Minimally Invasive Treatment of Chyle Leak After Thyroidectomy and Cervical Lymph Node Dissection in Patients with Thyroid Carcinoma: Results of a Study Involving 36 Patients.

Objective: Chyle leak (CL) after head and neck surgery is a rare but well-known complication. In patients with high-output leakage, the treatment can be complicated. This study aims to report on a recent innovation in lymphatic intervention for treating such patients. Materials and Methods: A retrospective review of 36 patients with chyle leak after neck surgery for thyroid cancer was conducted to assess the efficacy of percutaneous lymphatic embolization and thoracic duct (TD) disruption. Results: Antegrade catheterization of the thoracic duct was achieved in 31 of 36 patients (86.1%). Therefore, embolization of the thoracic duct and thoracic duct branches was performed in 26 and 5 patients, respectively. In 5 cases of unsuccessful antegrade catheterization into the thoracic duct, transcervical access embolization was performed in 2 patients, and TD disruption (TDD) was performed in 3 patients. The pooled overall technical success rate of lymphatic embolization was 33/36 patients (91.7%). One patient who underwent thoracic duct embolization (TDE) with technical success (1/33 patients) but clinical failure had additional treatment directly sclerosing the TD under computed tomography scan. Cervical fluid collection sclerotherapy was done in 7 patients as an additional treatment. Resolution of the chyle leak after procedures was observed in all patients (100%). The mean time to resolution was 3 days (1-7 days). There was no complication intra and after procedures. Conclusion: TDE, selective TD branches embolization and TDD are safe and effective minimally invasive treatments for CL post-surgery for thyroid carcinoma. Sclerosing cervical fluid collection contributes to clinical success.

A Rare Case of Kikuchi-Fujimoto Disease in a Young Female Patient.

BACKGROUND Kikuchi-Fujimoto disease (KFD) is a rare benign and usually local lymphadenopathy that typically occurs in young women. Patients with it usually have non-specific symptoms, such as fever in the afternoon, cervical lymphadenitis, and weight loss. Posterior cervical lymphadenopathy is the most common manifestation of KFD. The symptoms often last for a few weeks and then resolve spontaneously. The cause of KFD is unknown; however, it is considered to be related to some infectious agents, as well as several autoimmune diseases. Because of the non-specific symptoms and the rarity of KFD, the cervical lymphadenopathy associated with it can be misdiagnosed as coming from a more common condition. Making a correct diagnosis requires histology of the affected lymph nodes. CASE REPORT Here, we describe the case of a 25-year-old Vietnamese woman who presented with mild fever in the afternoons and enlarged cervical lymph nodes with no local sign of inflammation. She was initially believed to have tubercular lymphadenitis because of her symptoms and the high prevalence of tuberculosis in Vietnam. However, she had no respiratory symptoms and tested negative on QuantiFERON-TB Gold. Pathology from the patient's lymph node specimen showed an abnormal inflammatory reaction in the tissue. Her lesions were suspected to have been caused by KFD and she was treated successfully with nonsteroidal anti-inflammatory drug (NSAID) therapy. CONCLUSIONS KFD is a benign disease that manifests with common symptoms. The diagnosis is based on biopsy of a specimen and pathology results. No treatment is required in patients who have no symptoms. Patients with symptoms usually respond well to a short course of NSAID therapy.

Correlations between dynamic contrast-enhanced magnetic resonance imaging parameters and histopathologic factors in breast cancer.

