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Introduction: Schwannomas (Schs) are benign tumor masses that rarely occur intra-abdominally and rarely reach larger diameters. When present, they occur as rare solitary nerve sheath tumors of peri-neural Schwann cells. Schwannoma mostly affects the nerves of the extremities, trunk, or the head and neck region. They are more common in female patients, mostly among patients between the third and fifth decade. They occur spontaneously but could also be found in association with a group of genetic autosomal dominant disorders called type 2. When present intra-abdominally, schwannomas grow slowly without significant clinical signs and symptoms. Clinical importance is presented in cases of occupying intra-abdominal space and impingement of surrounding structures, which causes intermittent pain. Only 0.5–5% of all retroperitoneal tumors are schwannomas and their malignant transformation is very rare. Case report: The authors present a case of a large intra-abdominal schwannoma in a 70-year-old female patient. She underwent CT scanning due to refractory left-sided subcostal pain, which revealed a large tumor mass in the left-sided hemiabdomen. Preoperative cytologic biopsy confirmed Sch. The patient underwent an MRI scan upon admission to our department, which revealed the origin of the tumor at the left-sided L3 level and intra-abdominal tumor spreading with the largest diameter of 25 cm. The patient underwent multidisciplinary surgical excision, confirmed by MRI scan in a period of five months postoperatively. Conclusions: Its rare presentation leads to the necessity to adequately evaluate such patients, especially to avoid any hidden diagnosis which might lead to further complications. The goal of a multidisciplinary approach should be emphasized as maintaining a good postsurgical condition without neurological deficits. [ABSTRACT FROM AUTHOR]

One-third of cancer pain patients do not experience adequate pain relief using analgesic ladder by the World Health Organization. Interventional procedures, such as epidural morphine, have been considered. This study aimed to review the literature comparing the effects of epidural administration of morphine with the oral route. This systematic review included randomized controlled trials (RCTs) conducted with patients with gastrointestinal neoplasm. A search was conducted on PubMed, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL databases to identify studies published up to May 2023. The retrieved study was evaluated using the Risk of Bias 2 (RoB 2) tool and qualitatively synthesized. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach (Prospero: CRD42021264728). Only one RCT, a crossover trial, was included in this systematic review. The study was conducted with ten participants (one withdrawal) and reported a statistically significant difference between both subcutaneous and epidural morphine solutions and oral morphine. The adverse events were not described. The included study presents some concerns of bias and low certainty of evidence on the effectiveness and security of epidural morphine administration. The available literature does not suffice to elucidate whether morphine administration via the epidural route is more effective than other routes. Further RCTs are necessary to improve the level of evidence on the effectiveness and risk-benefit of epidural morphine in the management of cancer pain in gastrointestinal neoplasm patients. [ABSTRACT FROM AUTHOR]

Background. Teratomas are neoplasms that arise from pluripotent germ cells, derived from two or more layers of germ cells. They are classified as mature tumors (cystic or solid), which contain well-differentiated tissues, or as immature tumors, which contain immature and embryonic structures. Its most frequent location is the female and male gonads; the mesenteric location is rare and approximately 40 cases have been described in the world literature. Within the diagnostic and therapeutic approach, computed tomography and magnetic resonance imaging are used to characterize the lesion, assess intra-abdominal extension and the relationship with other structures. The diagnosis must be confirmed by histopathological examination. Clinical case. A 56-year-old female patient with a history of infiltrating ductal carcinoma of the left breast in remission. In follow-up studies, incidental abdominal tomography finding of an abdominopelvic lesion dependent on the mesentery at the level of the mesogastrium, smooth contours with fat-liquid level. Extension studies with negative tumor markers. Results: Due to high clinical and imaging suspicion of teratoma, the patient was taken to resection of the lesion. Histopathological examination confirmed the diagnosis of mature cystic teratoma of the mesentery. Conclusion: Mesenteric teratoma is a rare clinical entity and is considered one of the differential diagnoses of an abdominal mass with a compressive effect. Diagnosis is mainly based on clinical examination and imaging findings. Early surgical excision is the mainstay of treatment; laparoscopic or open approach depends on the clinical characteristics and the experience of the surgeon. [ABSTRACT FROM AUTHOR]

BackgroundThis study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.MethodsThis was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection.ResultsThis study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P

Introduction: Schwannomas (Schs) are benign tumor masses that rarely occur intra-abdominally and rarely reach larger diameters. When present, they occur as rare solitary nerve sheath tumors of peri-neural Schwann cells. Schwannoma mostly affects the nerves of the extremities, trunk, or the head and neck region. They are more common in female patients, mostly among patients between the third and fifth decade. They occur spontaneously but could also be found in association with a group of genetic autosomal dominant disorders called type 2. When present intra-abdominally, schwannomas grow slowly without significant clinical signs and symptoms. Clinical importance is presented in cases of occupying intra-abdominal space and impingement of surrounding structures, which causes intermittent pain. Only 0.5–5% of all retroperitoneal tumors are schwannomas and their malignant transformation is very rare. Case report: The authors present a case of a large intra-abdominal schwannoma in a 70-year-old female patient. She underwent CT scanning due to refractory left-sided subcostal pain, which revealed a large tumor mass in the left-sided hemiabdomen. Preoperative cytologic biopsy confirmed Sch. The patient underwent an MRI scan upon admission to our department, which revealed the origin of the tumor at the left-sided L3 level and intra-abdominal tumor spreading with the largest diameter of 25 cm. The patient underwent multidisciplinary surgical excision, confirmed by MRI scan in a period of five months postoperatively. Conclusions: Its rare presentation leads to the necessity to adequately evaluate such patients, especially to avoid any hidden diagnosis which might lead to further complications. The goal of a multidisciplinary approach should be emphasized as maintaining a good postsurgical condition without neurological deficits.

Adult intussusception presents a diagnostic challenge given its non-specific symptoms. It is not as common as in infants and young children. Traditionally, diagnostic steps are invariably fit for normal adults, but not in pregnancy which faces certain limitations. A 40-year-old pregnant mother, gravida 9 para 8 at 34-week gestation, complained of intermittent epigastric pain for 2 days, requiring hospitalization. She soon developed minimal per rectal bleeding that was ruled out as hemorrhoid. Imaging was limited due to her pregnancy status. She later developed spontaneous delivery to a premature baby. Computed tomography (CT) revealed an ileocolic intussusception, which was confirmed via exploratory laparotomy. Histology was consistent with inflammatory fibroid polyp. Acute abdomen in pregnancy can be due to various causes, thus a high index of suspicion and early CT abdomen might help in early diagnosis and treatment. The benefit of doing CT on the mother and the risk of CT on the fetus is to be weighed as the timely diagnosis can prevent bowel ischemia and reduce maternal morbidity and mortality. Surgery remains the definite management in adult intussusception and an exact diagnosis can be made during the operation.

