Alveolar Soft-part Sarcoma of the Retro Peritoneum: A Case Report and Review of the Literature

Background: Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm originating from soft tissue. It was initially described as a distinctive clinical entity by Christopherson et al. in 1952. The peak age of incidence is between 15 and 35 years with slight sex predominance among women. The most common sites involved include extremities and trunk and in young adults and head and neck in children. ASPS is a slow-growing tumor with unusual patterns of metastasis which runs a poor prognosis. The aim of this article was to present a case of ASPS of retroperitoneal origin along with its diagnostic and therapeutic workups. Case Report: A 31-year-old patients with a chief complain of an abdominal mass in right lower quadrant, underwent surgical resection as a neuroendocrine tumor according to pre-operative imaging studies. Pathology reported the lesion as ASPS. The patient refused adjuvant chemotherapy and unfortunately he did not show up to continue his treatment and further follow-ups. A careful investigation would be required including clinical findings, clinicopathological correlation, with appropriate radiological studies, before definitive treatment of ASPS.Conclusions: The main problem to gain an extended insight into clinical features and optimal treatment is the rarity of the disease. Given the ineffectiveness of current treatments in advanced ASPS, further future investigation to find new therapeutic options would be required

Mapowanie węzłów wartowniczych w raku brodawkowatym tarczycy z zastosowaniem radioznacznika i niebieskiego barwnika

Introduction: In the current study, we evaluated the accuracy of sentinel node mapping in thyroid cancer patients using both radiotracer and blue dye.Material and methods: 30 patients with a diagnosis of papillary thyroid carcinoma (PTC) were included in the study; 2–3 hours before surgery, 0.5 mCi 99m-Tc-Antimony Sulfide Colloid was injected intra-tumourally. 15 minutes post-injection, lymphoscintigraphy images of the neck were obtained. Immediately after anaesthesia induction, 0.5 mL patent blue V was also injected in the same fashion. Sentinel lymph nodes were detected intraoperatively using gamma probe and blue dye. Total thyroidectomy was performed for all patients with dissection of central neck lymph nodes as well as sampling of the lateral neck lymph nodes.Results: At least one sentinel node could be identified during surgery in 19 patients (63.3%). The median number of sentinel nodes per patient was 1. Sentinel nodes in 12 patients were pathologically involved. No false negative case was noted. Upstaging occurred in six patients (20%).Conclusions: Sentinel node mapping in papillary thyroid carcinoma is a feasible technique with high accuracy for the detection of lymph node involvement. This technique can guide surgeons to perform central lymph node dissection only in patients with pathologically involved sentinel nodes. Although SLN detection in the lateral neck lymph nodes increases the extension of lymphadenectomy, SLN mapping can result in upstaging in older patients (> 45 years of age) or treatment plan change in younger patients (< 45 years of age) by the detection of lateral lymph node involvement. (Endokrynol Pol 2014; 65 (4): 281–286)Wstęp: W badaniu oceniono dokładność mapowania węzłów wartowniczych u chorych na raka tarczycy w przypadku jednoczesnego zastosowania radioznacznika i niebieskiego barwnika.Materiał i metody: Do badania włączono 30 chorych z rozpoznaniem raka brodawkowego tarczycy (PTC, papillary thyroid carcinoma). Dwie do trzech godzin przed zabiegiem do guza wstrzykiwano koloid siarczanu antymonu znakowany 99m-Tc (0,5 mCi). Po upływie 15 minut od wstrzyknięcia radioznacznika wykonywano badanie limfoscyntygraficzne szyi. Bezpośrednio po znieczuleniu w ten sam sposób wstrzykiwano 0,5 ml błękitu patentowego V. Węzły wartownicze wykrywano śródoperacyjnie, używając sondy promieniowania gamma i błękitnego barwnika. U wszystkich pacjentów wykonano totalną tyroidektomię z wycięciem węzłów chłonnych szyjnych środkowego przedziału oraz pobraniem wycinków węzłów szyjnych bocznych.Wyniki: U 19 chorych (63,3%) udało się zidentyfikować w trakcie zabiegu co najmniej jeden węzeł wartowniczy. Mediana liczby węzłów wartowniczych na pacjenta wynosiła 1. U 12 chorych w węzłach wartowniczych wykryto zmiany patologiczne. Nie stwierdzono ani jednego przypadku uzyskania fałszywie ujemnego wyniku. U 6 (20%) chorych zmieniono stopień zaawansowania nowotworu na wyższy.Wnioski: Mapowanie węzłów wartowniczych w raku brodawkowatym tarczycy jest dostępną metodą cechującą się dużą dokładnością w wykrywaniu zajętych węzłów chłonnych. Ta metoda może stanowić wskazówkę dla chirurgów, aby usuwać węzły chłonne szyjne środkowego przedziału tylko u pacjentów ze zmianami w węzłach wartowniczych. Mimo że wykrycie węzłów wartowniczych w obrębie węzłów szyjnych bocznych zwiększa zakres limfadenektomii, mapowanie węzłów wartowniczych może spowodować zmianę oceny stopnia zaawansowanie nowotworu u starszych pacjentów (> 45 lat) lub zmianę planu leczenia u młodszych pacjentów (< 45 lat) w związku z wykryciem zmian w węzłach bocznych szyi. (Endokrynol Pol 2014; 65 (4): 281–286

Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma

Objective(s):  Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA).Methods: This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated.Results: In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively.Conclusion: Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result

Ruptured Giant Hepatic Hemangioma: Report of A Case

"nHemangiomas are the most common benign liver masses with a frequency of 0.4-7.3% at autopsy. They are usually discovered incidentally and a few require surgery. Spontaneous or traumatic ruptures are among indications of surgery for hemangiomas. We report a case of giant hepatic hemangioma presenting as hemoperitoneum following use of the slimming belt that underwent an emergent laparotomy. Abdominal exploration revealed that both right and left lobes of the liver were involved with giant hemangiomas. The liver was compressed by tightly packing laparotomy pads. After the operation, the patient was admitted to the surgical intensive care unit. Two days later, a second surgery was performed to remove the laparotomy pads. On the 6th day, the patient was discharged. One month later, to shrink the tumor, percutaneous transarterial embolization of the hepatic artery was performed

Solid Pseudopapillary Neoplasms Are Rare, Indolent Pancreatic Tumors in Young Women

Introduction. Solid pseudopapillary neoplasm (SPN) is a rare and indolent pancreatic tumor with low malignant potential which frequently occurs in reproductive-age females. Complete resection is almost always the curative option. Case Presentation. We present a 20-year-old woman with acute epigastric pain and vomiting in multiple episodes. Abdominal ultrasound showed a hypoechoic lesion with the probable source in the pancreas. Following that, CT scans and Endoscopic Ultrasound (EUS) manifested a 9×7.5 cm-sized hypodense mass with heterogeneous well-defined margins in the pancreas suggesting the diagnosis of SPN. Whipple’s procedure was performed. Histopathological examination and immunohistochemistry confirmed SPN without evidence of malignancy. Discussion. SPN is known as a tumor with a favorable prognosis and a long survival rate after complete resection. However, some literature focused on minimally invasive surgery as an alternative surgical approach

Oncogenic fusion transcript analysis identified ADAP1‐NOC4L, potentially associated with metastatic colorectal cancer

Abstract Purpose Fusion transcripts are transcriptome‐mediated alterations involved in tumorigenesis and are considered as diagnostic, prognostic, and therapeutic biomarkers. In metastatic colorectal carcinoma (mCRC), fusion transcripts are rarely reported. The main challenge is to identify driver chimeras with a significant role in cancer progression. Methods In the present study, 86 RNA sequencing data samples were analyzed to discover driver fusion transcripts. Functional assays included clonogenic cell survival, wound‐healing, and transwell cell invasion. Quantitative expression analysis of epithelial‐mesenchymal transition (EMT), apoptotic regulators, and metastatic markers were examined for the candidate fusion genes. Kaplan–Meier survival analysis was performed using patient overall survival (OS). Results A variety of driver fusions were identified. Fourteen fusion genes (51% of mCRC), each at least found in two mCRC samples, were determined as oncogenic fusion transcripts by in silico analysis of their functions. Among them, two recurrent chimeric transcripts confirmed by Sanger sequencing were selected. Positive expression of ADAP1‐NOC4L was significantly associated with an increased risk of poor OS in mCRC patients. In vitro transforming potential for the chimera, resulting from the fusion of ADAP1 and NOC4L was assessed. Overexpression of this fusion gene increased cell proliferation and enhanced migration and invasion of CRC cells. In addition, it significantly upregulated EMT and anti‐apoptotic markers. Conclusions ADAP1‐NOC4L transcript chimera, a driver chimera identified in this study, provides new insight into the underlying mechanisms involved in the development and spread of mCRC. It suggests the potential of RNA‐based alterations as novel targets for personalized medicine in clinical practice

A comparative study of the classic and piggyback techniques for orthotopic liver transplantation

