When the metastatic tumor presents as a primary tumor: Gastric signet-ring cell carcinoma presenting as advanced cervical cancer with ovarian metastasis / Philippine Journal of Obstetrics and Gynecology

@#Ovarian cancer is the second most common malignancy of the lower part of the female genital tract. Primary signet‑ring cell carcinoma (SRCC) of the ovary is rare and is most commonly metastatic from a primary lesion. Discerning between primary and metastatic SRCC of the ovary or cervix may be difficult. SRCC of the cervix is also a rare type of cervical carcinoma, and just like in the ovary, it is usually metastatic from a primary gastric tumor. Presented here is a case of a 37‑year‑old nulligravid, who presented with an increase in abdominal girth with associated abdominal pain. The initial impression was ovarian new growth, probably malignant, and cervical mass, probably malignant. On laparotomy, intraoperative impression was cervical with ovarian malignant tumor, primary unknown versus double primary. Histopathology revealed metastatic adenocarcinoma, right ovary, cervical stroma, omentum, and umbilical mass with anterior abdominal mass. Peritoneal fluid was positive for malignant cells. Clinical correlation, further workup, and immunohistochemical stains for CK7, CK19, CK20, and CDX2 were recommended. All immunohistochemical results tested positive in tumor cells and were noted to be consistent with metastatic carcinoma of gastric versus pancreatic primary. Further workup was done, and the biopsy from the esophagogastroduodenoscopy revealed poorly differentiated adenocarcinoma with signet‑ring features, antral mucosa.

Management experience of brain metastasis after liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

Objective:To explore the pathogenesis and prognostic factors of brain metastasis of hepatocellular carcinoma(HCC)after liver transplantation(LT).Methods:Retrospective review was performed for 17 HCC cases with brain metastasis after liver transplantation from 2000 to 2020.All cases were diagnosed as hepatitis B cirrhosis complicated with HCC.All of them were beyond the Milan Criteria.The immunosuppressive regimen consisted of baliximab + mycophenolate mofetil + calcineurin inhibitors(CNIs)+ corticosteroids in early postoperative period with a gradual tapering of corticosteroids and mycophenolate mofetil.Three patients received sirolimus immunotherapy after tumor recurrence and withdrew CNIs.One of three cases received sorafenib.Results:Other organ involvements included lung metastasis( n=16, 94.1%), bone metastasis( n=5, 29.4%)and liver metastasis( n=6, 35.3%). The median survival time after brain metastasis was 7 months and the 1-year cumulative survival rate 29.4%.The median survival time post-LT was 14 months and the 1-year cumulative survival rate 64.7%.Among 7 patients with a resection of brain metastasis, two deaths at Month 1 post-operation were due to cerebral hemorrhage.The longest survival time was 214 months and the median survival time 9 months. Conclusions:The prognosis of brain metastasis post-LT remains poor.However, early detection and reasonable treatment can prolong patient survival time and even achieve long-term survival.Most brain metastases are accompanied by lung metastases.And the finding of lung metastatic tumor hints at a presence of intracranial lesions.

Efficacy of comprehensive anti-cancer treatment for lung metastasis after liver transplantation for hepatocellular carcinoma / 中华器官移植杂志

Objective:To evaluate the efficacy of comprehensive anti-cancer treatment for lung metastases after liver transplantation (LT) for hepatocellular carcinoma (HCC).Methods:From March 2012 to July 2016, A total of 36 patients with lung metastasis after LT were divided into comprehensive anti-cancer treatment group (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib, n=22) and maintenance supportive care group ( n=14). The survival profiles of two groups were evaluated. Results:No significant inter-group differences existed in preoperative basic data, tumor pathology, time of pulmonary metastatic tumor after operation and lung metastasis tumor burden.In comprehensive anti-cancer treatment group, there were partial remission ( n=3), disease stability ( n=12) and disease progression after treatment ( n=7). In maintenance supportive care group, there were disease stability ( n=3) and disease progression after treatment ( n=11). And comprehensive anti-cancer treatment was superior to maintenance supportive care ( χ2=7.901, P=0.019). The median survival time after metastasis was 23 months (95%CI: 19.68-26.32) in comprehensive anti-cancer treatment group and 7 months (95%CI: 3.33-10.67) in maintenance supportive care group; 1-year survival rate 91% and 9%, 2-year survival rate 45% and 0% and 3-year survival rate 10% and 0% respectively.The survival rate of comprehensive anti-cancer treatment group was significantly better than that of maintenance supportive care group ( P<0.001). Conclusions:Comprehensive anti-cancer treatment (rapamycin + radioactive I 125 seed implantation + pulmonary artery infusion chemotherapy + sorafenib) can improve the survival time of patients with lung metastasis after liver transplantation for HCC.

