Irreversible electroporation (IRE) is a new nonthermal tumor ablation modality that induces apoptosis in the treated tissue without affecting collagen. Its use is particularly indicated for tumors involving major structures, such as encompassed or infiltrated vessels and/or ducts, which need to be preserved and hinder or preclude surgical resection. We report a 66-year-old male patient with locally advanced pancreatic adenocarcinoma, treated with IRE.Two cycles of neoadjuvant chemotherapy with nab-paclitaxel and gemcitabine were administered. After these 2 cycles, IRE ablation was performed with a percutaneous transgastric access under general anesthesia. Later, 4 additional chemotherapy cycles were administrated.At 48 hours of electroporation, blood tests were normal. On day 5, a computed tomography (CT) scan showed portal vein and celiac artery were normal in appearance. Three months later, a positron emission tomography (PET) scan showed disappearance of abnormal uptake in the pancreas and other sites. A 12-month follow-up the patient is disease free.IRE opens a new way to treat tumors with involvement or proximity of neighboring structures. This procedure is more costly than other techniques and is not free of complications. The percutaneous transgastric access is feasible and without serious complications. In our case, complications were resolved and the patient presented a good short/medium-term outcome.
Prostate-specific antigen (PSA) is the most commonly used tumour marker for prostate cancer, both in screening and in follow-up. However, there are many false positive increases in the presence of other prostate diseases and, currently, there is no consensus regarding sensitivity and specificity of the PSA test, nor what constitutes the upper limit of normality. We report a case of a 67-year-old patient with metastatic prostate cancer who, with increased level of alkaline phosphatase and normal PSA, showed clinical and radiological evidence of progression of the disease.
A 54 years old man casually diagnosed with right renal hypernephroma underwent a radical right nephrectomy seven years ago. The pathologic exam confirmed a clear cell carcinoma. In the follow up study, an abdominal CT demonstrated metastasis shaped lesions in liver and left kidney and a hypervascular colonic nodular lesion (Fig. 1). A colonoscopy was performed. The pathologic study of the colonic biopsies confirmed the presence of a clear cell carcinoma metastasis (immunohistochemistry was positive for cytokeratin AE1, AE3, vimentin, and focally CD10). Extension study was completed. Surgical treatment was not indicated and for an indefinite period of time sunitinib treatment was initiated. DISCUSSIONColonic metastasis of renal tumours is uncommon in medical literature. Descriptions deal with clear cell tumours (1), mixed granular and clear cells tumors (2) and sarcomatoid tumors (3). Differential diagnosis includes the also infrequent double kidney and colon cancer (4). Gastric and duodenum metastasis have also been described (5). Fig. 2. One cm diameter sized nodular lesion in ascending colon. Fig. 1. Image of hypervascularized 2.5 cm sized nodule dependant of ascending colon wall. Perinodular contrast enhancing and numerous small lymphadenopaties are also detected. The findings suggest colonic cancer. Nodular colonic lesion in a nephrectomized patient PICTURES IN DIGESTIVE PATHOLOGY
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