Long-term survivor of relapsed MFH on the thigh treated with autologous formalin-fixed tumor vaccine (AFTV) combined with limb-sparing surgery and radiotherapy

Malignant fibrous histiocytoma (MFH) is an aggressive spindle cell cancer of soft-tissue sarcoma type in the elderly, mostly affecting the extremities. Lesions > 5 cm, positive margins, and local recurrence are significant poor prognostic indicators. The strongest predictor for distant metastasis was tumor size (> 5 cm), and for overall survival, presence of local recurrence. Limb-sparing extensive tumor resection is preferred to achieve negative surgical margins. However, in some circumstances, amputation is inevitable. Recent studies demonstrated that adjuvant radiotherapy for microscopically positive surgical margins significantly improved local control and disease-free survival rates. Therefore, effective therapeutic strategies against locally relapsed high grade MFH are required to prevent distant metastasis and to achieve long-term disease-free survival. Here, we report local relapse of high grade MFH treated by successive application of autologous formalin-fixed tumor vaccination (AFTV) with limb-sparing surgery and postoperative radiotherapy. The patient is alive and well, disease-free and with no functional impairment, more than five years after treatment

Can expiratory or inspiratory contrast-enhanced computed tomography be more efficient for fast-track cannulation of the right adrenal vein in adrenal venous sampling?

PURPOSEThis study compares the usefulness of expiratory arterial phase (EAP)–contrast-enhanced computed tomography (CT) (CECT) with that of inspiratory arterial phase (IAP)–CECT in adrenal venous sampling (AVS).METHODSSixty-four patients who underwent AVS and CECT at the authors’ hospital between April 2013 and June 2019 were included in this study. The patients were classified into the following two groups: EAP (32 patients) and IAP (32 patients) groups. The single arterial phase images were obtained at 40 seconds in the IAP group. The double arterial phase images were obtained at 40 seconds in the early arterial phase and 55 seconds in the late arterial phase in the EAP group. The authors then compared the right adrenal vein (RAV) visualization rate on the CECT, the difference between the CECT images and adrenal venograms in the localization of the RAV orifice, the cannulation time to the RAV, and the volume of contrast agent administered intraoperatively between the two groups.RESULTSThe rates of the RAV visualization in the EAP group were 84.4% in the early arterial phase, 93.8% in the late arterial phase, and 100% in the combined early and late arterial phases. The rate of the RAV visualization in the IAP group was 96.9%. There was no significant difference between the two groups in terms of the rate of the RAV visualization. However, there was a small difference in the location of the RAV orifice between the CECT images and adrenal venograms in the EAP group as compared with the IAP group (P < 0.001). The median time to the RAV catheterization was significantly shorter in the EAP group (27.5 minutes) than in the IAP group (35.5 minutes; P = 0.035). The rates of the RAV visualization in the EAP group were not significant between the early arterial phase, late arterial phase, and combined early and late arterial phases (P = 0.066). However, the mean volume CT dose index in the combined early and late arterial phases was significantly higher than in the early and late arterial phases (P < 0.001).CONCLUSIONThe EAP–CECT is more useful for increasing the speed of the RAV cannulation due to the small difference in the localization of the RAV orifice compared to IAP–CECT. However, since EAP–CECT has double contrast arterial phases and increased radiation exposure compared to IAP–CECT, only the late arterial phase may be acceptable to reduce radiation exposure

Primary omental Gastrointestinal stromal tumor (GIST)

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Clear cell carcinoid tumor of the distal common bile duct

BACKGROUND: Carcinoid tumors rarely arise in the extrahepatic bile duct and can be difficult to distinguish from carcinoma. There are no reports of clear cell carcinoid (CCC) tumors in the distal bile duct (DBD) to the best of our knowledge. Herein, we report a CCC tumor in the DBD and review the literature concerning extrahepatic bile duct carcinoid tumors. CASE PRESENTATION: A 73-old man presented with fever and occult obstructive jaundice. Ultrasonography, computed tomography (CT) and magnetic resonance cholangiopancreaticography (MRCP) demonstrated a nodular tumor projection in the DBD without regional lymph node swelling. Under suspicion of carcinoma, we resected the head of the pancreas along with 2(nd )portion duodenectomy and a lymph node dissection. The surgical specimen showed a golden yellow polypoid tumor in the DBD (0.8 × 0.6 × 0.5 cm in size). The lesion was composed of clear polygonal cells arranged in nests and a trabecular pattern. The tumor invaded through the wall into the fibromuscular layer. Immunohistochemical stains showed that neoplastic cells were positive for neuron-specific enolase (NSE), chromogranin A, synaptophysin, and pancreatic polypeptide and negative for inhibin, keratin, CD56, serotonin, gastrin and somatostatin. The postoperative course was uneventful and he is living well without relapse 12 months after surgery. CONCLUSION: Given the preoperative difficulty in differentiating carcinoid from carcinoma, the pancreaticoduodenectomy is an appropriate treatment choice for carcinoid tumors located within the intra-pancreatic bile duct

OMI-VT stormに対するカテーテルアブレーション

A ６８-year-old woman with VT storm and frequent appropriate ICD therapy was referred for catheter ablation. Her past history was notable for aortic valve replacement by mechanical valve due to infectious endocarditis １７ years prior to presentation and left ventricular apical old myocardial infarction with unknown onset. At ６７ years old, She admitted to the prior hospital due to ventricular tachycardia with LBBB and superior axis at heart rate of ２１０ per minutes. Administration of amiodarone and magnesium sulfate was ineffective and cardioversion of ２００J was successfully terminated the tachycardia. Intra-cardiac defibrillator was implanted and the administration of amiodarone and mexiletine was started. ５ months after, she admitted to the hospital due to the frequent appropriate shock against the same ventricular tachycardia. Administration of lidocaine, sotalol, pilsicainide, and magnesium sulfate could not control the tachycardia and she was referred to our hospital for catheter ablation. During the first session, ventricular tachycardia was easily induced and electroanatomical mapping was performed both during tachycardia and during sinus rhythm. Late diastolic potential preceding the onset of QRS wave by ４５ms was detected at the infero-septal side of the apical aneurysm. ７．５s of the RF energy application at this site could terminate the tachycardia and thereafter no ventricular tachycardia was induced. But after dose-reduction or cessation of some anti-arrhythmic drugs, ventricular tachycardia was recurred and second session was performed. This time, no ventricular tachycardia was induced, then we performed isthmus transection and core isolation against the apical aneurysm. Thereafter no ventricular tachycardia was occurred in spite of dose-reduction or cessation of some anti-arrhythmic drugs