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Oesophageal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Nyree Griffin, Jason Dunn, Lee Alexander Grant
The MRI criteria used to determine the presence of tracheobronchial, pericardial, and aortic invasion are the same as those used for CT. MDCT and MR are equivalent in their ability to detect invasion into adjacent structures. The size criteria for mediastinal lymphadenopathy are identical for CT and MR.
Lymphoma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Enlarged lymph nodes can be present in any site, but most commonly in the neck. Typically, the nodes of Hodgkin lymphoma are described as firm and rubbery as opposed to the hard craggy nodes of carcinoma. Palpable hepatosplenomegaly or an abdominal mass owing to para-aortic or mesenteric nodes might also be present. Inguinal and pelvic lymphadenopathy can be associated with oedema of the lower limbs, although arm oedema is an unusual complication of axillary lymphadenopathy from lymphoma. Mediastinal lymphadenopathy might present with the signs of superior vena cava obstruction.
Test Paper 7
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
A 55-year-old man presents with a several-week history of worsening stridor. He has had several chest infections over recent months, with repeated courses of antibiotics providing little relief of symptoms. Mediastinal lymphadenopathy is evident on chest radiograph, with a few intrapulmonary nodules in the periphery of both lungs. Computed tomography confirms the presence of multiple nodules, most numerous in the subpleural region of the right lower lobe. Also of note is a mucosal polypoid lesion in the upper trachea and a further endobronchial lesion just distal to the carina in the right main bronchus. Which condition encompasses these clinical and radiographic findings? AmyloidosisAlveolar proteinosisPulmonary vasculitisHistoplasmosisHydatid disease
Treatment of classical Hodgkin’s lymphoma in children and adolescents
Published in Expert Opinion on Pharmacotherapy, 2019
David Gómez-Almaguer, Oscar González-Llano, Valentine Jiménez-Antolinez, Andrés Gómez-De León
It is clear now that a small group of HL patients will suffer from relapse or even refractory disease. High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) is currently the standard of care for this group of patients. Since there are no randomized studies to evaluate ASCT, the information in this setting is largely based on results derived from adult studies. However, there is some important information from retrospective studies; in the recent study by Giulino-Roth et al. [40], in which 36 pediatrics patients were treated with ASCT from 1989 to 2013, a median follow up of 9.6 years and a 10-year OS of 71.4% and EFS of 67.1% were observed. In the same study, the authors used the Childhood Hodgkin International Prognostic Score (CHIPS). This score was calculated at the time of relapse (R-CHIPS). Stage IV disease, bulky mediastinal adenopathy, albumin <3.5g/dL, add one point each. Bulky mediastinal lymphadenopathy was defined as a tumor diameter >1/3 the thoracic diameter as measured on an upright PA CXR with a nodal aggregate >6 cm in the longest cross-sectional diameter. Fever was defined as a temperature ≥38°C. A lower R-CHIPS score correlates with a better OS. In general, it is accepted that a low tumor burden and sensitivity to chemotherapy are very important factors to consider in the setting of ASCT; in fact, there is information regarding the impact of Pre-ASCT PET/CT based on Deauville criteria on post-ASCT outcome, and this should be considered an independent predictor of progression in relapsed or refractory cHL [41].
Vogt-Koyanagi-Harada Disease Associated with Hepatitis B Vaccination
Published in Ocular Immunology and Inflammation, 2019
Arjun B. Sood, Ghazala O’Keefe, Diem Bui, Nieraj Jain
The patient was then lost to follow-up and re-presented 5 months later due to recurrent symptoms. In the interim, he reported two flares during which he self-treated with oral and topical steroids for 3 days each with resolution. Review of systems was now significant for tinnitus and headaches. On re-evaluation of family history, our patient reported paternal Cherokee Native American ancestors. Inspection of the skin showed hypopigmented areas on the chin consistent with vitiligo. Best corrected visual acuity was 20/25 in both eyes. Funduscopic examination revealed recurrent disc edema bilaterally with new deep creamy-white lesions in the posterior pole of both eyes. A peri-papillary choroidal neovascular membrane (CNVM) was present in the right eye. Computed tomography of the chest showed mediastinal lymphadenopathy and an 8 mm lung nodule. A lumber puncture was normal without cerebrospinal fluid (CSF) pleocytosis or malignant cells. A clinical diagnosis of VKH was made and intraocular inflammation was controlled with oral corticosteroids followed by methotrexate for long-term disease control. The CNVM resolved with one treatment of intravitreal bevacizumab (1.25 mg/0.05 cc). The patient was referred to pulmonology and evaluation was not consistent with sarcoidosis.
Metastatic TFE3-overexpressing renal clear cell carcinoma with dense granules: a histological, immunohistochemical, and ultrastructural study
Published in Ultrastructural Pathology, 2018
Shoujun Chen, Elba A. Turbat-Herrera, Guillermo A. Herrera, Meghna Chadha, Rodney E. Shackelford, Eric X. Wei
Thoracic and abdominal computed tomography (CT) scans showed a solid heterogeneously enhancing mass lesion (15 × 10 cm) arising from the right kidney (Figure 1a). RCC was in the differential diagnosis. Nodular concentric left pleural thickening was noted consistent with neoplastic pleural disease, likely metastatic. A fairly large complex pleural effusion caused nearly complete opacification of the left hemi-thorax (Figure 1b). Multiple right pulmonary nodules raised concerns for metastatic disease (Figure 1c). In addition, mediastinal lymphadenopathy was noted. The brain magnetic resonance imaging revealed at least two small lesions mostly consistent with metastatic deposits in the right cerebellum and posterior to the roof of the right lateral ventricle. The pelvic CT scan showed large osseous metastases involving the right iliac bone and adjacent sacrum across the sacroiliac joint, with surrounding soft tissue involvement. After thoracotomy for biopsy of suspected pleural metastasis and pleurodesis for entrapped lung, the patient was discharged to hospice care.