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Baloji A, Kalra N, Chaluvashetty S, Bhujade H, Chandel K, Duseja A, Taneja S, Gorsi U, Kumar R, Singh H, Sood A, Bhattacharya A, Singh B, Mittal BR, Singh V, Sandhu MS. Efficacy of Yttrium-90 Transarterial Radioembolisation in Advanced Hepatocellular Carcinoma: An Experience With Hybrid Angio-Computed Tomography and Glass Microspheres. J Clin Exp Hepatol 2024; 14:101342. [PMID: 38283702 PMCID: PMC10819781 DOI: 10.1016/j.jceh.2023.101342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/23/2023] [Indexed: 01/30/2024] Open
Abstract
Background Hepatocellular carcinoma is one of the most common malignancies worldwide. Transarterial radioembolisation (TARE) involves selective intra-arterial administration of microspheres loaded with a radioactive compound like Yttrium-90 (Y-90). Conventionally, C-arm-based cone-beam computed tomography has been extensively used during TARE. However, angio-computed tomography (CT) is a relatively new modality which combines the advantages of both fluoroscopy and fCT. There is scarce literature detailing the use of angio-CT in Y90 TARE. Methods This was a retrospective study of primary liver cancer cases in which the TARE procedure was done from November 2017 to December 2021. Glass-based Y-90 microspheres were used in all these cases. All the cases were performed in the hybrid angio-CT suite. A single photon emission computed tomography-computed comography (SPECT-CT) done postplanning session determined the lung shunt fraction and confirmed the accurate targeting of the lesion. Postdrug delivery, positron emission tomography-computed tomography (PET-CT) was obtained to confirm the distribution of the Y-90 particles. The technical success, median follow-up, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS) were recorded. Results A total of 56 hepatocellular carcinoma patients underwent TARE during this period, out of which 36 patients (30 males and 6 females) underwent Y90 TARE. The aetiology of cirrhosis included non-alcoholic steatohepatitis (NASH) (11), hepatitis C (HCV) (11), hepatitis B (HBV) (9), metabolic dysfunction and alcohol-associated liver disease (MetALD) (2), alcoholic liver disease (ALD) (1), cryptogenic (1), and autoimmune hepatitis (AIH) (1). The technical success was 100 % and the median follow-up was 7 months (range: 1-32 months). The median OS was 15 months (range 10.73-19.27 months; 95 % CI) and the median local PFS was 4 months (range 3.03-4.97 months; 95 % CI). The ORR (best response, CR + PR) was 58 %. No major complications were seen in this study. Conclusion TARE is a viable option for liver cancer in all stages, but more so in the advanced stages. The use of angio-CT in TARE aids in the precise delivery of the particles to the tumour and avoids non-target embolisation.
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Affiliation(s)
- Abhiman Baloji
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara Chaluvashetty
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karamvir Chandel
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajender Kumar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Baljinder Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhagwant R. Mittal
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit S. Sandhu
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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2
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Premkumar M, Kajal K, Reddy KR, Izzy M, Kulkarni AV, Duseja AK, Sihag KB, Divyaveer S, Gupta A, Taneja S, De A, Verma N, Rathi S, Bhujade H, Chaluvashetty SB, Roy A, Kumar V, Siddhartha V, Singh V, Bahl A. Evaluation of terlipressin-related patient outcomes in hepatorenal syndrome-acute kidney injury using point-of-care echocardiography. Hepatology 2024; 79:1048-1064. [PMID: 37976391 DOI: 10.1097/hep.0000000000000691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 10/27/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND AIMS Treatment of hepatorenal syndrome-acute kidney injury (HRS-AKI), with terlipressin and albumin, provides survival benefits, but may be associated with cardiopulmonary complications. We analyzed the predictors of terlipressin response and mortality using point-of-care echocardiography (POC-Echo) and cardiac and renal biomarkers. APPROACH Between December 2021 and January 2023, patients with HRS-AKI were assessed with POC-Echo and lung ultrasound within 6 hours of admission, at the time of starting terlipressin (48 h), and at 72 hours. Volume expansion was done with 20% albumin, followed by terlipressin infusion. Clinical data, POC-Echo data, and serum biomarkers were prospectively collected. Cirrhotic cardiomyopathy (CCM) was defined per 2020 criteria. RESULTS One hundred and forty patients were enrolled (84% men, 59% alcohol-associated disease, mean MELD-Na 25±SD 5.6). A median daily dose of infused terlipressin was 4.3 (interquartile range: 3.9-4.6) mg/day; mean duration 6.4 ± SD 1.9 days; the complete response was in 62% and partial response in 11%. Overall mortality was 14% and 16% at 30 and 90 days, respectively. Cutoffs for prediction of terlipressin nonresponse were cardiac variables [ratio of early mitral inflow velocity and mitral annular early diastolic tissue doppler velocity > 12.5 (indicating increased left filling pressures, C-statistic: 0.774), tissue doppler mitral velocity < 7 cm/s (indicating impaired relaxation; C-statistic: 0.791), > 20.5% reduction in cardiac index at 72 hours (C-statistic: 0.885); p < 0.001] and pretreatment biomarkers (CysC > 2.2 mg/l, C-statistic: 0.640 and N-terminal proBNP > 350 pg/mL, C-statistic: 0.655; p <0.050). About 6% of all patients with HRS-AKI and 26% of patients with CCM had pulmonary edema. The presence of CCM (adjusted HR 1.9; CI: 1.8-4.5, p = 0.009) and terlipressin nonresponse (adjusted HR 5.2; CI: 2.2-12.2, p <0.001) were predictors of mortality independent of age, sex, obesity, DM-2, etiology, and baseline creatinine. CONCLUSIONS CCM and reduction in cardiac index, reliably predict terlipressin nonresponse. CCM is independently associated with poor survival in HRS-AKI.
