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Percutaneous biopsy can be used for tissue diagnosis of bladder tumors when cystoscopy with transurethral resection is not possible. The largest known case series includes 15 patients with no reported complications and good concordance with surgical pathology. However, concern remains regarding exposure of nonurothelial surfaces to tumor cells, as there are rare documented cases of tumor seeding along nephrostomy and biopsy tracts in upper tract urothelial carcinoma (UC). We present the first documented human case of bladder cancer involvement of the omentum and peritoneum along a biopsy tract and review the use of percutaneous access for upper and lower tract UC.

Background Surgery for colorectal cancer (CRC) is increasingly being performed via the minimally invasive route. However, reports of postoperative wound and port site seeding as well as peritoneal spillage have been worrisome. We investigated the risk of peritoneal spillage in patients undergoing laparoscopic surgery for CRC. Methods Cytology specimens were gained from the retrieval bag following intracorporeal resection and specimen retrieval using an endoscopic retrieval bag. Histopathologic examination of the cytology specimens was performed for the presence of malignant cells. Results Cytology specimens of 73 (34 female and 39 male) consecutive patients with a median age of 71 years were included for analysis. Advanced CRC in stages III and IV was present in 41% of the study population. Malignant cells were not found in any specimen. Conclusion Laparoscopic oncologic resection of colorectal cancer is not a risk factor for peritoneal spillage. Minimally invasive oncologic colorectal resection is safe without the increased risk of peritoneal carcinomatosis.

Purpose To quantify the occurrence of tumor seeding in computed tomography (CT)-guided high-dose-rate brachytherapy (HDRBT) and to identify potential risk factors. Materials and Methods CT-HDRBT is a minimally invasive therapeutic option for local ablation of unresectable tumors. The procedure involves CT-guided placement of an enclosed catheter and high-dose-rate brachytherapy using iridium-192. Transcutaneous puncture of a tumor with subsequent retraction of the applicator has the potential risk of tumor seeding along the puncture tract. A total of 1,765 consecutive CT-HDRBT procedures were performed at this center between 2006 and 2017 and were retrospectively analyzed. In addition, a distinction was made between whether the puncture tract was irradiated or not. Follow-up imaging datasets were evaluated for tumor seeding along the former puncture tracts. Descriptive and exploratory statistical analyses of the data were performed. Results Tumor seeding was observed in 25 cases (25 of 1,765 cases [1.5%]). A total of 0.008 cases occurred per person-age. Patient age was identified as a potential risk factor with an odds ratio of 1.046 (95% confidence interval, 1.003–1.091; P = .04). There were no differences between whether the puncture tract was irradiated or not (P = .552). Conclusions Tumor seeding along the puncture tract can occur in CT-HDRBT but is rare.

Transurethral resection of bladder tumor (TURBT) is still the gold standard for the diagnosis, treatment, and staging of nonmuscle invasive bladder cancer. En bloc resection of bladder tumor (EBRT) has been recently introduced to overcome the limitations of conventional TURBT. EBRT potential advantages are (1) complete resection, (2) a more precise and controlled resection (potentially fewer complications), (3) better sample orientation for histopathology analysis, (4) presence of detrusor in the specimen, and (5) less tumor seeding on normal urothelium by tumor fragments. This article aimed to present a step-by-step technique of conventional TURBT and EBRT with thulium laser support. We also aimed to provide tips and tricks for a correct surgical procedure and postoperative patient care. Finally, clinical outcomes of TURBT versus EBRT were reviewed.

Cases. Case 1 was a 58-year-old man who presented with an incidentally detected, slowly growing mass in the right hypochondrium area. An imaging study showed the mass arising from the 11th rib, with ill-defined margins and cortical destruction. Differential diagnoses included chondrosarcoma and metastatic malignant tumor. Open biopsy was associated with moderate bleeding (300 mL) despite small incision. Microscopic findings showed numerous irregular, dilated, and thin-walled vessels, consistent with the diagnosis of hemangioma of bone, and en bloc excision was performed with no surgical complication. Case 2 was a 49-year-old man who presented with an incidentally detected 4th rib mass with calcification on computed tomography scan. Chondrosarcoma was suspected according to imaging features. An open biopsy was considered to have a risk of tumor seeding because the tumor was located behind the scapula. En bloc excision of the tumor without biopsy was performed. The pathological findings were consistent with hemangioma of bone. Conclusion. We reported two cases of rare hemangioma arising from the rib, which mimicked chondrosarcoma. The preoperative diagnosis was challenging, both clinically and radiologically. Because biopsy for hemangioma of the rib is associated with a bleeding risk, the en bloc excision without biopsy can be a practical treatment option.

