Endometriosis presenting as a perianal abscess: case report.

Endometriosis is common benign disorder characterized by the presence of endometrial glands and stroma outside the uterine cavity. Endometriosis of perianal region is a rare condition. We report a case of perianal endometriosis presenting initially as a perianal abscess. Transperineal ultrasound showed a 1.5 cm size irregular mixed echogenicity lesion without involving anal sphincters. Complete surgical excision was performed. The histopathological examination confirmed as endometriosis.

Prediction of Response to Stereotactic Radiosurgery for Brain Metastases Using Convolutional Neural Networks.

BACKGROUND: It is unclear whether radiomic phenotypes of brain metastases (BM) are related to radiation therapy prognosis. This study assessed whether a convolutional neural network (CNN)-based radiomics model which learned computer tomography (CT) image features with minimal preprocessing, could predict early response of BM to radiosurgery. MATERIALS AND METHODS: Tumor images of 110 BM post stereotactic-radiosurgery (SRS) (within 3 months) were assessed (Response Evaluation Criteria in Solid Tumor, version 1.1) as responders (complete or partial response) or non-responders (stable or progressive disease). Datasets were axial planning CT images containing the tumor center, and the tumor response. Datasets were randomly assigned to training, validation, or evaluation groups repeatedly, to create 50 dataset combinations that were classified into five groups of 10 different dataset combinations with the same evaluation datasets. The CNN learned using training-group images and labels. Validation datasets were used to choose the model that best classified evaluation images as responders or non-responders. RESULTS: Of 110 tumors, 57 were classified as responders, and 53 as non-responders. The area under the receiver operating characteristic curve (AUC) of each CNN model for 50 dataset combinations ranged from 0.602 [95% confidence interval (CI)=36.5-83.9%] to 0.826 [95% CI, 64.3-100%]. The AUC of ensemble models, which averaged prediction results of 10 individual models within the same group, ranged from 0.761 (95% CI=55.2-97.1%) to 0.856 (95% CI=68.2-100%). CONCLUSION: A CNN-based ensemble radiomics model accurately predicted SRS responses of unlearned BM images. Thus, CNN models are able to predict SRS prognoses from small datasets.

Prognostic factors of non-functioning pancreatic neuroendocrine tumor revisited: The value of WHO 2010 classification.

BACKGROUNDS/AIMS: Various factors have been reported as prognostic factors of non-functional pancreatic neuroendocrine tumors (NF-pNETs). There remains some controversy as to the factors which might actually serve to successfully prognosticate future manifestation and diagnosis of NF-pNETs. As well, consensus regarding management strategy has never been achieved. The aim of this study is to further investigate potential prognostic factors using a large single-center cohort to help determine the management strategy of NF-pNETs. METHODS: During the time period 1995 through 2013, 166 patients with NF-pNETs who underwent surgery in Samsung Medical Center were entered in a prospective database, and those factors thought to represent predictors of prognosis were tested in uni- and multivariate models. RESULTS: The median follow-up time was 46.5 months; there was a maximum follow-up period of 217 months. The five-year overall survival and disease-free survival rates were 88.5% and 77.0%, respectively. The 2010 WHO classification was found to be the only prognostic factor which affects overall survival and disease-free survival in multivariate analysis. Also, pathologic tumor size and preoperative image tumor size correlated strongly with the WHO grades (p<0.001, and p<0.001). CONCLUSIONS: Our study demonstrates that 2010 WHO classification represents a valuable prognostic factor of NF-pNETs and tumor size on preoperative image correlated with WHO grade. In view of the foregoing, the preoperative image size is thought to represent a reasonable reference with regard to determination and development of treatment strategy of NF-pNETs.

Surgical Strategy for T2 Gallbladder Cancer According to Tumor Location.

