Objectives: To evaluate the accuracy of magnetic resonance imaging (MRI) in predicting deep myometrial invasion, cervical stromal invasion, and pelvic lymph node involvement in the preoperative assessment of women with endometrial cancer. Methods: Patients with endometrial cancer, having preoperative MRI available, and hysterectomy performed in a regional hospital in Hong Kong between 1 January 2010 and 31 December 2014 were included. Those treated with neoadjuvant therapy or without staging MRI were excluded. Primary outcome measure was the correlation between deep myometrial invasion suggested by preoperative MRI and subsequent histopathology of the hysterectomy specimen. Imaging-pathological correlation of cervical stromal invasion and pelvic node involvement was also assessed. Results: Overall 90 women met the criteria and were included in this study. Sensitivity, specificity, and accuracy of preoperative MRI was respectively 83.3%, 88.9%, and 87.8% for predicting deep myometrial invasion; 22.2%, 98.6%, and 83.3% for predicting cervical stromal invasion; and 60.0%, 96.6%, and 91.2% for predicting pelvic node disease. Conclusions: Preoperative MRI is highly accurate in the detection of deep myometrial invasion, which is the single most important prognostic factor. It is moderately accurate and highly specific in the diagnosis of cervical stromal invasion and pelvic node metastasis. The favourable performance of preoperative MRI allows better surgical planning that may then translate into better patient outcome. Although not formally included in the FIGO staging system, it is a highly valuable adjunct in preoperative assessment of women with endometrial cancer.
Mature cystic teratoma is the most common type of ovarian germ cell tumour. It is usually asymptomatic and slow growing until it manifests with torsion, infection, or spontaneous rupture. We report a case of ovarian teratoma eroding into the sigmoid colon with consequent per-rectal bleeding.
Purpose: To compare pathologic treatment response between conventional (cTACE) and doxorubicin-eluting bead chemoembolization (DEB-TACE) in explanted livers. Materials: A retrospective review was performed of all patients who received treatment with either cTACE or DEB-TACE that subsequently had a liver transplant from June 2009 to June 2016. A total of 200 unique patients were identified. 128 patients met inclusion criteria of having hepatocellular carcinoma (HCC) on pathology, quantitative tumor viability pathology reports, and only having one type of TACE (cTACE (n ¼ 95) and DEB-TACE (n ¼ 33)) before explant. Only treated tumors were included. Time interval between last TACE and liver transplant was a mean of 134 days (range, 1 -496 days). Student t-test was used to compare means and chi square test was used to compare categorical variables. Results: 173 tumors were identified in these 128 patients, with 124 tumors in the cTACE group and 49 tumors in the DEB-TACE group. Tumor grade was similar in both groups. Average number of treatments were 1.62 (SD: 0.82) in the cTACE group and 1.47 (SD: 0.66) in the DEB-TACE group. Categories of pathologic tumor response were 0%, h50%, i50%, and 100% viability. 0% viability was seen in 32/124 (25.8%) tumors in the cTACE group and 10/49 (20.4%) tumors in the DEB-TACE group. h50% viability was seen in 48/124 (38.7%) tumors in the cTACE group and 23/49 (46.9%) in the DEB-TACE group. i50% viability was seen in 33/124 (26.6%) in the cTACE group and 14/49 (28.6%) in the DEB-TACE group. The mean tumor viability after cTACE and DEB-TACE treatments were 41.8% and 38.8% respectively. The pathologic treatment response between both groups did not approach statistical significance (p ¼ 0.50). Conclusions: In this study, no difference in pathologic treatment response was seen in HCC treated with cTACE and DEB-TACE. Either cTACE or DEB-TACE can be an acceptable treatment to achieve tumor control for patients awaiting liver transplant.
Objectives: To review the clinical and pathological features of autoimmune pancreatitis (AIP) in a tertiary referral centre in Hong Kong, and to determine preoperative factors that facilitate diagnosis of AIP in order to avoid Whipple's procedure. Methods: According to our pathology and radiology databases, 13 patients were diagnosed in our hospital with type 1 AIP from 1 January 2003 to 31 December 2013. Clinical, serological, radiological and histopathological features and treatment outcomes were analysed. Results: The mean age of patients was 63.2 years with a male predominance (85%). Obstructive jaundice was the most common presenting symptom (69%). Serum immunoglobulin G4 (IgG4) was measured in 12 patients and was elevated in all cases. Focal pancreatic mass was the most common radiological manifestation (46%), followed by diffuse (31%) and segmental (23%) swelling of the pancreas. Subgroup analysis of subjects diagnosed only after surgery showed significant elevation of postoperative serum IgG4 level, with extrapancreatic manifestations present in two cases. Conclusions: In this cohort, our AIP patients showed similar features with those in China and Taiwan, but different to those in Japan and Korea. A future large-scale multicentre cohort would help determine whether AIP manifests differently in different geographical locations. AIP can mimic pancreatic and biliary malignancies, thus radiologists should be familiar with its typical radiological features. Serum IgG4 should be measured and extrapancreatic manifestations looked for in patients who manifest with radiologically suspected pancreatic cancer or extrahepatic cholangiocarcinoma at the pancreatic level. Judicious use of endoscopic ultrasound-guided biopsy, endoscopic retrograde pancreatography, and steroid trial in selected cases would be valuable to exclude malignancy and confirm AIP. Some Whipple's procedures can hopefully be avoided by these measures.
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