Efficacy and dosimetric analysis of CT-guided 125I seed implantation assisted by 3D-printed coplanar template in the treatment of metastatic tumors of chest wall / 中华放射医学与防护杂志

Objective:To investigate the technical method and clinical efficacy of CT-guided radioactive 125I seed implantation (RISI) assisted by 3D-printed coplanar template(3D-PCT) in the treatment of metastatic tumors of chest wall, and analyze the influence of dosimetric parameters on the treatment efficacy. Methods:A retrospective analysis was conducted for 55 patients with metastatic tumors of chest wall treated with 3D-PCT-assisted 125I radioactive seed implantation in Tengzhou Central People′s Hospital from January 2014 to March 2021.Preoperative plans were made using a brachytherapy treatment planning system, and dosimetric parameters were assessed at 3d after surgery. During regular CT reexaminations after surgery, the local control rate and overall survival (OS) rate were calculated and the pain relief degree and complications were assessed. The Logrank test and Cox regression were used for univariate and multivariate analyses of local control time (LCT). Meanwhile, receiver operating characteristic (ROC) curves were plotted to analyze the critical values of dosimetric parameters and to predict the LCT. Results:The 1-, 2-, and 3-year OS rates ofthe 55 patients were 72.7% (40/55), 21.8% (12/55), and 16.4% (9/55), respectively.The local control rates of 3, 6, 12, and 24 months were 96.4%(53/55), 86.5%(45/52), 85.0%(34/40), and 91.7%(11/12), respectively. There was no statistically significant difference between postoperative and postoperative dosimetric parameters of GTV, particle number, D90, D100, V100, V150, V200, CI, EI, and HI ( P> 0.05). Compared with postoperative V90, the postoperative V90 decreased with a statistically significant difference( P=0.006). As indicated by the univariate Cox regression analysis, the pathological grade, D90, D100, V90, and V200had significant effects on the LCT( P<0.05). Among them, the pathological grade and D90 were independent influencing factors of the LCT, while the other factors showed no statistically significant difference according to the multivariate Cox regression analysis.The LCT of patients with D90≥127 Gy was significantly longer than that of patients with D90<127 Gy (χ 2=16.61, P=0.000). The pain relief rate was 80.8%(21/26) after three months. Five cases suffered from grade Ⅰ-Ⅱ radioactive dermatitis and one case experienced grade Ⅲ radioactive dermatitis. Conclusions:The 3D-PCT-assisted CT-guided 125I radioactive seed implementation can achieve precise and controllable dose and definite efficacy in the treatment of metastatic tumors of chest wall, with few complications.The LCT was remarkably prolonged in the case of D90≥127 Gy, and D90 is an independent influencing factor of the LCT.

Atypical MSCT pleomorphic signs in metastatic adenocarcinoma and squamous cell carcinoma of the lung / 国际肿瘤学杂志