BACKGROUND: This study aimed to correlate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters with prognostic factors in breast cancer. METHODS: A retrospective analysis was performed in 45 patients who had breast DCE-MRI and were diagnosed with invasive ductal breast cancer following surgery. The following DCE-MRI parameters were calculated: percentage of initial peak enhancement (Epeak), time to initial peak enhancement (TTP), initial slope increase (IS), early signal enhancement ratio (ESER), and time-signal intensity curve (TIC) types. Correlations between Epeak, TTP, IS, ESER, and prognostic factors were determined using the Mann-Whitney U test and the Kruskal-Wallis test. The Chi-square test and Fisher's exact test were used to investigate the relationship between kinetic curve types and prognostic factors. RESULTS: Epeak and IS were significantly higher in the Ki-67 high-expression group than in the Ki-67 low-expression group (p = 0.031 and p = 0.012, respectively). ESER was significantly correlated with the histological type and Ki-67 expression level (p = 0.014 and p = 0.047, respectively). The TIC types were significantly correlated with the Ki-67 expression level (p = 0.009). Tumors with plateaus and washout curves were more likely to be associated with the Ki-67 high-expression group than tumors with a persistent curve (P = 0.027 and P = 0.038, respectively). TTP had no correlation with any prognostic factors (P > 0.05). CONCLUSIONS: This study showed that the DCE-MRI parameters of breast cancer were correlated with the expression of histopathological prognostic factors and might be useful for predicting prognosis.

Primary hepatic neuroendocrine tumor.

SUMMARY: Primary hepatic neuroendocrine tumor (PHNET) is a rare type of neuroendocrine tumor (NET) that is also a primary hepatic tumor. Patients are present with almost no specific clinical symptoms and typically present with negative test results and atypical imaging characteristics; therefore, the differentiation of PHNET from other types of primary hepatic masses can be very difficult. In this article, we describe a case of PHNET that mimicked a liver helminth infection in a 57-year-old man. The diagnosis of PHNET in this patient was challenging, and the final diagnosis was based on imaging, histopathology features, and long-term follow-up. LEARNING POINTS: An uncommon type of neuroendocrine tumor (NET) is a primary hepatic neuroendocrine tumor (PHNET). Primary hepatic neuroendocrine tumors are rare NET lesions found in the liver, characterized by non-specific clinical and imaging results, which can be easily confused with other liver lesions, including HCC and parasitic lesions. To have a conclusive diagnosis and classification, a mixture of many medical assessment techniques, such as imaging, gastrointestinal endoscopy, nuclear medicine, anatomy, including histopathology, and immunohistochemistry, is essential.

Correlations between apparent diffusion coefficient values and histopathologic factors in breast cancer.

BACKGROUND: Breast cancer is the most common malignancy dia-gnosed in women, and the incidence gradually increases. Magnetic resonance imaging (MRI) is become widely used to identify benign and malignant breast tumors. Objective: The aim of this study was to evaluate the relationships between apparent diffusion coefficient (ADC) values and histopathologic prognostic factors in breast cancer. METHODS: Forty-nine breast carcinoma patients were included evaluated for prognostic factors, including histological type, histo-logical grade, estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), and molecular subtype. Minimum (ADCmin) and mean (ADCmean) ADC values were compared among prognostic factor groups by Mann-Whitney U test and Kruskal-Wallis test. RESULTS: Lower mean ADCmin and ADCmean values were observed for no special type (NST) than for invasive lobular carcinoma (ILC) type (0.81 ± 0.03 × 10-3 and 0.96 ± 0.03 × 10-3 mm2/s, P= 0.002 and 0.03, respectively). The mean ADCmin and ADCmean values for the high-level Ki-67 group were significantly lower than those for the low-level Ki-67 group (P = 0.001 and 0.008, respectively). No correlations were observed between ADC values and histological grades, ER, PR, HER2, and molecular subtypes. CONCLUSION: ADCmin and ADCmean values correlated with the pro-liferation marker Ki-67 and histological grade. ADC values can serve as noninvasive indicators of cell proliferation in breast cancer.

A Case of Renal Inflammatory Pseudotumor Leading to Nephrectomy.