Desmoid-type fibromatosis (DF) is a locally aggressive myofibroblastic tumor accounting for approximately 0.03% of all neoplasms and less than 3% of all soft tissue tumors.1 The estimated incidence in the general population is 2 to 4 cases per million per year. In the past, this lesion was considered as an aberrant healing response against local trauma, irritation, or inflammation; however, later a clonal proliferation of the spindle cell was confirmed, and local recurrence as well as distant metastasis was identified.2 DF affects 10%-20% of patients with familial adenomatous polyposis. Sporadic DF predominantly affects young adults, especially women, and it is often related to pregnancy.3 Although it may occur in nearly every body part, it usually involves the extremities and trunk, including the abdominal wall and intra-abdomen. Intra-abdominal desmoid tumors are mainly located within the mesentery or pelvis.4 A bulky desmoid tumor located in the pelvis or lower abdominal wall near the uterus may be preoperatively suspected as a large subserosal uterine leiomyoma. Genetic alterations in theAPCandCTNNB1genes are thought to be vital events resulting in hereditary and sporadic DF. Sporadic DF is associated with a high incidence (85%) of mutations in theCTNNB1gene, which may lead to uninhibited activation of the Wnt pathway and the accumulation of excessive cytoplasmic β-catenin, ultimately resulting in tumor development.5 The early diagnosis of DF is challenging. The findings of computed tomography (CT) and magnetic resonance imaging (MRI) can guide the decisions regarding patient management, but the ultrasound features of DF are non-specific. The relationship between the tumor and the adjacent structures should be carefully evaluated to decide the feasibility of surgery.6 Complete surgical resection is usually the standard treatment in patients with resectable desmoid tumors. However, the local recurrence rate is still high after resection alone due to its infiltrative pattern and positive margins after surgical resection.7 Radiotherapy is another treatment modality for desmoid tumors, but its efficiency is controversial. Recently published meta-analysis and the review suggested the benefit of postoperative radiotherapy over surgery alone in long-term cure and prevention of recurrence.8 Low-dose chemotherapy or systemic therapy (such as hormonal therapy, non-steroidal anti-inflammatory therapy, or targeted therapy) in patients with advanced unresectable tumors or recurrent disease after surgery and/ or radiotherapy is also used.9 A 24-year-old lady presented with gradually progressive pain in the whole abdomen for six months. She had a prior history of lower uterine cesarean section done 3 years back and a history of missed abortion 4 years back. On per-abdominal examination, a 10x8 cm large mass was palpated mainly in the right lower abdomen, with side-to-side mobility. The speculum examination showed a smooth cervix. Per-vaginal examination revealed a large mass felt through the right fornix. Abdominal computed tomography showed bilateral normal ovaries and a large heterogeneous mass measuring 11x9 cm close to the uterus. A possibility of pedunculated subserosal leiomyoma was considered. Given progressive clinical symptoms, laparotomy was performed. On per-operative examination, a large mass was identified as closely adhered to the mesentery of the right colon. The uterus and bilateral adnexa were free of tumor. The tumor was excised in toto with the right colon. Gross examination revealed a rounded mass of size 11x9 cm with a smooth outer surface. The tumor was densely adhered to the cecum and appendix and had engulfed the appendix (Figure 1A). The cut surface shows a solid, whitish, firm lesion with prominent trabeculations (Figure 1B). Figure 1 A - Gross view of the giant globular tumor with a smooth surface and closely adhered to the right colon and appendix;the white arrowhead points towards the tip of the adhered appendix (scale bar= 5 cm); B - Cut surface of the tumor shows a solid, well-circumscribed whitish tumor with areas of trabeculations (scale bar= 5 cm); C - Photomicrograph shows a low-grade spindle cell mesenchymal tumor of low cellularity densely adhered to the serosal surface of the appendix with infiltration of muscularis of the appendix (H&E,40x); D - Photomicrograph shows spindle cell tumor with bland elongated nuclei and moderate cytoplasm disposed over a hyalinized and myxoid stroma interspersed with thin-walled vessels. (H&E, 100x); E - Photomicrograph shows tumor cells positive for smooth muscle actin (SMA) immunohistochemistry (100x); F - Photomicrograph shows tumor cells with nuclear localization of beta-catenin (100x).: Microscopic examination revealed a mesenchymal tumor with low cellularity, composed of bland spindled cells over a densely collagenized matrix interspersed with thin vascular channels (Figure 1D). Mitosis, necrosis, and significant atypia were absent. The tumor was adhered within the serosal surface of the appendix and colon and also showed infiltration of the retroperitoneal skeletal muscle fibers (Figure 1C). On IHC, the tumor cells were positive for Vimentin, Smooth muscle actin (SMA) and showed nuclear localization of beta-catenin with cyclinD1 (Figures 1E and 1F). IHC for h-caldesmon, S-100, CD117, DOG-1, myogenin, ALK, and STAT-6 were negative, ruling out other differential diagnoses, including leiomyoma, nerve sheath tumor, gastrointestinal stromal tumor, spindle cell rhabdomyosarcoma, inflammatory myofibroblastic tumor, and solitary fibrous tumor. Ki-67 labeling was ~2-3%. The DF diagnosis was rendered based on the histology and IHC features. Our patient was advised postoperative close follow-up with clinical and imaging modalities at regular intervals. In summary, awareness about this rare tumor in intra-abdominal locations in young female patients with a prior history of childbirth and surgery and its possible clinical and imaging overlap with leiomyoma prevents aggressive treatment in DF patients. A pre-operative biopsy can confirm the diagnosis. However, in symptomatic patients, surgery is the mainstay of therapy. A search for possible CTNNB1 and APC gene mutation is vital.

Objectives: The management of chronic pain among patients with abdominal cancer is complex; against that, the neurolysis of the celiac plexus (CPN) is the best technique at the moment to determine the efficacy and safety in the treatment of chronic pain secondary to oncological pathology of the upper abdomen. Material and Methods: This was a systematic review of controlled clinical trials between 2000 and 2021, in the sources MEDLINE/PubMed, Cochrane, Scopus, Web of Science, and Google Scholar. Three independent evaluators analysed the results of the bibliographical research. The quality of the studies was assessed with the Jadad scale and the mean difference (95% confidence interval) and heterogeneity of the studies (I2) were calculated with Review Manager 5.3. Results: Seven hundred and forty-four publications were identified, including 13 studies in the qualitative synthesis and three studies in the quantitative synthesis. No difference was found in the decrease in pain intensity between 1 and 12 weeks after the intervention, comparing the experimental group with the control (P > 0.05). The adverse effects related to neurolysis were not serious and transitory, mentioning the most frequent adverse effects and reporting a percentage between 21% and 67% (with 17% for echoendoscopic neurolysis and 49% for percutaneous neurolysis). Conclusion: Celiac plexus neurolysis for the treatment of severe chronic pain secondary to oncological pathology in the upper hemiabdomen produces similar pain relief as conventional pharmacological analgesic treatment. It is a safe analgesic technique since the complications are mild and transitory. [ABSTRACT FROM AUTHOR]

