Survival of patients with uveal melanoma metastatic to the liver correlates strongly with disease control in the liver. Unfortunately, there are no standardized treatments for this chemoresistant disease. Selective internal radiation therapy (SIRT) has been tested as salvage therapy, but no data exist about its use as firstline therapy. The purpose of this study was to investigate the safety and efficacy of SIRT as first-line therapy in patients with uveal melanoma metastatic to the liver. Methods: This retrospective analysis of a prospectively collected cohort included 22 patients treated with first-line SIRT. Biochemical and clinical toxicities were recorded. Tumor response was determined according to the European Association for the Study of Liver Disease (EASL) criteria. Predictive factors of survival were analyzed by univariate and multivariate analysis. Overall survival was calculated using the Kaplan-Meier method with the log-rank test. Results: Grade 3-4 biologic and clinical toxicities occurred in 24% of patients (for both). According to the EASL criteria, disease control at 6 mo after SIRT was achieved in 15 (52%) of the 29 SIRT patients and was predictive of survival. Median overall survival from the first SIRT was 18 mo (95% confidence interval [95%CI], 8-28 mo). At the time of the analysis, 5 patients (23%) were still alive. In multivariate analysis, largest lesion size (hazard ratio [HR], 1.22; 95%CI, 0.98-1.53], liver tumor volume (HR, 1.002; 95%CI, 1.0004-1.003), subsequent systemic therapy (HR, 0.04; 95%CI, 0.006-0.24), and liver-directed locoregional therapy (HR, 0.204; 95%CI, 0.04-0.94) were predictive of survival. Conclusion: First-line SIRT is safe and produced promising outcomes in patients with uveal melanoma metastatic to the liver. Subsequent systemic and liver-directed locoregional therapies ameliorated survival, highlighting the potential for improved outcomes with combination approaches. The results of this study suggest that prospective trials using first-line SIRT should be considered.

Uterine tumors resembling ovarian sex‐cord tumors (UTROSCTs) are rare uterine neoplasms of uncertain etiology that resemble the sex cord tumors of the ovary and display a combined sex cord, epithelial, and smooth muscle immunophenotype. Most tumors are associated with a benign clinical course. We report the first cytological description of uterine UTROSCTs in liquid‐based cervical cytology (LBC). A menopausal woman was discovered to have a uterine intraluminal polypoid mass protruding through the vagina. A Pap test was performed, and the LBC preparation showed isolated tumor cells with scant cytoplasm and slightly irregular, ovoid nuclei with fine chromatin and small nucleoli. Final histological evaluation identified a UTROSCT. This diagnostic possibility, albeit rare, should be included in the differential diagnosis when isolated malignant‐appearing adenocarcinomatous cells are seen in women in the above scenario. As these features are not specific, they may result in misinterpretation with tumors that are more common and aggressive.

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BACKGROUND AND PURPOSE:This study was prompted by recurrent angiographic observations of focal stenoses involving the proximal segment of the left upper thoracic intersegmental arteries, a few centimeters distal to their origin. The purpose was to investigate the nature and prevalence of this anomaly.

Sinus of Valsalva aneurysms are unusual, particularly when located on the left coronary sinus. They are mainly asymptomatic, however once ruptured, they are associated with high mortality. We present hereinafter an atypical case of a 71-year-old patient with an unruptured left sinus of Valsalva aneurysm causing myocardial ischaemia due to a compressed left main coronary artery. Surgical endoaneurysmorrhaphy was performed; however, a dehiscence of the suture line between the patch and the aortic wall required additional percutaneous implantation of a vascular occluder.