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Liang H, Guo W, Yang R, Tang X, Yan T, Ji T, Yang Y, Li D, Xie L, Xu J. Radiological characteristics and predisposing factors of venous tumor thrombus in pelvic osteosarcoma: A mono-institutional retrospective study of 115 cases. Cancer Med 2018; 7:4903-4913. [PMID: 30141256 PMCID: PMC6198205 DOI: 10.1002/cam4.1739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 07/29/2018] [Accepted: 07/30/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Venous tumor thrombus (VTT) in pelvic osteosarcoma has been regarded as a rare oncological condition and few literatures investigated this issue. METHODS We retrospectively reviewed 115 cases of pelvic osteosarcoma treated in our center from 2006 to 2016. Diagnosis of VTTs was made based on histo-pathological findings. We summarized the radiological manifestations of VTTs on CT, MRI, and PET/CT. We also compared the demographical, oncological, and radiological data between cases with or without VTTs to identify its predisposing factors. RESULTS Seventeen cases (14.8%) were diagnosed with VTT. Manifestations of VTTs on CT included increased caliber (64.7%), calcification (47.1%), low density on plain scan (100%), filling defect (100%), and streak-like enhancement (35.7%) on contrast enhancement. On MRI, the VTTs could be hypo- or iso-intense on T1WI (100%), hyperintense on T2WI (100%), and filling defect on contrast enhancement (100%). PET/CT showed high metabolic activity of the VTTs. The ranges of the VTTs included unilateral external iliac vein (EIV) (two cases), unilateral internal iliac vein (IIV) (one case), unilateral common iliac vein (CIV) and IIV (five cases), unilateral CIV + EIV (two cases), inferior vena cava (IVC) and unilateral CIV + EIV (one case), IVC and unilateral CIV + IIV (four cases), IVC and bilateral CIVs + IIVs (two cases). Multivariate analysis indicated that chondroblastic subtype and involvement of L5/S1 intervertebral foramen might predispose to VTTs. CONCLUSION The incidence of VTTs in pelvic osteosarcoma was 14.8%. Comprehensive radiological studies help preoperative diagnosis of VTTs. Predisposing factors included chondroblasic subtype and involvement of L5/S1 intervertebral foramen.
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Affiliation(s)
- Haijie Liang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Wei Guo
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Rongli Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Xiaodong Tang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Taiqiang Yan
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Tao Ji
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Yi Yang
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Dasen Li
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Lu Xie
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
| | - Jie Xu
- Musculoskeletal Tumor CenterPeking University People's HospitalBeijingChina
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Yedururi S, Chawla S, Amini B, Wei W, Salem UI, Morani AC, Wang WL, Gorlick R, Lewis VO, Daw NC. Tumor thrombus in the large veins draining primary pelvic osteosarcoma on cross sectional imaging. Eur J Radiol 2018; 105:49-55. [PMID: 30017298 PMCID: PMC6056011 DOI: 10.1016/j.ejrad.2018.05.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/20/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate the frequency of tumor thrombus in the large veins draining primary pelvic osteosarcoma on early cross-sectional imaging studies and its effect on patient survival. MATERIALS AND METHODS Our retrospective study included all patients with primary pelvic osteosarcoma treated at our facility between January 2000 and May 2014, who were ≤ 45 years of age, and had adequate imaging studies and clinical follow up. Four radiologists evaluated for tumor in the large draining veins on initial CT, MRI and PET/CTs. A consensus evaluation by the four radiologists together with findings on operative reports, pathology reports or follow-up imaging was used as the reference standard. RESULTS Thirty-nine patients with primary pelvic osteosarcoma met final inclusion criteria. Tumor thrombus was identified in the large draining veins in 10 of the 22 (45%) patients who underwent tumor resection and 10 of the 17 (59%) who did not. In the 22 patients who underwent tumor resection, tumor thrombus was significantly associated with worse overall survival (p = 0.03). CONCLUSIONS Tumor thrombus in the large draining veins is identified in a significant proportion of initial imaging studies in patients with pelvic osteosarcoma, and is associated with worse overall survival in patients who undergo tumor resection.
