ABSTRACT
Thrombus in transit (TIT) is a rare but potentially fatal condition. Transthoracic echocardiography is the diagnostic modality of choice. The major complications of TIT are pulmonary embolism, right ventricular dysfunction, obstructive shock, and paradoxical embolism through patent foramen ovale. We hereby present a case series of four patients with TIT and the challenges faced while managing them
ABSTRACT
Objective:To explore the feasibility and safety of robot-assisted retrohepatic inferior vena cava(IVC) tumor thrombectomy for renal tumor patients with a single position.Methods:The clinical data of 6 renal tumor patients with retrohepatic IVC thrombus (5 males and 1 female, mean age of 58 years) who underwent robot-assisted retrohepatic IVC tumor thrombectomy with a single position in First Affiliated Hospital of Zhengzhou University from December 2015 to August 2020 were retrospectively reviewed. Four cases had the renal tumor on the right side and two on the left side. The mean tumor size was 9.6 cm(range 7-13 cm). There were 4 cases of Mayo level Ⅱ and 2 cases of level Ⅲ IVC thrombus with the mean IVC thrombus length of 6.5 cm(range 5-8cm). The "IVC-first, kidney-last" robotic technique was developed to minimize chances of IVC thrombus embolization for retrohepatic IVC thrombus, and a "artery-first, vein-second" robotic operative strategy were developed to minimize chances of intraoperative hemorrhage. The whole procedure (the suprahepatic infradiaphramatic IVC, first porta hepatis and left renal vein control, caval exclusion, tumor thrombectomy, IVC repair, radical nephrectomy) was performed exclusively robotically with a single position.Results:All 6 robotic procedures were successful, without open conversion or mortality. The mean operative time was 210 min(130-320 min), estimated blood loss was 800 ml(300-2 100 ml) and three patients (5%) received intraoperative blood transfusion. The mean time of occlusion of IVC was 21 min (15-43min). Incomplete blocking occurred in two cases(one IVC, one first porta hepatis), and tumor thrombectomy were completed with intraoperative loss. IVC invasion was confirmed intraoperatively in one patient and we staple-transected the IVC without reconstruction. Six patients were all transferred to the intensive care unit for median of 2.1 days (1-4 days) after surgery. The mean time of postoperative drainage was 5 days (4-9 days). Renal dysfunction occurred in 3 patients and liver dysfunction occurred in 2 patients, and all recovered after medical therapy. Postoperative pathological diagnosis revealed 5 cases of clear cell carcinoma and 1 case of renal sarcoma, and the 5 cases received targeted therapy. With a median follow-up of 27 months (3-54 months), 3 patients were alive, 1 alive with tumor recurrence, and 2 died of cancer.Conclusions:Robot-assisted laparoscopic retrohepatic IVC thrombectomy with a single position have the advantage of simple procedure, shorter operative time, less trauma and quicker recovery, and it is a feasible and effective method for renal tumor patients with retrohepatic IVC thrombus.
ABSTRACT
@#Objective To observe the expression of Twist in esophageal squamous cell carcinoma (ESCC) and analyze the relationship between positive expression of Twist and disease-free survival, and to provide clinical evidence for reducing tumor recurrence, prolonging disease-free survival and improving prognosis. Methods Retrospective analysis of 70 ESCC patients receiving thoracic surgery from June 2010 to June 2012 in the Department of Thoracic Surgery, Sichuan Cancer Hospital was done, including 39 males and 31 females with an average age of 63.6 years. The expression of Twist in normal esophageal tissue, tumor tissue and vascular tumor emboli was observed by immunohistochemical staining of paraffin specimens. Results The positive rate of Twist in normal esophageal tissues was 42.9%, and in tumor tissue was 77.1% (P<0.05). The positive expression rate of Twist in tumor cells was 74.3% in patients with vascular tumor emboli and 80.0% in patients without vascular tumor emboli (P>0.05). The positive expression rate of Twist in tumor cells and in vascular tumor emboli was 74.3% and 71.4%, respectively (P>0.05). The expression of Twist in lymphatic vessels and blood vessels of patients with vascular tumor emboli was 56.0% and 72.0%, respectively (P>0.05). Conclusion Twist expression in esophageal cancer tissues is significantly higher than that in normal tissues, but there is no significant difference in the positive expression of Twist between tumor cells and the mean disease-free survival (P>0.05). At present, Twist expression can not be used as a prognostic indicator of esophageal cancer, and more researches need be further implemented.
