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Balodis A, Ņeverčika V, Zavertjajeva M, Mikijanskis R, Kalnina M, Breikša-Vaivode A, Briede I. Giant Myxopapillary Ependymoma with Multi-Site Neural Axis Metastases: A Rare Case with Suboptimal Outcome. Am J Case Rep 2024; 25:e942392. [PMID: 38291726 PMCID: PMC10846752 DOI: 10.12659/ajcr.942392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/22/2023] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Myxopapillary ependymoma is a rare type of slow-growing tumor that mainly occurs in the spinal cord, particularly in the region of the conus medullaris and the cauda equina. It originates from the ependymal glial cells found in the filum terminale. CASE REPORT We present a clinical case of a 44-year-old male patient who presented with symptoms of non-specific pain in the lower back persisting for the past 2 years. He did not report any specific neurological deficits or radicular symptoms. Unenhanced MRI of the lumbar spine showed a giant intradural, extramedullary, heterogenous, expansive tumor at the level L1-S4 with erosion of the sacral bone and invasion of presacral tissue. Based on its characteristic localization and growth pattern, suspicion arose for myxopapillary ependymoma. Biopsy confirmed the initial diagnosis. Partial resection of the tumor with laminectomy and laminoplasty was deemed necessary. Preoperative neural axis MRI showed contrast-enhancing lesions in the cerebellum and the cervical and thoracic spine; therefore, adjuvant radiation therapy was administered. Following the surgery, the patient experienced intermittent episodes of neurological deficits and required physiotherapy. Control MRI a year after the operation showed tumor growth and more metastases along the neural axis. CONCLUSIONS Complete surgical excision of the tumor is the preferred treatment approach, but there is a risk of recurrence even after total excision, so radiotherapy is recommended to minimize the risk of recurrence. Prior to surgery, it is essential to conduct MRI/PET/CT of the head and spine to assess the possibility of metastases.
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Affiliation(s)
- Arturs Balodis
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, Riga Stradiņš University, Riga, Latvia
| | | | - Marija Zavertjajeva
- Institute of Diagnostic Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Radiology, University of Latvia, Riga, Latvia
| | - Raimonds Mikijanskis
- Department of Neurosurgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | | | | | - Inese Briede
- Department of Pathology, Riga Stradiņš University Hospital, Riga, Latvia
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Jevdokimov D, Tauvena E, Jevdokimova N, Vilisova S, Kriviča O, Briede I, Tone T, Staka A, Gerina-Berzina A, Ozolins A, Pukitis A. Neuroendocrine Carcinoma of the Extrahepatic Bile Ducts: A Case Report. Am J Case Rep 2023; 24:e939239. [PMID: 37340629 DOI: 10.12659/ajcr.939239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
BACKGROUND Neuroendocrine tumors (NETs) primarily originating from the extrahepatic biliary (EB) tree are a medical rarity, accounting for less than 100 recorded instances globally. This case report outlines an encounter with this uncommon condition, demonstrating the complexities of diagnosis and management. CASE REPORT A 42-year-old woman presented at our Emergency Department with a 3-week history of itching and symptoms of obstructive jaundice. Initial laboratory tests showed hyperbilirubinemia and elevated liver transaminases. Abdominal ultrasonography indicated choledocholithiasis. Magnetic resonance imaging suggested either Mirizzi syndrome or a proximal common bile duct neoplasm. Abdominal computed tomography showed cholestasis, suggesting choledocholithiasis or cholangiocarcinoma (type-1). An endoscopic retrograde cholangiopancreatography with biliary and pancreatic duct stenting was performed for drainage, with brush cytology confirming adenocarcinoma. The patient was referred for surgical resection of the bile duct tumor, involving extrahepatic bile duct resection, en bloc cholecystectomy, lymphadenectomy, Roux-en-Y anastomosis, and biliary drainage. Histopathology identified a neuroendocrine carcinoma. Following surgery, the patient underwent eight cycles of FOLFOX6 chemotherapy, with no disease relapse post-treatment. CONCLUSIONS This case emphasizes multidisciplinary teamwork importance in managing rare diseases like EB bile duct NETs. These tumors' rarity and symptom ambiguity necessitate histological examination for accurate diagnosis. This report aims to guide healthcare professionals facing similar future cases.
