental Digital Content 1 (http://links.lww.com/JS9/C77) and Supplemental Digital Content 2 (http://links.lww.com/JS9/C78), and AMSTAR-2 guidelines, Supplemental Digital Content 3 (http://links.lww.com/JS9/C79), we systematically searched PubMed, Web of Science, Embase, Cochrane Library, and Google Scholar databases until 11 January 2024, to evaluate radiomics models' diagnostic precision in predicting preoperative LNM in CRC patients. The quality and bias risk of the included studies were assessed using the Radiomics Quality Score (RQS) and the modified Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Subsequently, statistical analyses were conducted. RESULTS: Thirty-six studies encompassing 8039 patients were included, with a significant concentration in 2022-2023 (20/36). Radiomics models predicting LNM demonstrated a pooled area under the curve (AUC) of 0.814 (95% CI: 0.78-0.85), featuring sensitivity and specificity of 0.77 (95% CI: 0.69, 0.84) and 0.73 (95% CI: 0.67, 0.78), respectively. Subgroup analyses revealed similar AUCs for CT and MRI-based models, and rectal cancer models outperformed colon and colorectal cancers. Additionally, studies utilizing cross-validation, 2D segmentation, internal validation, manual segmentation, prospective design, and single-center populations tended to have higher AUCs. However, these differences were not statistically significant. Radiologists collectively achieved a pooled AUC of 0.659 (95% CI: 0.627, 0.691), significantly differing from the performance of radiomics models (P<0.001). CONCLUSION: Artificial intelligence-based radiomics shows promise in preoperative lymph node staging for CRC, exhibiting significant predictive performance. These findings support the integration of radiomics into clinical practice to enhance preoperative strategies in CRC management.

First incidence of extrarenal wilms tumor within the spinal canal in the adult population: a novel case report and literature review.

BACKGROUND: Wilms tumor (WT), also known as nephroblastoma, is rare in adults, accounting for merely 3% of all nephroblastomas or 0.2 cases per million individuals. Extrarenal Wilms tumor (ERWT) emerges outside the renal boundaries and comprises 0.5 to 1% of all WT cases, with even rarer incidences in adults. Oncogenic mutations associated with ectopic nephrogenic rests (NR) may contribute to ERWT development. Diagnosis involves surgical resection and pathology examination. Due to scarce cases, adults often rely on pediatric guidelines. We thoroughly searched PubMed, Scopus, and Web of Science databases to establish our case's uniqueness. To the best of our knowledge, this is the first documented incidence of extrarenal Wilms tumor within the spinal canal in the adult population. CASE PRESENTATION: A 22-year-old woman with a history of congenital lipo-myelomeningocele surgery as an infant presented with a 6-month history of back pain. This pain gradually resulted in limb weakness, paraparesis, and loss of bladder and bowel control. An MRI showed a 6 × 5 × 3 cm spinal canal mass at the L4-S1 level. Consequently, a laminectomy was performed at the L4-L5 level to remove the intramedullary tumor. Post-surgery histopathology and immunohistochemistry confirmed the tumor as ERWT with favorable histology without any teratomatous component. CONCLUSION: This report underscores the rarity of extrarenal Wilms tumor (ERWT) in adults, challenging conventional assumptions about its typical age of occurrence. It emphasizes the importance of clinical awareness regarding such uncommon cases. Moreover, the co-occurrence of spinal ERWTs and a history of spinal anomalies warrants further investigation.

Intradural intramedullary epidermoid cyst in a 17-year-old male: An exceptionally rare case report and review of the literature.

