Complete Regression of Rhabdomyosarcoma in an Adult Secondary to Postoperative Wound Infection Following Limb Salvage Surgery: A Case Report.

CASE PRESENTATION: A 33-year old man presented with a 25-cm lower extremity embryonal rhabdomyosarcoma with presumed extensive nodal metastasis on positron emission topography scan. Neoadjuvant chemotherapy and radiation provided minimal response. Following limb salvage resection and flap coverage, a prolonged postoperative infection occurred requiring intravenous antibiotics and wound care over 5 months. Given the infection, no postoperative radiation or chemotherapy was administered. Eight months following surgery, positron emission topography scan showed complete regression of local and nodal disease. The patient has remained in complete remission for more than 4 years. CONCLUSION: Postoperative wound infection leading to complete regression of embryonal rhabdomyosarcoma has not been reported. Stimulation of the innate and adaptive immune system through infectious elements is an area of ongoing immunotherapy research to improve sarcoma treatment outcomes.

Feasibility and Value of Establishing a Community-Based Virtual Multidisciplinary Sarcoma Case Conference.

PURPOSE: Management of soft tissue and bone sarcoma presents many challenges, both diagnostically and therapeutically, and requires multidisciplinary collaboration; however, such collaboration is often challenging to establish, especially in the community setting. We share our experiences of a virtual multidisciplinary sarcoma case conference (VMSCC). METHODS: We conducted retrospective review of the VMSCC data-initially via Webex, now Microsoft Teams-and the surveys of referring physicians to understand the feasibility and value of the VMSCC. RESULTS: The VMSCC was established in March 2013 in Kaiser Permanente Northern California with consistent participation of the Departments of Musculoskeletal Oncology (orthopedic oncology), Musculoskeletal Radiology, Pathology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Surgical Oncology, and Genetics. Pediatric Oncology participated ad hoc when pediatric sarcoma cases were presented. Referrals were from multiple specialties and regions, including the Kaiser Permanente Mid-Atlantic and Hawaii regions. From March 2013 to December 2019, 1,585 cases were reviewed encompassing 36 histologic types. More than 300 cases were reviewed per year from 2017 to 2019. Survey results of referring physicians demonstrate that the VMSCC enhanced the confidence of treating physicians, and its recommendations frequently led to treatment changes. CONCLUSION: Establishing a valuable community-based VMSCC is feasible. VMSCC recommendations frequently led to treatment changes and improved the confidence of treating physicians.

Feasibility and Value of Establishing a Community-Based Virtual Multidisciplinary Sarcoma Case Conference.

PURPOSE: Management of soft tissue and bone sarcoma presents many challenges, both diagnostically and therapeutically, and requires multidisciplinary collaboration; however, such collaboration is often challenging to establish, especially in the community setting. We share our experiences of a virtual multidisciplinary sarcoma case conference (VMSCC). METHODS: We conducted retrospective review of the VMSCC data-initially via Webex, now Microsoft Teams-and the surveys of referring physicians to understand the feasibility and value of the VMSCC. RESULTS: The VMSCC was established in March 2013 in Kaiser Permanente Northern California with consistent participation of the Departments of Musculoskeletal Oncology (orthopedic oncology), Musculoskeletal Radiology, Pathology, Medical Oncology, Radiation Oncology, Nuclear Medicine, Surgical Oncology, and Genetics. Pediatric Oncology participated ad hoc when pediatric sarcoma cases were presented. Referrals were from multiple specialties and regions, including the Kaiser Permanente Mid-Atlantic and Hawaii regions. From March 2013 to December 2019, 1,585 cases were reviewed encompassing 36 histologic types. More than 300 cases were reviewed per year from 2017 to 2019. Survey results of referring physicians demonstrate that the VMSCC enhanced the confidence of treating physicians, and its recommendations frequently led to treatment changes. CONCLUSION: Establishing a valuable community-based VMSCC is feasible. VMSCC recommendations frequently led to treatment changes and improved the confidence of treating physicians.

Chronic stress alters behavior in the conditioned defensive burying test: role of the posterior paraventricular thalamus.

In the present studies, we examined the effects of chronic restraint on behavior in the conditioned defensive burying paradigm, a well-validated test of anxiety. This test is based on the findings that rodents tend to cover or bury the source of a noxious or aversive stimulus. However, little is known about whether prior chronic stress exposure can alter this anxiety-related behavior. In the present study, we examined whether chronic restraint affects indices of behavior in the conditioned defensive burying paradigm. Furthermore, since the posterior division of the paraventricular thalamus (pPVTh) regulates neuroendocrine activity specifically in chronically stressed but not control rats, we hypothesized that the pPVTh may also regulate any chronic stress-induced changes in behavior observed in the defensive burying test. Chronically stressed rats (30-min restraint per day for seven consecutive days) exhibited decreased latency to bury compared to control rats regardless of the presence of lesions suggesting increased reactivity to the shock in these animals. Importantly, pPVTh-lesioned chronically stressed rats exhibited increased duration and height of burying compared to control rats with pPVTh lesions, whereas no differences existed between sham-lesioned control and chronically stressed rats. Since both burying height and duration of burying are considered indices of anxiety in the defensive burying test, the present results suggest that the intact pPVTh may be important in dampening behaviors related to anxiety in chronically stressed rats.

[(18)F]Fluorodeoxyglucose-PET/Computed Tomography, PET, and Magnetic Resonance Imaging: Normal Anatomy, Pitfalls, and Artifacts.

Each anatomic region of the head and neck has physiologic variations that can mimic a primary tumor or lymph node. Many of these variations can be recognized as reflecting benign lymphoid, salivary, brown fat, and muscular activity. A few artifacts are related to computed tomography (CT) attenuation. A knowledge of tumor types and patterns of lymph node and metastatic spread helps categorize patterns as benign or malignant. The anatomic reference of CT helps solve many pitfalls. A recently introduced instrument, PET/magnetic resonance imaging, will face new pitfalls as its role in oncology is developed.