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Affiliation(s)
- Madhumita Premkumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kamal Kajal
- Department of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Rajender Reddy
- Department of Medicine, Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Manhal Izzy
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, Tennessee, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ajay Kumar Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - K Bhupendra Sihag
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Divyaveer
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Akash Roy
- Department of Hepatology, Apollo Hospital, Kolkata, India
| | - Vishesh Kumar
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vuppada Siddhartha
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Department of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Singh B, Kundu R, Mitra S, Bhujade H, Sood A, Samanta J, Gupta V. Duodenal gastrointestinal stromal tumor masquerading as an uncinate process pancreatic neoplasm. Diagn Cytopathol 2024. [PMID: 38563443 DOI: 10.1002/dc.25315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/26/2024] [Indexed: 04/04/2024]
Affiliation(s)
- Brijdeep Singh
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayanta Samanta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Biswas D, Gupta P, Gupta N, Srinivasan R, Bhujade H. A sub-hepatic nodule in a young female: Chase the case. Cytopathology 2024. [PMID: 38494675 DOI: 10.1111/cyt.13374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 03/19/2024]
Abstract
Sertoli-Leydig cell tumours (SLCTs) are rare, mixed sex-cord stromal tumours composed of varying proportions of both Sertoli and Leydig cells, which account for <0.5% of all ovarian tumours. The cytomorphologic features of SLCTs are not well described in literature. Herein, we describe the cytomorphologic features of an SLCT at an uncommon metastatic site in a young female. Sertoli-Leydig cell tumours (SLCTs) are rare, mixed sex-cord stromal tumours composed of varying proportions of both Sertoli and Leydig cells, which account for <0.5% of all ovarian tumours. The cytomorphologic features of SLCTs are not well described in literature. Herein, we describe the cytomorphologic features of an SLCT at an uncommon metastatic site in a young female.
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Affiliation(s)
- Dipanwita Biswas
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Nalini Gupta
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecologic Pathology, PGIMER, Chandigarh, India
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Singh B, Kundu R, Sharma C, Khurana S, Bhujade H, Singla N, Rudramurthy SM. Opportunistic microsporidiosis unveiled by fine-needle aspiration cytology of cervical lymph node with literature review. Diagn Cytopathol 2024; 52:E63-E68. [PMID: 38059410 DOI: 10.1002/dc.25262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/20/2023] [Accepted: 11/24/2023] [Indexed: 12/08/2023]
Abstract
Microsporidia are highly specialized obligate intracellular organisms closely related to fungi, traditionally linked to diarrheal diseases in acquired immunodeficiency syndrome patients. Over the past two decades, an increasing incidence of extraintestinal infections affecting various organ systems, especially in immunocompromised individuals, has been observed. The report presents a unique case of lymph node microsporidiosis in a 38-year-old male, positive for human immunodeficiency virus, with coinfections of hepatitis B and C. Fine-needle aspiration cytology (FNAC) from cervical lymph node yielded pus-like, necrotic material with periodic acid-Schiff stained smear uncovering small round to oval spores on microscopy suspicious for microsporidia. Based on polymerase chain reaction and sequencing done with aspiration material, the causative agent was identified as Vittaforma corneae. This rare encounter highlights the significance of recognizing unique morphological characteristics of infectious organisms and employing appropriate ancillary techniques for precise identification. The case underscores the crucial role of FNAC in diagnosing opportunistic infections involving the lymph nodes and the growing significance of molecular tests for specific pathogen confirmation.
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Affiliation(s)
- Brijdeep Singh
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Chayan Sharma
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sumeeta Khurana
- Department of Medical Parasitology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neeraj Singla
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shivaprakash M Rudramurthy
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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6
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Kerkar A, Kundu R, Bhujade H, Singh H, Dey P. Metastasis of solitary fibrous tumor to the parotid gland diagnosed on aspiration cytology supplemented with immunocytochemistry. Diagn Cytopathol 2023; 51:E345-E350. [PMID: 37675766 DOI: 10.1002/dc.25222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/08/2023]
Abstract
Solitary fibrous tumor (SFT) can occur in varied anatomic locations, most commonly being the extremities-superficial and deep soft tissues, followed by retroperitoneum, visceral organs, and the bone. Head and neck region may harbor a few with a predilection for the orbit and sinonasal tract, oral cavity, and rarely the salivary glands. The parotid gland is most involved among all salivary glands. Overall, SFT in salivary glands is rare and mostly seen as a primary tumor. The occurrence of metastasis to the parotid gland is exceedingly uncommon. We present cytological findings of SFT, metastatic to the parotid gland in a young 31-year-old lady where the diagnosis was confirmed with the help of immunocytochemistry (ICC) on the cell block. The smears were highly cellular and showed predominantly discrete round to oval tumor cells with mild pleomorphism, coarse chromatin, inconspicuous nucleoli, and scanty cytoplasm. Mitosis and focal areas of necrosis were noted. Lymphoglandular bodies were absent ruling out a non-Hodgkin lymphoma. Features were of a poorly differentiated malignant tumor with differentials being sarcoma, myoepithelial carcinoma, and carcinoma ex-pleomorphic adenoma. A panel of ICC was done and positivity for signal transducer and activator of transcription 6 (STAT6) helped in clinching the correct diagnosis of SFT.
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Affiliation(s)
- Aadya Kerkar
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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7
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Kajal K, Premkumar M, Izzy M, Kulkarni AV, Duseja AK, Divyaveer S, Loganathan S, Sihag B, Gupta A, Bahl A, Rathi S, Taneja S, De A, Verma N, Sharma N, Kaur H, Zohmangaihi D, Kumar V, Bhujade H, Chaluvashetty SB, Kalra N. Cirrhotic cardiomyopathy influences clinical outcomes and enhances performance of conventional risk prediction models in acute-on-chronic liver failure with severe sepsis. Aliment Pharmacol Ther 2023; 58:903-919. [PMID: 37688403 DOI: 10.1111/apt.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/12/2023] [Accepted: 08/17/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Point-of-care echocardiography (POC-Echo) is an essential intensive care hemodynamic monitoring tool. AIMS To assess POC-Echo parameters [i.e., cardiac index (CI), systemic vascular resistance index (SVRI) and cirrhotic cardiomyopathy (CCM) markers] and serum biomarkers in predicting circulatory failure (need for vasopressors) and mortality in patients with acute-on-chronic liver failure (ACLF) having sepsis-induced hypotension. METHODS We performed serial POC-Echo within 6 hours (h) of presentation and subsequently at 24, 48 and 72 h in patients with ACLF and sepsis-induced hypotension admitted to our liver intensive care unit. Clinical data, POC-Echo data and serum biomarkers were collected prospectively. RESULTS We enrolled 120 patients [59% men, aged 49 ± 12 years, 56% alcohol-related disease and median MELDNa of 30 (27-32)], of whom 68 (56.6%) had circulatory failure, with overall mortality of 60%. CCM was present in 52.5%. The predictors of circulatory failure were CI (aHR -1.5; p = 0.021), N-terminal brain natriuretic peptide (aHR -1.1; p = 0.007) and CCM markers; e' septal mitral velocity (aHR -0.5; p = 0.039) and E/e' ratio (aHR -1.2; p = 0.045). Reduction in CI by 20% and SVRI by 15% at 72 h predicted mortality with a sensitivity of 84% and 72%, and specificity 76% and 65%, respectively (p < 0.001). The MELD-CCM model and CLIF-CCM model were computed as MELDNa + 1.815 × E/e' (septal) + 0.402 × e' (septal) and CLIF-C ACLF + 1.815 × E/e' (septal) + 0.402 × e' (septal), respectively, based on multivariable logistic regression. Both scores outperformed MELDNa (z-score = -2.073, p = 0.038) and CLIF-C ACLF score (z score = -2.683, p-value = 0.007), respectively, in predicting 90-day mortality. CONCLUSION POC-Echo measurements such as CCM markers (E/e' and e' velocity) and change in CI reliably predict circulatory failure and mortality in ACLF with severe sepsis. CCM markers significantly enhanced the CLIF-C ACLF and MELDNa predictive performance.