Objective:To investigate the correlations between multi-slice spiral CT (MSCT) atypical pleomorphic signs and pathological findings of lung metastases.Methods:From January 2012 to July 2019, the MSCT chest imaging data of 168 metastatic tumor of lung from the General Hospital of Central Theater Command of the Chinese People′s Liberation Army and Shaanxi Provincial Tumor Hospital were collected. According to the pathological type, they were divided into metastatic adenocarcinoma group ( n=88) and metastatic squamous cell carcinoma group ( n=80). The atypical imaging signs of MSCT of the two groups were observed and recorded, and classified after labeling one by one. The difference of atypical MSCT imaging features between the two groups was compared, and the correlations between lesion size and atypical imaging features of MSCT in the metastatic adenocarcinoma group and metastatic squamous cell carcinoma group were analyzed. Results:The spicule sign in metastatic adenocarcinoma and metastatic squamous cell carcinoma were 61 (69.32%) and 28 (35.00%), with a statistically significant difference ( χ2=19.811, P<0.001). The pleural depression sign in the two groups were 48 (54.55%) and 16 (20.00%), and there was a statistically significant difference ( χ2=21.206, P<0.001). The vacuole/cavity sign in the two groups were 10 (11.36%) and 61 (76.25%), and there was a statistically significant difference ( χ2=72.303, P<0.001). The air bronchial sign in the two groups were 43 (48.86%) and 13 (16.25%), with a statistically significant difference ( χ2=20.057, P<0.001). The halo sign/ground glass shadow in the two groups were 58 (65.91%) and 37 (46.25%), with a statistically significant difference ( χ2=6.591, P=0.010). The results of the Spearman rank correlation analysis indicated a positive correlation between the size of metastatic adenocarcinoma and spicule sign, pleural depression sign ( r=0.270, P=0.011; r=0.226, P=0.035). There was no correlation between the nodule size and atypical MSCT imaging features in metastatic squamous cell carcinoma (all P>0.05). Conclusion:The atypical MSCT of metastatic lung adenocarcinoma are mostly spicule sign, pleural depression sign, air bronchial sign and halo sign/ground glass shadow. The characteristic atypical imaging of metastatic squamous cell carcinoma is vacuole/cavity sign. The spicule sign and pleural depression sign are related to the size of metastatic lung adenocarcinoma nodules.

CT diagnosis of isolated pulmonary nodules in patients with a history of malignant tumor / 中华胸心血管外科杂志

Objective To analyze the CT features of solitary pulmonary nodules(SPN) in patients with malignant tumor with the aim of improving its diagnosis and differential diagnosis in this special background .Methods From May 2014 to De-cember 2018, the CT data of 76 pathologically confirmed SPNs in patients with malignant tumor were retrospectively analyzed . The CT features of SPNs, including density, morphology and change of peripheral lung field and adjacent structures, were mainly analyzed.The characteristics of different types of nodules and their differences were summarized .Results Among the 76 SPNs, there were 41(53.9％) primary lung cancers, 14(18.5％) metastatic tumors, and 21(27.6％) benign lesions(in-cluding 12 inflammatory nodules, 7 tuberculous nodules and 2 benign tumors).Of all nodules, there were 57(75％) solid nodules, including 23(40.4％) primary lung cancers which mainly manifested as nodules with rough margin , close to adjacent vessel and bronchus and usually had internal or edge features(19, 82.6％), 14(24.6％) metastatic tumors which mainly showed as round or oval, homogeneous density, smooth margin nodules(12, 85.7％), and 18(31.6％) inflammatory nodules which mainly showed as lesions with rough and blurred margin accompanied by peripheral patch or fibrosis (14, 77.8％). There were 19(25％) sub-solid nodules, including 18(94.7％) primary lung cancers, which mainly manifested as nodules with heterogeneous density and clear border(14, 77.8％).There was only 1(5.3％) sub-solid inflammatory nodule.Conclu-sion The pathological nature of SPNs in patients with malignant tumors is various .Understanding their CT characteristics is helpful for diagnosing and differentiating and providing useful information for further treatment .

Value of MRI histogram analysis in differential diagnosis of brain high-grade glioblastomas,primary lymphoma and metastatic tumor / 实用放射学杂志

