OBJECTIVE: We aimed to describe radiologic signs and time-course of imatinib-associated fluid retention (FR) in patients with gastrointestinal stromal tumor (GIST), and its implications for management. MATERIALS AND METHODS: In this Institutional Review Board-approved, retrospective study of 403 patients with GIST treated with imatinib, 15 patients with imaging findings of FR were identified by screening radiology reports, followed by manual confirmation. Subcutaneous edema, ascites, pleural effusion, and pericardial effusion were graded on a four-point scale on CT scans; total score was the sum of these four scores. RESULTS: The most common radiologic sign of FR was subcutaneous edema (15/15, 100%), followed by ascites (12/15, 80%), pleural effusion (11/15, 73%), and pericardial effusion (6/15, 40%) at the time of maximum FR. Two distinct types of FR were observed: 1) acute/progressive FR, characterized by acute aggravation of FR and rapid improvement after management, 2) intermittent/steady FR, characterized by occasional or persistent mild FR. Acute/progressive FR always occurred early after drug initiation/dose escalation (median 1.9 month, range 0.3-4.0 months), while intermittent/steady FR occurred at any time. Compared to intermittent/steady FR, acute/progressive FR was severe (median score, 5 vs. 2.5, p = 0.002), and often required drug-cessation/dose-reduction. CONCLUSION: Two distinct types (acute/progressive and intermittent/steady FR) of imatinib-associated FR are observed and each type requires different management.
Adult ; Aged ; Aged, 80 and over ; Antineoplastic Agents/*adverse effects/therapeutic use ; Ascites/pathology/radiography ; Benzamides/*adverse effects/therapeutic use ; Echocardiography/methods ; Edema/pathology/radiography ; Female ; Gastrointestinal Stromal Tumors/drug therapy/pathology/*radiography ; Gastrointestinal Tract/pathology/*radiography ; Heart Failure/radiography ; Humans ; Male ; Middle Aged ; Molecular Targeted Therapy/*adverse effects ; Pericardial Effusion/pathology/radiography ; Peritoneal Neoplasms/diagnosis/radiography/secondary ; Piperazines/*adverse effects/therapeutic use ; Pleural Effusion/pathology/radiography ; Pyrimidines/*adverse effects/therapeutic use ; Radiology ; Retrospective Studies ; Tomography, X-Ray Computed

No abstract available.
Coronary Angiography ; Diagnosis, Differential ; Electrocardiography ; Heart Neoplasms/*secondary/therapy ; Humans ; Lung Neoplasms/*pathology/therapy ; Male ; Myocardial Infarction/*diagnosis ; Neoplasm Invasiveness ; *Neoplasm Recurrence, Local ; Predictive Value of Tests ; Tomography, X-Ray Computed

Inferior vena caval (IVC) tumor thrombus, majorly originated from intravenous leiomyomatosis (IVL) and renal or hepatic carcinoma, can extend into right cardiac cavities. Complete tumor resection, supported by cardiopulmonary bypass (CPB), has been proved to be the most effective treatment but also to be dramatically challenging. Randomized clinical trials of the surgical treatment for IVC tumor with cardiac extension are very limited due to the disease rarity, whereas publications on IVC tumor surgery are predominately confined to case report. So far, no clinical research or review, focused on intraoperative anesthesia management for surgical resection of IVC tumor with cardiac extension, has been identified; even anesthesia-targeted case report can not be found. In this article, we briefly introduce the disease characteristic and related surgical procedure and offer some suggestions upon the anesthesia management based on our own clinical experiences.
Anesthesia ; Heart Neoplasms ; secondary ; Humans ; Kidney Neoplasms ; pathology ; Liver Neoplasms ; pathology ; Thrombosis ; pathology ; Vena Cava, Inferior

The mechanism of chronic pain is very complicated. Memory, pain, and opioid dependence appear to share common mechanism, including synaptic plasticity, and anatomical structures. A 48-yr-old woman with severe pain caused by bone metastasis of breast cancer received epidural block. After local anesthetics were injected, she had a seizure and then went into cardiac arrest. Following cardiopulmonary resuscitation, her cardiac rhythm returned to normal, but her memory had disappeared. Also, her excruciating pain and opioid dependence had disappeared. This complication, although uncommon, gives us a lot to think about a role of memory for chronic pain and opioid dependence.
Amnesia/*diagnosis ; Anesthesia, Local/adverse effects ; Bone Neoplasms/drug therapy/radiotherapy/secondary ; Breast Neoplasms/drug therapy/pathology/radiotherapy ; *Cardiopulmonary Resuscitation ; Electroencephalography ; Female ; Heart Arrest/etiology ; Humans ; Magnetic Resonance Imaging ; Mepivacaine/adverse effects ; Middle Aged ; *Pain Management ; Seizures/etiology ; Tomography, X-Ray Computed

