Isolated sigmoid colon metastasis from a primary fallopian tube carcinoma: a case report.

Isolated metastasis of primary fallopian tube carcinoma (PFTC) is extremely rare. We describe a case of a 41-year-old asymptomatic woman who was referred three years after the initial treatment for PFTC due to elevated sertum CA-125 levels. The abdominal and pelvic CT scans revealed a pelvic mass near the top of the vaginal vault. On surgery, a sigmoid colon tumour was found and a sigmoidectomy was performed. On histopathology the tumour involved the bowel wall from serosa to submucosa, without involvement of the underlying mucosa. Immunohistochemical staining was positive for cytokeratin 7 and negative for cytokeratin 20, and the tumour was determined to be a metastatic müllerian neoplasm, consistent with the initial PFTC. Although this is the first reported case of colon metastasis of PFTC, the possibility of such an unusual site of metastasis should be kept in mind, as PFTC may recur as isolated bowel lesions even in the absence of peritoneal disease.

Fallopian tube cancer presenting as inflammatory breast carcinoma: report of a case and review of the literature.

Metastases of ovarian or fallopian tube carcinomas to the breast and axillary lymph nodes are quite uncommon and usually occur in advanced stages. These metastases may represent a pitfall for the pathologist, because they may mimic primary breast carcinoma. A 56-year-old woman was admitted to the hospital with a left-sided pelvic tumor, redness and swelling of the right breast and palpable right axillary nodes and left lower neck and supraclavicular lymphadenopathy. The imaging, surgical and pathologic findings were those of a papillary serous carcinoma of the fallopian tube with metastases to the breast, axillary and neck lymph nodes. It is important that metastasis to the breast be differentiated accurately from primary breast cancer, because prognosis and treatment differ significantly. Imaging, immunohistochemical analysis and pathology can help in making the correct diagnosis.

Recurrence of granulosa cell tumor 25 years after initial diagnosis. Report of a case and review of the literature.

Granulosa cell tumors (GCTs) are rare functional sex cord-stromal ovarian tumors constituting approximately 2-3% of all ovarian malignancies. They are characterized by low malignant potential, local spread, late recurrence and high survival rates. We report a case of recurrent ovarian GCT in a 60-year-old woman 25 years after the initial diagnosis. The patient underwent surgical resection of the pelvic masses and refused to receive any adjuvant treatment, considering the late recurrence and high survival rates of this tumor. This case illustrates an example of a very late recurrence and emphasizes the importance of the extended follow-up required for these patients.

Primary fallopian tube carcinoma associated with ovulation induction; a case report.

The potential relationship between ovulation induction and gynecological cancer has been raised recently. Primary fallopian tube carcinoma (PFTC) is an uncommon malignancy, not previously associated with fertility drugs use. We describe a case of a 38-year-old woman with primary infertility and a history of three ovulation inductions with gonadotropin-releasing hormone agonist and gonadotrophins, referred for treatment of bilateral ovarian cysts, which were discovered in the beginning of the last cycle. During laparotomy, bilateral adnexal masses were identified, presumed to be of ovarian origin, and total abdominal hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, and retroperitoneal lymph nodes sampling were performed. Histologic examination showed a primary right fallopian tube endometrioid adenocarcinoma and bilateral adnexal endometriosis. Surgery was followed by six cycles of combination chemotherapy using paclitaxel and carboplatin without significant complications. Although evidence of a direct causal link between ovarian stimulation and PFTC does not yet exist, this case highlights the importance for careful evaluation of all discovered adnexal masses in women undergoing ovulation induction treatment.

Very late thrombosis after implantation of sirolimus eluting stent.

Stent thrombosis after sirolimus eluting stent implantation has been reported to occur at six hours to 375 days after the procedure and usually within the two weeks after discontinuation of antiplatelet medication. A case is reported of very late stent thrombosis after 17 months of sirolimus eluting stent implantation and eight months after clopidogrel discontinuation despite aspirin continuation. This case underlines the possible need for long term antiplatelet medication among patients receiving sirolimus eluting stents.

Photodynamic therapy in normal pig stomach: protective effect of octreotide.