Objective: Rare disease. Background: Primary adrenal epithelioid angiosarcoma (PAEA) is a very uncommon primary adrenal gland tumor that usually occurs around the age of 60 years and is more common among males. Owing to its rarity and histopathological features, PAEA could be misdiagnosed as adrenal cortical adenoma, adrenal cortical carcinoma, or other metastatic cancers, such as metastatic malignant melanoma and epithelioid hemangioendothelioma. Case Report: A 59-year-old male patient presented to our hospital with a complaint of abdominal bloating that started 2 months prior. His vital signs and the results of his physical and neurological examinations were unremarkable. A computed tomography scan showed a lobulated mass arising from the hepatic limb of the right adrenal gland but no evidence of metastasis to the chest or abdomen. The patient underwent right adrenalectomy, and the macroscopic pathological findings from a right adrenalectomy specimen revealed atypical tumor cells with an epithelioid appearance in the background of an adrenal cortical adenoma. Immunohistochemical staining was performed to confirm the diagnosis. The final diagnosis was epithelioid angiosarcoma involving the right adrenal gland with a background adrenal cortical adenoma. The patient had no postoperative complications, pain in the surgical wound, or fever. Therefore, he was discharged with a schedule for followup appointments. Conclusions: PAEA may be misinterpreted as adrenal cortical carcinoma, metastatic carcinoma, or malignant melanoma radiologically and histologically. Immunohistochemical stains are essential for diagnosing PAEA. Surgery and strict monitoring are the main treatments. In addition, early diagnosis is essential for patient recovery. [ABSTRACT FROM AUTHOR]

Methods:Nine patients (seven pancreas, one liver, and one lung) were recruited. 4D-MRI was performed using two prototype k-space sorted techniques, stack-of-stars (SOS) and koosh-ball (KB) acquisitions. Post-processing using MoCoAve was implemented for both methods. Image quality score, apparent SNR (aSNR), sharpness, motion trajectory and standard deviation (σ_GTV) of the gross tumor volumes were compared between original and MoCoAve image sets.Results:All subjects successfully underwent 4D-MRI scans and MoCoAve was performed on all data sets. Significantly higher image quality scores (2.64 ± 0.39 vs 1.18 ± 0.34, p = 0.001) and aSNR (37.6 ± 15.3 vs 18.1 ± 5.7, p = 0.001) was observed in the MoCoAve images when compared to the original images. High correlation in tumor motion trajectories in the superoinferior direction (SI: 0.91 ± 0.08) and weaker in the anteroposterior (AP: 0.51 ± 0.44) and mediolateral (ML: 0.37 ± 0.23) directions, similar image sharpness (0.367 ± 0.068 vs 0.369 ± 0.072, p = 0.805), and minimal average absolute difference (0.47 ± 0.34  mm) of the motion trajectory profiles was found between the two image sets. The σ_GTV in pancreas patients was significantly (p = 0.039) lower in MoCoAve images (1.48 ± 1.35  cm3) than in the original images (2.17 ± 1.31  cm3).Conclusion:MoCoAve using interphase motion correction and averaging has shown promise as a post-processing method for improving k-space sorted (SOS and KB) 4D-MRI image quality in thoracic and abdominal cancer patients.Advances in knowledge:The proposed method is an image based post-processing method that could be applied to many k-space sorted 4D-MRI methods for improved image quality and signal-to-noise ratio while preserving image sharpness and respiratory motion fidelity. It is a useful technique for the radiotherapy planning community who are interested in using 4D-MRI but aren't satisfied with their current MR image quality.

Introduction: Surgical palliation of malignancy is defined best as a procedure used with the primary intention of improving Quality of Life (QoL) or relieving symptoms caused by an advanced malignancy. Surgical procedures for palliation include resections, reconstruction, functional repairs, drainage, and biopsy. Primary benefits include QoL improvement through symptom prevention or control, with survival advantage as a secondary benefit. Aim: To evaluate mortality (30 days and 6 months), length of hospital stay and Intensive Care Unit (ICU) stay and QoL among patients undergoing palliative surgery for advanced cancer. Materials and Methods: A retrospective study was conducted at Dr. B. Borooah Cancer Institute, India, from September 2020 to March 2021. The clinicodemographic profile, tumour type and staging, treatment, investigations, surgery, anaesthesia and complications were studied. The outcome was defined by mortality, length of hospital stay and quality of life. Descriptive statistics was used for analysis. A p-value of less than 0.05 was considered significant at 5% level of significance. Results: A total of 86 patients underwent palliative surgeries, out of which 52 (60.5%) were females and 34 (39.5%) were males with the mean age of 49.6±15.9 years. Among them, 8 (9.3%) died within 30 days of surgery and 11 (12.8%) at six months after surgery. There was a significant association of mortality with pallor, deranged Thyroid Stimulating Hormone (TSH), co-morbidities, chemotherapy, type of surgery and anaesthesia but not with age, sex, type and stage of cancer, American Society of Anaesthesiology (ASA) status and General Condition (GC) of the patient. The mean duration of postoperative hospital stay was 15.8 days and mean ICU stay was 0.8 day for all patients. Patients with pallor had longer duration of hospital and ICU stay. Type of surgery was significantly associated with hospital stay but not with ICU stay. On evaluating the quality of life using Eastern Cooperative Oncology Group (ECOG) score, it was seen that the number of patients with poor ECOG scores (3 to 5) increased significantly from 10 (11.63%) to 13 (15.12%) in the immediate postoperative period. Conclusion: Patient factors affected the outcome after palliative surgery more than surgical and anaesthetic factors. The high mortality rate of 12.8% warrants detailed prospective studies in the future. [ABSTRACT FROM AUTHOR]

Objective To explore the safety, feasibility and short-term outcomes of hyperthermic intraperitoneal chemotherapy (HIPEC) for abdominal cancer in children. Methods From December 2019 to May 2021,16 patients with abdominal malignant tumor underwent surgical resection (cytoreductive surgery or tumorectomy) plus HIPEC.The median age was 68(8-167) months. Clinical characteristics, therapies and short-term outcomes were retrospectively analyzed. Results The histologic types included wilms tumor (n=5),rhabdomyosarcoma (n=4),malignant renal rhabdoid (n=1),undifferentiated sarcoma (n=1),immature teratoma (n=1),neuroblastoma (n=2),serous peritoneal carcinoma (n=1) and malignant ovarian germ cell tumor (n=1).Six cases underwent the initial operation and ten cases were re-operated for tumor recurrences. The median peritoneal carcinomatosis index (PCI) was 2.5(0-21) and the completeness of cytoreduction (CC) score (0-1) post-resection. There was no perioperative mortality or life-threatening complication. Four children had grade 3 adverse events within 30 days after surgery and HIPEC. The median follow-up period was 8(3.3-20) months. After surgery and HIPEC, six cases recurred. Three children died due to recurrence. One case had chemotherapy, surgery and radiotherapy after recurrence and survived without disease while another two cases received chemotherapy after recurrence and survived with disease. The remainders had no evidence of disease. The median disease-free survival (DFS) was 7.4(2-20) months. Conclusion HIPEC is both safe and feasible for pediatric abdominal malignant tumors. There is no onset of serious perioperative complications and adverse events are tolerable. The short-term outcomes are decent while long-term effectiveness requires more cases and extended follow-ups. [ABSTRACT FROM AUTHOR]