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Affiliation(s)
- Kamal Kajal
- Departments of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manhal Izzy
- Division of Gastroenterology, Hepatology, and Nutrition, Vanderbilt University, Nashville, Tennessee, USA
| | - Anand V Kulkarni
- Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India
| | - Ajay Kumar Duseja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Smita Divyaveer
- Departments of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sekar Loganathan
- Departments of Anesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhupendra Sihag
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ankur Gupta
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Bahl
- Departments of Cardiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahaj Rathi
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Navneet Sharma
- Departments of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harpreet Kaur
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepy Zohmangaihi
- Departments of Biochemistry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishesh Kumar
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Saini T, Kundu R, Bhujade H, Singh H. Primary leiomyosarcoma of the parotid gland: Aspiration cytology with emphasis on differential diagnosis. Cytopathology 2023; 34:607-610. [PMID: 37470366 DOI: 10.1111/cyt.13275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/21/2023]
Abstract
Most salivary gland neoplasms are of epithelial origin. Sarcomas of the parotid gland, including leiomyosarcoma, are exceedingly rare mesenchymal tumours. A definitive diagnosis of leiomyosarcoma is challenging on cytomorphology alone. We herein describe a case of a 41-year-old woman who presented with parotid gland swelling. The patient was previously diagnosed with leiomyosarcoma of the parotid gland on histopathology. Fine needle aspiration cytology was done from this recurrent swelling. Cytomorphology combined with cell block immunocytochemistry was fruitful in confirming the tumour recurrence. Primary and recurrent/metastatic leiomyosarcoma of the parotid gland is a rarity and cannot be distinguished on cytology. Such a distinction is based on the known history of prior malignancy, which was forthcoming in the present case, or after an exhaustive work-up. Pertinent clinical history and radiology provide leads for the cytopathologist. They must be sought so that immunocytochemistry can be applied judiciously and a precise/nearly precise cytological diagnosis rendered, as it guides patient management. The diagnosis is challenging on cytology as the spindle cell lesions of the parotid gland range from reactive to benign to malignant tumours.
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Affiliation(s)
- Tarunpreet Saini
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Sekar A, Jain S, Bakshi J, Rachagiri S, Bhujade H, Kumar R, Bal A. Disseminated Nasal subtype Extranodal NK/T-cell lymphoma and its diagnostic difficulties in antemortem biopsies. Autops Case Rep 2023; 13:e2023445. [PMID: 38034525 PMCID: PMC10688205 DOI: 10.4322/acr.2023.445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 08/11/2023] [Indexed: 12/02/2023]
Abstract
Extranodal NK/T- cell lymphoma (ENKTCL) is an aggressive lymphoma driven by Epstein-Barr virus (EBV) infection in genetically susceptible individuals. It was historically called a lethal midline granuloma. Due to the angio-destructive nature of ENKTCL, lymphoma cells are often accompanied and masked by necrosis and dense inflammation in the biopsy. Further, the biopsy may show vasculitis, which can mimic granulomatosis with polyangiitis. Due to these masquerades, ENKTCL is often misdiagnosed in the biopsy. Several biopsies may be required to establish the diagnosis. We describe the clinical course and autopsy findings of a young female who presented with a hard-palate ulcer. Antemortem biopsies failed to establish the diagnosis. The autopsy revealed an advanced nasal subtype of Extranodal NK/T-cell lymphoma with dissemination to the kidneys, adrenals, liver, spleen, and small intestine.
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Affiliation(s)
- Aravind Sekar
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Siddharth Jain
- All India Institute of Medical Sciences, Department of Medicine, New Delhi, India
| | - Jaimanti Bakshi
- Post Graduate Institute of Medical Education and Research, Department of Otolaryngology, Chandigarh, India
| | - Suneel Rachagiri
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
| | - Harish Bhujade
- Post Graduate Institute of Medical Education and Research, Department of Radiodiagnosis, Chandigarh, India
| | - Rajender Kumar
- Post Graduate Institute of Medical Education and Research, Department of Nuclear Medicine, Chandigarh, India
| | - Amanjit Bal
- Post Graduate Institute of Medical Education and Research, Department of Histopathology, Chandigarh, India
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10
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Rathi S, Kalantri A, Shastri A, Shree R, Mahesh KV, Taneja S, Chaluvasetty SB, Bhujade H, Verma N, Premkumar M, De A, Kalra N, Singh V, Duseja A. Endoscopic Ultrasound-Guided Transgastric Shunt Obliteration for Recurrent Hepatic Encephalopathy. Am J Gastroenterol 2023; 118:1895-1898. [PMID: 37589493 DOI: 10.14309/ajg.0000000000002477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/11/2023] [Indexed: 08/18/2023]
Abstract
INTRODUCTION Occlusion of spontaneous portosystemic shunts (SPSSs) in patients with cirrhosis may be required in recurrent or refractory hepatic encephalopathy. We describe a novel method for occlusion of SPSS using endoscopic ultrasound (EUS). METHODS EUS-guided transgastric shunt obliteration was performed by injecting glue and coils directly into SPSS. RESULTS EUS-guided transgastric shunt obliteration was performed for 7 patients in 9 sessions. Complete cessation of Doppler flow was achieved in 6/7 cases. Adequate clinical response was observed in 6/7 patients. No procedure-related severe adverse events were seen. DISCUSSION This novel technique is a potentially effective and efficient method for shunt obliteration.