BACKGROUND: Radical cholecystectomy is recommended for T2 gallbladder cancer. However, it is unclear whether hepatic resection is essential for peritoneal-side gallbladder cancer. METHODS: From January 2000 to December 2011, we identified T2 gallbladder cancer patients who had undergone curative intent surgery. A peritoneal-side tumor was defined when the epicenter of the tumor was located within the free peritoneal-side gallbladder mucosa. Hepatic-side gallbladder cancer was defined when the epicenter of the tumor was located within the gallbladder bed or neck. RESULTS: A total of 157 patients with T2 gallbladder cancer were included; 33 peritoneal-side and 124 hepatic-side tumors. In total, 122 patients underwent hepatic resection, whereas the remaining 35 patients did not. After a median follow-up period of 40 (range 5-170) months, the survival of the peritoneal-side group was better than that of the hepatic-side group (p = 0.002). In a multivariate analysis, tumor location, lymph node metastasis, hepatic resection, lymphatic invasion, and perineural invasion were significant prognostic factors (p = 0.045, p < 0.001, p = 0.003, p = 0.046, and p = 0.027, respectively). For the peritoneal-side group, there was no recurrence or death after cholecystectomy without hepatic resection. However, hepatic resection was an important factor associated with overall survival in patients with hepatic-side gallbladder cancer (p = 0.007). CONCLUSIONS: In T2 gallbladder cancer patients, hepatic resection is recommended when there is tumor invasion of the gallbladder bed or neck. However, it is not always necessary in selected patients with peritoneal-side gallbladder cancer.

Clinical outcomes after percutaneous vertebroplasty for pathologic compression fractures in osteolytic metastatic spinal disease.

OBJECTIVE: Percutaneous vertebroplasty (VP) can provide immediate stabilization in pathologic fractures of spinal tumors. However, long term follow-up data in cases of pathologic fractures are lacking. The authors report follow-up results of VP in 185 pathologic fractures of 102 spinal tumor patients. METHODS: Percutaneous VP was performed at 185 vertebral bodies of 102 patients from 2001 to 2007. Retrospective analysis was done with medical records and radiological data. The change of visual analogue score (VAS), vertebral body (VB) height and kyphotic angle were measured preoperatively and on postoperative one day and at 3, 6, and 12 months. RESULTS: The patients were composed of metastatic spine tumors (81%) and multiple myeloma (19%). Involved spinal segments were between T6 and L5. Mean follow-up period was 12.2 months. VAS for back pain was 8.24 preoperatively, 3.59 (postoperative one day), 4.08 (three months) and 5.22 (one year). VB compression ratio changed from 21.33% preoperatively to 13.82% (postoperative one day), 14.36% (three month), and 16.04% (one year). Kyphotic angle changed from 15.35 degrees preoperatively to 12.03 degrees (postoperative one day), 13.64 degrees (three month), and 15.61 degrees (one year). CONCLUSION: Immediate pain relief was definite after VP in pathologic compression fracture of osteolytic spinal disease. Although VAS was slightly increased on one year follow-up, VP effect was maintained without significant change. These results indicate that VP could be a safe and effective procedure as a palliative treatment of the spinal tumor patients.

Radiosurgery for recurrent brain metastases after whole-brain radiotherapy : factors affecting radiation-induced neurological dysfunction.

OBJECTIVE: We retrospectively analyzed survival, local control rate, and incidence of radiation toxicities after radiosurgery for recurrent metastatic brain lesions whose initial metastases were treated with whole-brain radiotherapy. Various radiotherapeutical indices were examined to suggest predictors of radiation-related neurological dysfunction. METHODS: In 46 patients, total 100 of recurrent metastases (mean 2.2, ranged 1-10) were treated by CyberKnife radiosurgery at average dose of 23.1 Gy in 1 to 3 fractions. The median prior radiation dose was 32.7 Gy, the median time since radiation was 5.0 months, and the mean tumor volume was 12.4 cm(3). Side effects were expressed in terms of radiation therapy oncology group (RTOG) neurotoxicity criteria. RESULTS: Mass reduction was observed in 30 patients (65%) on MRI. After the salvage treatment, one-year progression-free survival rate was 57% and median survival was 10 months. Age (<60 years) and tumor volume affected survival rate (p=0.03, each). Acute (6 months) toxicity occurred in 21%, respectively. Less acute toxicity was observed with small tumors (<10 cm(3), p=0.03), and less chronic toxicity occurred at lower cumulative doses (<100 Gy, p=0.004). "Radiation toxicity factor" (cumulative dose times tumor volume of <1,000 Gyxcm(3)) was a significant predictor of both acute and chronic CNS toxicities. CONCLUSION: Salvage CyberKnife radiosurgery is effective for recurrent brain metastases in previously irradiated patients, but careful evaluation is advised in patients with large tumors and high cumulative radiation doses to avoid toxicity.

ACNU-cisplatin continuous infusion chemotherapy as salvage therapy for recurrent glioblastomas: phase II study.

