Ofer Benjaminov

Factors associated with radiation exposure in patients with inflammatory bowel disease.

Background  Inflammatory bowel disease (IBD) patients undergo multiple radiological evaluations.

Post-traumatic soft tissue tumors: Case report and review of the literature a propos a Post-traumatic paraspinal desmoid tumor

BackgroundAntecedent trauma has been implicated in the causation of soft tissue tumors. Several criteria have been established to define a cause-and-effect relationship. We postulate possible mechanisms in the genesis of soft tissue tumors following antecedent traumatic injury.Case presentationWe present a 27-year-old woman with a paraspinal desmoid tumor, diagnosed 3-years following a motor vehicle accident. Literature is reviewed.ConclusionSoft tissue tumors arising at the site of previous trauma may be desmoids, pseudolipomas or rarely, other soft tissue growths. The cause-and-effect issue of desmoid or other soft tissue tumors goes beyond their diagnosis and treatment. Surgeons should be acquainted with this diagnostic entity as it may also involve questions of longer follow-up and compensation and disability privileges.

Stercoral colitis: a lethal disease-computed tomographic findings and clinical characteristic.

Objective The aim of this study was to describe the radiographic findings in stercoral colitis. Methods The computed tomographic scans and abdominal radiographs of 13 patients with surgically and pathologically confirmed stercoral colitis from 4 affiliated hospitals were reviewed by a board-certified abdominal radiologist blinded to the official imaging, surgical, and pathologic findings. Results The median age was 66 years. The patients presented mainly with constipation (100%) and an acute inflammatory process (85%); 5 patients (38%) had frank septic shock. Mortality was 46%. Imaging scans showed that the colon dilated proximally to the impaction site in 6 patients (50%). Other findings included fat stranding (100%), mucosal sloughing (58%), mesenteric hyperemia (58%), and extraluminal gas (17%). Conclusions Computed tomography is an important diagnostic modality for stercoral colitis. The presence of a large fecaloma with distention of the affected colon and wall thickening and pericolonic fat stranding should alert radiologists and surgeons to the presence of this potentially fatal condition.

Myxoid Liposarcoma: An Unusual Presentation

3Department of Gynecology–Oncology, Rabin Medical Center, Sackler School of Medicine, University of Tel Aviv, Tel Aviv, Israel. iposarcoma is the second most common soft-tissue sarcoma in adults. Myxoid liposarcoma is the second most common type of liposarcoma, representing 30–40% of all liposarcomas in the extremities. It occurs most commonly in the extremities, particularly the thighs [1, 2]. Liposarcomas involving the pelvis are uncommon. The more frequent sites of myxoid liposarcomas, in decreasing order of frequency, are the buttocks, retroperitoneum, trunk, ankle, proximal limb girdle, head and neck, and wrist [1, 2]. Establishing the correct diagnosis in cases of myxoid liposarcoma using imaging may be difficult. On images obtained without the administration of contrast material, the tumor may mimic a fluid-filled cyst on both CT and MRI, and the tumor lacks the signal intensity of fat. Sonography may help in establishing the presence of solid components and in differentiating between a cyst and a solid tumor. The combination of different imaging techniques helps in defining the extent of the tumor for preoperative planning. We present an unusual case of a giant myxoid retroperitoneal and pelvic liposarcoma that presented as a large buttock mass (Fig. 1A). The combined information gathered from MRI, CT, and sonography was crucial for defining the extent of the tumor and for preoperative planning.

Giant colon diverticulum: clinical and imaging findings in 17 patients with emphasis on CT criteria.

PURPOSE The purpose of the study was to review the clinical and radiologic features of giant colonic diverticulum (GCD). METHODS Medical records of 17 patients with GCD on computed tomographic (CT) examination were reviewed. RESULTS CT examination revealed the GCD in all patients as a predominantly gas-filled structure communicating with the adjacent colon. Thirteen patients showed a gas-filled structure on abdominal radiograph. The mean GCD diameter was 7 cm. Most diverticula were found in the sigmoid colon. Associated diverticulosis was present in 71% of patients. CONCLUSION Our experience suggests that GCD can often be diagnosed on the basis of the characteristic radiographic and CT findings in these patients.

Radiotherapy and Sorafenib in the Management of Patients with Hepatocellular Carcinoma Have Led to Improved Survival: A Single Center Experience.