Introduction: Surgical palliation of malignancy is defined best as a procedure used with the primary intention of improving Quality of Life (QoL) or relieving symptoms caused by an advanced malignancy. Surgical procedures for palliation include resections, reconstruction, functional repairs, drainage, and biopsy. Primary benefits include QoL improvement through symptom prevention or control, with survival advantage as a secondary benefit. Aim: To evaluate mortality (30 days and 6 months), length of hospital stay and Intensive Care Unit (ICU) stay and QoL among patients undergoing palliative surgery for advanced cancer. Materials and Methods: A retrospective study was conducted at Dr. B. Borooah Cancer Institute, India, from September 2020 to March 2021. The clinicodemographic profile, tumour type and staging, treatment, investigations, surgery, anaesthesia and complications were studied. The outcome was defined by mortality, length of hospital stay and quality of life. Descriptive statistics was used for analysis. A p-value of less than 0.05 was considered significant at 5% level of significance. Results: A total of 86 patients underwent palliative surgeries, out of which 52 (60.5%) were females and 34 (39.5%) were males with the mean age of 49.6±15.9 years. Among them, 8 (9.3%) died within 30 days of surgery and 11 (12.8%) at six months after surgery. There was a significant association of mortality with pallor, deranged Thyroid Stimulating Hormone (TSH), co-morbidities, chemotherapy, type of surgery and anaesthesia but not with age, sex, type and stage of cancer, American Society of Anaesthesiology (ASA) status and General Condition (GC) of the patient. The mean duration of postoperative hospital stay was 15.8 days and mean ICU stay was 0.8 day for all patients. Patients with pallor had longer duration of hospital and ICU stay. Type of surgery was significantly associated with hospital stay but not with ICU stay. On evaluating the quality of life using Eastern Cooperative Oncology Group (ECOG) score, it was seen that the number of patients with poor ECOG scores (3 to 5) increased significantly from 10 (11.63%) to 13 (15.12%) in the immediate postoperative period. Conclusion: Patient factors affected the outcome after palliative surgery more than surgical and anaesthetic factors. The high mortality rate of 12.8% warrants detailed prospective studies in the future.

The first generation Tachyon PET (Tachyon-I) is a demonstration single-ring PET scanner that reaches a coincidence timing resolution of 314 ps using LSO scintillator crystals coupled to conventional photomultiplier tubes. The objective of this study was to quantify the improvement in both lesion detection and quantification performance resulting from the improved time-of-flight (TOF) capability of the Tachyon-I scanner. We developed a quantitative TOF image reconstruction method for the Tachyon-I and evaluated its TOF gain for lesion detection and quantification. Scans of either a standard NEMA torso phantom or healthy volunteers were used as the normal background data. Separately scanned point source and sphere data were superimposed onto the phantom or human data after accounting for the object attenuation. We used the bootstrap method to generate multiple independent noisy datasets with and without a lesion present. The signal-to-noise ratio (SNR) of a channelized hotelling observer (CHO) was calculated for each lesion size and location combination to evaluate the lesion detection performance. The bias versus standard deviation trade-off of each lesion uptake was also calculated to evaluate the quantification performance. The resulting CHO-SNR measurements showed improved performance in lesion detection with better timing resolution. The detection performance was also dependent on the lesion size and location, in addition to the background object size and shape. The results of bias versus noise trade-off showed that the noise (standard deviation) reduction ratio was about 1.1-1.3 over the TOF 500 ps and 1.5-1.9 over the non-TOF modes, similar to the SNR gains for lesion detection. In conclusion, this Tachyon-I PET study demonstrated the benefit of improved time-of-flight capability on lesion detection and ROI quantification for both phantom and human subjects.

ABSTRACT BACKGROUND: Solid pseudopapillary tumor of the pancreas has been frequently reported in the past two decades. Surgery remains the treatment of choice, with the liver being the most frequent site of metastases. AIMS: The study aimed to present an option of surgical treatment for an 18-year-old female patient with a solid lesion in the body and tail of the pancreas associated with metastatic lesions in both hepatic lobes. METHODS: Two surgical procedures were scheduled. In the first procedure, body-caudal pancreatectomy with splenectomy was performed, associated with the resection of three lesions of the liver's left lobe. A right hepatectomy was performed 6 months later, progressing without complications. RESULTS: The patient continues without clinical complaints on the last return, and abdominal magnetic resonance performed 28 months after the second procedure does not show liver or abdominal cavity lesions. CONCLUSIONS: The knowledge on the biological behavior of tumors, evolution, and recurrence risks allows the indication of more rational surgical techniques that best benefit patients.

The impact of venous thromboembolism in Japanese colorectal cancer patients has not been elucidated. This prespecified subanalysis of the Cancer‐VTE Registry aimed to report venous thromboembolism and event data after 1 year of follow‐up in 2477 patients with colorectal cancer and investigate risk factors of venous thromboembolism. Of 2477 patients, 158 (6.4%) had venous thromboembolism in venous thromboembolism screening at enrollment. Asymptomatic distal deep‐vein thrombosis accounted for 123/158 (77.8%) of venous thromboembolism cases. During the follow‐up period, symptomatic, incidental events requiring treatment and composite venous thromboembolism incidences were 0.3%, 0.8%, and 1.0%, respectively. The incidence of bleeding events, cerebral infarction/transient ischemic attack/systemic embolic event, and all‐cause death were 1.0%, 0.3%, and 4.8%, respectively. These results were consistent with the main study results. In multivariable analysis, venous thromboembolism at baseline was a risk factor of composite venous thromboembolism during the follow‐up period. Japanese patients with colorectal cancer and advancing cancer stage before treatment had more frequent venous thromboembolism complications at baseline, higher incidence of venous thromboembolism events during cancer treatment, and higher mortality. [ABSTRACT FROM AUTHOR]

Mesenteric paragangliomas (PGLs) are extremely rare, with a limited number of reported cases. These tumors are typically non-functioning and commonly manifest as a palpable abdominal mass or abdominal pain; however, a significant proportion of patients remain asymptomatic. Despite their rarity, they should be considered in the differential diagnosis of mesenteric masses. Surgical treatment is the preferred approach, and even after successful complete resection, long-term follow-up is crucial due to the unpredictable potential for metastasis. In this report, we describe the case of a 48-year-old male patient who presented with a self-limited episode of severe abdominal pain, without hyperfunctioning symptoms. The physical examination was unremarkable. Imaging studies revealed the presence of a mesenteric mass. The clinical, laboratory, imaging, and biopsy findings were insufficient to differentiate between an epithelial neuroendocrine tumor and a paraganglioma. Following a review by a neuroendocrine multidisciplinary team, surgery was proposed. While the initial suspicion was an epithelial neuroendocrine tumor, the histopathological examination of the surgical specimen was consistent with a PGL. Currently, after two years of follow-up, the patient remains asymptomatic and is undergoing regular clinical monitoring., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Martins Fernandes et al.)

