Cheng-Hong Toh

Combined hepatocellular-cholangiocarcinoma: a case report

Combined hepatocellular‐cholangiocarcinoma (HCC‐CC) is a rare primary liver tumour. We report a carrier of both HBV and HCV presenting with intermittent abdominal pain, fever, chillness and elevated á‐fetoprotein (AFP) of 1197 ng/ml. Computed tomography showed an irregular hypodense mass in the left lateral segment of the liver with vague contrast enhancement and multiple regional lymphadenopathy. Hepatic angiogram showed that the mass was hypovascular and the left portal vein was occluded with a tapered end. Percutaneous ultrasound‐guided core needle biopsy of the liver yielded HCC‐CC. We suggest that HCC‐CC should be considered in hypovascular liver tumours with striking elevation of serum AFP and multiple regional lymphadenopathy.

Cystic nodal metastasis in patients with oropharyngeal squamous cell carcinoma receiving chemoradiotherapy: Relationship with human papillomavirus status and failure patterns

Objectives We investigated the relationships of cystic nodal metastasis, human papillomavirus (HPV) status, and treatment failure patterns in patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with chemoradiotherapy. Methods We retrospectively reviewed pretreatment MRI and clinical courses of patients with OPSCC whose tumors were tested for HPV-induced p16 expression via immunohistochemistry and who completed chemoradiotherapy. Cervical cystic nodal metastasis and necrotic nodal metastasis were classified on MRI. Results Of 98 patients eligible for analysis, 33 were p16-positive. Cystic nodal metastasis was significantly more prevalent in p16-positive than in p16-negative patients (39.4% versus 18.5%, respectively; p = 0.025). Necrotic nodal metastasis was significantly more prevalent in p16-negative than in p16-positive patients (73.8% versus 51.5%, respectively; p = 0.027). On multivariate analysis, necrotic nodal metastasis (odds ratio [OR] = 7.310, p = 0.011) was an independent predictor of regional failure, while advanced nodal stage (OR = 4.119, p = 0.022) and cystic nodal metastases (OR = 0.087, p = 0.026) were independent positive and negative predictors of distant failure, respectively. Conclusions Cervical cystic and necrotic nodal metastases are associated with HPV-induced p16-positive and p16-negative OPSCC, respectively. Patients with necrotic nodal metastasis at presentation have an increased risk of regional failure. Distant failure is directly and inversely correlated with advanced nodal stage and cystic nodal metastasis, respectively.

Retrograde Cerebral Venous Air Embolism: A Case Report and Review of Literature

We present a patient with cerebral venous air embolism after central venous catheterization (CVC) removal. Clinicians and radiologists should be aware of this possibility. This 63-year-old man with right lower lung cancer was admitted to the hospital for surgery. After surgery, CVC was removed then the patient was found unconscious. Immediate brain computed tomography (CT) showed air collection in bilateral cavernous sinuses, straight sinus and bilateral cerebral cortical veins, suggesting cerebral venous air embolism. Magnetic resonance imaging (MRI) obtained 10 hours after CT showed no residual air in the venous sinus system and no apparent abnormality. Follow-up MRI of brain 12 days later revealed bilateral cerebral subacute infarction with cortical pseudolaminar necrosis. He received supportive treatment with gradual return of consciousness despite remaining paralyzed.

CT-guided core needle biopsy of deep suprahyoid head and neck lesions in untreated patients.

This study aimed to evaluate the efficacy of CT-guided core needle biopsy (CNB) in the diagnosis of deep head and neck tumors in untreated patients. We retrospectively reviewed the records of ten consecutive CT-guided CNB procedures from ten patients without a related history from March 2004 to February 2012. The surgical results, treatment response and clinical follow-up were used as the diagnostic standards. All specimens were considered adequate. Nine out of ten cases matched the final diagnosis. Biopsy failed to diagnose the infratemporal meningioma en plaque in a particular case. Three cases were carcinomas. No complication was encountered. CT-guided core needle biopsy is an efficient and safe technique for histological diagnosis of skull base lesions in patients without a related history. This technique can offer a definite tissue diagnosis and avoid unnecessary surgical interventions for such patients.