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Affiliation(s)
- Denis Jevdokimov
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Elina Tauvena
- Department of Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Natalija Jevdokimova
- Department of Internal Medicine, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Sofija Vilisova
- Department of Oncology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Olga Kriviča
- Department of Radiology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Inese Briede
- Department of Pathology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Pathology, Riga Stradiņš University, Riga, Latvia
| | - Tatjana Tone
- Department of Pathology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Pathology, Riga Stradiņš University, Riga, Latvia
| | - Aiga Staka
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Aija Gerina-Berzina
- Department of Oncology, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
| | - Arturs Ozolins
- Department of Surgery, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
- Department of Surgery, Riga Stradiņš University, Riga, Latvia
| | - Aldis Pukitis
- Center of Gastroenterology, Hepatology and Nutrition, Pauls Stradiņš Clinical University Hospital, Riga, Latvia
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Veinberga L, Meidrops K, Rumba R, Gedins M, Anufrijevs D, Vilmanis J, Drizlionoka K, Zellans E, Krustina I, Berzins J, Briede I, Sivins A, Radzina M, Stradins P, Ozolins A. Surgical Treatment of Hepatocellular Carcinoma with a Tumor Thrombus Invading the Right Atrium: A Case Report. Case Rep Oncol 2023; 16:422-430. [PMID: 37384203 PMCID: PMC10294241 DOI: 10.1159/000529831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 02/15/2023] [Indexed: 06/30/2023] Open
Abstract
Up to 3% of all hepatocellular carcinomas (HCCs) present with a tumor thrombus (TT) in the inferior vena cava (IVC) and right atrium (RA). Extensive growth of HCC into the IVC and the RA is associated with a particularly poor prognosis. This clinical condition is related to a high risk of sudden death due to pulmonary embolism or acute heart failure. Therefore, a technically challenging treatment undergoing hepatectomy and cavo-atrial thrombectomy is necessary. We report a 61-year-old man presenting with right subcostal pain, progressive weakness, and periodic shortness of breath for 3 months. He was diagnosed with advanced HCC with a TT extending from the right hepatic vein into the IVC and RA. A multidisciplinary meeting with cardiovascular and hepatobiliary surgeons, oncologists, cardiologists, anesthesiologists, and radiologists was held to determine the best treatment approach. Initially, the patient underwent right hemihepatectomy. As follows, the cardiovascular stage using cardiopulmonary bypass was successfully performed, removing the TT from the RA and ICV. In the early postoperative period, the patient remained stable and was discharged on the 8th postoperative day. A morphological examination revealed grade 2/3 HCC, a clear cell variant with microvascular and macrovascular invasion. Immunohistochemical staining was positive for HEP-1, CD10, whereas negative for S100. The morphological and immunohistochemical results corresponded to HCC. The treatment of such patients requires the cooperation of various specialties. Although the approach of the surgery is extremely complex including specific technical support, as well as high perioperative risks, the result offers favorable clinical outcomes.