BACKGROUND AND STUDY AIMS: Many factors, such as oxygen and vasculature, are involved in the cytotoxic effect of photodynamic therapy (PDT). It is known that somatostatin and its analog octreotide decrease the splanchnic blood flow and have multiple inhibitory effects in different functions of the peptic system. The aim of this experimental study was to assess the effect of octreotide administration on PDT outcome in normal pig stomach. METHODS: 28 healthy pigs, randomly assigned to two groups, A and B, were studied. Pigs in both groups were sensitized with 0.3 mg/kg intravenous meta-tetra (hydroxyphenyl) chlorin (m-THPC), and 48 hours later light of wavelength 650 nm was delivered from a 50-mW diode laser for 300 s (energy fluence 15 J/cm (2)) through a gastroscope to the gastric mucosa. Group A underwent PDT without octreotide and group B had PDT with administration of octreotide. At 72 h after light delivery, all the animals were sacrificed for macroscopic and histological evaluation of the irradiated site. RESULTS: The macroscopic images and the histology of the stomach PDT lesions (inflammation, ulceration, necrosis) showed significantly less severity in the group of animals with octreotide injection (group B). In this group, full-thickness necrosis was observed in 28.5 %, compared with over 71.4 % in group A; this was statistically significant ( P < 0.05). CONCLUSION: Octreotide may have a modulating effect on m-TPHC PDT in normal gastric tissue in pigs, probably due to alterations of hemodynamics in the stomach and to suppression of the inflammatory process.

Cutting balloon angioplasty for treatment of calcified coronary lesions.

The aim of the study was to evaluate the feasibility, safety, and efficacy of cutting balloon angioplasty in treatment of angiographically moderate and severe calcified coronary lesions. Thirty-seven calcified coronary lesions (29 patients) detected by angiography were dilated with cutting balloon. Predilatation with plain balloon was performed in 27 (73.0%) lesions and stent was implanted in 23 (62.2%) lesions following cutting balloon. Acute gain following cutting balloon in predilated lesions was compared to the acute gain following plain balloon predilatation. For predilated lesions, acute gain after cutting balloon was significantly greater compared with plain balloon predilatation (1.51 +/- 0.49 vs. 0.77 +/- 0.42; P = 0.01). This result was achieved with larger size and lower pressure of cutting balloon compared with plain balloon (3.28 +/- 0.46 vs. 2.94 +/- 0.55, P = 0.01; 10.38 +/- 1.64 vs. 13.19 +/- 3.63, P = 0.001, respectively). The final gain following cutting balloon dilatation was significantly higher than the expected gain obtained by using a plain balloon of the same size (1.51 +/- 0.49 vs. 0.93 +/- 0.48; P < 0.0001), which was inflated at significantly higher pressure compared with cutting balloon. When we compared acute gain following cutting balloon in lesions with and without predilatation, we found no significant difference (P = 0.31). Angiographic success was achieved in 36 (97.3%) lesions and procedural success in 33 (89.1%) lesions. In-hospital major adverse cardiac event (MACE) occurred in three (10.3%) patients. Follow-up MACE was reported from three (10.3%) patients. In conclusion, cutting balloon angioplasty is feasible and safe in treatment of angiographically moderate and severe calcified lesions. Dilating efficiency of cutting balloon seems to be greater compared with a plain balloon of the same size, which was inflated at significantly higher pressure compared with cutting balloon. These results can be achieved with low in-hospital MACE and are associated with a good long-term outcome.

Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions.

