RESUMEN
Acute pneumothorax is a frequent complication after percutaneous pulmonary radiofrequency (RF) ablation. In this study we present three cases showing delayed development of pneumothorax after pulmonary RF ablation in 34 patients. Our purpose is to draw attention to this delayed complication and to propose a possible approach to avoid this major complication. These three cases occurred subsequent to 44 CT-guided pulmonary RF ablation procedures (6.8%) using either internally cooled or multitined expandable RF electrodes. In two patients, the pneumothorax, being initially absent at the end of the intervention, developed without symptoms. One of these patients required chest drain placement 32 h after RF ablation, and in the second patient therapy remained conservative. In the third patient, a slight pneumothorax at the end of the intervention gradually increased and led into tension pneumothorax 5 days after ablation procedure. Underlying bronchopleural fistula along the coagulated former electrode track was diagnosed in two patients. In conclusion, delayed development of pneumothorax after pulmonary RF ablation can occur and is probably due to underlying bronchopleural fistula, potentially leading to tension pneumothorax. Patients and interventionalists should be prepared for delayed onset of this complication, and extensive track ablation following pulmonary RF ablation should be avoided.
Asunto(s)
Ablación por Catéter , Neoplasias Pulmonares/cirugía , Neumotórax/etiología , Complicaciones Posoperatorias/etiología , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/secundario , Masculino , Persona de Mediana Edad , Neumotórax/prevención & control , Complicaciones Posoperatorias/prevención & control , Radiografía Intervencional , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Radiofrequency (RF) ablation is an increasingly applied technique. Promising results of hepatic RF ablation raised expectations of its capabilities for treatment of primary and secondary lung tumors. Because of different thermal and electrical properties of lung tissue, compared with liver tissue, a simple analogy of tissue response is not possible. The authors aimed to evaluate the effectiveness of image-guided pulmonary RF ablation and to characterize pathomorphology of tissue response. METHODS: RF ablations of 11 pulmonary malignancies in 9 patients were performed under computed tomography (CT)-guidance. Three days after RF ablation, surgical resection was performed followed by pathologic examination. Specimens were evaluated macroscopically, histologically by hematoxylin and eosin (H & E) staining, terminal deoxy-nucleotidyl transferase-mediated nick end-labeling (TUNEL), and electron microscopy. RESULTS: Tumor tissues and adjacent lung tissues were characterized by double-strand fragmentation as determined by TUNEL. Ultrastructurally apoptotic bodies were found, indicating apoptotic cells. Criteria for tissue necrosis were not fulfilled by standard histological staining (H & E), showing preserved tissue architecture and only few microscopic cellular details suggestive of tumor regression. Because of DNA fragmentation, as determined by TUNEL and results from electron microscopy, the authors confirmed the tumor tissue to be completely ablated in 10 (90.9%) cases. However, in 2 cases, a safety margin was absent. CONCLUSIONS: CT-guided pulmonary RF ablation of pulmonary malignancies is a locally effective treatment. Three days after RF ablation, tumor tissue seemed to be thermally fixed still showing characteristics of vital tumor tissue in standard histological staining; however the tissue proved to be in regression toward coagulative necrosis verified ultrastructurally and by TUNEL.
Asunto(s)
Ablación por Catéter/métodos , Neoplasias Pulmonares/cirugía , Adulto , Anciano , Apoptosis , Muerte Celular , Fragmentación del ADN , Femenino , Humanos , Pulmón/patología , Pulmón/efectos de la radiación , Pulmón/cirugía , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Cirugía Asistida por Computador , Tomógrafos Computarizados por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND: The occurrence of ossifying fibromas (OFs) in childhood and adolescence has been described in the literature, along with different courses of the disease due to different growth rates. CASE REPORT: In the case of the 15-year-old female patient presented here, an OF resulted in displacement of a maxillary third molar far into the maxillary sinus. It is assumed that the tumour originated coronal to the affected tooth 18. Radiographs document an initial rapid growth of this tumour over a period of 2 years, while its growth almost completely ceased in the next 2 years immediately prior to diagnosis and surgical treatment. The operation was complicated by unexpected profuse bleeding from the tumour tissue. CONCLUSION: The peculiarity of the OF in the case presented here is its similarity, in terms of clinical and radiological appearances, with a follicular cyst, its unusual place of origin that resulted in the migration of the tooth 18 into the maxillary sinus, its different growth dynamics, and the pronounced haemorrhage encountered as the tumour was surgically removed.