INTRODUCTION: Spinal epidermoid tumors are exceptionally rare, comprising less than 1 % of all spinal tumors. True intramedullary epidermoid cysts (IECs) are even more infrequent, constituting only 0.8 % of all spinal epidermoid tumors, with a notable cranial preference. Due to their gradual growth, the clinical presentation varies widely based on factors such as size, location, and the patient's age. CASE PRESENTATION: A 17-year-old male patient was admitted after experiencing an eight-month-long gradual weakening of both lower limbs. Initially, he experienced paresthesia in the right lower extremities, which progressed to gait disturbances, impacting balance and coordination. Clinical examination indicated bilateral lower limb weakness, reduced vibration sense, and proprioception with a positive clonus sign and extensor plantar responses. Magnetic resonance imaging (MRI) revealed an intramedullary lesion at the T3-T4 level, appearing hypointense on T1-weighted and hyperintense on T2-weighted images. Subsequently, the patient underwent laminectomy of the T2-T5 vertebrae and microsurgical resection of the intramedullary lesion. Histopathological analysis confirmed the diagnosis of an epidermoid cyst. Following two months of physiotherapy, there was progressive improvement in the lower limb coordination and mobility. CLINICAL DISCUSSION: Progressive neurological deficits emphasize the importance of comprehensive neurological evaluation. Diagnosis involves clinical manifestations, imaging, and histopathological examination. Patients often exhibit gradual motor weakness, sensory alterations, and varying degrees of pain. Advanced neuroimaging such as MRI aids diagnosis. Surgical resection is the primary treatment with potential complications. CONCLUSION: A multidisciplinary approach is imperative for timely diagnosis and patient management, ensuring favorable outcomes while minimizing complications.

Rare incidence of parietal lobe metastasis in an adult with desmoplastic/nodular medulloblastoma: A case report and review of the literature.

INTRODUCTION AND IMPORTANCE: Medulloblastoma in adults is a rare and highly aggressive central nervous system (CNS) tumor, representing less than 1 % of all brain tumors. Supratentorial metastasis is uncommon, and extra-neural metastasis occurs in approximately 5 % of cases, primarily in frontal and temporal lobes. Here, we present an exceptional case of parietal lobe metastasis in an adult with desmoplastic/nodular medulloblastoma. To explore prior cases and establish the uniqueness of our case, we conducted a thorough search on the PubMed database. CASE PRESENTATION: A 46-year-old male, who was previously treated for medulloblastoma with surgery and adjuvant chemoradiotherapy seven years ago, presented with clinical symptoms suggestive of potential tumor recurrence. Despite two years of dedicated adjuvant chemoradiotherapy, the patient exhibited progressive right hemiparesis, ataxia, and gait disturbances. Subsequent brain magnetic resonance imaging (MRI) revealed a distinct 6 × 4 × 2 cm lesion in the left parietal lobe, which, upon post-operative histopathological examination, was identified as a supratentorial metastasis originating from desmoplastic/nodular medulloblastoma. CLINICAL DISCUSSION: Medulloblastomas, once categorized as primitive neuroectodermal tumors (PNET), are now distinctly classified as high-grade embryonal tumors, mainly characterized by their histological features and cellular origin. Common clinical presentations include hydrocephalus, headache, unsteady gait, and truncal ataxia. Surgical intervention aims for radical excision, complemented by vital adjuvant chemoradiotherapy to minimize recurrence risk. CONCLUSION: Considering the possibility of tumor recurrence or intracranial metastasis in patients with medulloblastoma is crucial. Therefore, regular follow-ups are strongly recommended to promptly detect any signs of reoccurrence in these atypical presentations.

Successful management of a giant retroperitoneal ancient schwannoma mimicking malignant tumors: A case report and literature review.

Introduction and Importance: Schwannomas, originating from Schwann cells surrounding nerve sheaths, tend to be slow-growing. Among these, giant ancient schwannomas are remarkable for their rare occurrence and their capacity for substantial growth and regressive changes. Furthermore, the expansiveness and flexibility of the retroperitoneal space often conceal the symptoms of retroperitoneal schwannomas, leading to delayed diagnosis and allowing these tumors to grow significantly and become large and long-standing before detection. Case Presentation: A 24-year-old man presented with left flank pain and a growing abdominal bulge in the left upper quadrant. Computed tomography scan revealed a 15×15×10 cm lytic expansile lesion. Consequently, the encapsulated mass was surgically excised and diagnosed as an ancient retroperitoneal schwannoma through histological and immunohistochemical studies. Clinical Discussion: Comprehensive preoperative planning and a multidisciplinary strategy are imperative for the complete excision of schwannomas. These tumors can present diagnostic complexities, particularly due to nuclear atypia and pleomorphism, which might lead to misinterpretation regarding malignancy. Despite the risks associated with percutaneous biopsies, the low mitotic count is a critical diagnostic factor. Our study underscores the consensus that the definitive diagnosis should rely on postoperative histopathological findings, highlighting the importance of accurate assessment. Conclusion: Rare giant retroperitoneal ancient schwannomas pose diagnostic challenges due to their rarity, lack of distinct symptoms, and atypical locations. This study presents a successful case and management.