Objective To investigate the feasibility of histogram analysis in differentiating brain high-grade glioblastomas,primary lymphoma from metastatic tumor.Methods 26 cases of brain high-grade glioblastomas,22 cases of primary lymphoma and 18 cases of metastatic tumor confirmed by postoperative pathological were analyzed retrospectively.Delineation of ROI and extraction of texture parameters were performing by using Mazda software.The histogram parameters,including Mean,Variance,Skewness,Kurtosis,Perc0.1%,Perc10%,Perc50%, Perc90% and Perc99% were analyzed statistically,and the ROC was then established.Results Mean,Perc0.1%,Perc10%and Perc50% exhibited statistically significant differences (P＜0.05).The best diagnostic parameters for differentiation between brain high-grade glioblastomas and primary lymphoma,primary lymphoma and metastatic tumor,and brain high-grade glioblastomas and metastatic tumor were Perc0.1%,Perc0.1%and Kurtosis.The AUC for these preferred diagnostic parameters were 0.937,0.879 and 0.7 1 8,respectively,with optimal thresholds of 50,70 and －0.43,sensitivity and specificity of 90.9% and 88.5%,77.3% and 88.9%,and 61.5% and 77.8%.Conclusion The histogram analysis of MRI images contributes to differentiate quantitatively between brain high-grade glioblastomas,primary lymphoma and metastatic tumor.

Cáncer metastásico con primario desconocido. Una revisión / A review of metastatic cancer with unknown primary cancer

Resumen El tumor metastásico no siempre tiene un origen evidente, hasta en un tercio de los casos nunca se encuentra el tumor primario. Este artículo es una guía de los avances más recientes para mejorar el enfoque diagnóstico y el manejo del paciente con este tumor fatal y frecuente. El objetivo de este artículo, además de ser una guía, es ayudar a evitar errores comunes y graves. Uno de los errores más importantes es no tener en cuenta el papel fundamental de la confirmación histológica, pues esta puede evitar investigaciones innecesarias. En el artículo también se detallan los componentes de la evaluación estándar, la clasificación según su pronóstico y las indicaciones de la evaluación secundaria, que incluye las indicaciones de la endoscopia alta y baja, los marcadores tumorales, la tomografía por emisión de positrones (TEP), el papel que ocupa el perfil genético, la epigenética y el ácido desoxirribonucleico (ADN) viral. Adicionalmente, se indica el momento en que se debe detener la investigación. Recientemente, el tratamiento se ha modificado, lo que parece cambiar la historia de estos pacientes y de sus contrapartes con primario conocido.

Abstract Metastatic tumors do not always have obvious origins: in one third of these cases, the primary tumor is never found. This article is a guide to the most recent advances in diagnostic approaches and patient management of these fatal and frequent tumors. An additional objective of this article is to help avoid common and serious errors. One of the most important errors is not taking the fundamental role of histological confirmation into account since it can avoid unnecessary investigations. The article also details the components of a standard evaluation, classification according to prognosis and indications for a secondary evaluation. These include indications for upper and lower endoscopy, tumor markers, positron emission tomography, and the roles of genetic profiling, epigenetics and viral DNA. It also indicates the moment at which an investigation should be stopped. Recently, treatment has changed, and these changes seems to have changed the history of these patients and their counterparts with known primary tumors.

Application of cMRI and MRS in diagnosis and differential diagnosis of single brain metastases and localized high grade gliomas / 实用放射学杂志

Objective To explore the value of cMRI and MRS in diagnosis and differential diagnosis of single brain metastases and localized high grade gliomas.Methods The cMRI (T1WI,T2WI and contrast-enhanced MRI)and MRS data of 23 cases with single brain metastases and in 28 cases with high grade gliomas confirmed by pathology were collected and analyzed retrospectively.Results cMRI:①There were no significant differences of T1WI,T2WI and constrast-enhanced MRI between single brain metastases and high-grade gliomas.②Enhanced images of single brain metastases and localized high-grade gliomas showed that there was a significant difference in the peritumoral edema area:the nodular or ring enhancement were found in single brain metastases,the outer outline of ring enhancement was smooth,and there was no enhancement at the peripheral edema area;Irregular patchy or ring enhancement were found in localized high-grade glioma tumor,both of the outer and inner edges of the ring enhancement rough,a little patchy enhancement at the peripheral edema area were found in 1 6 patients,and there was no enhancement of the edema area in the other 1 2 patients.MRS:①There were no significant differences of the tumor parenchyma in the peaks of NAA,Cr,Cho and central Lac between single brain metastases and localized high grade gliomas.②A significant difference of the peripheral edema area were observed between them.The peaks of NAA,Cr,Cho at the edema area in all single brain metastases patients were normal.But in all high-grade glioma patients,the NAA and Cr peaks were decreased,while the Cho peaks were increased.Conclusion The morphological manifestations of single brain metastases are similar to localized high grade gliomas.An obvious difference of cMRI and MRS lines exists in the peritumoral edema area between them,which could be used for differential diagnosis.