PURPOSE: To evaluate the activity and the toxicity of ACNU (1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-3-(2-cholroethyl)-3-nitrosourea hydrochloride) administered with cisplatin by intravenous infusion for 72 h in select patients with recurrent glioblastoma. PATIENTS AND METHODS: From April 1996 to 2002, 37 patients with histologically proven glioblastoma, who showed recurrence on image study after operation and radiation, met the eligibility criteria of our cohort. The mean time to recurrence was 9.7+/-7.0 (1-26 months). Treatment response was evaluated every 6 weeks using magnetic resonance imaging (MRI). Complete blood counts were collected every week to monitor and treat possible bone marrow suppression from the treatment. Survival rates were analyzed using the Kaplan-Meier and log rank test. RESULTS: Post-chemotherapy MRI was available in 36 of 37 patients. Response to treatment was observed in 19 patients (53%) including two cases of complete remission. Six patients (17%) showed progression (PD) and 11 patients (31%) had stable disease (SD). Two or more cycles of chemotherapy was the only factor that predicted response to treatment. The overall median survival for all patients was 17.0+/-5.5 months. Age (< 40 years) and time to recurrence (>or=1 year) were the clinical factors that predicted improved overall survival. Survival gain after chemotherapy was 9 months. Patients who responded and those with SD after treatment (11 months) had a longer median survival compared to PD (5 months) (P=0.01). Myelosuppression was severe (grade III/IV leukopenia in 15 patients (40%) and grade III/IV thrombocytopenia in 19 patients (52%)) but most recovered more than WHO grade II at the end of the chemotherapy cycles. There was only one fatality due to sepsis from pneumonia during the initial leukopenic state. CONCLUSION: ACNU and cisplatin chemotherapy can be an effective salvage therapy for recurrent glioblastoma patients. Myelosuppression from the chemotherapy regimen was the greatest side-effect but was manageable.

Hypofractionated stereotactic radiation therapy for skull base and upper cervical chordoma and chondrosarcoma: preliminary results.

INTRODUCTION: Chordoma and chondrosarcoma are rare tumors of the base of the skull and are difficult candidates for surgical treatment. They are also usually resistant to conventional radiation therapy. We report preliminary results of hypofractionated stereotactic radiation therapy (SRT) using the Cyberknife system (Accuray Inc., Sunnyvale, Calif., USA) for primary and recurrent chordomas and chondrosarcomas of the skull base and upper cervical region. MATERIAL AND METHODS: Nine pathologically proven chordoma/chondrosarcoma patients underwent Cyberknife treatment, and in 4 patients Cyberknife was performed as a primary adjuvant treatment after operation. Remainder of the patients had previously received conventional radiotherapy except 1 who had received Gamma Knife treatment. The prescribed tumor dose ranged from 21 to 43.6 Gy in three to five fractions. The dosimetric characteristics were evaluated for conformity and coverage indices. Dose volume histograms of both the tumor and the critical structure were obtained, and the dose delivered to a specific volume (25, 50 and 100%) of the critical structure was calculated in each case. Mass response was measured on follow-up MRI scans. Total tumor doses of different fractionation numbers were converted into single session equivalent doses and linear quadratic equivalent doses of conventional radiation for comparison among patient groups. RESULT: No significant complications were observed during the treatment and early follow-up periods except one instance of transient esophagitis and one instance of otitis. All treatment plans met the criteria for standard protocol of radiosurgery suggested by the Radiation Therapy Oncology Group, specifically in terms of conformity index, which ranged from 1.01 to 1.83. Three plans had a coverage index that was rated as a minor acceptable deviation. All patients were followed from 11 to 30 (median 24) months following the treatment with regular magnetic resonance images, and 4 patients showed mass reduction. Disease progression was not noted in any patient during the above follow-up period except 1 patient who showed asymptomatic recurrence on 27-month follow-up MRI. Dose volume histograms revealed that the relative dose to volume percent of critical structure, measured at 25, 50 and 100%, was apparently lower in the pretreatment surgical decompression group than in the nondecompression group. Two patients developed radiation-induced myelopathy. The delivered radiation dose to the critical structure calculated using the linear-quadratic formula was within the acceptable range in one case and exceeded 70 Gy at 50% volume of the spinal cord in the other. CONCLUSION: The hypofractionated Cyberknife SRT is effective in generating therapeutic response in these radioresistant tumors, with minimal toxicity during the procedure and early follow-up period. Repeated radiosurgical treatment may also be feasible for tumor recurrences but deserves great caution with respect to the biological effects of the accumulated dose on the adjacent critical structures. Cyberknife SRT may be a potentially valuable treatment option once the long-term results and appropriate dose calculators are optimally defined.