Introduction: Malignant colonic occlusion is traditionally considered a surgical emergency. With the development of endoscopic techniques, metallic stents have emerged to ensure the colonic patency in nonsurgical candidates and, more recently, as a temporary measure until elective resection surgery is possible. Materials and methods: The research was conducted in PubMed and collected a total of 46 articles, including cross-references. Results: Ideally, intestinal occlusion should be resolved through tumor's primary resection with direct anastomosis. To avoid dehiscence of the anastomosis, tumor's resection may be performed with Hartmann's procedure. Metal stents are an alternative to emergency surgery and show excellent results in reliving colonic obstruction. However, they may have serious complications related to colonic perforation, migration and tumor dissemination. Discussion and conclusion: Observational studies and clinical trials show discrepant results. Metal stents are increasingly accepted in palliative care but are not yet recommended as a bridge to curative surgery. Treatment should be individualized, according to surgical risk and the probability of endoscopic complications. Resumo: Introdução: A oclusão intestinal aguda maligna é tradicionalmente considerada uma emergência cirúrgica. Com o desenvolvimento das técnicas endoscópicas surgiram os stents metálicos que asseguram a patência do cólon em doentes não candidatos a cirurgia e, mais recentemente, como uma medida temporária até ser possível realizar uma cirurgia de resseção eletiva. Materiais e métodos: A pesquisa decorreu na PubMed e reuniu um total de 46 artigos, incluindo referências cruzadas. Resultados: Idealmente, a oclusão intestinal deve ser abordada através da resseção primária do tumor com anastomose primária. Para evitar a deiscência da anastomose, a resseção tumoral pode ser realizada recorrendo à cirurgia Hartmann ou a um estoma derivativo sem resseção tumoral. Os stents metálicos são uma alternativa à cirurgia de emergência com resultados excelentes na resolução da obstrução cólica. Contudo, poderão levar a complicações como a perfuração cólica, a migração e a disseminação tumoral. Discussão e conclusão: Os estudos observacionais e ensaios clínicos mostram resultados discrepantes. O uso dos stents metálicos é cada vez mais aceite como tratamento paliativo, mas ainda não são inequivocamente recomendados como ponte para uma cirurgia curativa. O tratamento deve ser individualizado de acordo com o risco cirúrgico e a probabilidade de complicações endoscópicas. Keywords: Malignant colonic obstruction, Emergency surgery, Colonic endoscopic stent, Tumor seeding., Palavras-chave: Obstrução maligna do colon, Cirurgia de emergência, Stents endoscópicos do cólon, Disseminação tumoral.

Objective To evaluate ventral skull base lesion recurrences along surgical access pathways attributed to iatrogenic seeding. Methods A systematic review of the literature was performed searching for recurrence of ventral skull base lesions attributed to iatrogenic implantation. Studies were assessed for level of evidence. Primary intervention, pathology, and other clinical factors were reported following Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Results Among 69 patients with recurrent skull base lesions attributed to seeding, the most common pathologies were craniopharyngioma (52.2%), chordoma (33.3%), adenocarcinoma (4.3%), adenoid cystic carcinoma (2.9%), and squamous cell carcinoma (2.9%). Median time to recurrence was 36 months. Time to recurrence was significantly longer for craniopharyngiomas than for chordomas (42 months vs. 24 months, P ≤ 0.05). Surgical approaches included craniotomy (62.0%), transseptal (11.3%), transfacial (12.7%), and transpalatal (4.2%). Mean time to recurrence after craniotomy was 69 months. Endoscopic/endoscopic-assisted approaches were used in 5 cases (7.0%). Commonly reported recurrence sites included subarachnoid (29.6%), dura (21.1%), incision (12.7%), septum (7.0%), and ethmoid sinuses (4.2%). Conclusions The potential for iatrogenic tumor seeding exists for numerous skull base lesions, most notably craniopharyngioma and chordomas. Routine surveillance may be necessary owing to significant latency intervals to ectopic recurrence. Although transnasal endoscopic techniques have been extensively employed in recent decades, only a handful of reported cases involve lesions originally treated with this approach. Further direct comparison of traditional approaches with endoscopic approaches may be invaluable in further elucidating the role of surgical technique in tumor implantation and recurrence.