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Affiliation(s)
- Sahaj Rathi
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amrita Kalantri
- Department of Radiology, Government Medical College and Hospital, Chandigarh, India
| | - Arpit Shastri
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ritu Shree
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Karthik Vinay Mahesh
- Department of Neurology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sunil Taneja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvasetty
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nipun Verma
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Madhumita Premkumar
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Arka De
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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11
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Choudhary S, Prabhakar N, Muthu V, Bhujade H, Sekar A, Debi U, Garg M. 'T2 Hypointense Rim Sign' on Chest MRI in a Patient of Pulmonary Mucormycosis. Mycopathologia 2023:10.1007/s11046-023-00729-x. [PMID: 37185791 DOI: 10.1007/s11046-023-00729-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Sonam Choudhary
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Aravind Sekar
- Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Uma Debi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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12
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Susngi T, Shah J, Bhujade H, Jearth V, Singh AK, Mandavdhare HS, Sharma V, Gupta R, Rana S, Dutta U. Deep Venous Thrombosis in Acute Pancreatitis Is Associated with High Mortality: A Prospective Study. Dig Dis Sci 2023; 68:988-994. [PMID: 35867193 DOI: 10.1007/s10620-022-07617-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/04/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND Incidence and risk factors for the development of extremity deep vein thrombosis (eDVT) in admitted patients of acute pancreatitis have been rarely explored. AIMS To identify the incidence of eDVT and to explore role of clinical scores for predicting eDVT in admitted patients of acute pancreatitis. METHODS We prospectively enrolled admitted patients of acute pancreatitis and performed a weekly eDVT screen for the duration of their admission. Well's score and Padua's score were also calculated weekly. The incidence of venous thrombosis (eDVT and splanchnic thrombosis based on contrast-enhanced CT scan abdomen) was noted, and the risk factors were determined using multivariate analysis. The correlation between Well's score, Padua's score, and development of DVT was calculated using Pearson's correlation. RESULTS Of the 102 patients of acute pancreatitis enrolled, 73.5% of patients had necrotizing pancreatitis. Total of 46 patients (45.1%) developed thrombosis: 43 patients had splanchnic vein thrombosis; 5 patients had eDVT; and 1 patient had pulmonary embolism. Patients with eDVT had higher BISAP score (2.6 ± 0.9 vs 1.7 ± 0.8; p = 0.039), requirement of mechanical ventilation (60% vs 8.2%; p = 0.008), and mortality (60% vs 12.4%; p = 0.022). Well's score of ≥ 2 had sensitivity and specificity of 80% and 96.9% for prediction of eDVT and it had better correlation with the development of eDVT compared to Pauda's score. CONCLUSION Incidence of DVT is 5% in patients with acute pancreatitis requiring admission. It is associated with higher disease severity and mortality. The Well's score is useful to predict the development of eDVT in routine clinical practice.
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Affiliation(s)
- Terence Susngi
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Jimil Shah
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vaneet Jearth
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Anupam K Singh
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harshal S Mandavdhare
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Surinder Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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13
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Bhatia H, Bhujade H, Dey P, Mavuduru R. Epididymo-orchitis Presenting as Bilateral Hydrocele in a Young Adult. Urology 2023:S0090-4295(23)00148-6. [PMID: 36804551 DOI: 10.1016/j.urology.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/11/2023] [Accepted: 02/01/2023] [Indexed: 02/17/2023]
Abstract
We present a case of young patient who presented with a progressive scrotal swelling and low-grade fever. An ultrasound of the scrotum revealed multiple small well-defined hypoechoic lesions in both testes with bulky epididymis and bilateral hydrocele. The final diagnosis was confirmed on cytology. The typical imaging findings may help to reach the diagnosis and to plan the further management in such cases.
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Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Pranab Dey
- Department of Cytology and Gynaecological Pathologies, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ravimohan Mavuduru
- Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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14
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Irodi A, Bhalla AS, Robinson Vimala L, Yadav T, Adithan S, Bhujade H, Sanghavi P, Kale A, Garg M, Jaykar David Livingstone YK, Das SK, H. GM, Sasidharan B, Thangakunam B, Pavamani S, Isiah R, Joel A, Bhat TA. Imaging Recommendations for Diagnosis, Staging, and Management of Lung Cancer. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
AbstractGlobally and in India, lung cancer is one of the leading malignancies in terms of incidence and mortality. Smoking and environmental pollution are the common risk factors for developing lung cancer. Traditionally, lung cancer is divided into small cell and nonsmall cell types, with nonsmall cell carcinomas including squamous cell carcinoma, adenocarcinoma, and large cell carcinoma.In this review article, we describe the imaging recommendations and findings in the diagnosis, staging, and management of lung cancer, including the imaging of treatment-related complications.
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Affiliation(s)
- Aparna Irodi
- Department of Radiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Ashu Seith Bhalla
- Department of Radiodiagnosis and Interventional Radiology, AIIMS, New Delhi, India
| | | | - Taruna Yadav
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences (AIIMS) Jodhpur, Rajasthan, India
| | - Subathra Adithan
- Department of Radiodiagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | - Parang Sanghavi
- Department of Radiology, Picture this by Jankharia, Mumbai, Maharashtra, India
| | - Alok Kale
- Radiology and Imaging Science Department, Apollo Main Hospital, Chennai, Tamil Nadu, India
| | - Mandeep Garg
- Department of Radiodiagnosis and Imaging, PGIMER, Chandigarh, India
| | | | | | - Geethi M. H.
