Malignant triton tumor of the rectum - A case report and review of the literature.

INTRODUCTION: Malignant triton tumors (MTT) are rare but highly aggressive tumors that originate from the Schwann cells. These tumors can occur in any part of the body, mostly present late and carry poor prognosis. PRESENTATION OF CASE: We present a 24-year-old man with a rectal MTT causing non-specific abdominal pain and recurring ileus. The MRI showed a rectal mass near the urinary bladder with compression on the seminal vesical. A complete surgical resection of the tumor was performed. The immunohistological report confirmed a rectal MTT. Because of persistent ileus during the post-operative palliative chemotherapy, another tumor debulking was performed. The patient died 9 months after the diagnosis of MTT due to local recurrence under chemotherapy. DISCUSSION AND CONCLUSION: MTTs are uncommon tumors in young age with high morbidity and mortality because of local recurrence also after complete resection.

Incidentally detected splenic lesions in ultrasound: does contrast-enhanced ultrasonography improve the differentiation of benign hemangioma/hamartoma from malignant lesions?

PURPOSE: The aim of the study was to identify and validate enhancing features for differentiating benign vascular neoplasms of the hemangioma/hamartoma type from malignant splenic lesions on contrast-enhanced ultrasonography (CEUS). MATERIALS AND METHODS: 136 splenic lesions (58 benign vascular neoplasms, 78 malignant) in 136 patients underwent baseline US and pulse-inversion CEUS after sulfur hexafluoride-filled microbubble injection. Two on-site readers assessed lesion enhancement features during arterial and parenchymal phase in consensus. Best predicting CEUS features for lesion diagnosis were identified through univariate and multivariate analyses. Two blinded off-site readers independently issued a confidence rating for lesion diagnosis in baseline US and CEUS using extracted diagnostic CEUS features. Diagnostic performance, receiver operating curves (Az-value), and interreader agreement were calculated. The reference standards were histopathology or CT and/or MR imaging with clinical follow-up.  RESULTS: Multivariate analysis outlined arterial hyperenhancement or isoenhancement to be an independent CEUS predictor of benign vascular neoplasms (odds ratio, 3.558; p < 0.0017). Within the subgroup of isoechoic or hypoechoic lesions, arterial hyperenhancement was virtually diagnostic for benign vascular neoplasm (odds ratio, 21.333; p < 0.001). The diagnostic accuracy and confidence (Az-value) of the two readers was 63.2 % and 70.6 % (0.785 and 0.818) for baseline US, which improved significantly to 87.5 % and 88.2 % (0.915 and 0.908) for CEUS (p < 0.001). Interreader agreement also increased with CEUS (қ = 0.88) compared to baseline US (қ = 0.52). CONCLUSION: Sulfur hexafluoride-enhanced CEUS improves differentiation between benign vascular and malignant splenic tumors and may be especially useful in clinical scenarios in which the incidental hypoechoic splenic lesion is unclear on conventional US.

Percutanous and intraoperative ultrasound-guided radiofrequency ablation of hepatic tumours.

