Disease control with sunitinib in advanced intrahepatic cholangiocarcinoma resistant to gemcitabine-oxaliplatin chemotherapy

Advanced cholangiocarcinoma is associated with poor prognostic survival and has limited therapeutic options available at present. The importance of angiogenesis and expression of pro-angiogenic factors in intrahepatic forms of cholangiocarcinoma suggest that therapies targeting angiogenesis might be useful for the treatment of this disease. Here we report three cases of patients with advanced intrahepatic cholangiocarcinoma progressive after standard chemotherapy and treated with sunitinib 50 mg/d in 6-wk cycles of 4 wk on treatment followed by 2 wk off treatment(Schedule 4/2). In all three patients, sunitinib treatment was associated with a sustained disease control superior to 4 mo, patients achieving either a partial response or stable disease. A reduction in tumor size and density was observed in all cases, suggesting tumor necrosis as a result of sunitinib treatment in these patients. In addition, sunitinib was generally well tolerated and the occurrence of side effects was managed with standard medical interventions, as required. Our results suggest that sunitinib therapy maybe associated with favorable outcomes and tolerability in patients with advanced cholangiocarcinoma. Those observations contributed to launch a prospective phase Ⅱ multicenter trial investigating sunitinib in advanced intrahepatic cholangiocarcinoma(SUN-CK study; NCT01718327).

CT-Scan Findings of Hepatic Mass Patients Attending at a Tertiary Care Hospital in Bangladesh

Background: CT-scan is a very useful diagnostic tool for the detection of hepatic mass. Objective: The present study was undertaken to determine the CT-scan findings of benign and malignant hepatic mass patients. Methodology: This was a cross sectional study conducted in Radiology and Imaging Department at Mymensingh Medical College Hospital (MMCH), Mymensingh;Dhaka Medical College Hospital (DMCH), Dhaka and Banghabandhu Sheikh Mujib Medical University (BSMMU), Dhaka with the collaboration of Pathology Department of the same institute for histopathological confirmation. This study was carried out from January 2006 to December 2007 for a period of 2 years. The patients who were clinically suspected of having hepatic mass attended in the Radiology and Imaging Department in the above mentioned institutes were included as study population. All the CT-scan findings were recorded. Result: A total number of 50 patients were enrolled for this study. CT-scan was done among 40 males and 10 females with a mean age of 51.28 years old. Hypodensity was found in 17 (60.7%) and 18 (81.8%) cases in malignant and benign hepatic lesions respectively. Ill-defined margin was detected in 12 (42.9%) and 6 (27.3%) cases respectively. Calcification was present on 11 (39.3%) malignant lesion and 6 (27.3%) benign lesions. Pressure effect on biliary apparatus was found in 11 (39.3%) malignant lesions and 1 (4.5%) benign lesions (p < 0.05). Lymphadenopathy was found in 10 (35.7%) malignant lesions and 1 (4.5%) benign lesions (p < 0.05). Conclusion: In conclusion, CT-scan findings of malignant and benign hepatic mass show hypodensity with more contrast enhancement in malignant lesions with more calcification in malignant lesion;however, significant difference is detected in pressure effect on biliary apparatus and lymphadenopathy.

Xanthogranulomatous cholecystitis: What every radiologist should know

Xanthogranulomatous cholecystitis(XGC) is an uncommon variant of chronic cholecystitis characterized by xanthogranulomatous inflammation of the gallbladder. Intramural accumulation of lipid-laden macrophages and acute and chronic inflammatory cells is the hallmark of the disease. The xanthogranulomatous inflammation of the gallbladder can be very severe and can spill over to the neighbouring structures like liver, bowel and stomach resulting in dense adhesions, perforation, abscess formation, fistulous communication with adjacent bowel. Striking gallbladder wall thickening and dense local adhesions can be easily mistaken for carcinoma of the gallbladder, both intraoperatively as well as on preoperative imaging. Besides, cases of concomitant gallbladder carcinoma complicating XGC have also been reported in literature. So, we have done a review of the imaging features of XGC in order to better understand the entity as well as to increase the diagnostic yield of the disease summarizing the characteristic imaging findings and associations of XGC. Among other findings, presence of intramural hypodense nodules is considered diagnostic of this entity. However, in some cases, an imaging diagnosis of XGC is virtually impossible. Fine needle aspiration cytology might be handy in such patients. A preoperative counselling should include possibility of differential diagnosis of gallbladder cancer in not so characteristic cases.

Hypodense cerebellar tuberculoma on CT scan masquerading low grade glioma

We report a case of hypodense cerebellar tuberculoma in a 26 year old postpartum lady who presented with one episode of generalized tonic-clonic seizures and discuss the histopathology findings where on CT scan the lesion was suspected as low grade glioma.She was started on isoniazid,rifampicin,pyrazinamide,ethambutol and pyridoxine.She is asymptomatic and had no neurological deficits at follow up.