Inflammatory pseudotumor (IPT) of the kidney is a rare benign disorder with unknown etiology. In IPT patients, some nonspecific symptoms might present, such as fever, hematuria, and back pain. As it can appear on computed tomography and magnetic resonance imaging as a hypovascular mass with surrounding fat stranding, IPT can be misdiagnosed as a primary tumor. Since the clinical symptoms, radiographic features, and preoperative findings can be inconsistent, it is imperative to confirm IPT based on histopathological assessment. In the present study, we describe a case of renal IPT in a 13-year-old girl. The patient was treated with nephrectomy of the right kidney since the preoperative diagnosis was renal carcinoma. Pathological examination revealed an IPT. This article emphasizes the importance of preoperative definitive diagnosis in avoiding unnecessary nephrectomy.

Congenital bronchobiliary fistula: a case report and literature review.

Congenital bronchobiliary fistula (CBBF) is a very rare malformation associated with clinical symptoms of dyspnoea, vomiting, cyanosis, persistent pneumonia, and poor response to antibiotics. Typical imaging techniques used to diagnose this malformation include bronchography, computed tomography (CT), cholangiography, hepatobiliary nuclear imaging, and magnetic resonance imaging (MRI). We diagnosed a case of CBBF that was initially diagnosed as non-resolving pneumonia. CT and fistulography were used to obtain the correct diagnosis. The fistula was confirmed by fistulography under the guidance of bronchoscopy. Surgical excision of the fistulous tract was performed, with complete recovery. The aim of this report was to emphasize the epidemiology and clinical features of CBBF patients.

Use of Mini-Percutaneous Nephrolithotomy Technique to Remove Extra-Peritoneal Foreign Bodies.

BACKGROUND Foreign bodies (FBs) in the intra- or extra-peritoneal cavity are relatively rare. The aim of treatment is to remove the FB to prevent chronic inflammation and/or infection. Traditionally, surgical management is necessary, as the detection and localization of FBs can be difficult. Mini-percutaneous nephrolithotomy (Mini-PCNL) under the guidance of ultrasonography (US-guided) has recently been used as an alternative to conventional therapeutic options for FB removal. CASE REPORT In this article, we report the cases of 2 patients with an extra-peritoneal wooden toothpick FB treated using the mini-percutaneous nephrolithotomy technique as an effective treatment for removing the FBs. These patients recovered quickly and were discharged uneventfully. CONCLUSIONS Using ultrasound to guide mini-PCNL represents a potential alternative to laparoscopic surgery for the detection and removal of FBs, allowing the patient to recover quickly. This approach is simple, minimally invasive, and feasible under local anesthesia and should be considered as an alternative to surgery.

Two rare cases of horseshoe lung with scimitar syndrome in Vietnam.

Horseshoe lung is a rare, congenital, pulmonary anomaly in which the caudal and basal segments of the left and right lungs are joined together. Most cases of horseshoe lung are associated with scimitar syndrome. Horseshoe lung can be diagnosed using pulmonary angiography, showing that the isthmus of the pulmonary parenchyma crosses the midline into the contralateral side. The isthmus parenchyma is typically supplied by the hypoplastic pulmonary artery. Clinical symptoms, therapeutic methods, and prognosis depend on the incidence of pulmonary hypertension, heart failure, recurrent pneumonia, and other combinations of congenital malformations. In this article, we describe two cases of horseshoe lung associated with scimitar syndrome and pulmonary malformation.

Enlarged accessory spleen after splenectomy mimicking a pancreas tumor.

INTRODUCTION: An accessory spleen (AS), a common condition, is usually located in the hilar region of the spleen. ASs are not often large; however, after splenectomy, the initially inactive AS may become reactive and hypertrophic. Therefore, an AS can be misdiagnosed as a neoplastic tumor and removed unnecessarily. An undiagnosed abdominal mass located in the spleen site in a patient who has had a splenectomy must be managed carefully. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) may provide useful information for the diagnosis, preventing unnecessary surgery. CASE PRESENTATION: Herein, we report the case of a 38-year-old female with an enlargement of AS after splenectomy that was misdiagnosed as a primary tumor of the pancreas and managed by a nonessential surgery. CONCLUSION: An AS should be added to the differential diagnosis of a pancreatic tail tumor for patients with prior splenectomy in order to avoid nonessential surgery to ensure the patient's safety.