CT guided coplanar template assisted in the treatment of metastatic or recurrent chest wall malignant tumor with 125I seed implantation / 中华放射医学与防护杂志

Objective To evaluate the dosimetry accuracy and clinical efficacy of 125I radioactive seed implantation using coplanar template (CPT) in the treatment of metastatic or recurrent chest wall tumor.Methods Thirty-one patients with metastasis or recurrence of chest wall tumor,who had been diagnosed with pathology between July 2005 and July 2015,were retrospectively studied.All patients underwent CPT-assisted 125I radioactive seed implantation.Brachytherapy radiation treatment planning system (BTPS) was used to make preoperative plans,and the prescribed dose (PD) was 110 Gy.CPT was used to assist CT guided 125I radioactive seeds implantation.Dose evaluation was performed immediately after implantation.The difference of dose parameters was compared between preoperation and postoperation,including Dg0,D100,V90,V100 and the numbers of seeds.Postoperative chest CT was conducted regularly to assess the treatment efficacy based on the response evaluation criteria in solid tumors (RECIST Version 1.1).The patients were followed up till July 2016.Results All patients went through implantation procedure successfully and there was no significant statistical difference between preoperative and postoperative dose parameters (P ＞ 0.05).The conformal index (CI) was 0.951 ± 0.13,external index(EI) was 6.5％ ±0.9％.Six months after implantation,CR,PR,SD and PD were 25.8％ (8/31),51.6％ (16/31),6.5％ (2/31) and 16.1％ (5/31),respectively.The effective rate was 77.4％,and local control rate was 83.9％ (26/31).Skin pigmentation occurred in 13 patients during the follow-up period,without any special treatment.Conclusions The auxiliary of CPT in the treatment of metastatic or recurrent chest wall tumor under the guiding of CT could achieve quality control,safety and effectiveness.

Study of the uniformity between MRI and 18F-FDG PET/CT in detection of spinal metastatic tumor / 实用放射学杂志

Objective To compare the uniformity between spine MRI and 18F-FDG PET/CT in detection of spinal metastatic tumor, and to analyze the reasons for the discrepancy between them.Methods Data of 42 malignant tumor patients underwent spine MRI and 18F-FDG PET/CT were analyzed retrospectively.And the two tests were underwent within 30 days.The author censused and analyzed the number of centrums with metastatic tumor detected by spine MRI and 18F-FDG PET/CT,and supposed that 18F-FDG PET/CT was gold standard,to evaluate the sensitivity and specificity of spine MRI.The inconsistent between two tests was analysed.Results The study included 509 centrums of 42 patients.123 positive centrums (24.2%) were detected on spine MRI,and 114 positive centrums (22.4%) on 18F-FDG PET/CT(P=0.22>0.05).The uniformity between two tests was good (Kappa=0.76).Supposing that 18F-FDG PET/CT was gold standard,the sensitivity,specificity,positive predictive value, negative predictive value,false negative rate and false positive rate of spine MRI was 85.1%(97/114),93.4%(369/395),85.1%(97/114),93.4% (369/395),14.9%(17/114) and 6.6%(26/395) respectively.43 centrums of 14 patients were diagnosed inconsistently by spine MRI and 18F-FDG PET/CT.The main reasons for the inconformity were as following: types of primary tumors, insensitivity of spine MRI for diffuse scattered spinal metastatic tumors, the existence of misdiagnosis on spine MRI, misdiagnosis of spine MRI for metastatic lesions located in the vertebral appendix and paramedian vertebral body,misdiagnosis of 18F-FDG PET/CT for metastatic lesions located in the sacral centrum, existence of false positive on 18F-FDG PET/CT and so on.Conclusion The uniformity between spine MRI and 18F-FDG PET/CT is good.The inconformity still existes in some cases.Carefully comparative analysis of them contributes to find metastatic lesions.