OBJECTIVES: The purpose of this study was to evaluate the approach of intravascular ultrasound (IVUS)-guided percutaneous transluminal coronary angioplasty (PTCA) with spot stenting (SS) for the treatment of long coronary lesions. BACKGROUND: Treating long coronary lesions with balloon angioplasty results in suboptimal short- and long-term outcomes. Full lesion coverage with traditional stenting (TS) has been associated with a high restenosis rate. METHODS: We prospectively evaluated a consecutive series of 130 long lesions (>15 mm) in 101 patients treated with IVUS-guided PTCA and SS. The results were compared with those of TS in a matched group of patients. Coronary angioplasty was performed with a balloon to vessel ratio of 1:1, according to the IVUS media-to-media diameter of the vessel at the lesion site, to achieve prespecified IVUS criteria: lumen cross-sectional area (CSA) > or =5.5 mm(2) or > or =50% of the vessel CSA at the lesion site. The stents were implanted only in the vessel segment where the criteria were not met. RESULTS: In the SS group, stents were implanted in 67 of 130 lesions, and the mean stent length was shorter than that of lesions in the matched TS group (10.4 +/- 13 mm vs. 32.4 +/- 13 mm, p < 0.005). The 30-day major adverse cardiac event (MACE) rate was similar (5%) for both groups. Angiographic restenosis was 25% with IVUS-guided SS, as compared with 39% in the TS group (p < 0.05). Follow-up MACE and target lesion revascularization rates were lower in the SS group than in the TS group (22% vs. 38% [p < 0.05] and 19% vs. 34% [p < 0.05], respectively). CONCLUSIONS: Intravascular ultrasound-guided SS for the treatment of long coronary lesions is associated with good acute outcome. Angiographic restenosis and follow-up MACE rates were significantly lower than those with TS.

Directional atherectomy prior to stenting in bifurcation lesions: a matched comparison study with stenting alone.

The ideal catheter-based intervention for treatment of coronary lesions at bifurcation site still has to be defined. The aim of the study was to assess the acute and long-term outcome after treatment of bifurcation lesions with directional atherectomy (DCA) and stenting in comparison with stenting alone. Thirty-one consecutive patients treated for bifurcation coronary lesions (62 lesions) with DCA and stenting in at least one branch (DCA group) were compared with a matched group of 31 patients with bifurcation coronary lesions (62 lesions) treated with stenting alone in at least one branch (non-DCA group). Procedural success was 87.1% in the DCA group compared with 100% in the non-DCA group (P = 0.03). In-hospital major adverse cardiac events (MACE) occurred only in the DCA group (12.9% vs. 0%, P = 0.03), mainly non-Q-wave myocardial infarction. After the procedure, minimum lumen diameter (MLD) and acute gain were significantly greater (P = 0.004 and P = 0.05, respectively) and % diameter stenosis was significantly lower (P = 0.05) in the main branch in the DCA group. At follow-up angiogram, MLD in the main branch was still significantly greater in the DCA group compared to the non-DCA group (2.31 vs. 1.65, respectively, P = 0.04), with no significant difference in late loss and loss index between the two groups. Restenosis rate was 28.8% in the DCA group vs. 43.5% in the non-DCA group (P = 0.13). The incidence of follow-up MACE was 29% in the DCA group compared with 48.4% in the non-DCA group, mainly due to target lesion revascularization. In conclusion, treatment of bifurcation coronary lesions with DCA and stenting was associated with greater acute gain after the procedure and greater MLD at follow-up in the main branch compared with stenting alone. Procedural myocardial infarction was more frequent in the DCA group. Restenosis rates and follow-up MACE were lower following DCA and stenting, without reaching any statistical significance.

Cutting balloon angioplasty for the treatment of in-stent restenosis.

The results using the Cutting Balloon for the treatment of in-stent restenosis may be superior to those of conventional percutaneous transluminal coronary angioplasty (PTCA) or even the combination of PTCA preceded by rotational atherectomy. The reasons for these possible differences are not yet well defined. The case we report suggests that the Cutting Balloon achieves a better final result than conventional PTCA, by making the tissue more amenable to being pushed outward through the stent struts.

MR imaging of complex tail-gut cysts.

Retrorectal-cyst hamartomas (RCH) are rare developmental tail-gut cystic tumours of the retrorectal space, which occasionally undergo malignant transformation. We describe the magnetic resonance imaging (MRI) findings in two patients with RCH and in a third patient with unclassified sarcoma arising from a RCH. The RCH were hypointense or hyperintense on T1-weighted images and hyperintense on T2-weighted images; they did not enhance and they contained multiple septations. A solid component in the periphery of one cyst was markedly hypointense on T2-weighted images in keeping with fibrous material. The sarcoma arising from the wall of the RCH enhanced and was of intermediate signal intensity on all sequences. MR may help establish the diagnosis of RCH if an unenhanced cystic tumour is discovered in the retrorectal space and it can help detect those rare cases of malignant transformation of these developmental tumours.