Traumatic injuries in children during COVID-19 pandemic: a national report from northern Iran.

BACKGROUND: There are no comprehensive and accurate statistics on epidemiology and clinical features, especially during the COVID-19 period. The present study tries to describe the pediatric traumas in a referral treatment center in northern Iran during the COVID-19 period and to compare the available statistics with the years before pandemics to examine the differences in the epidemiology of this event in our country. METHODS: This cross-sectional study was performed on 543 children under 15 years admitted to this hospital due to different types of traumas in the first six months of 2019 (before the COVID-19 pandemic) and the first six months of 2020 (coinciding with the peak of the pandemic). The information was retrospectively collected by reviewing the hospital recorded files and the trauma-specific hospital information system. RESULTS: In total, 436 children were referred before the COVID-19 pandemic period and 107 within the pandemic outbreak. The peak age of patients admitted was 2 to 6 years (32.0%) and 70.5% were male. Most of the pointed children had normal weight. The most common mechanism of trauma before and during the COVID-19 pandemic was falling from a height (46.3% versus 42.1%), followed by road accidents (35.6% versus 36.4%). The overall prevalence of penetrating trauma was 6.9% and 9.3%. The most common body sites affected were the head and neck (32.1%) followed by extremities (before the COVID-19 period) and extremities (29.0%) followed by the head and neck (24.3%) (in the COVID-19 period). The overall rates of multiple trauma before and within the pandemic were also 35.6% versus 35.5%. In children aged 12 to 15 years, road accidents were more reported during the COVID-19 pandemic period (68.4% versus 50.9%) and contrarily falling from a height more before the pandemic (25.5% versus 0.0%). In children under two years of age, head and neck trauma was more reported before the COVID-19 period than in the COVID-19 period (55.6% versus 35.5%), while at this age, limb trauma was more common during the COVID-19 period than before (5.6% versus 20.8%) (P = 0.043). In lean children, abdominal and pelvic trauma were mainly seen in the COVID-19 period (28.6% versus 2.6%) (P = 0.035). CONCLUSION: Referrals of children from traumatic injuries decreased during the COVID-19 period. However, the main differences in the mechanism of trauma and the type and severity of traumatic injuries to children in this period emphasize the provision of specific guidelines for trauma management in children.

Traumatic brain injuries in children during COVID-19 pandemic: a national report from northern Iran.

BACKGROUND: Evidence suggests that referral cases of traumatic injuries have decreased during the COVID-19 pandemic both in childhood and in adulthood. Still we have very little evidence of referrals due to traumatic brain injury among children during the COVID-19 outbreak. The present study aimed to describe epidemiological and clinical features of pediatric traumatic brain injuries. METHODS: This cross-sectional study was performed on all patients under 15 years with any evidence of head trauma, referring to Poursina teaching hospital, a referral center for trauma and road accidents in northern Iran. The patients' data were retrospectively collected by reviewing the hospital recorded files and the trauma-specific hospital information system. RESULTS: Of all 543 pediatric traumatic injuries referred to our hospital during the two pointed periods, 166 had any evidence of head and neck injuries leading to an overall prevalence rate of 30.6%. In this regard, the prevalence rate of head/neck injuries was estimated to be 140 out of 436 within a pre-COVID-19 period (32.1%) and 26 out of 107 within the COVID-19 period (24.3%) indicating no significant difference between the two time periods (P = 0.243). However, assessing the rate of head/neck injuries pre-COVID-19 and COVID-19 periods according to patients' age showed a higher rate of such injuries in pre-COVID-19 as compared to COVID-19 periods in patients aged less than two years (55.6% versus 37.5%, P = 0.013) as well as aged 2 to six years (45.8% versus 30.0%, P = 0.036). CONCLUSION: The rate of admission of children due to traumatic brain injury during the COVID-19 period does not show a significant change compared to before, and only in children under 6 years of age a decrease in referrals due to brain trauma during the COVID-19 period was observed.