1/6. Pseudo-aneurysm of the carotid bifurcation secondary to radiation.Pseudoaneurysms of the extracranial carotid vessels have a varied etiopathogenesis. Cases have been attributed to spontaneous rupture, following tonsillectomy or peritonsillar abscesses, trauma, postanastamotic and, rarely, postirradiation, and ECMO. The authors present a case of a pseudoaneurysm involving the carotid artery bifurcation following radiation therapy. A saphenous vein graft was used to establish continuity between the common and the internal carotid arteries. A vascular shunt was used to maintain cerebral perfusion during surgery. This case highlights the technical difficulties encountered in correcting this condition. This case exemplifies the technical difficulties that are encountered in a complicated case such as this. Numerous previous operations and radiotherapy compounded the hazards of the surgical procedure. Although technically challenging, every attempt must be made to resect pseudoaneurysms caused by radiation induced vascular damage.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/6. Angioleiomyoma in the tonsil: an uncommon tumour in a rare site.An angioleiomyoma was excised from the palatine tonsil in a 30-year-old woman who complained of a painless swelling in the region of the tonsil. The mucosa covering the lesion showed prominent dilated blood vessels, necessitating vascular laboratory investigations to exclude any possibility of an aneurysm arising from the carotid system. The mass was excised with little blood loss. This was an uncommon tumour in an unusual site and required radio-imaging and angiographic studies of the great vessels of the head and neck before any operation was attempted. To the best of our knowledge, this is the first case reported in English.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
3/6. Mucosal metastases in malignant melanoma.BACKGROUND: We present the case of a patient with malignant melanoma stage IV according to the American Joint Committee on Cancer (AJCC) classification and an unusual pattern of metastasis to the mucosa of the esophagus, the stomach, the bladder and the palatine tonsil. CASE REPORT: A 38-year-old male patient with metastatic malignant melanoma of stage III (AJCC) was admitted for initiation of adjuvant therapy. 4 months earlier a primary melanoma of the left upper leg had been excised and 2 months later the patient had undergone a left inguinal lymph node dissection revealing 2 metastatic lymph nodes. On admission the patient complained of a sore throat and right cervical lymphadenopathy. He underwent a tonsillectomy and a lymphadenectomy which both revealed melanoma metastases. A PET scan using F-18-fluorodeoxyglucose (FDG) showed focal metabolic activity in the middle mediastinum. Two cycles of dacarbazine (DTIC) chemotherapy were performed during which the patient developed cutaneous metastases, dyspepsia, and mild hematemesis. gastroscopy revealed bleeding from mucosal metastases of the esophagus and stomach. A few weeks later the patient developed macroscopic hematuria. A cystoscopy was performed and showed metastases to the mucosa of the bladder. Nutrient vessels of these bladder metastases were embolized in order to control bleeding. The patient is currently alive with progressive disease. RESULTS: This case presents common and uncommon sites of metastatic melanoma to the mucosa with the typical clinical manifestations in a single patient.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/6. Carotid stenting for symptomatic radiation-induced arteritis complicated by recurrent aneurysm formation.We describe a 56-year-old male who underwent successful carotid stenting (CS) with adjuvant distal protection in response to symptomatic radiation-induced carotid disease. During the CS procedure, it was incidentally noted that the lesion yield pressure was surprisingly low (2 atm). The patient returned with local symptoms from common carotid aneurysmal dilation at the proximal edge of the stent that was successfully treated with a stent graft. A second aneurysm developed proximal to the stent graft and, based on intravascular ultrasound mapping, he ultimately underwent venous bypass covered by a free-muscle graft. We believe the low lesion yield pressure in this case reflected loss of vessel integrity and it may be prudent to avoid oversizing the stent in such patients.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/6. Delayed radiation myelopathy: serial MR-imaging and pathology.Clinical data, MR-scans, time-dose fractionation schemes and neuropathologic findings of two cases of delayed radiation myelopathy (DRM), are presented. Both patients, a 72-year-old diabetic woman with cervical lymphnode metastasis from a squamous cell carcinoma and a 46-year-old woman with tonsillar carcinoma, developed paraparesis followed by quadriplegia, at 7 and at 10 months following radiation. The spinal cord received 46 and 49 Gy. (Fraction dose 2.25 Gy and 2.0 Gy, 4 times/week). Serial MR-scans showed spinal cord enlargement and focally increased signal intensity (T1-gd). The second patient survived and stabilized following therapy with coumarins. The first patient died 13 months after radiotherapy. At autopsy necrosis, local calcium deposits, lipid macrophages and swollen astrocytes were observed in the white matter. There was slight hyalinosis of the intramedullary vessel walls. We conclude that serial MRI may be helpful to distinguish DRM from other causes of spinal cord injury. DRM may occur at a total dose less than 50 Gy. Additional risk factors (diabetes, hypertension), and fraction doses above 2 Gy contribute to the development of DRM.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
6/6. Contribution to the pathogenesis of radiation-induced injury to large arteries.We report a case of a 35-year-old man who died of a brain infarct 20 months after radiotherapy for carcinoma of the tonsil with metastases to the cervical lymph nodes. histology revealed mild atherosclerosis, necrotizing vasculitis, and occlusive thrombosis of the internal carotid artery. Significant changes were observed in the vasa vasorum: swelling and detachment of the endothelium, subendothelial oedema, hyaline change, fibrinoid necrosis of the vessel walls with mononuclear cellular infiltration, accompanied by focal haemorrhages and chronic inflammation in the periadventitial soft tissue. We believe that these changes of the vasa vasorum and necrotizing vasculitis are causally related and that vasculitis represents focal ischaemic necroses with inflammatory reaction. Our findings support the hypothesis, based on experimental studies, that injury to the vasa vasorum is an important mechanism in the development of radiation-induced vasculopathy of large arteries. They also suggest an evolution of the injury to the vasa vasorum and periadventitial tissue from the early lesions described in our patient, to late stages resulting in dense periadventitial fibrosis as reported previously. We suggest that injury to the vasa vasorum and the consequent ischaemic lesions of the arterial wall are morphological features distinguishing radiation-induced arterial injury from spontaneous atherosclerosis.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |