Abstract: Paragangliomas are extra-adrenal neuroendocrine tumors of the paraganglia arising from multiple sites including the retroperitoneum. Primary hepatic paragangliomas originating from the liver parenchyma are rare. We present a retroperitoneal paraganglioma presenting as a hepatic mass and management using robotic resection. A 62-year-old man with history of hypertension who was found to have elevated liver enzymes on routine physical laboratory tests thus undergoing a right upper quadrant ultrasound (RUQ US) which revealed a mass in the lateral segment of the liver. Computer tomography guided percutaneous liver biopsy was obtained which pathologic analysis consistent with a paraganglioma. Given the rarity of a primary hepatic paraganglioma, evaluation of other primary sites was undertaken and he was referred to our facility Colonoscopy, galium-68 (68Ga) dotatate whole body positron emission tomography (PET) and computer tomography (CT) of chest, abdomen and pelvis did not demonstrate other possible primary sites. During robotic-assisted resection of this supposed hepatic mass, it was found to be arising from the retroperitoneum near the crus with limited hepatic segment 2 capsular invasion, parasitic inflow vasculature to the tumor from the liver and outflow into the inferior vena cava (IVC). Pathology results were congruent with preoperative biopsy favoring paraganglioma. The robotic system is a versatile platform that allowed for safe, minimally invasive resection of the large retroperitoneal paraganglioma.
Epithelial ovarian cancer (EOC) has poor prognosis and rapid recurrence because of widespread dissemination of peritoneal metastases at diagnosis. Multiple pathways contribute to the aggressiveness of ovarian cancer, including hypoxic signaling mechanisms. In this study, we have determined that the hypoxia-inducible histone demethylase KDM4B is expressed in ∼60% of EOC tumors assayed, including primary and matched metastatic tumors. Expression of KDM4B in tumors is positively correlated with expression of the tumor hypoxia marker CA-IX, and is robustly induced in EOC cell lines exposed to hypoxia. KDM4B regulates expression of metastatic genes and pathways, and loss of KDM4B increases H3K9 trimethylation at the promoters of target genes like LOXL2, LCN2 and PDGFB. Suppressing KDM4B inhibits ovarian cancer cell invasion, migration and spheroid formation in vitro. KDM4B also regulates seeding and growth of peritoneal tumors in vivo, where its expression corresponds to hypoxic regions. This is the first demonstration that a Jumonji-domain histone demethylase regulates cellular processes required for peritoneal dissemination of cancer cells, one of the predominant factors affecting prognosis of EOC. The pathways regulated by KDM4B may present novel opportunities to develop combinatorial therapies to improve existing therapies for EOC patients.
Abstract Optimal breast care requires a multidisciplinary and integrated approach, including appropriate processes and communication between the radiology and pathology departments. It is important for breast radiologists to have an understanding of the important events that occur between the time a percutaneous biopsy sample is obtained and the point at which the final pathology report is issued. This article reviews the essential processes from breast biopsy through to pathology diagnosis, including the general pathology workflow, tissue preparation, immunohistochemical staining, and pathologic reporting. Upon completion of this educational article, participants will have gained an understanding of the essential steps in the pathology workflow. This article will also highlight the important clinical information a radiologist should provide to the pathologist to ensure the most accurate and clinically relevant diagnosis. This clinical information includes the BI-RADS assessment category, the type of imaging finding that was targeted for biopsy (particularly when there are calcifications), the location of the targeted lesion relative to other findings, and other pertinent patient history.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of T-cell lymphoma that arises in the setting of textured breast implants. In this case report, a 69-year-old woman with a remote history of right-sided invasive lobular carcinoma status post right mastectomy and bilateral breast reconstruction presents with spontaneous right breast swelling and pain, suspicious for implant rupture. Diagnostic MRI revealed a peri-implant fluid collection in the right breast and focal nonmass enhancement in the left breast. The patient was ultimately diagnosed with right-sided BIA-ALCL and left-sided invasive lobular carcinoma. Although intravenous gadolinium contrast is not needed to assess implant integrity, it can be used to evaluate for malignancy when the patient is at an increased risk for developing breast cancer. In this case, the use of contrast revealed the rare instance of a synchronous contralateral invasive lobular carcinoma. Despite the rarity of BIA-ALCL with an estimated incidence of 1:30,000 in women with textured implants, it is essential that radiologists include this entity in the differential in the appropriate clinical setting as surgical resection is curative if performed before the disease has spread.