Asunto(s)
Fibroma Osificante/complicaciones , Neoplasias Maxilares/complicaciones , Tercer Molar/fisiopatología , Migración del Diente/etiología , Adolescente , Femenino , Fibroma Osificante/cirugía , Cuerpos Extraños , Humanos , Neoplasias Maxilares/cirugía , Seno Maxilar , Procedimientos Quirúrgicos Orales/efectos adversos , Hemorragia Posoperatoria/etiologíaRESUMEN
BACKGROUND AND OBJECTIVES: Mucormycoses are seen with an increasing incidence in immunocompromised patients. Most common presentations are rhinocerebral and pulmonary. We here report the experience of a single center with mucormycoses in patients with hematologic malignancies. RESULTS: Mucormycoses were diagnosed in six patients, (median age of 52 years; range, 26-74) treated between 2001-2004. Diagnoses included acute myeloid leukemia (AML) (n=3), acute lymphoblastic leukemia (n=1), chronic lymphocytic leukemia (n=1) and multiple myeloma (n=1). Mucormycosis was diagnosed in the neutropenic state following allogeneic hematopoietic cell transplantation (n=3) or intense chemotherapy (n=3). Sites of infections were rhinocerebral, facial and pulmonary involvement in one patient each and disseminated mucormycosis in three patients. The diagnosis was established by computed tomography followed by surgical interventions and histological diagnosis in 4 patients and post-mortem in two patients. Species identified were Rhizopus (n=3), Rhizomucor (n=2) and Absidia (n=1). Treatment responses were best if surgical resection was followed by aggressive antifungal chemotherapy. Five of six 6 patients died, all of complications of mucormycosis or their underlying disease. Only one patient with facial mucormycosis is still alive. CONCLUSIONS: This experience demonstrates that patient with mucormycoses have a high mortality rate and early recognition followed by aggressive surgical debridement, high dose antifungal therapy and attempts to correct the underlying immunocompromised state are crucial in the treatment of this fatal infection.
Asunto(s)
Enfermedades Transmisibles Emergentes , Neoplasias Hematológicas/complicaciones , Mucormicosis/etiología , Adulto , Anciano , Anfotericina B/uso terapéutico , Antifúngicos/uso terapéutico , Antineoplásicos/efectos adversos , Dermatomicosis/tratamiento farmacológico , Dermatomicosis/cirugía , Susceptibilidad a Enfermedades , Femenino , Fluconazol/uso terapéutico , Trasplante de Células Madre Hematopoyéticas , Humanos , Huésped Inmunocomprometido , Itraconazol/uso terapéutico , Enfermedades Pulmonares Fúngicas/tratamiento farmacológico , Enfermedades Pulmonares Fúngicas/mortalidad , Masculino , Persona de Mediana Edad , Mucormicosis/tratamiento farmacológico , Mucormicosis/mortalidad , Mucormicosis/cirugía , Neutropenia/inducido químicamente , Neutropenia/complicaciones , Pirimidinas/uso terapéutico , Sinusitis/tratamiento farmacológico , Sinusitis/mortalidad , Acondicionamiento Pretrasplante/efectos adversos , Triazoles/uso terapéutico , Vísceras/microbiología , VoriconazolRESUMEN
Whipple's disease (WD) is a chronic systemic inflammatory disease of infectious origin caused by Tropheryma whipplei (TW). Abdominal pain and recurrent diarrhea are usually the main symptoms leading to the suspicion of a primary bowel disease. Systemic manifestations can mimic hematologic disorders. A 49-year-old man presented with fever, weight loss, long-standing arthralgia, and diarrhea. A duodenal biopsy was unremarkable. Bone marrow histology provided no evidence of a malignant hematological disorder but revealed noncaseating granulomas. TW was detected in the bone marrow trephine by polymerase chain reaction. This is the first report to describe TW-associated granulomatous myelitis as the initially recognized organ manifestation of WD, proven at the molecular level. This observation is relevant for the differential diagnosis of patients with systemic symptoms and granulomatous diseases affecting the bone marrow, emphasizing that WD should be considered in cases of unexplained granulomatous myelitis, even when small bowel biopsy specimens are negative.