Background Percutaneous needle biopsy of renal masses has been increasingly utilized to aid the diagnosis and guide management. It is generally considered as a safe procedure. However, tumor seeding along the needle tract, one of the complications, theoretically poses potential risk of tumor spread by seeded malignant cells. Prior studies on the frequency of needle tract seeding in renal tumor biopsies are limited and clinical significance of biopsy-associated tumor seeding remains largely controversial. Methods Here we investigated the frequencies of biopsy needle tract tumor seeding at our institution by reviewing the histology of renal cell carcinoma nephrectomy specimens with a prior biopsy within the last seventeen years. Biopsy site changes were recognized as a combination of foreign body reaction, hemosiderin deposition, fibrosis and fat necrosis. The histologic evidence of needle tract tumor seeding was identified as clusters of tumor cells embedded in perinephric tissue spatially associated with the biopsy site. In addition, association between parameters of biopsy techniques and tumor seeding were investigated. Results We observed needle tract tumor seeding to perinephric tissue in six out of ninety-eight (6 %) renal cell carcinoma cases including clear cell renal cell carcinoma, papillary renal cell carcinoma, chromophobe, and clear cell papillary renal cell carcinoma. The needle tract tumor seeding was exclusively observed in papillary renal cell carcinomas (6/28, 21 %) that were unifocal, small-sized (≤ 4 cm), confined to the kidney and had type 1 features. No recurrence or metastasis was observed in the papillary renal cell carcinoma cases with tumor seeding or the stage-matched cases without tumor seeding. Conclusions Our study demonstrated a higher than reported frequency of needle tract tumor seeding. Effective communication between pathologists and clinicians as well as documentation of tumor seeding is recommended. Further studies with a larger patient cohort and longer follow up to evaluate the impact of needle tract tumor seeding on long term prognosis are needed. This may also help reach a consensus on appropriate pathologic staging of renal cell carcinoma when the only site of perinephric fat invasion is within a biopsy needle tract.

Displacement or seeding of malignant cells into the needle tract following percutaneous biopsy is a known phenomenon, although it does not affect disease recurrence or overall survival of patients with breast cancer. It has, however, been previously hypothesized that needle tract seeding may occasionally progress to clinical tumor recurrence, and there have been case reports of breast cancer recurrence that are likely to be related to needle tract seeding. We are presenting a case of invasive mucinous carcinoma of the breast with associated malignant cell seeding within the biopsy tract, which was diagnosed preoperatively on contrast-enhanced MR imaging. A needle tract can often be visualized on contrast-enhanced MRI post biopsy and these changes may reflect tissue damage and regeneration only. In our case, an unusual nodular enhancement pattern was demonstrated along the biopsy needle tract, which was consistent with the histopathological finding of tumor seeding.

The role of endoscopic ultrasound (EUS) in cholangiocarcinoma (CCA) has grown in recent years due to the suboptimal endoscopic methods in obtaining tissue diagnosis. The current chapter focuses on the role of EUS in the diagnosis and staging of CCA. While EUS-guided fine needle aspiration (FNA) of the primary CCA tumor is strongly discouraged due to risk of tumor seeding, EUS-FNA plays an essential role in evaluating CCA-associated lymphadenopathy and has a significant impact on prognosis and guiding management. Regardless of cross-sectional imaging (unless unresectable disease is identified), EUS can be useful in providing enhanced staging data, primarily via improved nodal assessment. Although primary sclerosing cholangitis and the presence of biliary stents can hinder EUS performance, their impact is greatly minimized by adopting careful examination techniques.