Background: The classic technique of hepatectomy with venovenous bypass may cause a longer anhepatic phase and increase the rate of some complications, such as post-operative renal failure and thromboembolic events. But, in some cases, such as tumors and anatomic difficulties, the surgeon is obligated to use the classic technique even though there is some controversy about the safety of this technique without venovenous bypass in liver transplantation. The aim of this study was to compare the results of using the classic technique without venovenous bypass and the piggyback technique for liver transplantation. Methods: A retrospective case-series study was conducted on 227 consecutive successful liver transplants, including 55 cases in which the classic technique was used and 172 cases in which the piggyback technique was used. The transplants were performed from March 2010 through June 2011 in the Visceral Transplantation Ward at Namazi Hospital in Shiraz, Iran. The piggyback method was the preferred approach for hepatectomy, but the classic technique without venovenous bypass was performed in cirrhotic cases with anatomic difficulties, when there was a tumor, or when the surgeon preferred it. Results: There were no significant differences in post-operative rise in creatinine, decreases in intraoperative blood pressure, transfused packed red blood cells (RBC), or survival rates between the groups. Warm ischemic time (duration that donor liver is out of ice until it’s blood reperfusion in the recipient) was approximately seven minutes longer in the classic group (P = 0), but it was less than 52 minutes, which is an acceptable time for this phase. Hospital stays were shorter in the classic group than in the piggyback group (P = 0.024). Conclusion: Although the piggyback technique is the preferred technique for hepatectomy in liver transplantation, the classic technique without venovenous bypass can be used safely in cirrhotic livers when necessary or if the physician prefers it

The Association Between the Gut Microbiome and COVID-19 Severity: The Potential Role of TMAO Produced by the Gut Microbiome

Context: The COVID-19 pandemic has had profound impacts on public health, resulting in nearly 1 million deaths. Emerging evidence suggests an association between certain metabolites produced by gut microbiota and potential alterations in the severity of infection. Trimethylamine N-oxide (TMAO) is a waste metabolite generated by gut microbes from dietary choline and betaine. Evidence Acquisition: Several investigations have indicated an association between serum TMAO concentrations and the development of inflammation and thrombosis. Trimethylamine N-oxide, produced by the gut microbiome in a state of dysbiosis, upregulates various molecular mechanisms, such as the nuclear factor kappa (NF-kB) molecular pathway, and promotes the expression of scavenger receptors (SRs) on the surfaces of macrophages, leading to foam cell formation and inflammation. High levels of TMAO have been shown to induce the expression of pro-inflammatory cytokines like tumor necrosis factor-alpha (TNF-α) and interleukin 1β (IL-1β) while reducing the expression of anti-inflammatory cytokines such as interleukin-10 (IL-10). Additionally, gut-derived TMAO enhances platelet aggregation and adhesion to collagen, increasing the risk of thrombosis. Conclusions: Understanding the association between gut microbiome compositions such as gut TMAO and their effects on SARS-CoV-19 infection progression helps to control disease severity. In this review, we presented a hypothesis that the gut TMAO has the potential to increase COVID-19 disease severity

Effects of N-Acetylcysteine Addition to University of Wisconsin Solution on the Rate of Ischemia-Reperfusion Injury in Adult Orthotopic Liver Transplant

Objectives: One of the main concerns in liver transplant is the prolonged ischemia time, which may lead to primary graft nonfunction or delayed function. N-acetylcysteine is known as a hepato-protective agent in different studies, which may improve human hepatocyte viability in steatotic donor livers. This study investigated whether N-acetylcysteine can decrease the rate of ischemia-reperfusion syndrome and improve short-term outcome in liver transplant recipients. Materials and Methods: This was a double-blind, randomized, control clinical trial of 115 patients. Between April 2012 and January 2013, patients with orthotopic liver transplant were randomly divided into 2 groups; in 49 cases N-acetylcysteine was added to University of Wisconsin solution as the preservative liquid (experimental group), and in 66 cases standard University of Wisconsin solution was used (control group). We compared postreperfusion hypotension, inotrope requirement before and after portal reperfusion, intermittent arterial blood gas analysis and potassium measurement, pathological review of transplanted liver, in-hospital complications, morbidity, and mortality. Results: There was no significant difference between the groups regarding time to hepatic artery reperfusion, hospital stay, vascular complications, inotrope requirement before and after portal declamping, and blood gas analysis. Hypotension after portal reperfusion was significantly more common in experimental group compared with control group (P = .005). Retransplant and in-hospital mortality were comparable between the groups. Conclusions: Preservation of the liver inside Univer-sity of Wisconsin solution plus N-acetylcysteine did not change the rate of ischemia reperfusion injury and short-term outcome in liver transplant recipients

Hydrogel Templates for Rapid Manufacturing of Bioactive Fibers and 3D Constructs.

Hydrogel templates are formed to entrap various pre-polymers prior to their crosslinking process. Upon the completion of the crosslinking process, an independent polymer network with the same fiber geometry is formed. The hydrogel template can be removed if necessary. As the proof-of-principle, fibers from various polymers are fabricated. The fabricated hybrid polymeric fibers are bioactive and can be bioprinted or assembled using textile processes. The approach can be used for creating complex 3D constructs for various applications