ABSTRACT
Objective@#To investigate the grading system for lymph vessel tumor emboli and its prognostic value in patients with invasive carcinomas of no special type (ICNST) of the breast.@*Methods@#Clinical data of 466patients with ICNST were collected from January 2006 to December 2008 in the Fourth Hospital of Hebei Medical University. The expression levels of D2-40, estrogen receptor(ER), progesterone receptor(PR) and human epidermal growth factor receptor 2 (HER-2) were analyzed using immunohistochemical staining. Grades for lymph vessel tumoremboli were classified based on the number of mitotic and apoptotic figures in tumor cells under a high-power field. Correlation analysis was performed using Spearman rank correlation test. Kaplan-meier curves and Log-rank tests were used to analyze the survival rate. Multivariate Cox proportional hazard model was used to analyze the prognostic factors.@*Results@#Among the 466 patients, grades for lymph vessel tumor emboli were categorized as follows: 280 cases were grade 0 (60.1%); 112 cases were grade 1 (24.0%); 58 cases were grade 2 (12.5%); 16 cases were grade 3 (3.4%). Correlation analyses showed that lymph vessel tumor emboli grading system was positively correlated with lymph node metastasis (r=0.365, P<0.001). Kaplan-Meier univariant analysis showed that histological grading, lymph vessel tumor emboli grading system, lymph node metastasis, the expression levels of ER, PR and HER-2 and molecular typing were associated with prognosis of patients (P<0.05 for all). Multivariate analysis of Cox proportional hazard model showed that lymph vessel tumor emboli grading system and lymph node metastasis were independent prognostic factors in patients with ICNST(P<0.05 for all).@*Conclusion@#Grading system for lymph vessel tumor emboli canpredict the clinical outcome of patients with ICNST.
ABSTRACT
BACKGROUND: Angiogenesis, which is essential for tumor growth, is known to occur in the extravascular stroma. However, vascular structures were noted in intravascular tumor emboli in surgical specimens. This prompted our investigation of the frequency and morphology of angiogenesis in tumor emboli. METHODS: Hematoxylin-eosin stained specimens were reviewed for tumor emboli, in 21 cases of stomach adenocarcinoma and 22 cases of colon adenocarcinoma. The cases were examined with immunohistochemistry using antibodies against epithelial antigen (cytokeratin), endothelial antigens (CD31, CD34), lymphatic endothelial antigen (D2-40), and proliferation-associated antigen (MIB1). RESULTS: Endothelial cells were observed in 16 tumor emboli among four (19.1%) of the 21 cases of stomach adenocarcinoma and in 32 tumor emboli among four (18.2%) of the 22 cases of colon adenocarcinoma. The endothelial cells in the tumor emboli showed papillary ingrowth from the vessel wall, formation of vascular lumens, scattered distribution, or surface coating of the emboli. Some of the endothelial cells in the tumor emboli were D2-40-positive, and some were MIB1- positive. CONCLUSIONS: These findings demonstrated that angiogenesis occurs in intravascular tumor emboli as well as in the extravascular stroma. Angiogenesis in the tumor emboli may reflect an active process and may facilitate tumor growth.
Subject(s)
Adenocarcinoma , Antibodies , Colon , Endothelial Cells , Immunohistochemistry , StomachABSTRACT
Objective To analyze the clinical effects of 131I-HAb18F(ab')2 radioimmunotherapy via hepatic artery on PLC with portal vein tumor emboli. Methods Under the condition of thyroid protection and negative dermal sensitivity test, 12 times of intraarterial injection with 131I labeled murine HCC monoclonal antibody fragment HAb18F(ab')2 were performed in 8 patients of PLC complicated with portal vein tumor emboli. A 0.75 mCi/kg dose of 131I was administrated individually into certain target vessel after hepatic artery angiography using Seldinger technique. Results 3 of 7 patients with symptoms of pains showed remission with simultaneous improvement and stabilization in Karnofsky score in 3 and 4 patients respectively. AFP levels decreased about 50%(3/6)in 3 cases among those 6 positives and the values of I.B. and ALT changed within a very narrow range to a certain extent after the treatment. The overall rate of CR + PR was 28.6% and similar better result was obtained in a non-symptomatic diffuse PLC patient.1 year survival rate was 12.5%. Conclusion 131I-HAb18F(ab')2 radioimmunotreating drug(0.75 mCi/kg)with hypotoxicity to liver-function can be used as an acceptable method for unresectable PLC with portal vein tumor emboli, especially for those without tumor emboli in the main trunk.
ABSTRACT
The most causes of an icteric hepatoma are a late stage hepatocellular carcinoma or intrahepatic cholangiocarcinoma. A hepatocellular carcinoma, causing an obstrucution of the bile duct, rarely results in jaundice. With a late stage hepatocellular carcinoma, the accurate diagnosis and treatment may be difficult. Herein, we report a case of a hepatocellular carcinoma and obstructive jaundice, due to hilar tumor emboli, with a review of the literature.
Subject(s)
Bile Ducts , Carcinoma, Hepatocellular , Cholangiocarcinoma , Diagnosis , Jaundice , Jaundice, ObstructiveABSTRACT
The number of Kupffer cells was evaluated in hepatocellular carcinomas, including 18 primary lesions, 3 tumor emboli within the portal vein radicles and 4 metastatic lesions and in non-neoplastic liver adjacent to the primary lesions, to persue the origin of Kupffer cells dwelling in hepatocellular carcinoma. Hepatocellular carcinomas of the sinusoidal(trabecular) type were carefully selected, and excluded were those carcinomas which showed inflammation or other changes evoking inflammation. The immunohistochemical stains for CD 68 and lysozyme were done to identify Kupffer cells and to draw the mean Kupffer cell number per high power microscopic field of each lesion. Kupffer cell was most numerous in primary lesions followed by tumor emboli and still fewer in metastatic lesions. The Kupffer cell number in the primary lesions of hepatocellular carcinoma was in turn smaller than that of the adjacent non-neoplastic liver. The results suggest that, during the early neoplastic transformation, sinusoids of the non-neoplastic liver could creep into the carcinomatous tissue accompanying Kupffer cells.