Antonios Drevelegas

Giant fibrovascular polyp of the oesophagus: a case report and review of the literature

IntroductionWe present a case of fibrovascular polyp, a rare submucosal tumour of the oesophagus that has been reported only sporadically in the literature. The biapproach for surgical removal of fibrovascular polyp has only been mentioned once in the literature.Case presentationA 65-year-old Greek man presented with a 9-month history of gradually progressive intermittent dysphagia. Radiologic work-up with oesophagogram and computed tomography revealed a large, sausage-shaped intraluminal polyp extending from the level of the cervical oesophagus to the level of the upper body of the stomach. The diagnosis of giant fibrovascular polyp was made radiographically and confirmed by endoscopic biopsy. The polyp was removed using a biapproach surgical technique: pharyngotomy and subsequent gastrostomy.ConclusionFibrovascular polyp is a rare submucosal tumour. Proper treatment depends on accurate assessment of the origin, size, and vascularity of the pedicle and the size of the tumour. Choice of the appropriate surgical approach depends on the correct diagnosis, which can usually be indicated radiographically by the presence of a smooth, sausage-shaped defect with a discrete bulbous tip.

Meningioma growth and interferon beta-1b treated multiple sclerosis: coincidence or relationship?

Although the coincidence of multiple sclerosis (MS) and central nervous system (CNS) tumors has been reported in over 30 cases in English literature, meningioma growth was associated with interferon-beta (INF-b) treated MS only in two of them. We report the case of a 19-year-old woman with clinically possible, laboratory supported MS, and a concomitant right intraventricular tumor with magnetic resonance imaging (MRI) characteristics consistent with meningioma (similar signal with grey matter on T1 and T2-weighted images and homogenous, intense enhancement). Two years after initiation of INF-b treatment, follow-up brain MRI revealed enlargement of the intraventricular mass and relative increase in the number of white matter lesions without significant clinical deterioration. She underwent almost total resection of the mass and histology confirmed the diagnosis of papillary meningioma. Based on the immunohistochemistry results, we speculate that INF-b resulted in meningioma growth by enhancing platelet derived growth factor (PDGF) receptors or/and down-regulating transforming growth factor receptors on the tumor itself.

New spontaneous breast seroma 5 years after augmentation: a case report

The case of a 36 year old woman who experienced a late, spontaneous breast seroma 5 years after augmentation in the absence of any known precipitating factors is reported. Although seroma is not an uncommon complication in the immediate postoperative period, it is extremely rare as a late complication of breast implantation. Magnetic resonance imaging is a reliable method to confirm the diagnosis of late seroma formation. Surgery is the preferred treatment.

Brucella liver abscess; imaging approach, differential diagnosis, and therapeutic management: a case report

We report a new case of a brucellar liver abscess (brucelloma) in a young woman without previous remote brucellosis who presented with pronounced systemic and mild local symptoms. Brucelloma is the result of calcification of a granoulomatous reaction induced by persistent Brucella in macrophages. It represents a rare manifestation that follows previously undetected brucellosis. We describe the findings in plain radiograph, ultrasound, computed tomography, and magnetic resonance images. Together with the positive serology, imaging yielded important elements supporting the diagnosis. Modern radiological techniques also contributed to the final therapeutic management, preventing unnecessary laparotomy. Sequencing confirmed the definite diagnosis of Brucella melitensis as the causative factor.

Angiomatoid fibrous histiocytoma with cystic structures of sweat duct origin

Angiomatoid fibrous histiocytoma is an unusual soft tissue tumor, mostly arising in the subcutaneous fibro‐adipose tissue of children and young adults and measuring a few centimeters in greatest dimension. Reported herein is a unique case of angiomatoid fibrous histiocytoma containing epithelium‐lined cystic structures. This large tumor (12u2003cm) was located in the subcutaneous tissue of the left leg of a 28‐year‐old woman. The cystic structures were variably sized and were lined by a double cell layer with areas of squamous metaplasia. Their overall histological features suggested a sweat duct origin. Immunohistochemical stains confirmed such origin, demonstrating an inner epithelial and an outer myoepithelial (smooth muscle actin and cytokeratin 17 positive) cell layer. The present case is illustrative of a mechanism of sweat duct dilatation that may occur during the growth of neoplasms involving the dermis and subcutis, resulting in formation of tumors with unusual histological features.