Some studies state that laryngeal squamous cell carcinoma (LSCC) is associated with possible direct tumor cell seeding to percutaneous endoscopic gastrostomy (PEG) site. However, there is a lack of experimental proof that LSCC tumor tissue can adhere and grow in distant sites. Therefore, we aimed to investigate the growth pattern of LSCC implants on chicken embryo chorioallantoic membrane (CAM) and evaluate possible associations between clinical course of the disease and behavior of experimentally implanted LSCC tumors. Our results show that implanted LSCC tissue survives on CAMs in 95% of cases while retaining essential morphologic characteristics and proliferative capacity of the original tumor. We identified the increased CAM vascularization, an infiltrative growth pattern of the implant and formation of distant isolated metastatic nodes on the CAMs. LSCC tumors with worse differentiation degree (G2 or G3) adhered to the experimental CAMs significantly better than G1. These results facilitate the understanding of tumor biology and allow presuming that dissemination and direct implantation of LSCC cells into the stomal wall during the pull PEG procedure might be possible.

The term 'intra-operative tumor spillage' refers to the unexpected or unplanned exposure of tumor cells into the sterile surgical field during cases with otherwise no tumor cells outside the affected organ site. As a result, tumor spillage could theoretically lead to tumor seeding and metastasis.

Tumor seeding after intra-abdominal and head and neck cancer surgery is a well-known entity. The risk of disseminating cancerous cells during surgery is also described for soft-tissue sarcoma of the extremities. Nonetheless, after reconstructive surgery using flaps, the risk of recurrence at the donor site is extremely rare. Up to this date, the literature describes only three cases, but none of them reported a translocated recurrence after a reconstruction with a propeller flap. Here, we report a case of high-grade pleomorphic sarcoma of the knee, which recurred at the proximal edge of a propeller flap 28 months after the first excision surgery. The reasons for such local recurrences are not clear and previous works have advocated different theories: direct contamination by tumor cells, physical manipulation of the tumor and creation of surgical wounds with tumor supportive properties. Although these particular cases of recurrence are exceedingly rare, certain precautionary meticulous surgical techniques and a thorough preoperative planning are pivotal to avoid the contamination of “clean” areas during the first excision surgery.

Background Bone tumors are often treated with intralesional curettage. High-speed burring, an adjuvant therapy, was performed to maximize the tumor cell killing; however, tumor recurrence might still occur, which may be caused by residual tumor or local tumor spread during surgery. Methods A porcine cadaver (femur) was utilized to determine whether the use of a high-speed burr causes bone cement spray. To mimic residual tumor after curettage, luminescent cement was smeared on two locations of the bone cavity, the wall and the bottom. The cavity in the femoral bone was then placed in the middle of a sheet of drawing paper featuring 10 cm, 20 cm, and 30 cm concentric circles. The luminescent cement was then burred totally with a high-speed burr. Results The intensity of the area in the wall in circle I was 72.6% ± 5.8%; within circle II, it was 22.1% ± 4.2%; and within circle III, it was 5.4% ± 1.5%. The intensity of the area within the bottom of the femoral bone within circle I was 66.5% ± 6.1%, within circle II was 28.1 ± 4.8%, and within circle III, it was 5.4% ± 1.4%. The amount of luminescent cement seeding decreased with distance, but there was no difference while burring at different locations of the bone cavity. Under the handpiece cover, a greater amount of cement spray was retained in circle I during burring of the cement in the bottom of the cavity and less was sprayed out in circle III. Conclusions High-speed burring may cause explosive bone cement spray, which could extend to 20 cm. The intensities of spray did not decrease, even when the handpiece cover was used. The wide range of bone cement spray caused by high-speed burr was inspected in this pilot study, which may lead to tumor seeding. Level of evidence Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

To investigate the efficacy of a newly-developed laser-heated core biopsy needle in the thermal ablation of biopsy tract to reduce hemorrhage after biopsy using in vivo rabbit's liver model.Five male New Zealand White rabbits weighed between 1.5 and 4.0 kg were anesthetized and their livers were exposed. 18 liver biopsies were performed under control group (without tract ablation, n = 9) and study group (with tract ablation, n = 9) settings. The needle insertion depth (~3 cm) and rate of retraction (~3 mm/s) were fixed in all the experiments. For tract ablation, three different needle temperatures (100, 120 and 150 °C) were compared. The blood loss at each biopsy site was measured by weighing the gauze pads before and after blood absorption. The rabbits were euthanized immediately and the liver specimens were stained with hematoxylin-eosin (HE) for further histopathological examination (HPE).The average blood loss in the study group was reduced significantly (p 0.05) compared to the control group. The highest percentage of bleeding reduction was observed at the needle temperature of 150 °C (93.8%), followed by 120 °C (85.8%) and 100 °C (84.2%). The HPE results show that the laser-heated core biopsy needle was able to cause lateral coagulative necrosis up to 14 mm diameter along the ablation tract.The laser-heated core biopsy needle reduced hemorrhage up to 93.8% and induced homogenous coagulative necrosis along the ablation tract in the rabbits' livers. This could potentially reduce the risk of tumor seeding in clinical settings.