Asunto(s)
Médula Ósea/patología , Granuloma/patología , Enfermedad de Whipple/diagnóstico , Médula Ósea/microbiología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Mielitis/etiología , Mielitis/patología , Reacción en Cadena de la Polimerasa , Enfermedad de Whipple/microbiologíaRESUMEN
Follicular dendritic cell sarcomas (FDCSs) are very rare and usually originate in lymph nodes. We report an exceedingly rare case with localization in the dorsal mediastinum and, for the first time, provide positron emission tomography (PET) data for this tumor. This report describes the case of a 76-year-old man with a clinically aggressive tumor in the dorsal mediastinum. Computed tomography scan revealed displacement of soft tissue and lymph nodes. PET showed that the tumor had a high proliferation rate. Investigation of the successfully removed tumor mass revealed reactivity of the tumor cells for follicular dendritic cell markers and desmosomes linking adjacent tumor cells at the ultrastructural level. Marked atypia, a high mitotic rate, and areas of coagulative necrosis were found. The tumor in our case revealed the typical features and thus was classified as FDCS. In contrast to previous reports in the literature, preoperative imaging, histology, and immunohistochemistry studies indicated at least an intermediate degree of malignancy. Nevertheless, the patient made a good postoperative recovery and remained apparently disease-free 2 years later.
Asunto(s)
Células Dendríticas Foliculares/patología , Neoplasias del Mediastino/patología , Sarcoma/parasitología , Anciano , Antígenos CD/análisis , Biomarcadores de Tumor/análisis , Células Dendríticas Foliculares/química , Células Dendríticas Foliculares/diagnóstico por imagen , Desmosomas/patología , Humanos , Inmunohistoquímica , Masculino , Neoplasias del Mediastino/química , Neoplasias del Mediastino/diagnóstico por imagen , Microscopía Electrónica , Índice Mitótico , Necrosis , Sarcoma/química , Sarcoma/diagnóstico por imagen , Tomografía Computarizada de EmisiónRESUMEN
BACKGROUND: Posttransplantation lymphoproliferative disorder (PTLD) of the iris is a rare entity with only ten cases having been published as yet. Its clinical aspect is typical. Therapy is multimodal and affords an interdisciplinary approach. METHODS: A 7-year-old boy developed a lymphoproliferative mass of the iris with uveitis 4 years after heart transplantation and immunosuppression. A progressive, flesh-colored thickening of the iris with secondary angle closure glaucoma necessitated a diagnostic and therapeutic iridectomy. Morphological investigation of the iris specimen disclosed a polymorphic posttransplantation lymphoproliferative disorder (PTLD) and the presence of Epstein-Barr virus (EBV) within the tissue. The EBV load in peripheral blood monocytes was massively elevated, thus indicating a chronic EBV infection. After conservative treatment and radiation therapy, the iris mass quickly resolved. There was no evidence of systemic PTLD. CONCLUSIONS: PTLD is a well-known, EBV-induced entity that rarely affects the eye. EBV is principally detectable in specimens of iris PTLD. If conservative, antiviral treatment fails, the iris lesions can be treated by local radiation therapy with very good success. In the near future, patients with PTLD of the eye may benefit from immunologic treatment with ex vivo generation of virus-specific T-lymphocytes.
Asunto(s)
Infecciones por Virus de Epstein-Barr/complicaciones , Infecciones Virales del Ojo , Trasplante de Corazón/efectos adversos , Enfermedades del Iris/virología , Trastornos Linfoproliferativos/virología , Antivirales/uso terapéutico , Niño , Terapia Combinada , Infecciones por Virus de Epstein-Barr/diagnóstico , Infecciones por Virus de Epstein-Barr/terapia , Infecciones Virales del Ojo/diagnóstico , Infecciones Virales del Ojo/etiología , Infecciones Virales del Ojo/terapia , Glaucoma de Ángulo Cerrado/etiología , Herpesvirus Humano 4/aislamiento & purificación , Humanos , Inmunosupresores/administración & dosificación , Iridectomía , Enfermedades del Iris/diagnóstico , Enfermedades del Iris/terapia , Trastornos Linfoproliferativos/diagnóstico , Trastornos Linfoproliferativos/terapia , Masculino , Radioterapia Adyuvante , Uveítis/etiología , Carga ViralRESUMEN
The rare hypocellular variants of acute leukemia (AL) previously also termed smouldering leukemia, almost always exhibit myeloid differentiation. Very rare cases of hypocellular AL with lymphoid differentiation have been reported, usually in children. This paper describes two cases (an 87-year-old woman and a 79-year-old man) in whom the blood findings were suggestive of AL. Paraffin-embedded bone marrow biopsy specimens revealed similar findings in both patients: there was severe hypocellularity, the cells of normal hemopoiesis were greatly reduced in number, and there was a diffuse increase in blast cells, which represented more than 50% of nucleated marrow cells. The blasts coexpressed TdT and CD34 and were negative for myeloperoxidase, CD117, CD68 and naphthol AS-D chloroacetate esterase. For the first time immunohistochemical Pax-5/CD34 doublestainings are provided, which revealed the blasts in one case to coexpress Pax-5 and CD34. All the blasts were CD79a-positive and 20% were also CD10-positive. In the other case, 20% of the blasts were CD79a-positive, 30% coexpressed Pax-5 and CD34 by doublestaining, and showed a clonal rearrangement of the immunoglobulin heavy chain gene. Thus a diagnosis of AL of lymphoid lineage, hypocellular variant, was made on the basis of immunohistochemical findings. The clinical course appears to be similar to that of hypocellular AML, as neither patient has developed overt leukemia during the one-year follow-up period.