Introduction: Periampullary tumors are defined as lesions that are located in a radius of 2 centimeters around the ampulla of Vater, constituted by 4 types of neoplasms with a high rate of malignancy originated in the pancreas, ampulla, distal bile duct or duodenum. Surgical management through the pancreatoduodenectomy remains the best choice in terms of curative resection. Objetive: To characterize periampullary tumors treated in our institution with pancreatoduodenectomy, associating the relationship between tumor type and postoperative complications. Material and Method: Cross-sectional, retrospective, observational study with a follow-up of 45 patients underwent pancreatoduodenectomy in the Hospital Internacional de Colombia - Fundación Cardiovascular between January 2011 and March 2020 with histopathological diagnosis of periampullary tumor. Results: Were performed 75 pancreatoduodenectomies, 45 patients presented with Periampullary tumor, 44% being of pancreatic origin, followed by ampulla 40%, distal bile duct 8.8% and duodenal 6.6%. Most frequent postoperative complications were pancreatic fistula and delayed gastric emptying. Mortality was of 1 patient. Conclusion: Pancreatoduodenectomy is a procedure with a high morbidity rate. Thanks to technological advances, the diagnosis of periampullary pathology is increasingly accurate. The type of periampullary tumor may influence not only in its prognosis, but also in its post-surgical morbidity. [ABSTRACT FROM AUTHOR]

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Purpose: Robotic assistance is rapidly evolving and may help physicians optimize needle guidance during percutaneous interventions. The purpose of the study was to report feasibility, safety, accuracy, immediate clinical success and short-term local tumor control after robotic-assisted computed tomography (CT)-guided thermal ablation of abdominal tumors., Materials and Methods: Forty-one patients who underwent percutaneous thermal ablation of abdominal tumors using robotic-assisted CT-guided were included. All ablations were performed with robotic assistance, using an optically-monitored robotic system with a needle guide sent to preplanned trajectories defined on three-dimensional-volumetric CT acquisitions with respiration monitoring. Endpoints were technical success, safety, distance from needle tip to planned trajectory and number of needle adjustments, and complete ablation rate., Results: Forty-one patients (31 men; mean age, 66.7 ± 9.9 [standard deviation (SD)] years [age range: 41-84 years]) were treated for 48 abdominal tumors, with 79 planned needles. Lesions treated were located in the liver (23/41; 56%), kidney (14/41;34%), adrenal gland (3/41; 7%) or retroperitoneum (1/41; 2%). Technical success was achieved in 39/41 (95%) patients, and 76/79 (96%) needle insertions. The mean lateral distance between the needle tip and planned trajectory was 3.2 ± 4.5 (SD) mm (range: 0-20 mm) before adjustments, and the mean three-dimensional distance was 1.6 ± 2.6 (SD) mm (range: 0-13 mm) after 29 manual depth adjustments (29/78; 37%) and 33 lateral adjustments (33/78; 42%). Two (2/79; 3%) needles required complete manual reinsertion. One grade 3 complication was reported in one patient (1/41; 2%). The overall clinical success rate was 100%. The 3-month local tumor control rate (progression free survival) was 95% (38/41)., Conclusion: These results provide further evidence on the use of robotic-assisted needle insertion regarding feasibility, safety, and accuracy, resulting in effective percutaneous thermal ablation of abdominal tumors., Competing Interests: Declaration of competing interest The authors declare there is no conflict of interests., (Copyright © 2024 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction. Calcifying fibrous tumor is a rare benign neoplasm of soft tissue origin. The tumor is commonly found in young adults. In most cases it is an incidental finding, because patients do not have obvious symptoms. This tumor may appear in different anatomical locations mimicking other stromal lesions. The diagnosis is made based on pathohistological characteristics and an appropriate immunohistochemical profile. The treatment is surgical, and the prognosis is good. Case Report. A 19-year-old female patient was admitted for abdominal surgery presenting with abdominal pain and pressure. Abdominal ultrasonography and multislice computed tomography of the abdomen showed a tumor mass in the right hemiabdomen. The patient underwent surgical treatment and the tumor was completely removed. Macroscopic analysis showed that the tumor was encapsulated and had a smooth surface. Microscopically, the tumor consisted of bundles of partially hyalinized collagen fibers with calcifications in the form of psammoma bodies that were permeated with mononuclear inflammatory infiltrates. Conclusion. Given the higher incidence of other mesenchymal tumors in the abdomen, due to its rare occurrence, calcifying fibrous tumor presents a diagnostic challenge. [ABSTRACT FROM AUTHOR]

PurposeTo determine if and by how much the commercial 4DCT protocols under- and overestimate tumor breathing motion.Methods1D simulations were conducted that modeled a 16-slice CT scanner and tumors moving proportionally to breathing amplitude. External breathing surrogate traces of at least 5-min duration for 50 patients were used. Breathing trace amplitudes were converted to motion by relating the nominal tumor motion to the 90th percentile breathing amplitude, reflecting motion defined by the more recent 5DCT approach. Based on clinical low-pitch helical CT acquisition, the CT detector moved according to its velocity while the tumor moved according to the breathing trace. When the CT scanner overlapped the tumor, the overlapping slices were identified as having imaged the tumor. This process was repeated starting at successive 0.1 s time bin in the breathing trace until there was insufficient breathing trace to complete the simulation. The tumor size was subtracted from the distance between the most superior and inferior tumor positions to determine the measured tumor motion for that specific simulation. The effect of the scanning parameter variation was evaluated using two commercial 4DCT protocols with different pitch values. Because clinical 4DCT scan sessions would yield a single tumor motion displacement measurement for each patient, errors in the tumor motion measurement were considered systematic. The mean of largest 5% and smallest 5% of the measured motions was selected to identify over- and underdetermined motion amplitudes, respectively. The process was repeated for tumor motions of 1-4 cm in 1 cm increments and for tumor sizes of 1-4 cm in 1 cm increments.ResultsIn the examined patient cohort, simulation using pitch of 0.06 showed that 30% of the patients exhibited a 5% chance of mean breathing amplitude overestimations of 47%, while 30% showed a 5% chance of mean breathing amplitude underestimations of 36%; with a separate simulation using pitch of 0.1 showing, respectively, 37% overestimation and 61% underestimation.ConclusionsThe simulation indicates that commercial low-pitch helical 4DCT processes potentially yield large tumor motion measurement errors, both over- and underestimating the tumor motion.