The new concept of spread through air spaces (STAS) was introduced for pulmonary adenocarcinomas in the 2015 WHO classification for lung cancer. Yet, available data demonstrate that STAS is of high prognostic impact and associated with specific clinic-pathological characteristics. This article provides a comprehensive overview of recent developments in this field.

Kidney cancer accounts for 2% of cancer related deaths. Historically, a patient with a solid renal mass would undergo surgery without biopsy given the previously low diagnostic yield of biopsy and the fear of tumor seeding. This led to a high rate of resection for benign masses. With the rising incidence of renal masses discovered on imaging, improvements in biopsy technique and advancements in pathologic evaluation of biopsy samples of renal masses, renal mass biopsy now plays an important role in selected patients with renal masses. Coaxial core needle biopsy is the preferred technique with a low rate of complications and a high diagnostic yield. This article will discuss indications, methods, utility, limitations and complications of renal mass biopsy.

We report a rare case of a papillary renal cell carcinoma seeding along a percutaneous biopsy tract detected at the time of partial nephrectomy in a 51-year-old man with a 3.5 cm renal mass discovered on computed tomography scan (CT scan). Although renal percutaneous biopsy is now considered as an accurate and safe technique to provide valuable diagnostic information for indeterminate renal lesions, some inherent risks have been reported to associate with this procedure. One of the risks is tumor needle tract seeding, which is a very rare complication of renal percutaneous biopsy. Our well-documented case report could provide some useful information to evaluate the prognosis of patients with tumor seeding along a percutaneous biopsy tract.

No abstract.

Pancreatic ductal adenocarcinoma behaves aggressively, with surgically resectable disease having the best chance of long-term survival. Recurrence after surgery and adjuvant therapy is commonly due to distant metastatic disease and is typically managed with systemic therapies, not surgery. We present a rare case of an isolated gastric metastasis due to endoscopic ultrasound-guided with fine-needle aspiration (EUS-FNA) needle tract seeding that was managed surgically. Treatment was informed by input from a mutlidisciplinary team of medical, surgical, and radiation oncologists, radiologists, and pathologists. Rising carbohydrate antigen (CA)19-9 levels suggested disease recurrence, but the tumor’s unusual location and slow growth made diagnosing the cause difficult, resulting in the late identification of the tumor. Palliative resection was performed, rending the patient with no evidence of disease followed by normalized CA19-9 levels. This case highlights the importance of multidisciplinary decision-making in detecting and treating the uncommon but significant tumor seeding with EUS-FNA biopsies in pancreatic ductal adenocarcinoma.

Seeding of tumor cells is a rare complication of minimally invasive surgery. We reviewed and improved current knowledge of prostate cancer seeding.A literature review was performed using MEDLINE®, Embase® and the Cochrane Library, including cases of peritoneal and port site seeding reported after minimally invasive prostatectomy. In addition, after institutionally approved chart review a descriptive summary of a single institution experience on the topic is provided.The data from 9 reported cases of port site metastases from prostate cancer in the world literature are summarized along with 3 additional cases from our experience. Similarly, 5 cases of peritoneal seeding are reviewed from the literature with the addition of 3 more cases from our institution. Good long-term outcomes are achievable with multimodality and individualized regimens, including seeding directed treatments.Although no definitive recommendation can be made for treatment strategies for these patients, there is a need for awareness and further discussion of this atypical presentation.