Asunto(s)
Diferenciación Celular , Tejido Linfoide/patología , Leucemia-Linfoma Linfoblástico de Células Precursoras/patología , Anciano , Anciano de 80 o más Años , Antígenos CD/análisis , Médula Ósea/patología , Femenino , Humanos , Inmunofenotipificación , Tejido Linfoide/metabolismo , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/metabolismoRESUMEN
RATIONALE AND OBJECTIVES: To evaluate the efficiency of 4 radiofrequency (RF) systems by assessing the amount of delivered energy for each thermal induced lesion after perfusion mediated RF ablation and to compare the influence of perfusion mediation types on the energy efficiency. METHODS: A total of 43 ablations in 16 male landrace pigs with 4 RF devices were performed strictly according to the manufacturers' instructions. Total absorbed energy was computed and then related to 3D volumetry obtained after histopathological evaluation. Sixteen ablations were performed under physiological liver perfusion and 27 ablations with occlusion of portal vein, hepatic artery, or both vessels. Energy efficiency values of the RF systems for different vascular occlusion techniques were compared and analyzed by a nonparametrical rank sum test. RESULTS: Under physiological perfusion, the average energy delivered to produce 1-cm3 lesion size was calculated to 1650 +/- 929, 3097 +/- 389, 8312 +/- 2068, and 5493 +/- 2306 Watt x s/cm3 for the Berchtold, Radionics, Radiotherapeutics, and RITA system, respectively. After perfusion-mediated RF ablation, artery occlusion was not as effective as portal vein occlusion, which reduced the energy to 587 +/- 148, 869 +/- 276, and 903 +/- 394 Watt. s/cm3 for the Berchtold, Radionics, and Radiotherapeutics system, respectively. The occlusion of vessels, portal vein, and artery or portal vein alone increased the energy efficiency compared with physiological liver perfusion or occlusion of the artery (P = 0,003). CONCLUSIONS: Under physiological liver perfusion the open perfused system and the internally cooled system provided the best efficiency values with lowest standard deviations. The energy efficiency was increased markedly for all systems after occlusion of the portal vein either alone or in combination with arterial occlusion. Occlusion of the hepatic artery did not improve the efficiency.
Asunto(s)
Ablación por Catéter/instrumentación , Hígado/cirugía , Animales , Análisis de Falla de Equipo , Hígado/fisiología , Hígado/fisiopatología , Masculino , Modelos Animales , Porcinos , Resultado del TratamientoRESUMEN
Efficient engulfment of the intact cell corpse is a critical end point of apoptosis, required to prevent secondary necrosis and inflammation. The presentation of "eat-me" signals on the dying cell is an important part of this process of recognition and engulfment by professional phagocytes. Here, we present evidence that apoptotic cells secrete chemotactic factor(s) that stimulate the attraction of monocytic cells and primary macrophages. The activation of caspase-3 in the apoptotic cell was found to be required for the release of this chemotactic factor(s). The putative chemoattractant was identified as the phospholipid, lysophosphatidylcholine. Further analysis showed that lysophosphatidylcholine was released from apoptotic cells due to the caspase-3 mediated activation of the calcium-independent phospholipase A(2). These data suggest that in addition to eat-me signals, apoptotic cells display attraction signals to ensure the efficient removal of apoptotic cells and prevent postapoptotic necrosis.