Copyright of Der Onkologe is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Hospital a Domicilio is the property of Centro Internacional Virtual de Investigacion en Nutricion and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To determine how small bowel neuroendocrine neoplasms (SBNEN's) are diagnosed and examine the effect of CT enterography (CTE) on diagnosis and rates of disease-free survival. Methods: Histopathologically-confirmed SBNEN's diagnosed at our institution between 1996 and 2016 were identified. Clinical presentation, radiology, endoscopy, surgery, and pathology reports were reviewed and compared between consecutive 5-year periods. Results: Of the 178 SBNEN initially diagnosed at our institution, the incidence increased 12-fold from 9 (during 1996–2000) to 114 (during 2011–2016). Comparing the first 5 to the last 5 years, GI bleeding and abdominal pain increased significantly as indications (with both increasing from 0 to > 25%, p ≤ 0.023). Initial diagnosis by radiology increased 2-fold [from 33% (n = 3) to 66% (n = 75); p = 0.263]. Detection of a small bowel mass and the suggestion that SBNEN was present varied significantly between imaging modalities (p < 0.0001; CTE − 95% (52/55) and 91% (50/55) vs. abdominal CT 45% (37/85) and 35% (29/85), respectively). Recurrence rates increased with SBNEN size (p = 0.012; e.g., of SBNEN diagnosed by endoscopy, 18% of SBNEN measuring 0.6 ± 0.3 cm recurred vs. 75% measuring 3.7 ± 1.0 cm). Rates of disease-free survival, and the incidence of local and liver metastases were decreased when tumors were first identified by CTE rather than other CT/MR imaging modalities (p = 0.0034, 0.0475, and 0.0032, respectively). Conclusion: There has been a dramatic increase in SBNENs detected by CTE and endoscopy over the last 20 years. SBNEN's detected by CTE and small tumors detected at endoscopy have longer disease-free survival after surgical resection. [ABSTRACT FROM AUTHOR]

Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are therapeutic options for the treatment of intra-abdominal neoplasms. Following the resection of all visible tumor areas by CRS, microscopic tumor areas are treated with HIPEC. This procedure increases the quality of life and survival. The CRS with HIPEC is a complex surgical procedure in which the mainly younger and often otherwise healthy patients undergo several pathophysiological changes during the operation. The main concern of the anesthesiologist is the massive volume loss, volume shift and metabolic alterations. Patients with a high comorbidity should undergo preoperative optimization to reduce the perioperative morbidity and mortality especially by protracted interventions. [ABSTRACT FROM AUTHOR]

BackgroundRheumatoid nodules are the most common extra-articular findings in patients with rheumatoid arthritis. They occur most commonly at pressure points such as the extensor surfaces of the forearms, fingers, and occiput, but have also been reported to occur in unusual locations including the central nervous system, pericardium, pleura, and sclera. We present the unusual case of rheumatoid nodules in the small bowel mesentery masquerading as an intra-abdominal malignancy.Case presentationA 65-year-old-male with a known history of longstanding erosive, nodular, seropositive rheumatoid arthritis was incidentally found to have a mesenteric mass on computed tomography (CT) exam of the abdomen. This mass had not been present on prior imaging studies and was worrisome for a malignancy. Attempts at noninvasive biopsy were nondiagnostic but consistent with a "spindle" cell neoplasm. Laparotomy revealed extensive thickening and fibrosis of the small bowel mesentery along with large, firm nodules throughout the mesentery. A limited bowel resection including a large, partially obstructing, nodule was performed. Pathology was consistent with an unusual presentation of rheumatoid nodules in the mesentery of the small bowel.ConclusionRheumatoid nodules should be considered in the differential diagnosis of a patient who presents with an intra-abdominal mass and a history of rheumatoid arthritis. Currently, no tests or imaging modality can discriminate with sufficient accuracy to rule out a malignancy in this difficult diagnostic delimma. Hopefully, this case will serve as impetus for further study and biomarker discovery to allow for improved diagnostic power.

Health literacy (HL) is pivotal in managing patients with abdominal cancer and is associated with treatment outcomes and care experience. However, detailed characteristics of HL and their associations with clinical features remain uncertain in the population. Therefore, we aimed to comprehensively investigate HL and its associations with clinical characteristics in older patients with abdominal tumours. We analysed 103 older patients with abdominal tumours prescribed perioperative rehabilitation programs in an acute care hospital. The Japanese version of the European Health Literacy Survey Questionnaire was used to measure comprehensive HL. Multivariate ordinal or linear regression analyses were used to explore the associations between HL and the following clinical characteristics: physical status, physical function, cardiopulmonary function, levels of activities of daily living (ADL), physical activity level, and health-related quality of life (HR-QoL). All regression analyses included patient demographics as covariates. Approximately 50%–70% of the participants had difficulty accessing and appraising health-related information, and 20%–45% thought it was difficult to understand and apply the information. The percentage of limited HL levels in general HL, three health-relevant domains, and four competencies ranged from 62% to 83%. Moreover, regression analyses revealed that lower HL was associated with worse physical status/function, lower ADL, and poorer HR-QoL. Most older patients with abdominal tumours have limited HL, which may lead them to make treatment decisions without fully understanding what healthcare providers advise. Furthermore, patients with lower HL are at a higher risk of poor treatment outcomes because of their worse clinical characteristics. • Accessing healthcare information was difficult for older patients with abdominal tumours. • Half or more participants felt that appraising healthcare information was difficult. • About 70% of the participants had limited health literacy. • Lower health literacy was associated with worse physical status, ADL, and HR-QoL. [ABSTRACT FROM AUTHOR]

Competing Interests: Competing interests: None declared.