An analysis of breast metastasis from renal clear cell carcinoma:report of three cases / 天津医药

Metastasis of renal cell carcinoma to mammary gland is rare clinically. Based on the retrospective analysis of 3 cases of metastatic clear cell renal cell carcinoma of the breast identified pathologically from January 2010 to June 2017 in Tianjin Medical University Cancer Institute and Hospital, we discussed the clinical manifestation, pathological characteristics, diagnosis, treatment and prognosis of metastatic breast cancer of renal cell carcinoma.

Clinical application of CT-guided 125I radioactive seed implantation in treating cervical lymph node metastasis / 介入放射学杂志

Objective To discuss the method, therapeutic effect and safety of CT-guided 125I radioactive seed implantation for the treatment of cervical lymph node metastasis. Methods CT-guided 125I radioactive seed implantation was performed in 32 patients with pathologically proved cervical lymph node metastasis Results The local effective control rates of the cervical lymph node metastasis at one, 3, 6 and 12 months after the treatment were 81.3%(26/32), 84.4%(27/32), 93.7%(30/32) and 87.5%(28/32) respectively. Conclusion For the treatment of cervical lymph node metastasis, CT-guided 125I radioactive seed implantation is technically simple and clinically safe with reliable curative effect; this treatment is very effective in improving local tumor control rate.

Unusual Presentation of a Metastatic Tumor to the Temporal Bone: Severe Otalgia and Facial Paralysis

Metastatic temporal bone tumors are rare diseases and they are usually clinically asymptomatic, so it is difficult to diagnose them. Breasts are the most common sites of temporal bone metastasis. Tumors of lung, kidney, gastrointestinal tract, prostate gland, larynx and thyroid gland are the other sites. The pathogenesis of the temporal bone is most commonly related to the hematogenous route. We present the case of a 78-year-old man with facial paralysis combined with severe otalgia. This patient was initially diagnosed with Bell's palsy. However, based on the radiologic findings, the patient was diagnosed with lung cancer with temporal bone metastasis.

Development and application of neural stem cells for treating various human neurological diseases in animal models / 한국실험동물학회지

Stem cells derived from adult tissues or the inner cell mass (ICM) of embryos in the mammalian blastocyst (BL) stage are capable of self-renewal and have remarkable potential for undergoing lineage-specific differentiation under in vitro culturing conditions. In particular, neural stem cells (NSCs) that self-renew and differentiate into major cell types of the brain exist in the developing and adult central nervous system (CNS). The exact function and distribution of NSCs has been assessed, and they represent an interesting population that includes astrocytes, oligodendrocytes, and neurons. Many researchers have demonstrated functional recovery in animal models of various neurological diseases such as stroke, Parkinson's disease (PD), brain tumors, and metastatic tumors. The safety and efficacy of stem cell-based therapies (SCTs) are also being evaluated in humans. The therapeutic efficacy of NSCs has been shown in the brain disorder-induced animal models, and animal models may be well established to perform the test before clinical stage. Taken together, data from the literature have indicated that therapeutic NSCs may be useful for selectively treating diverse types of human brain diseases without incurring adverse effects.

Research progress on the clinical classification and treatment of metastatic Spinal Tumors / 中国肿瘤临床

The clinical classification of metastatic spinal tumors is based on the degree of malignancy, nervous system function, osteoclasia, and prognosis of patients. The application of this classification system is relatively simple. The assessment and evaluation of patients to estimate the period of survival can guide the individualized treatment of patients. Patients with clear surgical indications can choose to undergo a palliative operation, tumor resection, or total spondylectomy. Alternatively, other patients can opt to have mini-mally invasive surgery aside from the normal surgical approach. Stereotactic radiotherapy and intensity-modulated radiation therapy combined with the use of radiofrequency ablation, radiation, and other therapies can achieve local tumor control, relieve pain, and main-tain normal neurological function. Thus, the quality of life of the patient is improved. Percutaneous vertebroplasty, radiofrequency abla-tion, spinal endoscopy, and other modern forms of minimally invasive surgery will have more applications in the treatment of spinal metastatic tumors.