- Division of Radiation Oncology, RCC, Thiruvananthapuram, Kerala, India
| | - Balukrishna Sasidharan
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Simon Pavamani
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | - Rajesh Isiah
- Department of Radiation Oncology, Ida B. Scudder Cancer Centre Christian Medical College, Vellore, Tamil Nadu, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Tameem Ahmad Bhat
- Radiology, Shri Mata Vaishno Devi Narayana Superspeciality Hospital, Jammu, India
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15
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Shastri M, Kundu R, Krishnaraju VS, Bhujade H, Bhandari RM, Sood A. Cystic hepatic metastases in treatment naïve neuroendocrine tumor: Cytomorphology clubbed with cell block immunocytochemistry clinches the diagnosis. Diagn Cytopathol 2023; 51:E10-E13. [PMID: 36029215 DOI: 10.1002/dc.25047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 12/13/2022]
Abstract
Cystic hepatic lesions encompass a vast spectrum of infectious, non-neoplastic, and neoplastic entities. Most hepatic cysts are benign and asymptomatic, requiring no active intervention. However, symptomatic and malignant cysts need proper evaluation and specific treatment. An accurate preoperative diagnosis is pivotal for patient management. At times, these lesions may mimic, especially symptomatology and radiology, leading to a diagnostic ordeal. We herein present a case of a patient with cystic liver lesions in a treatment naïve neuroendocrine tumor that was a diagnostic dilemma on radiology. Low cellularity of cytology smears made the diagnosis challenging, and cell block immunocytochemistry finally clinched the diagnosis. A timely diagnosis provided on cytology fuelled further work-up, the discovery of primary tumor, and initiation of appropriate therapy.
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Affiliation(s)
- Malvika Shastri
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology & Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Harish Bhujade
- Department of Radiodiagnosis & Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rajan Mani Bhandari
- Department of Radiodiagnosis & Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashwani Sood
- Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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16
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Subramanian PC, Chidanandaswamy N, Soundararajan R, Bhujade H, Prabhakar N. An Aberrant Right Subclavian Artery-Esophageal Fistula-A Fatal Complication of a Common Anomaly: A Case Report and Review of Literature. Indian J Radiol Imaging 2022; 33:117-120. [PMID: 36855716 PMCID: PMC9968551 DOI: 10.1055/s-0042-1758194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
An aberrant right subclavian artery (ARSA), also called as arteria lusoria, is one of the most common aortic arch anomalies. ARSA-esophageal fistula is a rare, life-threatening complication, with only 37 cases reported in literature. We describe a case of a young girl who developed acute episode of massive hematemesis after the recovery from novel coronavirus disease 2019 (COVID-19) pneumonia. Computed tomography (CT) angiography showed ARSA with retroesophageal course and active contrast leak in esophagus. Digital subtraction angiography confirmed the site of active contrast extravasation from the ARSA. However, the patient succumbed to hypovolemic shock even before the endovascular or surgical interventions could be done.
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Affiliation(s)
- Pavithra C. Subramanian
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Chidanandaswamy
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India,Address for correspondence Harish Bhujade, MD, FVIR Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and ResearchChandigarh 160012India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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17
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Bhujade H, Mishra S, Butt AS, Kamani L, Premkumar M. Work-up for Incidentally Detected NAFLD: How Far is It Worth? Euroasian J Hepatogastroenterol 2022; 12:S26-S36. [DOI: 10.5005/jp-journals-10018-1364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Saini T, Kundu R, Bhujade H. Extensive spindling in medullary thyroid carcinoma posing a diagnostic challenge: A case report. Diagn Cytopathol 2022; 50:E339-E343. [PMID: 35880247 DOI: 10.1002/dc.25020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 07/16/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022]
Abstract
Medullary thyroid carcinoma is a neuroendocrine tumor derived from parafollicular or 'C' cells with sporadic and familial forms. Fine needle aspiration cytology is a quick way to establish the diagnosis. Sometimes a usual tumor may show prominent spindling on cytomorphology due to sampling issues, which poses a diagnostic challenge. When encountering spindled tumor cells on cytology smears from the thyroid, differential diagnoses encompass many benign and malignant lesions. We present cytological findings of the usual type of medullary thyroid carcinoma showing extensive spindling on cytology smears, which was a diagnostic dilemma. An accurate diagnosis was reached with the judicious use of immunocytochemistry on the cell block. We also discuss the available literature, differential diagnoses, and how to troubleshoot.
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Affiliation(s)
- Tarunpreet Saini
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Kundu R, Iangngap E, Bhujade H, Dey P. Umbilical metastasis as an initial presentation of gastrointestinal stromal tumour diagnosed on aspiration cytology. Cytopathology 2022; 33:628-632. [PMID: 35689547 DOI: 10.1111/cyt.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/30/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022]
Abstract
Umbilical metastasis is a rare event, with a majority being adenocarcinomas. Metastatic squamous cell carcinoma, small cell carcinoma, lymphoma, melanoma, and rarely malignant mesenchymal tumours like leiomyosarcoma can occur as umbilical nodules. These often emerge during a known malignancy, but once in a while they may be an initial presentation of an undetected tumour. An extensive literature search failed to reveal a case of gastrointestinal stromal tumour (GIST) with umbilical metastasis as an initial presentation. We believe that this is an exceptional phenomenon. The diagnosis may easily be missed considering the rarity of this occurrence. A history of primary diagnosis of GIST, when available, is helpful. Here we present cytological findings of metastatic GIST presenting as an umbilical lump, where the diagnosis was reached with the help of limited immunocytochemistry. A timely diagnosis is valuable for locating the primary and initiating surgical management, which may have survival benefits for the patient.
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Affiliation(s)
- Reetu Kundu
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Elgiva Iangngap
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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20
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Rana SS, Shah J, Bhujade H, Gorsi U, Kang M, Gupta R. Prevention of Serious Complications during Endoscopic Ultrasound-Guided Biliary Drainage: A Case-Based Technical Review. Journal of Digestive Endoscopy 2022. [DOI: 10.1055/s-0042-1743519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
AbstractEndoscopic ultrasound-guided biliary drainage (EUS-BD) has a potential risk of clinically significant adverse events including fatal complications. Learning from complications improves the results from interventional procedures especially the high-risk procedure like EUS-BD. The various complications that have been reported following EUS-BD include bile leak, bleeding, cholangitis, peritonitis, stent migration both internal and external as well as in the peritoneal cavity and fatal perforations. In this technical review, we discuss technical strategies to prevent serious adverse events during EUS-BD using a case based approach.
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Affiliation(s)
- Surinder Singh Rana
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | | | - Harish Bhujade
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rajesh Gupta
- Department of Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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21
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Bhujade H, Baloji A. Myiasis of a Percutaneous Biliary Drainage Site. J Vasc Interv Radiol 2022; 33:476. [DOI: 10.1016/j.jvir.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/04/2021] [Indexed: 10/18/2022] Open
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22
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Choudhary SR, Bhujade H, Gupta P, Singh H, Kalra N, Kang M. A Challenging Case of Postcholecystectomy Pseudoaneurysm at an Uncommon Location. Journal of Clinical Interventional Radiology ISVIR 2022. [DOI: 10.1055/s-0042-1742728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractHepatic artery pseudoaneurysm in postcholecystectomy choleduodenal fistula is an extremely rare but clinically significant complication. A 52-year-old male presented with hematemesis and melena several weeks after open cholecystectomy for complicated gallstone disease. Upper gastrointestinal endoscopy revealed bleeding from the choledochoduodenal fistula site. On computed tomography angiography, a small right hepatic artery pseudoaneurysm close to fistula site was identified. Endovascular embolization failed due to nonopacification of the proximal right hepatic artery. Endoscopic ultrasound-guided embolization was also unsuccessful due to the small size of the aneurysm and inadequate visualization. Following this, percutaneous n-butyl cyanoacrylate glue was successfully injected into the pseudoaneurysm. The patient recovered and was planned for hepaticojejunostomy to restore biliary continuity.
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Affiliation(s)
- Shayeri Roy Choudhary
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harjeet Singh
- Surgical Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Mandeep Kang
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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23
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Pruthi H, Bhujade H, Kundu R, Gy S. Bilateral renal metastases from extraskeletal mesenchymal chondrosarcoma of thigh. BMJ Case Rep 2022; 15:e246375. [PMID: 34996769 PMCID: PMC8744114 DOI: 10.1136/bcr-2021-246375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/04/2022] Open
Abstract
Mesenchymal chondrosarcoma (MC) is a rare cartilaginous tumour that occurs in the extraskeletal locations in about one-third of cases. It is aggressive in behaviour and may involve the lower extremities, central nervous system or spine. Mesenchymal tumours are known for distant metastasis; however, metastasis to bilateral kidneys after treatment has not been reported earlier. We present a case of a soft-tissue intramuscular MC of the thigh in a 38-year-old patient which had been surgically excised after neoadjuvant chemotherapy. The patient presented with bilateral dense calcified renal masses after 6 years, which were cytologically proven as MC metastases. In the evaluation of bilateral calcified renal masses in patients with a history of MC, metastasis should be considered.
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Affiliation(s)
- Himanshu Pruthi
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Reetu Kundu
- Department of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Srinivasa Gy
- Radiotherapy and Oncology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Pruthi H, Muthu V, Bhujade H, Sharma A, Baloji A, Ratnakara RG, Bal A, Singh H, Sandhu MS, Negi S, Chakrabarti A, Singhal M. Pulmonary Artery Pseudoaneurysm in COVID-19-Associated Pulmonary Mucormycosis: Case Series and Systematic Review of the Literature. Mycopathologia 2021; 187:31-37. [PMID: 34936060 PMCID: PMC8692820 DOI: 10.1007/s11046-021-00610-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
Literature on COVID-19-associated pulmonary mucormycosis (CAPM) is sparse. Pulmonary artery pseudoaneurysm (PAP) is an uncommon complication of pulmonary mucormycosis (PM), and rarely reported in CAPM. Herein, we report five cases of CAPM with PAP managed at our center and perform a systematic review of the literature. We diagnosed PM in those with clinico-radiological suspicion and confirmed it by microbiology or histopathology. We encountered five cases of CAPM with PAP (size ranged from 1 × 0.8 cm to ~ 4.9 × 4.8 cm). All subjects had diabetes and were aged 55–62 years (75% men). In two cases, COVID-19 and mucormycosis were diagnosed simultaneously, while in three others, COVID-19 preceded PM. One subject who underwent surgery survived, while all others died (80% mortality). From our systematic review, we identified one additional case of CAPM with PAP in a transplant recipient. CAPM with PAP is rare with high mortality. Early diagnosis and multimodality management are imperative to improve outcomes.
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Affiliation(s)
- Himanshu Pruthi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Valliappan Muthu
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Arun Sharma
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Abhiman Baloji
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Rao G Ratnakara
- Department of Pulmonary Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Amanjit Bal
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harkant Singh
- Department of Cardiothoracic Vascular Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India
| | - Sunder Negi
- Department of Cardiac Anesthesia, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Manphool Singhal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Sector-12, Chandigarh, 160012, India.
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Premkumar M, Bhujade H, Karki T, Chaluvashetty SB, Kaur H, Duseja AK, Singh V. New Portal Vein Thrombosis in Cirrhosis - is the Thrombophilia Exacerbated due to Vaccine or COVID-19? J Clin Exp Hepatol 2021; 12:1025-1028. [PMID: 34776709 PMCID: PMC8574119 DOI: 10.1016/j.jceh.2021.10.149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022] Open
Affiliation(s)
- Madhumita Premkumar
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tanka Karki
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sreedhara B Chaluvashetty
- Departments of Radiodiagnosis and Interventional Radiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harmanpreet Kaur
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajay K Duseja
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Departments of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Bhatia H, Sinha A, Bhujade H, Vaiphei K, Singh V. Neuroendocrine tumour of the gallbladder. Lancet Oncol 2021; 22:e377. [PMID: 34339657 DOI: 10.1016/s1470-2045(21)00198-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Kim Vaiphei
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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Kumar P, Gupta P, Priyaranjan P, Rastogi P, Bhujade H, Rajwanshi A. An adolescent with an abdominal mass. Cytopathology 2021; 31:355-358. [PMID: 32242996 DOI: 10.1111/cyt.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Pankaj Kumar
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Parikshaa Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prashant Priyaranjan
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pulkit Rastogi
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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28
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Kajal K, Premkumar M, Chaluvashetty SB, Bhujade H, Kulkarni AV. Point-of-Care Thoracic Ultrasonography in Patients With Cirrhosis and Liver Failure. Cureus 2021; 13:e15559. [PMID: 34277182 PMCID: PMC8271278 DOI: 10.7759/cureus.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2021] [Indexed: 11/06/2022] Open
Abstract
Point-of-care ultrasonography (POCUS) helps determine liver-related pathologies like an abscess, portal vein or hepatic vein thromboses, presence of ascites, site for pleural or ascitic paracentesis, and guiding biopsies. POCUS is revolutionizing the management of critically ill patients presenting with pneumonia, acute respiratory distress syndrome, acute-on-chronic liver failure, and in the emergency. The objectives of thoracic ultrasonography (TUS) are to aid the clinician in differentiating between pneumonia, effusions, interstitial edema and collections, and in estimating the volume status of patients with liver disease using inferior vena cava dynamic indices. The use of POCUS in patients with cirrhosis has since evolved. It is now widely used to help diagnose volume status, left ventricular diastolic dysfunction, myocardial infarction, and right ventricular dilation due to pulmonary embolism and to determine the causes for weaning failures such as effusions, lung collapse, and pneumothorax. During the Coronavirus Disease 2019 (COVID-19) pandemic, moving patients for computed tomography can be difficult. Therefore, TUS is now essential in liver transplantation and intensive care practice to assess ventilatory pressures, cardiac function, and fluid management. This review indicates the current and optimized use of TUS, offers a practical guide on TUS in the liver intensive care unit (ICU), and presents a diagnostic pathway for determining lung and pleural pathology, resolution of respiratory failure, and aid weaning from mechanical ventilation.