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Affiliation(s)
- Laura Veinberga
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Surgery, Riga Stradins University, Riga, Latvia
| | - Kristians Meidrops
- Department of Surgery, Riga Stradins University, Riga, Latvia
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Roberts Rumba
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Marcis Gedins
- Department of Vascular Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Deniss Anufrijevs
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Surgery, Riga Stradins University, Riga, Latvia
| | - Janis Vilmanis
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Surgery, Riga Stradins University, Riga, Latvia
| | - Karina Drizlionoka
- Department of Cardiac Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Edgars Zellans
- Department of Cardiac Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Inguna Krustina
- Department of Cardiac Anaesthesia and Intensive Care, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Juris Berzins
- Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Inese Briede
- Department of Pathology, Riga Stradins University, Riga, Latvia
- Pathology Institute, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Armands Sivins
- Clinic of Surgical Oncology, Riga East Clinical University Hospital, Riga, Latvia
| | - Maija Radzina
- Diagnostic Radiology Institute, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Radiology Research Laboratory, Riga Stradins University, Riga, Latvia
| | - Peteris Stradins
- Department of Surgery, Riga Stradins University, Riga, Latvia
- Centre of Cardiac Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Arturs Ozolins
- Department of Surgery, Pauls Stradins Clinical University Hospital, Riga, Latvia
- Department of Surgery, Riga Stradins University, Riga, Latvia
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Briede I, Strumfa I, Vanags A, Gardovskis J. The Association Between Inflammation, Epithelial Mesenchymal Transition and Stemness in Colorectal Carcinoma. J Inflamm Res 2020; 13:15-34. [PMID: 32021376 PMCID: PMC6955597 DOI: 10.2147/jir.s224441] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background Inflammation plays an important albeit dual role in carcinogenesis. Survival studies have highlighted the prognostic significance of peritumorous inflammation. Currently, the theoretical background allows inflammation, epithelial mesenchymal transition (EMT) and the closely associated stem cell differentiation in colorectal carcinoma (CRC) to be linked. However, there is scarce direct morphological evidence. Purpose and methods The aim of our study was to investigate the role of inflammation in cancer growth and invasion by analyzing the association between inflammation and known morphological prognostic features of colorectal cancer, EMT, stemness and mismatch repair (MMR) protein expression. The study was designed as a retrospective morphological and immunohistochemical assessment of 553 consecutive cases of surgically treated primary CRC. Results There were statistically significant associations between high-grade inflammation and lower pT (p = 0.002), absence of lymph node metastases (p < 0.001) and less frequent lymphatic (p = 0.003), venous (p = 0.017), arterial (p = 0.012), perineural (p = 0.001) and intraneural (p = 0.01) invasion. In contrast, Crohn's like reaction (CLR) by density of lymphoid follicles in the invasive front lacked significant differences in regard to pT, pN, tumor invasion into surrounding structures (blood or lymphatic vessels, nerves), grade or necrosis (all p > 0.05). The expression of E-cadherin, CD44 and MMR proteins yielded no statistically significant associations with peritumorous inflammation by Klintrup-Mäkinen score or the density of lymphoid follicles. Nevertheless, E-cadherin levels were significantly associated with the density of eosinophils (p = 0.007). Conclusion High-grade peritumorous inflammation is associated with beneficial morphologic CRC features, including less frequent manifestations of invasion, and is not secondary to tissue damage and necrosis. CLR is not associated with cancer spread by pTN; this finding indirectly suggests an independent role of CLR in carcinogenesis. Further, inflammation by Klintrup-Mäkinen grade and CLR is not dependent on epithelial-mesenchymal transition and stem cell differentiation. Our study highlights the complex associations between inflammation, tumor morphology, EMT, stemness and MMR protein expression in human CRC tissues.