Magnetic resonance imaging findings in pseudo-Meigs' syndrome associated with a large uterine leiomyoma: a case report

IntroductionPseudo-Meigs syndrome is a rare pathological entity characterized by the presence of a pelvic mass other than an ovarian fibroma. The mass is associated with ascites with or without hydrothorax.Case presentationWe describe the case of a 41-year-old Caucasian woman with a large uterine leiomyoma associated with massive ascites. A magnetic resonance imaging scan showed a large subserosal leiomyoma with multiple areas of cystic degeneration.ConclusionTo the best of our knowledge, this is the first reported case of pseudo-Meigs syndrome caused by a uterine leiomyoma and diagnosed using magnetic resonance imaging. The pathophysiology of this syndrome and the role of magnetic resonance imaging are emphasized in this case report.

Littoral cell angioma, a rare cause of long standing anaemia: a case report

Littoral cell angioma is a rare primary splenic tumor that is difficult to differentiate preoperatively from other benign and malignant splenic lesions. We report a case of littoral cell angioma of the spleen in a 51-year-old woman that presented with long standing anaemia.

Safety of transarterial chemoembolization plus sorafenib combination treatment in unresectable hepatocellular carcinoma.

TOTHE EDITOR: Sorafenib, a multi-kinase inhibitor with antiproliferative and antiangiogenetic properties, has been shown [1] to improve survival in patients with advanced hepatocellular carcinoma (HCC). There is experimental evidence [2,3] that adding sorafenib to locoregional therapies could enhance effectiveness. However, the safety of these regimens is unknown. We retrospectively report a cohort of 14 patients with intermediate and advanced HCC treated with transarterial chemoembolization (TACE) and sorafenib. HCC diagnosis was based on multiphase computed tomography (CT) findings and histology. None of the patients had received previous anticancer therapy. Response to treatment was evaluated according to the closest to follow-up end CT [4]. Sorafenib was added to treatment 4.5 (0–20) months after first TACE. Only patients with at least one TACE after sorafenib initiation were included. The initial sorafenib dose was 400 mg b.i.d. Dose reductions (400 mg and then 200 mg o.d.) were permitted according to the investigators’ discretion. All patients with chronic hepatitis B received concomitant nucleos(t)ide analogue treatment. Primary endpoint of our study was overall survival. Patients’ baseline characteristics are summarized in Table I. The median age was 69 (53–79) years and the predominant liver disease was CHB-related cirrhosis (n = 13, 93%). At the time of sorafenib initiation 9 patients (64%) had stage B HCC and 5 (36%) had stage C according to the Barcelona Clinic Liver Cancer (BCLC) staging system [5]. A mean of 1.4 ± 0.5 TACE per patient were performed after sorafenib administration. The mean duration of combined treatment was 12.5 ± 5.8 months. The combination treatment was generally well tolerated without grade 3 or 4 adverse events. Fatigue (29%), diarrhea (29%) and hand-foot skin reaction (14%) were the more common side effects (Table II). Sorafenib dose was reduced in 9 (64%) patients, but was not discontinued in any patient. Based on the last CT, partial response to treatment was observed in 10 patients, stable disease in 3 and disease progression in 1. The median survival under combination treatment was 15 months. Interim analyses of trials [6,7] have demonstrated that the combination of sorafenib with TACE is safe. However, there is still skepticism for using this strategy, due to adverse events concerns. TACE has been reported to induce gastrointestinal bleeding in up to 10% of cases [8]. Sorafenib has been also associated with bleeding [9], although these reservations were not confirmed [1]. Furthermore, sorafenib is associated with diarrhea, weight loss and hand-foot skin reactions. In our patients we observed no major complications. The rate and type of adverse events were comparable to those reported under sorafenib monotherapy [1]. Notably, we observed no bleeding episodes. There was no difference in adverse events or dose reduction requirements between patients with Child-Pugh grade A or B. The median survival was superior to that reported on monotherapy with either sorafenib or TACE [1,8]. The mean time of sorafenib addition to TACE was 4.5 months, thus suggesting a synergistic effect. This observation has been recently confirmed [6,7].

McCune-Albright syndrome: Report of a case☆

The McCune Albright syndrome is seldom encountered and rarely reported in dental literature. It represents a special category of polyostic fibrous displasia associated with skin pigmentation and endocrine disturbances. We describe the case of a 9-year-old boy with the McCune Albright syndrome, who was treated for a mandibular osteolytic lesion.

Submitral left ventricular pseudoaneurysm after mitral valve replacement.

ig. 2. Multislice CT (a) in a four-chamber view shows the submitral pseuoaneurysm of the left ventricle, (b) short axis view shows the posterior neurismal dilatation of the left ventricle, (c and d) coronal views show the homboid aneurysm correlated with the shape on catheterization. The origin nd course of the Cx were normal. Iatrogenic intraoperative left circumflex njury and subsequent infarction was the cause of pseudoaneurysm. Aneursmectomy was performed with good postoperative cardiac function.