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Affiliation(s)
- Sireesha Yedururi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, United States.
| | - Sumedha Chawla
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, United States.
| | - Behrang Amini
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, United States.
| | - Wei Wei
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1411, Houston, TX, 77030, United States.
| | - Usama I Salem
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, United States.
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1473, Houston, TX, 77030, United States.
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 0085, Houston, TX, 77030, United States.
| | - Richard Gorlick
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 0087, Houston, TX, 77030, United States.
| | - Valerae O Lewis
- Department of Orthopedic Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1448, Houston, TX, 77030, United States; Pelvic Sarcoma Center of Excellence, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 1448, Houston, TX, 77030, United States.
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Street, Unit 0087, Houston, TX, 77030, United States.
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Wang J, Cheng Y, Lee YZ, Wang Y, Zheng Y, Dong R, Lai Y, Tang X, Yang Y, Wang S, He N, Jia Y, Cheng W, Liu D, Wang X, Zhang C. Sonography and Transthoracic Echocardiography for Diagnosis of Systemic Cardiovascular Metastatic Tumor Thrombi. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1993-2027. [PMID: 27492390 DOI: 10.7863/ultra.15.10038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/23/2015] [Indexed: 06/06/2023]
Abstract
Sonography and transthoracic echocardiography (TTE) are seldom used for assessment of metastatic tumor thrombi in the cardiovascular system in routine clinical practice. We performed this retrospective study to evaluate the combination of sonography with TTE for diagnosis of metastatic tumor thrombi in heart and systemic vessels. Vascular, abdominal, pelvic, and small-part sonography was applied in 18 patients, and TTE was conducted simultaneously in 14 patients. Tumor thrombi invaded into the inferior vena cava system in 12 patients, superior vena cava system in 5 patients, and aorta in 1 patient; they extended to the right cardiac chambers in 11 patients. Six patients had diagnoses by pathologic examination. The primary neoplasms were identified by conventional imaging in 17 patients. The morphologic and echogenic characteristics of the tumor thrombi were diverse and depended on their original tumors. The thrombi were either contiguous or discrete from the original tumors. The neoplastic vascularity of the thrombi and the invasive extension were the primary characteristics that distinguished them from bland thrombi. Simultaneous application of sonography and TTE is a feasible way to comprehensively evaluate cardiovascular metastatic tumor thrombi in most patients.
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Affiliation(s)
- Jiong Wang
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China, Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA, Department of Medical Ultrasonography, Peking University International Hospital, Beijing, China
| | - Yi Cheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yueh Z Lee
- Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina USA
| | - Yongmei Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ye Zheng
- Department of Ultrasound, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Ran Dong
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yongqiang Lai
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaobin Tang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yaoguo Yang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Sheng Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Nan He
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Yunfeng Jia
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Wei Cheng
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Dan Liu
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Xiaona Wang
- Department of Vascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
| | - Chun Zhang
- Department of Echocardiography, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China
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Yedururi S, Morani AC, Gladish GW, Vallabhaneni S, Anderson PM, Hughes D, Wang WL, Daw NC. Cardiovascular involvement by osteosarcoma: an analysis of 20 patients. Pediatr Radiol 2016; 46:21-33. [PMID: 26411434 PMCID: PMC4707059 DOI: 10.1007/s00247-015-3449-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 06/28/2015] [Accepted: 07/30/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although hematogenous spread of osteosarcoma is well known, the imaging findings of cardiovascular involvement by osteosarcoma are seldom reported and can be difficult to recognize. The enhanced resolution of modern CT and MRI scanners may lead to better detection of cardiovascular involvement. OBJECTIVE To describe the key imaging findings and clinical behavior of cardiovascular involvement by osteosarcoma. MATERIALS AND METHODS We retrospectively reviewed the imaging findings and clinical characteristics of 20 patients with cardiovascular involvement by osteosarcoma identified by two pediatric radiologists from a review of imaging studies at our institution from 2007 to 2013. RESULTS At initial diagnosis, the median age of the patients was 15.1 years (range 4.8-24.6 years), and 7 (35%) patients had detectable metastases. Median time to detection of cardiovascular metastases was 1.8 years (range 0-7.3 years). Sixteen patients died of disease; 4 have survived a median of 7.4 years since initial diagnosis. The sites of cardiovascular involvement were the systemic veins draining the primary and metastatic osteosarcoma, pulmonary arteries, pulmonary veins draining the pulmonary metastases, and heart. A dilated and mineralized terminal pulmonary arteriole is an early sign of metastatic osteosarcoma in the lung. Unfamiliarity with the imaging features resulted in under-recognition and misinterpretation of intravascular tumor thrombus as bland thrombus. CONCLUSION Knowledge of imaging findings in the era of modern imaging modalities has enhanced our ability to detect cardiovascular involvement and lung metastases early and avoid misinterpreting tumor thrombus in draining systemic veins or pulmonary arteries as bland thrombus.