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Affiliation(s)
- Inese Briede
- Department of Pathology, Riga Stradins University, Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, Riga, Latvia
| | - Andrejs Vanags
- Department of Surgery, Riga Stradins University, Riga, Latvia
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Ferreira M, Robalo M, Saraiva T, Cunha M, Goncalves L, Albuquerque A, Ramos D, Costa G, Lima J, Pego M, Peovska I, Davceva Pavlovska J, Pop Gorceva D, Zdravkovska M, Vavlukis M, Kostova N, Bulugahapitiya DS, Feben A, Avison M, Foley J, Martin J, De Graaf MA, Van Den Hoogen I, Leen A, Kharagjitsingh A, Kroft L, Jukema J, Bax J, Scholte A, Patel K, Mahan M, Ananthasubramaniam K, Durmus Altun G, Alpay M, Altun A, Andreini D, Pontone G, Mushtaq S, Bertella E, Conte E, Segurini C, Volpato V, Petulla M, Baggiano A, Pepi M, Van Dijk J, Huizing E, Jager P, Slump C, Ottervanger J, Van Dalen J, Yambao E, Calleja H, Sibulo A, Ramirez Moreno A, Siles Rubio J, Noureddine M, Munoz-Bellido J, Bravo R, Martinez F, Valle A, Milan A, Inigo-Garcia L, Velasco T, Ramaiah VL, Devanbu JS, Taywade SK, Hejjaji VS, Zafrir N, Bental T, Gutstein A, Solodky A, Mats I, Kornowski R, Lagan J, Hasleton J, Meah M, Mcshane J, Trent R, Massalha S, Israel O, Koskosi A, Kopelovich M, Marai I, Venuraju S, Jeevarethinam A, Dumo A, Ruano S, Darko D, Cohen M, Nair D, Rosenthal M, Rakhit R, Lahiri A, Pizzi MN, Roque A, Fernandez-Hidalgo N, Cuellar-Calabria H, Gonzalez-Alujas M, Oristrell G, Rodriguez-Palomares J, Tornos P, Aguade-Bruix S, Smettei O, Abazid R, Ahmed WMK, Samy W, Behairy N, Tayeh O, Hassan A, Berezin A, Kremzer A, Samura T, Berezina T, Scrima G, Bertuccio G, Canseco Nadia N, Cruz Raul C, Gonzalez Cristian G, Hernandez Salvador S, Alexanderson Erick E, Zerahn B, Shugushev Z, Maximkin D, Chepurnoy A, Volkova O, Tsedenova A, Faibushevich A, Baranovich V, Yoshida H, Mizukami A, Matsumura A, Keller M, Silber S, Falcao A, Imada R, Azouri L, Giorgi M, Santos R, Mello S, Kalil Filho R, Meneghetti J, Chalela W, Kanni L, Ohrman T, Nygren AT, Irabi R, Falcao A, Imada R, Azouri L, Parisotto T, Soares J, Kalil Filho R, Meneghetti J, Chalela W, Burrell S, Burrell S, Lo C, Zavadovskyi K, Gulya M, Lishmanov Y, Amin A, Kandeel A, Shaban M, Nawito Z, Caobelli F, Soffientini A, Thackeray J, Bengel F, Pizzocaro C, Guerra U, Hellberg S, Silvola J, Kiugel M, Liljenback H, Savisto N, Thiele A, Laine V, Knuuti J, Roivainen A, Saraste A, Ismail B, Hadizad T, Dekemp R, Beanlands R, Dasilva JN, Hyafil F, Sorbets E, Duchatelle V, Rouzet F, Le Guludec D, Feldman L, Martire V, De Pierris C, Martire M, Pis Diez E, Ramaiah V, Devanbu JS, Hejjaji VS, Lebasnier A, Legallois D, Peyronnet D, Desmonts C, Zalcman G, Bienvenu B, Agostini D, Manrique A, Solomyanyy V, Mintale I, Zabunova M, Narbute I, Ratniece M, Jakobsons E, Kaire K, Kamzola G, Briede I, Jegere S, Erglis A, Mostafa S, Abdelkader M, Abdelkader H, Abdelkhlek S, Khairy E, Huidu S, Popescu A, Lacau S, Huidu A, Dimulescu D, Abazid R, Smettei O, Sayed S, Al Harby F, Habeeb A, Saqqah H, Merganiab S, Selvanayagam J, Harms H, Tolbod L, Hansson N, Kero T, Orndahl L, Kim W, Bouchelouche K, Wiggers H, Frokiaer J, Sorensen J, Hansson N, Tolbod L, Harms H, Wiggers H, Kim W, Hansen E, Zaremba T, Frokiaer J, Sorensen J, Harms H, Tolbod L, Hansson N, Kero T, Orndahl L, Kim W, Bouchelouche K, Wiggers H, Frokiaer J, Sorensen J. Poster Session 3: Tuesday 5 May 2015, 08:30-12:30 * Room: Poster Area. Eur Heart J Cardiovasc Imaging 2015. [DOI: 10.1093/ehjci/jev054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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