Competing Interests: Conflict of interest: None

We present a case of an extremely rare type of soft-tissue sarcoma with an atypical clinical presentation. The patient, a female in her 20s with Li Fraumeni syndrome, had prior surgery for a large intra-abdominal tumour that was given the diagnosis of malignant myxoid spindle cell neoplasm. Her recurrence manifested as diffuse intra-abdominal sarcomatosis for which she ultimately underwent subtotal debulking with palliative intent. Final pathology rendered the diagnosis of myxoid pleomorphic liposarcoma, a newly described entity, distinct from the more common liposarcoma subtypes. The optimal treatment for this typically aggressive disease is currently unknown; until that is better defined, management should be carried out by sarcoma specialists., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Splanchnic nerve neurolysis (SNN) shows beneficial effects in reducing malignancy-associated refractory abdominal pain. Using adjuvants, such as dexmedetomidine to improve the pain was studied., Objective: To detect any role of dexmedetomidine as an additive to local anesthetics with an alcohol injection in the chemical SNN process to improve pain in patients having upper-abdominal cancer., Study Design: Double-blinded, prospective randomized study., Setting: Department of Anesthesia and Intensive Care, faculty of medicine, Minia University,Egypt., Methods: Forty patients with upper-abdominal malignancy-associated refractory abdominal pain underwent fluoroscopic guided SNN were divided into 2 groups. The SNN was performed by using 1.5 mL lidocaine 1%, dexmedetomidine 2 μg/kg, and then an injection of 4.5 mL of ethanol 96% on each side in group D and without dexmedetomidine in group C is done. Patients gave the score of abdominal pain expressed by the Visual Analog Scale (VAS), which measures the pain intensity. Scors were recorded prior to injection, during injection, after injection by 5 min, and after 2, 6, 12, 24, 72 hours, one week (W), 2 W, one month (M), and 2 M. Also, we recorded the amount of morphine required to relieve the residual pain after injection, the effect of procedure on quality of life (QOL), and any complication after injection., Results: VAS scores showed a significant increase in group C in comparison to group D during injection, after injection by 5 min, 2, 6, 12, 24 hours, one and 2 months (P < 0.0001, 0.0001, 0.029, 0.031, 0.025, 0.040, 0.020, 0.015), respectively. The morphine requirement was significantly increased at one W, one M, and 2 M in group C in comparison to Group D (P < 0.044, 0.017, 0.033) with no significant change in the QOL observed between groups., Limitations: The limitations of this study were a relatively small sample size and short period of follow-up., Conclusions: This study revealed that using dexmedetomidine in the chemical SNN process improves the pain results from injection of alcohol and refractory cancer related pain with reduction in the consumption of morphine in patients with upper-abdominal malignancy.

Cancer patients are at increased risk of infection. Fecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) may increase this risk. There are few studies on the prevalence of ESBL-PE colonization and surgical site infections (SSIs). This prospective cohort study included patients with gastrointestinal and gynecological malignancies who were admitted to the hospital for elective surgery. Rectal swab cultures were obtained on the day of admission and during the postoperative period every 5 days. Prevalence of ESBL-PE fecal colonization and risk factors for the development of SSI were assessed. We included 171 patients, 30 (17.5%) of whom were colonized with ESBL-PE at admission. This proportion increased to 21% (37 of 171) of the samples during the hospital stay. Incidence of SSI was 14.6% (n = 25). Ten of 37 (27%) patients colonized by ESBL-PE developed SSI versus 15 of 134 (11%) of the non-ESBL-PE (relative risk [RR], 2.163; 95% confidence interval [CI], 1.201-3.897; P =.016). Five patients developed a bloodstream infection, and 4 patients were colonized with ESBL-PE (RR = 4.02; 95% CI, 1.2-3.89; P =.008). The rate of ESBL-PE fecal colonization in surgical patients was 17.5%. Colonization of ESBL-PE duplicated the risk of SSI by the same strain and, by a factor of 4, the risk of bloodstream infections. [ABSTRACT FROM AUTHOR]

Actinomyces infection (actinomycosis) may create diagnostic conflicts and be confused with malignant neoplasms, especially in the abdomen. The objective of this study was to report a case of abdominal wall actinomycosis with hepatic infiltration, and review the existing evidence. Female patient, 33 years of age, with no surgical history or use of intra-uterine devices. She consulted for abdominal pain and palpable mass at the epigastrium. It was studied with images, which allowed verifying an abdominal wall mass with hepatic fistulae. A broad extirpation of the lesion was performed. The histological study revealed sulfur granules consistent with actinomyces. The patient has evolved satisfactorily, without problems; and is currently in treatment with amoxicillin. We present an unusual case of abdominal wall actinomycosis with hepatic infiltration that resulted in a difficult diagnosis. When a large intraperitoneal mass is found, actinomycosis needs to be included as a differential diagnoses. [ABSTRACT FROM AUTHOR]

The identification of an abdominal mass in a child, either coincidental or symptomatic, may be due to a tumour. An abdominal tumour may present with life-threatening symptoms, requiring prompt assessment and management. Although the discovery of such a finding usually warrants inpatient transfer or outpatient referral to the tertiary oncology centre, the initial evaluation, management and communication with the family by the general paediatrician is crucial. A thorough history and examination, which includes an organised, structured approach to abdominal masses, is paramount. The anatomical location of the mass, age of the patient and the presence of any associated symptoms or signs must be considered together in order to formulate a list of potential differential diagnoses and guide the next appropriate investigations. This article aims to guide general paediatricians through the assessment and initial management of a child presenting with an abdominal mass suspected to be a tumour. [ABSTRACT FROM AUTHOR]

Objective: To evaluate symptoms among patients with abdominal cancer and associated factors. Materials and methods: A cross- sectional study with 100 patients. The prevalence of symptoms was evaluated through the Memorial Symptom Assessment Scale (MSAS) and its association with demographic and clinical variables using chi-square and ANOVA tests. Results: The most prevalent symptoms were weight loss (64.0 %), pain (56.0 %), dry mouth (50.0 %), "I do not look more myself" (48.0 %) and lack of energy (45.0 %). There was a significant difference between sex and high-frequency (PHYS-H) (p = 0.001) and low-frequency (PHYS-L) physical symptoms (p = 0.004), and for general scale (TMSAS) (p = 0.002); (p = 0.001), general range (p = 0.027) and borderline significance for the global scale (GDI) (p = 0.051); high-frequency physical symptoms (p = 0.022), low-frequency physical symptoms (p = 0.034) and the overall scale (p = 0.034). There was one major complaint regarding the severity of high-frequency physical symptoms in patients with liver cancer (p = 0.018). Conclusion: Symptoms of physical and psychological aspects in cancer patients were associated with gender, race, marital status and tumor location. There is a need for tools to assess symptoms and enable health professionals to intervene more effectively. [ABSTRACT FROM AUTHOR]

BACKGROUND: Disseminated peritoneal leiomyomatosis is a rare disease; It is characterized by smooth muscle nodules, fibroblastic and myofibroblastic nodules on submesothelial peritoneal surfaces, with a benign histological appearance. It can originate from metaplasia of submesothelial multipotential mesenchymal cells. CLINICAL CASES: First case: female patient of 48 years, with a history of two nodules in the right breast and BIRADS II by mammography. The physical examination revealed an abdominal tumor that occupied almost the entire abdomen and another in the left iliac fossa, mobile; At the level of the right breast, two nodules were palpated, one around the external superior quadrant of 4 cm in diameter, not adhered to deep, non-painful planes and the other smaller in the lower external quadrant. Second case: female patient of 57 years, with a history of left oophorectomy, cesarean section and salpingoclasm. The condition began with persistent pain located in the epigastrium, which subsequently migrated to the lower abdomen. The finding of the neoplasm was fortuitous after a picture of acute appendicitis. CONCLUSIONS: The infrequency of this disease and the similarity of its behavior with some malignant diseases makes it difficult to establish the correct diagnosis. Knowing the disease, its risk factors and its probable manifestations or clinical complications is useful to keep in mind the probable diagnosis of that disease and treat it in time. Despite being classified as a benign neoplasm can generate various complications. [ABSTRACT FROM AUTHOR]

The insertion of self-expanding stents into malignant strictures of the small and large bowel has become a routine procedure around the world. However, stent development has happened very much on a “trial & error” approach, based mostly on bright ideas of enthusiastic individuals or marketing decisions by the manufacturer. A large variety of stents are commercially available, covered to a variable degree by a membrane to reduce tissue ingrowth. However, in vitro characteristics and in vivo behavior vary significantly between stents and few operators are aware of the differences. While the ideal stent still remains to be defined, it is important that interventionists understand the variations, in order to make the best possible choice for the individual patient. This article illustrates current principles of stent construction.

