Liver metastasis 13 years after the resection of a malignant triton tumor originating in the duodenum

Primary hepatic malignant triton tumor mimicking hepatocellular carcinoma by demonstrating arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging: a case report and literature review

Background

Malignant Triton tumor (MTT) is a relatively rare subtype of malignant peripheral nerve sheath tumor (MPNST) characterized by rhabdomyosarcoma differentiation. There are no distinct features of MTT, and it is easy to misdiagnose preoperatively.

Case presentation

Here, we describe a rare case of primary hepatic MTT in a 56-year-old male who presented with nonspecific abdominal pain for 1 day. Magnetic resonance imaging and abdominal computed tomography revealed an extremely large mass located in the right liver with intratumoral hemorrhage, arterial-phase hypervascularity and subsequent washout on dynamic contrast-enhanced imaging and the possibility of intrahepatic metastasis. Tumor marker levels revealed only an elevated level of alpha-fetoprotein (AFP: 5304.0 ng/mL). Then, he received transcatheter arterial chemoembolization combined with lenvatinib and pembrolizumab, and he was diagnosed with hepatocellular carcinoma. After 3 months of neoadjuvant therapy, we resected the hepatic cancer and adherent diaphragmatic pleura. MTT was confirmed by postoperative pathology and immunohistochemistry.

Conclusion

Despite the preoperative diagnosis of hepatocellular carcinoma with a rising serum AFP level, typical CT and MRI findings, histopathology assessment showing MPNST with rhabdomyosarcoma differentiation confirms the diagnosis of primary hepatic MTT.

Malignant triton tumor of uterus: A case report and literature review

Malignant triton tumor (MTT) is a highly aggressive malignant neoplasm, classified as a variant of malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. There are few reports that MTT occurred in urogenital system. In the present study, we report the first MTT occurring in the uterus. A 57-year-old woman came to the emergency department due to persistent vaginal bleeding for 2 months. The gynecological palpation found that a club-shaped excrescence existed in the vagina about 7 cm × 3 cm × 3 cm. The mass located in the lower segment of the uterus and the cervix was confirmed by gynecological vaginal ultrasound and magnetic resonance imaging, which was preliminarily diagnosed as cervical carcinoma. After neoplasm punch biopsy, the pathological diagnosis was malignant triton tumor. The patient finally lost follow-up. This is the first report about MTT in the uterus and suggests that pathological biopsy combined with imaging examination is necessary for the diagnosis of rarely MTT.

Impact of CT and MRI in the diagnostic workup of malignant triton tumour-a monocentric analysis and review of the literature

OBJECTIVES

Malignant triton tumours (MTTs) are rare but aggressive subtypes of malignant peripheral nerve sheath tumours (MPNSTs) with a high recurrence rate and 5-year survival of 14%. Systematic imaging data on MTTs are scarce and mainly based on single case reports. Therefore, we aimed to identify typical CT and MRI features to improve early diagnosis rates of this uncommon entity.

METHODS

A systematic review on literature published until December 2022 on imaging characteristics of MTTs was performed. Based on that, we conducted a retrospective, monocentric analysis of patients with histopathologically proven MTTs from our department. Explorative data analysis was performed.

RESULTS

Initially, 29 studies on 34 patients (31.42 ± 22.6 years, 12 female) were evaluated: Literature described primary MTTs as huge, lobulated tumours (108 ± 99.3 mm) with central necrosis (56% [19/34]), low T1w (81% [17/21]), high T2w signal (90% [19/21]) and inhomogeneous enhancement on MRI (54% [7/13]). Analysis of 16 patients (48.9 ± 13.8 years; 9 female) from our institution revealed comparable results: primary MTTs showed large, lobulated masses (118 mm ± 64.9) with necrotic areas (92% [11/12]). MRI revealed low T1w (100% [7/7]), high T2w signal (100% [7/7]) and inhomogeneous enhancement (86% [6/7]). Local recurrences and soft-tissue metastases mimicked these features, while nonsoft-tissue metastases appeared unspecific.

CONCLUSIONS

MTTs show characteristic features on CT and MRI. However, these do not allow a reliable differentiation between MTTs and other MPNSTs based on imaging alone. Therefore, additional histopathological analysis is required.

ADVANCES IN KNOWLEDGE

This largest published systematic analysis on MTT imaging revealed typical but unspecific imaging features that do not allow a reliable, imaging-based differentiation between MTTs and other MPNSTs. Hence, additional histopathological analysis remains essential.

Highly sensitive detection of CYFRA21-1 with a SERS sensing platform based on the MBs enrichment strategy and antibody-DNA-mediated CHA amplification

Laryngeal carcinoma (LC) is the second most common malignant tumor of the head and neck. Due to its insidious nature, most patients have developed to the middle and late stages by the time they are diagnosed, missing the best treatment period. Thus, early detection, diagnosis and treatment are crucial to improve the prognosis of LC and enhance the quality of life of patients. In this study, a surface-enhanced Raman (SERS) sensing platform was developed by combining the magnetic beads (MBs) enrichment strategy and the antibody-DNA-mediated catalytic hairpin self-assembly (CHA) signal amplification technology. 4-Mercaptobenzoic acid (4-MBA) and hairpin DNA 1 (hpDNA1) were modified onto the surface of gold nanobipyramids (GNBPs) as SERS nanotags. Hairpin DNA 2 (hpDNA2) modified MBs were used as capture nanoprobes. Under the action of CHA and magnet-induced MBs enrichment, GNBPs can be assembled on the surface of MBs, forming high-density "hot spots" for the SERS signal enhancement. The results showed that the SERS sensing platform has the advantages of high sensitivity, high specificity and high reproducibility, with the limit of detection (LOD) low to pg/mL level. The expression level of CYFRA21-1 in serum of LC patients and healthy controls was successfully detected by the SERS sensing platform. The accuracy of the SERS results was verified by enzyme linked immunosorbent assay (ELISA). Therefore, this SERS sensor can be used for the detection of CYFRA21-1 in serum, providing a simple and reliable new method for the early diagnosis of LC.