PURPOSE: Ultrasonography (US)-guided Radiofrequency ablation (RFA) is increasingly used to treat liver tumours. The aim of this study was to evaluate the impact of multidisciplinary patient selection on clinical results. MATERIALS AND METHODS: From January 2002 to December 2004, 69 consecutive patients with malignant hepatic tumours were presented to our clinic for RFA-treatment. After a multidisciplinary tumour board decision, 33 patients (47.8%) with 70 liver tumours underwent RFA using a 14-gauge needle electrode via a percutaneous (26) or surgical (7) approach, either alone or combined with resection (3) or chemoembolisation (3). 36 patients (52.2%) were excluded from RFA treatment, mainly because of extensive disease or failure of prior chemotherapy. With a median of 20 months (range 6 - 42 months), all 69 patients were followed clinically to assess survival, and the 33 patients who received additional treatment were examined by contrast-enhanced CT to assess local success. RESULTS: Complete necrosis was obtained in 64/70 of ablated tumours (91.4%).The corresponding mean sizes (ranges) of lesion vs. necrosis achieved were 2.3 cm (0.9 - 5.0) vs. 3.7 cm (2.1 - 5.7). Two complications (6.6%) occurred, including one liver abscess and one postablational syndrome. At the time of the tumour board decision, the RFA (33) and non-RFA (36) group differed in mean sizes of tumours (2.3 vs. 3.5 cm), average tumours per patient (2.1 vs. 3.8), and failure of prior chemotherapy (2/33 vs. 22/36). From 36 patients judged to be ineligible for RFA, 24 (66.6%) underwent RFA at another institution. When comparing survival of patients who underwent RFA at our institution (33) vs. those who underwent RFA outside (24) vs. those who underwent no RFA (12), 1/33 (3%) vs. 9/24 (37.5%) vs. 8/12 (66.6%) died within 6 month and 27/33 (81.2%) vs. 5/24 (29.2%) vs. 2/12 (16.7%) were alive after 20 months median follow up. CONCLUSION: US-guided RFA offers a safe local treatment option to destroy small liver tumours (< 3 cm). Carefully and multidisciplinary selected patients may derive benefit, but uncritical application leads to unsatisfying clinical results.

[Minimally-invasive regional treatment of a symptomatic ischial metastasis using radiofrequency ablation and osteoplasty]. / Minimal-invasive Lokaltherapie einer symptomatischen Sitzbeinmetastase durch Radiofrequenzablation und Osteoplastie.

HISTORY AND ADMISSION FINDINGS: A 46-year-old woman presented with worsening, morphine-resistant pain during the previous 8 weeks in the right ischium which rendered her immobile. The patient refused further surgery, radiotherapy or chemotherapy, as she had been treated for ovarian cancer and recurring rectal carcinoma with peritoneal carcinomatosis for the last three years almost without interruption and experienced several complications. The pelvic region had radiotherapy up to 70,4 Gy. INVESTIGATION: Scintigraphy of the bone showed enhancement in the right ischium. Conventional radiography demonstrated an irregular lesion with destruction of the corticalis 3 x 4 cm in size. Computed tomography revealed numerous microfractures and pseudo-arthritic changes. Needle biopsy confirmed a bone metastasis from the rectal carcinoma. Examination of radiation fields showed a high risk for radiation damage using conventional fractionation. TREATMENT AND COURSE: After achieving an interdisciplinary consensus the metastatic lesion of the patient under analgesia and sedation was thermo-ablated by using radiofrequency percutaneously under ct-control and filled with bone cement. 8 days later the patient was released from hospital pain-free and mobile. Her Karnofsky index rose from 30 % to 90 %. Morphine could be reduced to zero. No complications occurred. 9 month later, though newly appearing lung metastasis, the lesion of the ischium was still asymptomatic and stable and conventional radiography did not indicate local tumor progress or dislocated bone cement. The patient now agreed to further chemotherapy. CONCLUSION: Palliative minimally invasive radiofrequency ablation with concurrent osteoplasty can be effective in individual cases giving a better quality of life and mobility. Benefits and risks should be carefully evaluated in studies examining quality of life, especially in patients without the options of surgical and radiotherapy.

Ultrasound-guided radiofrequency ablation: a new treatment option after failure to stop severe acute upper gastrointestinal tumor bleeding using endoscopic techniques.

Endoscopy is well established as the primary approach in cases of severe acute upper gastrointestinal bleeding. Although endoscopic techniques can achieve hemostasis in up to 95% of instances, not all sources of bleeding seen at endoscopy can be managed endoscopically. Massive and diffuse bleeding from locally advanced gastric adenocarcinoma is not usually self-limit-ing and is often refractory to endoscopic treatment. If surgery or endovascular tumor embolization are not possible after failure of endoscopic hemostasis, the situation may become life-threaten-ing. We present a new option for the treatment of patients in this rare but potentially fatal situation, which involves radiofrequency ablation using a needle electrode placed percutaneously un-der ultrasound guidance.