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Affiliation(s)
- Kamal Kajal
- Anesthesia and Critical Care, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | - Madhumita Premkumar
- Hepatology, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
| | | | - Harish Bhujade
- Radiodiagnosis, Post Graduate Institute of Medical Education & Research, Chandigarh, IND
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29
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Chaluvashetty SB, Kalra N, Bhujade H, Keshava SN, Mohan C. Interventional radiology and COVID-19: How to face the challenge? Indian J Radiol Imaging 2021; 31:S38-S44. [PMID: 33814760 PMCID: PMC7996698 DOI: 10.4103/ijri.ijri_351_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/29/2020] [Accepted: 07/06/2020] [Indexed: 11/23/2022] Open
Abstract
With the sudden outbreak of Coronavirus disease-19 (COVID-19) in China, and its rapid spread across the continents over a short period of time, healthcare workers are posed with the challenge of managing these patients as well protecting themselves from getting infected. Since interventional radiology deals with both elective and emergency services, wherein close patient contact is a norm, there is a substantial risk of acquiring and transmitting infection. Given the circumstances, it is imperative to develop broadly applicable guidelines to utilize the available resources in an optimal fashion and limit transmission of disease. This brief review deals with infection control measures within the Interventional Radiology department or section and possible recommendations that can be adopted at the institutional level.
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Affiliation(s)
- Sreedhara B Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Chander Mohan
- Department of Interventional Radiology, BLK Superspeciality Hospital, New Delhi, India
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Gupta P, Maralakunte M, Sagar S, Kumar-M P, Bhujade H, Chaluvashetty SB, Kalra N. Efficacy and safety of irreversible electroporation for malignant liver tumors: a systematic review and meta-analysis. Eur Radiol 2021; 31:6511-6521. [PMID: 33638687 DOI: 10.1007/s00330-021-07742-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 12/26/2020] [Accepted: 02/03/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE The data regarding overall survival (OS) and progression-free survival (PFS) following irreversible electroporation (IRE) is scarce. We performed a systematic review of the safety and efficacy of IRE for liver malignancies. METHODS Searches of MEDLINE, EMBASE, and SCOPUS databases were performed through September 1, 2019. Studies reporting the survival data (OS and PFS) and complications (graded according to the Society of interventional Radiology classification) were included. A generalized linear mixed method with a random-effects model was used for assessing pooled incidence rates and corresponding 95% confidence intervals (CIs). RESULTS A total of 25 studies (n = 776, 15 prospective, 10 retrospective) were included. Metastasis, hepatocellular carcinoma, and cholangiocarcinoma were present in 354, 285, and 100 patients, respectively. The pooled OS at 6, 12, 24, and 36 months was 93.28% (95% CI: 63.23-99.12, I2= 67%), 81.29% (95% CI: 69.80-89.22, I2 = 73%), 61.47% (95% CI: 52.81-69.46, I2 = 0%), and 40.88% (95% CI: 28.43-54.61, I2 = 64%), respectively. The pooled PFS at 6, 12, and 24 months was 79.72% (95% CI: 67.88-87.97, I2 = 70%), 64.19% (95% CI: 56.68-71.06, I2 = 57%), 49.05% (95% CI: 11.47-87.73, I2 = 96%), respectively. Overall complication rate was 23.7%. Major complications (grade C-F) occurred in 6.9% patients. CONCLUSION IRE is associated with favorable OS and PFS. Although the overall complication rate is high, most complications are graded as minor. KEY POINTS • The pooled OS and PFS at 6, 12, and 24 months for all the tumor types was 93.28% and 79.72%, 81.29% and 64.19%, and 61.47% and 49.05%, respectively. • HCC was associated with a better OS at 12 and 36 months. • The overall complication rate was 23.7%, with major complications (SIR grade C-F) comprising 6.9%.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Muniraju Maralakunte
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sathya Sagar
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sreedhara B Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Gupta P, Maralakunte M, Kumar-M P, Chandel K, Chaluvashetty SB, Bhujade H, Kalra N, Sandhu MS. Overall survival and local recurrence following RFA, MWA, and cryoablation of very early and early HCC: a systematic review and Bayesian network meta-analysis. Eur Radiol 2021; 31:5400-5408. [PMID: 33439319 DOI: 10.1007/s00330-020-07610-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/17/2020] [Accepted: 12/04/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To compare overall survival (OS) and local recurrence (LR) following radiofrequency ablation (RFA), microwave ablation (MWA), and cryoablation (CA) for very early and early hepatocellular carcinoma (HCC). METHODS This systematic review was performed according to the PRISMA guidelines. MEDLINE, Embase, and Cochrane databases were searched. Randomized controlled trials (RCTs) and observational studies were included. OS and LR at 1 year and 3 years were assessed. OS was reported as hazard ratio (HR) with 95% credible intervals (CrI) and LR as relative risk (RR) with 95% CrI, to summarize effect of each comparison. RESULTS Nineteen studies (3043 patients), including six RCTs and 13 observational studies, met inclusion criteria. For OS at 1 year, as compared to RFA, CA had HR of 0.81 (95% CrI: 0.43-1.51), and MWA had HR of 1.01 (95% CrI: 0.71-1.43). For OS at 3 years, as compared to RFA, CA had HR of 0.90 (95% CrI: 0.48-1.64) and MWA had HR of 1.07 (95% CrI: 0.73-1.50). For LR at 1 year, CA and MWA had RR of 0.75 (95% CrI: 0.45-1.24) and 0.93 (95% CrI: 0.78-1.14), respectively, as compared to RFA. For LR at 3 years, CA and MWA had RR of 0.96 (0.74-1.23) and 0.98 (0.87-1.09), respectively, as compared to RFA. Overall, none of the comparisons was statistically significant. Age of patients and tumor size did not influence treatment effect. CONCLUSIONS RFA, MWA, and CA are equally effective for locoregional treatment of very early and early HCC. KEY POINTS • There is no significant difference in the OS and LR (at 1 year and 3 years) following ablation of very early and early HCC with RFA, MWA, and CA. • There was no effect of tumor size on the treatment efficacy. • More RCTs comparing CA with RFA and MWA should be performed.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Muniraju Maralakunte