A 10-year-old female presented with a palpable mass occupying the entire abdomen. Computerized tomography scan showed a large expansive lesion measuring 22 cm × 20 cm × 13 cm. The mass was resected and the diagnosis of leiomyoma was made from immunehistochemical findings. Mesenteric leiomyoma is an uncommon tumor among gastrointestinal stromal tumors.

Abstract: We report a case of a 76-year-old patient with a history of recent weight loss and ulcerated umbilical nodular lesion. Initially, we considered the diagnostic hypothesis of Sister Mary Joseph's nodule. However, histopathological evaluation revealed that it was an ulcerated intradermal nevus. We perform a brief review of umbilical nodules.

Purpose: Typically, preoperative imaging is viewed in two dimensions (2D) only, but three-dimensional (3D) virtual models may improve viewers' anatomical perspective by permitting them to interact with the imaging through manipulating it in space. Research into the utility of these models in most surgical specialties is growing rapidly. This study investigates the utility of 3D virtual models of complex pediatric abdominal tumors for clinical decision making, particularly the decision to proceed with surgical resection or not., Methods: 3D virtual models of tumors and adjacent anatomy were created from CT images of pediatric patients scanned for Wilms tumor, neuroblastoma or hepatoblastoma. Pediatric surgeons individually assessed the resectability of the tumors. First, they assessed resectability using the standard protocol of viewing imaging on conventional screens and then reassessed resectability after being presented with the 3D virtual models. Inter-physician agreement on resectability for each patient was analyzed using Krippendorff's alpha. Inter-physician agreement was used as a surrogate for correct interpretation. Participants were also surveyed afterward on the utility and practicality of the 3D virtual models for clinical decision making., Results: Inter-physician agreement when using CT imaging alone was "fair" (Krippendorff's alpha α = 0.399), while inter-physician agreement when using 3D virtual models increased to "moderate" (Krippendorff's alpha α = 0.532). When surveyed about model utility, all 5 participants considered them helpful. Two participants felt the models would be practical for clinical use in most cases, while 3 felt they would be practical for select cases only., Conclusion: This study demonstrates the subjective utility of 3D virtual models of pediatric abdominal tumors for clinical decision making. The models are an adjunct that can be particularly useful in complicated tumors that efface or displace critical structures that may impact resectability. Statistical analysis demonstrates the improved inter-rater agreement with the 3D stereoscopic display over the 2D display. The use of 3D displays of medical images will increase over time, and evaluation of their potential usefulness in various clinical settings is necessary., (© 2023. CARS.)

Purpose: Surgical navigation techniques can guide surgeons in localizing pelvic-abdominal malignancies. For abdominal navigation, accurate patient registration is crucial and is generally performed using an intra-operative cone-beam CT (CBCT). However, this method causes 15-min surgical preparation workflow interruption and radiation exposure, and more importantly, it cannot be repeated during surgery to compensate for large patient movement. As an alternative, the accuracy and feasibility of tracked ultrasound (US) registration are assessed in this patient study., Methods: Patients scheduled for surgical navigation during laparotomy of pelvic-abdominal malignancies were prospectively included. In the operating room, two percutaneous tracked US scans of the pelvic bone were acquired: one in supine and one in Trendelenburg patient position. Postoperatively, the bone surface was semiautomatically segmented from US images and registered to the bone surface on the preoperative CT scan. The US registration accuracy was computed using the CBCT registration as a reference and acquisition times were compared. Additionally, both US measurements were compared to quantify the registration error caused by patient movement into Trendelenburg., Results: In total, 18 patients were included and analyzed. US registration resulted in a mean surface registration error of 1.2 ± 0.2 mm and a mean target registration error of 3.3 ± 1.4 mm. US acquisitions were 4 × faster than the CBCT scans (two-sample t-test P < 0.05) and could even be performed during standard patient preparation before skin incision. Patient repositioning in Trendelenburg caused a mean target registration error of 7.7 ± 3.3 mm, mainly in cranial direction., Conclusion: US registration based on the pelvic bone is accurate, fast and feasible for surgical navigation. Further optimization of the bone segmentation algorithm will allow for real-time registration in the clinical workflow. In the end, this would allow intra-operative US registration to correct for large patient movement., Trial Registration: This study is registered in ClinicalTrials.gov (NCT05637359)., (© 2023. CARS.)

Purpose: Research on fibroblast activating protein (FAP)-targeting inhibitor (FAPI) has become an important focus for cancer imaging and radiotherapy. Quinoline-based tracers [ 68  Ga]FAPI-04 and [ 18 F]FAPI-42 have been widely used for positron emission tomography (PET) imaging of most tumors. However, there exist some limitations of these tracers with high uptake in biliary duct system and unstable uptake in pancreas, unsuitable for abdominal tumors PET imaging. Here we developed a [ 18 F]-labeled glycopeptide-containing FAPI tracer (named [ 18 F]FAPT) for PET imaging of FAP in cancers., Methods: [ 18 F]FAPT was synthesized manually and automatically. The competitive binding to FAP, cellular internalization, and efflux characteristics were examined in vitro using A549-FAP cells. Dynamic MicroPET and biodistribution studies of [ 18 F]FAPT were then conducted in A549-FAP and U87MG xenograft tumor mouse models compared with [ 18 F]FAPI-42. Five healthy volunteers and three patients with cancer underwent [ 18 F]FAPT PET/CT., Results: Preclinical and clinical studies showed specific binding of [ 18 F]FAPT to FAP and favorable pharmacokinetic properties with better hydrophilicity, lower uptake in biliary duct system, higher tumor uptake and longer tumor retention compared with [ 18 F]FAPI-42. The biodistribution of [ 18 F]FAPT in healthy volunteers and patients with cancer displayed low uptake in most normal tissues except for pancreas, thyroid and salivary gland, which could contribute to high tumor-to-background ratios in most cancers., Conclusion: [ 18 F]FAPT is better PET tracer than [ 18 F]FAPI-42 for imaging of biliary duct system cancer, potentially providing a tool to examine FAP expression in most cancers with high tumor-to-background ratios., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)