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Affiliation(s)
- Sireesha Yedururi
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA.
| | - Ajaykumar C Morani
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA
| | - Gregory W Gladish
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, MDT Boone Pickens Academic Tower, 1400 Pressler St., Unit 1473, Houston, TX, 77030, USA
| | | | - Peter M Anderson
- Department of Pediatrics Hematology/Oncology/BMT, Carolinas Healthcare System, Levine Children's Hospital/Levine Cancer Institute, Charlotte, NC, USA
| | - Dennis Hughes
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Najat C Daw
- Division of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gunasekaran G, Bencsath K, Hupertz V, Fung JJ, Pettersson G, Miller C. Deep hypothermia with circulatory arrest to aid in the management of suprahepatic vena cava stenosis after liver transplantation. Liver Transpl 2010; 16:1434-6. [PMID: 21117254 DOI: 10.1002/lt.22183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Liver transplantation is the treatment of choice for many liver diseases in the pediatric population. Complications involving late suprahepatic vena cava obstructions after liver transplantation are not common, but they tend to be more frequently seen in pediatric recipients. When such complications have occurred, approaches involving direct abdominal surgery or interventional radiology guidance have been used with satisfactory results. We present a case report of an alternative approach to a suprahepatic vena cava complication. An 18-year-old man who underwent pediatric liver transplantation for biliary atresia presented with a symptomatic total occlusion of the suprahepatic caval anastomosis that could not be crossed with a wire. We used a right atrial approach and hypothermic circulatory (cardiac) arrest. The anastomotic stricture was easily identified and excised. The postoperative course was uneventful with a rapid resolution of the symptoms. Because the occlusion was not amenable to angioplasty or stenting, a direct surgical approach was necessary. The right atrial approach with hypothermic cardiac arrest gave us direct access to the obliterated cavoatrial anastomosis through a virgin area and allowed us to avoid the difficulties and dangers of the large collaterals in the abdomen.
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Affiliation(s)
- Ganesh Gunasekaran
- Hepato-Pancreato-Biliary and Transplant Surgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA.
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Lai P, Bomanji JB, Mahmood S, Nagabhushan N, Syed R, Gacinovic S, Lee SM, Ell PJ. Detection of tumour thrombus by 18F-FDG-PET/CT imaging. Eur J Cancer Prev 2007; 16:90-4. [PMID: 17220710 DOI: 10.1097/01.cej.0000220641.46470.77] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tumour thrombus is a rare complication of many solid cancers including renal cell carcinoma, Wilms' tumour, testicular tumour, adrenal cortical carcinoma, lymphoma, pancreatic cancer, osteosarcoma and Ewing's sarcoma. We describe six patients who harboured occult tumour thrombus detected by fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography (PET)/X-ray computerized tomography (CT) imaging as part of the staging investigations. Recognition of this rare complication by PET/CT can change the management plan and prevent unnecessary long-term anti-coagulation treatment because of wrong diagnosis of cancer-related venous thrombus.
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Affiliation(s)
- Peter Lai
- Institute of Nuclear Medicine, University College London Hospitals NHS Trust, London, UK
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