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Karamvir Chandel
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Sreedhara B Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Kalra N, Gupta P, Jugpal T, Naik SS, Gorsi U, Chaluvashetty SB, Bhujade H, Duseja A, Singh V, Dhiman RK, Sandhu MS. Percutaneous Cryoablation of Liver Tumors: Initial Experience from a Tertiary Care Center in India. J Clin Exp Hepatol 2021; 11:305-311. [PMID: 33994713 PMCID: PMC8103339 DOI: 10.1016/j.jceh.2020.10.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/12/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Percutaneous ablation is an important part of management strategy for liver tumors. While radiofrequency ablation and microwave ablation are the most widely used ablative techniques, cryoablation (CA) has several technical advantages but has been underused till recently. In this study, we report the initial experience with percutaneous CA of liver tumors. METHODS This was a retrospective evaluation of consecutive patients with liver tumors who underwent percutaneous CA between October 2018 and August 2019. The ablation procedures were performed under combined ultrasound and computed tomography guidance using argon-helium-based CA systems. The baseline tumor characteristics (including size and location), Barcelona Clinic Liver Cancer stage, and Child-Pugh score were recorded. Each patient underwent a follow-up after 1 month and at 3 months subsequently. Technical success, complete response, local tumor progression, and overall survival were evaluated. RESULTS Nine patients (mean age, 62.4 years, median age, 66 years, five men and four women) with 10 liver tumors (mean size, 2.22 cm) underwent CA. Seven (77.8%) patients had hepatocellular carcinoma (HCC), and 2 patients had solitary liver metastasis. One patient with HCC had two lesions, while the rest had only one lesion. Of the two metastatic lesions, one was from carcinoma of the cervix and the other was from jejunal neuroendocrine tumor. Five tumors were located adjacent to the gallbladder, two lesions were adjacent to the right portal vein, two lesions were subcapsular, and one lesion was adjacent to the stomach. Technical success was achieved in all the patients. Complete response was achieved in 7 (77.8%) patients. The median follow-up period was 7 months (range, 3-12 months). There was no local tumor progression and no death during the follow-up period. No procedure-related complication was seen. CONCLUSION Percutaneous CA of hepatic tumors is technically feasible and is a safe and effective ablative technique.
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Affiliation(s)
- Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India,Corresponding author. Dr. Naveen Kalra, Professor, Department of Radiodiagnosis, PGIMER, Chandigarh, India. Tel.: 9855426320.
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Tejeshwar Jugpal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shailendra S. Naik
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sreedhara B. Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Radha K. Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manavjit S. Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kalra N, Gupta P, Gorsi U, Bhujade H, Chaluvashetty SB, Duseja A, Singh V, Dhiman RK, Chawla YK, Khandelwal N. Irreversible Electroporation for Unresectable Hepatocellular Carcinoma: Initial Experience. Cardiovasc Intervent Radiol 2019; 42:584-590. [PMID: 30697637 DOI: 10.1007/s00270-019-02164-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 01/07/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of irreversible electroporation (IRE) in the treatment of unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS A retrospective study was conducted from September 2014 to June 2017. A total of 21 HCCs in 21 patients with cirrhosis were treated with IRE. There were eight subcapsular or exophytic, ten perivascular and three peribiliary tumors. The median tumor size was 26 mm (range 14-40 mm). The technical success of the procedure was recorded. Median follow-up, median time to local recurrence, median local tumor progression-free survival (PFS) and complications were recorded. RESULTS Technical success was achieved in all the patients. The median follow-up was 10 months (range 2-30 months). The median time to local recurrence and local tumor PFS were 4 months (range 3-4 months) and 7 months (range 3-30 months), respectively. The tumor-related factor that was significantly associated with local PFS was the size. Maximum tumor diameter < 25 mm was significantly associated with local tumor PFS (p = 0.045). Other parameters including tumor location, segmental portal vein thrombosis, baseline alpha-fetoprotein level and underlying etiology did not affect local tumor PFS. Complications were noted in nine patients and were classified as grades 1 and 2. No procedure-related mortality was encountered. CONCLUSION IRE is an effective treatment for ablation of small HCCs. Larger prospective studies with strict selection criteria will establish the safety and efficacy of IRE in the treatment of unresectable HCC in patients who cannot undergo thermal ablation.
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Affiliation(s)
- Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Pankaj Gupta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ujjwal Gorsi
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Harish Bhujade
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Shreedhara B Chaluvashetty
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ajay Duseja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Virendra Singh
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Radha K Dhiman
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Yogesh K Chawla
- Department of Hepatology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Niranjan Khandelwal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Kalra N, Gupta P, Bhujade H, Gorsi U, Chawla Y, Khandelwal N. 3:54 PM Abstract No. 177 Irreversible electroporation for unresectable hepatocellular carcinoma: initial experience. J Vasc Interv Radiol 2018. [DOI: 10.1016/j.jvir.2018.01.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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