1/27. The significance of incidental noncardiac findings in Tc-99m sestamibi myocardial perfusion imaging: illustrated by a case.technetium 99m sestamibi is widely used in the evaluation of myocardial perfusion imaging. Although the aim of such imaging is cardiac evaluation, numerous other organs are included in the imaging field. Failure to identify incidental abnormal findings in these organs delays diagnosis and treatment. In common with other radiopharmaceutical agents, technetium 99m sestamibi is distributed throughout the body and accumulates in multiple tissues. When interpreting studies that involve this radiotracer, the physician must be aware of its physiologic distribution, in order to recognize abnormal uptake. We present an illustrative case in which areas of decreased tracer activity were noted incidentally during the evaluation of unprocessed single photon emission computed tomography data. These findings were due to metastasis of colon cancer to the liver.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/27. adrenal insufficiency due to metastatic hepatocellular carcinoma.A 73-year-old man with general malaise and nausea following a common cold diagnosed by a local physician was found to have multiple hepatocellular carcinomas with enlarged bilateral adrenal glands, combined with adrenal insufficiency. hydrocortisone replacement improved the symptoms and laboratory findings. autopsy findings revealed that each adrenal gland was completely replaced by the tumor measuring 11 cm in diameter, and no adrenal tissue was recognized. Histologically, the adrenal tumors, as well as the liver tumors, were moderately differentiated Edmondson type II hepatocellular carcinomas. This is a second report of adrenal insufficiency due to hepatocellular carcinoma as a primary site of metastatic adrenal tumor.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/27. Colorectal cancer: dilemmas regarding patient selection and toxicity prediction.Irinotecan (Campto, Rhone-Poulenc Rorer) is probably the most studied drug used as second-line treatment for colorectal cancer. Its main disadvantages are toxicity and cost. Delayed diarrhea and neutropenia are the most common toxic side effects, both of which can usually be predicted, by knowing the criteria for patients who are at increased risk for those side effects. These criteria include poor performance status (>2), bulky disease, previous abdominal-pelvic irradiation, hyperleukocytosis and increased bilirubin >1.5 x normal upper range. There are some other less common toxic effects of irinotecan, such as pneumonitis, cardiac arrhythmia, paralytic ileus, liver dysfunction, tumor lysis syndrome. While these side effects are very rare, physicians should be able to recognize them, because the number of patients being treated with irinotecan is increasing. The authors report four cases of probable irinotecan-related toxicity with fatal outcome in all 4 patients. Two of these 4 patients were not in the known risk categories for irinotecan toxicity. One patient died with signs of hepato-renal syndrome, the other with signs of rapid tumor lysis-like syndrome. Two other patients with bulky disease and performance status 2, had increased urea, creatinine and bilirubin serum levels after irinotecan administration, that could not be explained as manifestation of disease progression only. Data on all uncommon irinotecan toxic effects should be gathered and analyzed so that toxic effects, other than diarrhea and neutropenia, are better defined and predicted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/27. A case of poorly differentiated hilar lung adenocarcinoma of an unidentified histological type.The patient was a 74-year-old man, a physician, whose chief complaint was an unproductive cough. The shadow of a mass was seen at the hilum of the left lung, and the mediastinal lymph nodes on both sides were swollen. No histological diagnosis was obtained even after bronchoscopy, including transbronchial needle aspiration biopsy, but large-cell carcinoma of the lung was diagnosed on the basis of ultrasound-guided biopsy of a shadow in the liver suspected of being a metastatic tumor (T2N3M1, Stage IV). Two courses of chemotherapy (CBCDA VDS) failed to gain any improvement, and the pain resulting from recurrent bone metastases was managed mainly by the administration of the best supportive care. The patient was readmitted to the hospital after development of numbness in the right upper extremity followed by complication of pneumonia and heart failure, and he passed away. autopsy revealed a primary hilar lung tumor with a histological diagnosis of poorly differentiated adenocarcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/27. Neurocutaneous melanosis: a case of primary intracranial melanoma with metastasis.Neurocutaneous melanosis is a rare disorder characterized by the presence of large or multiple congenital melanocytic naevi and benign or malignant pigment cell tumours of the leptomeninges. Distant metastasis is unusual in primary leptomeningeal/intracranial melanomas. We present the case history of an adult male who had multiple primary intracranial melanomas associated with neurocutaneous melanosis (naevus of Ota) in the ophthalmic division of the left trigeminal nerve. Excision of the intracranial tumours was carried out in two stages, but the patient died 2 days after the second operation. autopsy showed multiple metastatic deposits in the liver. Symptoms and signs of raised intracranial pressure, the presence of Ota's naevus, and a dural-based mass or masses should alert the treating physician to suspect a primary leptomeningeal/intracranial melanoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/27. Percutaneous gadolinium injection under MR guidance to mark target for CT-guided radiofrequency ablation.Selection of the appropriate imaging tool depends on a number of factors that reflect the patient, the procedure, and the physician. Multiple imaging techniques are often required to perform elements of a whole procedure. A patient with an allergy to iodinated contrast material and a 3.0-cm hepatic metastasis that was invisible on computed tomography (CT) was treated with CT-guided radiofrequency ablation by first injecting gadolinium under magnetic resonance guidance to mark the location of the lesion. gadolinium's high atomic number makes it a viable contrast agent for attenuating x rays under fluoroscopic or CT guidance.