A patient presented with a large pericardial tumor of uncertain etiology. Five years earlier, she had been treated for myxoid liposarcoma of the thigh. For pre-surgical evaluation, conventional radiography, positron emission tomography/computed tomography (PET/CT), magnetic resonance imaging (MRI), CT of the heart, transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed. The final histopathologic diagnosis was metastatic liposarcoma. Each of the imaging modalities used had advantages and disadvantages, and their coordination was necessary for optimal evaluation.
Echocardiography, Transesophageal ; Female ; Heart Neoplasms ; diagnosis ; secondary ; Humans ; Liposarcoma ; diagnosis ; secondary ; Middle Aged ; Multidetector Computed Tomography ; Multimodal Imaging ; Pericardium ; pathology ; Positron-Emission Tomography ; Tomography, X-Ray Computed

An osteosarcoma of cardiac origin is extremely rare, and a comprehensive description of MR imaging (MRI) findings of cardiac osteosarcoma and its metastasis in the femur have not been reported in the literature. We present a case of cardiac osteosarcoma in a 47-year-old woman and its metastasis to the femur, focusing on the description of MRI findings of the cardiac and metastatic bony osteosarcoma with a histopathologic correlation.
Female ; Femoral Neoplasms/pathology/*secondary ; Heart Neoplasms/*diagnosis/pathology ; Humans ; *Magnetic Resonance Imaging ; Middle Aged ; Osteosarcoma/*diagnosis/pathology/*secondary

Adult ; Desmin ; metabolism ; Diagnosis, Differential ; Female ; Heart Neoplasms ; pathology ; Humans ; Myxoma ; pathology ; Ovarian Neoplasms ; secondary ; surgery ; Pulmonary Veins ; Sarcoma ; diagnostic imaging ; metabolism ; pathology ; secondary ; surgery ; Tomography, X-Ray Computed ; Vascular Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Vimentin ; metabolism

Actins ; metabolism ; Female ; Heart Atria ; pathology ; Heart Neoplasms ; secondary ; surgery ; Humans ; Iliac Vein ; pathology ; surgery ; Leiomyomatosis ; metabolism ; pathology ; surgery ; Middle Aged ; Uterine Neoplasms ; metabolism ; pathology ; surgery ; Vascular Neoplasms ; metabolism ; pathology ; surgery ; Veins ; pathology ; surgery ; Vena Cava, Inferior ; pathology

Heart Neoplasms ; diagnostic imaging ; secondary ; surgery ; Heart Ventricles ; pathology ; Humans ; Lung Neoplasms ; pathology ; Male ; Middle Aged ; Radiography

Primary adrenocortical carcinoma (ACC) is a rare tumor and its usual sites of metastasis are the lung (71%), lymph node (68%), liver (42%), and bone (26%). However, intracaval invasion extending into the right atrium is very rare and spontaneous regression of tumor burden in adrenal carcinoma is also rare. We report a case of ACC with direct invasion of the inferior vena cava and right atrium. A 34-yr-old male patient presented with progressive dyspnea, weight loss, and poor oral intake over 3 months. Non-functioning ACC with direct invasion of the inferior vena cava and right atrium was confirmed by imaging, pathologic, and hormonal study. Chemo-radiotherapy was attempted. However, tumor burden was not changed, but rather toxic hepatitis and thrombocytopenia were developed. His subjective symptoms and general conditions were improved after 1 month of conservative management and the patient was discharged. During clinical follow-up, this tumor showed spontaneous regression.
Vena Cava, Inferior/*pathology ; Tomography, X-Ray Computed ; Remission Induction ; Neoplasm Metastasis ; Male ; Humans ; Heart Neoplasms/pathology/*secondary ; Heart Atria/*pathology ; Follow-Up Studies ; Echocardiography ; Biopsy ; Adult ; Adrenocortical Carcinoma/*diagnosis/*pathology ; Adrenal Cortex Neoplasms/*diagnosis/*pathology