Diagnosis of diffusion-weighted imaging in cervical lymph nodes lesions / 中国医师进修杂志

Objective To investigate the diagnosis of diffusion-weighted imaging (DWI) in cervical lymph nodes lesions.Methods Twenty patients with metastatic lymph node,10 patients with tuberculosis lymph node and 10 volunteers were underwent both conventional MRI and DWI,and the ADC values of lymph nodes' solid components were measured.The difference of ADC values between three kinds of lymph nodes were analyzed.Results ADC values of metastatic lymph nodes was (0.842 ± 0.156) × 10-3 mm2/s,ADC values of tuberculosis lymph nodes was (1.249 ± 0.142) × 10-3 mm2/s,and ADC values of normal lymph nodes was (1.291 ± 0.176) × 10-3 mm2/s.There was significant difference between ADC values of metastatic lymph nodes and with the two later kinds of lymph nodes (P＜ 0.01),and no difference in the two later kinds of lymph nodes (P ＞ 0.05).Conclusion ADC values with features of conventional MR is helpful for differentiate metastatic lymph node,tuberculosis lymph node and normal lymph nodes.

A Case of Recurrent Metastatic Malignant Fibrous Histiocytoma in the Right Atrium Which Was Protruding into the Pericardial Space / 日本心臓血管外科学会雑誌

We report a rare case of a protruding tumor from the right atrial free wall into the cardiac sac. A cardiac tumor was incidentally detected in the right atrium of a 64-year-old man by transthoracic echocardiography. The tumor was located in the right atrial anterior free wall, infiltrating the right artrial appendage near the tricuspid valve annulus. It had an irregular surface, did not have a tumor stalk, and was considerably mobile. We resected the tumor and performed cryosurgical ablation of the remnant tissue to reduce the risk of local recurrence. Histopathologic examination confirmed the tumor to be metastatic malignant fibrous histiocytoma (MFH). The postoperative course was uneventful, and the patient was discharged 11 days after surgery. Follow-up computed tomographic scans and transthoracic echocardiography did not reveal any evidence of local cardiac recurrence or distant metastasis.

Spinal Epidural Cavernous Hemangioma Resembling a Metastatic Tumor in an 89-year-old Man: A Case Report

Cavernous hemangioma is a vascular malformation that can be encountered in any organ of the body; however, purely epidural cavernous hemangioma is a rare entity with a benign nature. The authors report a case of thoracic epidural cavernous hemangioma in an 89-year-old man with radiologic findings resembling those of a metastatic spinal tumor. Initially, the patient refused surgery because of his age and presumed malignancy. However, due to the progression of bilateral leg weakness, he later underwent total mass removal and decompression without neurological deficit. Intraoperative findings and a postoperative biopsy revealed cavernous hemangioma. Because initial radiological findings may suggest a malignant nature for several benign pathologies, the authors recommend that, unless malignancy is proven, aggressive tissue biopsy and treatment should be considered, even in elderly patients.

A Case of Modified Photodynamic Therapy in the Management of Choroidal Metastasis of Breast Cancer

PURPOSE: To report a case of choroidal metastasis of breast cancer that was treated with modified photodynamic therapy. CASE SUMMARY: A 45-year-old woman visited our clinic with blurred vision of the right eye, which began 1 month before. The patient previously suffered from a low back pain for 1 year. The best corrected visual acuity was 20/20 in both eyes. Fundus examination revealed an elevated yellowish mass-like lesion at the superonasal area in the right eye. Ultrasonography of the right eye showed a highly echogenic choroidal mass with moderate to high internal reflectivity. Fluorescein angiography showed hypofluorescence during the prearterial and arteriovenous phase, and well circumscribed hyperfluorescence during the venous phase. Radiologic examination was performed upon suspicion of metastasis. The examination revealed breast cancer with lung, spine and ovary metastasis. Subsequently, biopsy of the breast mass revealed an invasive ductal carcinoma. Based on these results, the patient was diagnosed with choroidal metastasis from breast carcinoma. The patient received systemic chemotherapy, and modified photodynamic therapy (PDT) was performed on the metastatic choroidal mass. Six days after modified PDT, the mass size was unchanged, and serous retinal detachment developed at the macula and inferior retina. However, 22days after treatment, the mass size markedly decreased and the serous retinal detachment was improved.