Background & Aims: Hepatocellular Carcinoma (HCC) is the sixth most common malignancy and the third most common cause of cancer mortality worldwide. We aimed to assess the effect of novel treatment options on the survival of HCC patients. Methods: This retrospective study included all HCC patients diagnosed between 2000 and 2013 referred to the Davidoff center and treated by a multidisciplinary team. Results: The analysis included 321 patients (median age, 64 years; 74.8% males; 74.1% viral carriers; 76.0% cirrhosis; 56.7% diagnosis at an early stage). The estimated hazard ratio by multivariate analysis for the effect of the period of diagnosis (2007-2013 vs. 2000-2006) on survival was 0.72 (95% CI: 0.54-0.96; p=0.027). There was no difference in the distribution by CP score, by BCLC stage at diagnosis or in the proportion of patients undergoing surgical procedures (liver transplantation or resection). In the later time frame, there was a significant decrease in the proportion of patients undergoing percutaneous treatments (14.6% vs.4.2%, p=0.004) and embolization (46.9% vs.24.6%, p=0.001), and a significant increase in radiotherapy (1.5% vs. 8.4%, p=0.009) and treatment with sorafenib (6% vs. 18.3%, p=0.002). Conclusion: Technological/pharmaceutical innovations have led to advancement in HCC treatment. Since there was no significant difference in the proportion of patients undergoing surgical procedures during the evaluated timeframe, the improved survival may stem from better management of advanced stage patients by a multidisciplinary team.

A phase I clinical trial of dTCApFs, a derivative of a novel human hormone peptide, for the treatment of advanced/metastatic solid tumors

The aim of the present phase I first-in-human study was to investigate the safety/efficacy of dTCApFs (a novel hormone peptide that enters cells through the T1/ST2 receptor), in advanced/metastatic solid tumors. The primary objective of this open-label dose-escalation study was to determine the safety profile of dTCApFs. The study enrolled patients (aged ≥18 years) with pathologically confirmed locally advanced/metastatic solid malignancies, who experienced treatment failure or were unable to tolerate previous standard therapy. The study included 17 patients (64% male; median age, 65 years; 47% colorectal cancer, 29% pancreatic cancer). The patients received 1–3 cycles of escalating dTCApFs doses (6–96 mg/m2). The mean number ± standard deviation of treatment cycles/patient was 3.2±1.4; no dose-limiting toxicities were observed up to a dose of 96 mg/m2, and the maximum tolerated dose was not reached. Half-life, maximal plasma concentration, and dTCApFs exposure were found to be linearly correlated with dose. Five patients were treated for ≥3 months (12, 24, 48 mg/m2) and experienced stable disease throughout the treatment period, and 1 experienced pathological complete response. Analysis of serum biomarkers revealed decreased levels of angiogenic factors at dTCApFs concentrations of 12–48 mg/m2, increased levels of anticancer cytokines, and induction of the endoplasmic reticulum (ER) stress biomarker GRP78/BiP. Efficacy and biomarker data suggest that patients whose tumors were T1/ST2-positive exhibited a better response to dTCApFs. In conclusion, dTCApFs was found to be safe/well-tolerated, and potentially efficacious, with linear pharmacokinetics. Consistent with preclinical studies, the mechanism through which dTCApFs exerts anticancer effects appears to involve induction of ER stress, suppression of angiogenesis, and activation of the innate immune response. However, further studies are warranted.

Multiple Liver Lesions After Oxaliplatin-Based Chemotherapy for Colorectal Cancer

The Liver Institute, Department of Pathology, Department of Radiology, Rabin Medical Center, Beilinson hospital; and Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 Question: A 37-year-old woman presented with multiple liver lesions recently revealed by imaging studies. The patient’s history is remarkable for rectal cancer diagnosed 4 years earlier and that was treated with neoadjuvant radiochemotherapy followed by a low anterior resection surgery. The tumor was found to be at stage III and the patient underwent adjuvant chemotherapy with a 12course regimen of FOLFOX (folinic acid, fluorouracil, oxaliplatin). Follow-up imaging studies performed during the next 3 years showed no signs of disease recurrence. Three months before admission, a computed tomography scan showed multiple small hepatic lesions. A follow-up MRI performed 2 months later confirmed those findings, revealing fast-growing hypervascular lesions (Figure A), all of them undergoing marked enhancement during the arterial phase but becoming isointense to the liver parenchyma during the later portal venous phases (Figure B). Notably, all lesions were found to be negative on a subsequent fluorodeoxyglucose-PET scan (Figure C). The patient has no history of chronic liver disease. At presentation, the patient was asymptomatic and her medications included oral contraceptives only. Her hepatocellular liver enzymes were at the upper normal level and her blood tumor markers carcinoembryonic antigen, alpha-fetoprotein, and CA-19-9 were within normal ranges. A needle core biopsy from the largest 2.5-cm hepatic lesion was performed (Figure D) and showed no signs of malignant cells. A Masson trichrome stain of the biopsy specimen is presented in Figure E. An additional immunohistochemistry was performed (Figure F) that strongly supported the diagnosis. What is the diagnosis? What are the radiologic features that suggest the right diagnosis? What type of additional immunohistochemistry was performed to support diagnosis?