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/27. thorium induced hepatic hemangioendothelioma. Roentgen-angiographic findings in two additional cases with clinical "inform and consent" problems.1. Two additional cases of presumed, thorium-induced hemangioendothelioma of the liver are reported. 2. The angiographic pattern of large venous lakes conforms closely to the pathologic descriitions of this malignancy. 3. To our knowledge, angiography of the thorotrast (and vinyl chloride) liver, before the clinical evolution of malignancy, has not been recorded and may provide information of prognostic and therapeutic value. 4. Incidental identification of thorium deposits in the tissues of clinically healthy patients creates perplexing "inform and consent" problems. Presumably, these must be solved on an individual basis. 5. Because the use of thorotrast has been discontinued since the early 1950s, all physicians reviewing chest and abdominal roentgenograms should be aware of the characteristic appearance of human thorotrast deposits, especially in the liver, spleen and celiac lymph nodes. 6. The number of living thorotrast "carriers" and previous deaths from thorotrast related malignancy seems highly uncertain at this time.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/27. Resection of an icteric type hepatoma with tumor thrombi filling the right posterior bile duct.A 67-year-old male with jaundice was found to have hepatocellular carcinoma in the right hepatic lobe and tumor thrombi in the common hepatic duct. physicians initially considered the tumor unresectable, and treated the patient with transcatheter arterial infusion chemotherapy and biliary endoprosthesis. The patient developed a liver abscess after the second transcatheter arterial infusion, and the physicians consulted our department for another form of therapy. Percutaneous transhepatic biliary drainage was performed to relieve revived obstructive jaundice. cholangiography revealed tumor thrombi extending through the right posterior segmental bile duct into the common hepatic duct. Most biliary branches of the caudate lobe joined with the left lateral posterior segmental branch. Arterial and portal venous branches of the caudate lobe were not involved. Right hepatic lobectomy and extrahepatic bile duct resection were performed 1 year after initial diagnosis. On histologic examination, the epithelium of the right posterior segmental bile duct, which was filled with the tumor thrombi, was not detected. The patient is alive without recurrence 24 months after surgery. Careful investigation of biliary branches of the caudate lobe on cholangiography is essential to determine the necessity of caudate lobectomy in patients with hepatocellular carcinoma and tumor thrombi filling the right posterior segmental bile duct.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/27. Epithelioid hemangioendothelioma of the liver. MR imaging findings.We report the MR appearance of epithelioid hemangioendothelioma (EHE) in a 51 year old man, who presented with a 14-month history of fatigue and anemia to his physician. The tumor showed massive replacement of the liver and had an unusual appearance of multiple high fluid content focal lesions with diminished vascularity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/27. carcinoembryonic antigen: clinical and historical aspects.To further define and determine the usefulness of CEA, 1100 CEA determinations have been made over the past two years at The ohio State University hospitals on patients with a variety of malignant and nonmalignant conditions. Correlation of CEA titers with history and clinical course has yielded interesting results not only in cancers of entodermally derived tissues, for which CEA has become an established adjunct in management, but also in certain other neoplasms and inflammatory states. The current total of 225 preoperative CEA determinations in colorectal carcinomas shows an 81% incidence of elevation, with postoperative titers remaining elevated in patients having only palliative surgery but falling to the negative zone after curative procedures. An excellent correlation exists between CEA levels and grade of tumor (more poorly differentiated tumors showing lower titers). Left-side colon lesions show significantly higher titers than right-side lesions. CEA values have been shown to be elevated in 90% of pancreatic carcinomas studied, in 60% of metastatic breast cancers, and in 35% of other tumors (ovary, head and neck, bladder, kidney, and prostate cancers). CEA levels in 35 ulcerative colitis patients show elevation during exacerbations (51%). During remissions titers fall toward normal, although in 31% still remaining greater than 2.5 ng/ml. In the six colectomies performed, CEA levels all fell into the negative zone postoperatively. Forty percent of adenomatous polyps showed elevated CEA titers (range 2.5-10.0) that dropped following polypectomy to the negative zone. Preoperative and postoperative CEA determinations are important in assessing the effectiveness of surgery. Serial CEA determinations are important in the follow-up period and in evaluation of the other modes of therapy (e.g., chemotherapy). These determinations of tumor antigenicity give the physician added prognostic insight into the behavior of the tumor growth. Rectal examination with guaiac determinations, sigmoidoscopy, cytology, barium enema, and a good clinical evaluation remain the primary tools for detecting colorectal disease. However, in the high-risk patient suspicious of developing cancer, CEA determinations as well as colonoscopy are now being used increasingly and provide additional highly valuable tools in the physician's armamentarium.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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