Minimally invasive biopsy procedures have proven over the years to be essential for obtaining a correct diagnosis of retroperitoneal tumors, that allows proper therapeutical conduct. These procedures offer valuable tissue fragments for histopathological examination, that permits the distinction between benign and malignant tumors, identifying the tumors that can benefit from neo-adjuvant treatments, such as chemotherapy or radiotherapy and those that have a direct surgical indication. We have searched the existing data regarding minimally invasive biopsy in retroperitoneal tumors using the PubMed database, in order to evaluate the role of this procedure in establishing a correct diagnosis, as well as to find out the risks of tumor cell seeding and local recurrence after needle biopsy. The risk of tumor cell seeding is very low (

Biliary tract cancers, specifically cholangiocarcinomas (CCAs), arise from the epithelial cells of the biliary tree. They can be divided into three groups based on their location: intra-hepatic, peri-hilar or distal extra-hepatic CCAs. Traditionally, the main role of endoscopy in the management of biliary tract cancers was diagnosis and biliary decompression. For diagnosis, endoscopic retrograde cholangiopancreatography (ERCP) can be used to obtain either brushings or intra-ductal biopsies however both techniques have poor sensitivity. The introduction of cholangioscopy has allowed endoscopists to perform both targeted biopsies and also obtain a visual diagnosis. Similarly, with the spread of endoscopic ultrasound (EUS), the ability to obtain tissue by fine-needle aspiration is another avenue available, but concerns regarding tumor seeding still persist. For biliary decompression, with the advent of neo-adjuvant therapy, the role of early decompression is growing. Nevertheless, it is still not clear whether endoscopic decompression is superior to percutaneous decompression, especially in advanced hilar tumors. When possible, at least 50% of viable liver should be drained, and that will determine whether unilateral or bilateral stents are required. Additionally, there is growing evidence on the benefits of metal stents over plastic stents, but care should be taken as metal stents are generally permanent. Finally, although not widely available or adopted, with the growing use of radiofrequency ablation and the introduction of drug-eluting metal stents, the near-future might allow newer techniques to treat the disease itself.

Highlights • The objective of our study is to correlate pathological and CT findings of 70 kidney cancer in order to determine the reliability of CT in kidney cancer and its extension., Our Moroccan context is experiencing an increase in the frequency of renal tumors. This trend can be explained by the generalization of the use of imaging, in particular abdominal ultrasound, which has become almost systematic among general practitioners (Godley and Ataga, 2000 [1]). The specificity of kidney cancer is anatomopathological heterogenicity: histological type, nuclear grade, tumor stage, these elements constitute the most important prognostic factors. Renal biopsy appears to be a safe and reliable solution with a low risk of tumor seeding and complications, however it cannot provide all the detailed histological information needed. Hence the interest in the abdominal scanner. The abdominal scanner is the reference examination for the evaluation of renal tumors, it diagnoses the tumor, specifies these characteristics, it assesses the loco regional, venous extension. The objective of our study is to correlate pathological and CT findings of 70 kidney cancer in order to determine the reliability of CT in kidney cancer and its extension.

// Ren-Yuan Bai 1 , Verena Staedtke 1 , Xuewei Xia 2 and Gregory J. Riggins 1 1 Department of Neurosurgery and Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA 2 Department of Neurosurgery, Affiliated Hospital of Guilin Medical College, Guilin, China Correspondence to: Ren-Yuan Bai, email: // Gregory J. Riggins, email: // Keywords : biopsy, intracranial implantation, tumor seeding, brain tumor, gelatin stick Received : November 02, 2016 Accepted : February 05, 2017 Published : February 16, 2017 Abstract Needle biopsy is an indispensable diagnostic tool in obtaining tumor tissue for diagnostic examination. Tumor cell seeding in the needle track during percutaneous needle biopsies has been reported for various types of cancers. The mechanical force of the biopsy both directly displaces the malignant cells and causes bleeding and fluid movement that can further disseminate cells. To prevent the risk of tumor cell seeding during biopsy, we developed a gelatin stick loaded with chemotherapeutics such as doxorubicin (DXR) that was inserted into the biopsy canal. The gelatin-doxorubicin sticks (GDSs) were created by passively loading precut gelatin foam strips (Gelfoam) with doxorubicin solution. The dried GDSs were inserted into the needle track through the sheath during the needle biopsy and eventually self-absorbed. We showed that this procedure prevented iatrogenic tumor seeding during needle biopsies in two subcutaneous tumor models. In an alternative application, using GDSs in intracranial brain tumor implantation avoided the outgrowth of tumor from the rodent brain, which could otherwise potentially fuse the tumor with the meninges and distort the results in therapeutic studies in rodent brain tumor models.

Purpose: To report the clinical features and pathology of orbital solitary fibrous tumors and present a case of a recurrence in a 12-year-old boy. Methods: Case Report. Results: A 12-year-old boy presented to our institution with double vision in upgaze for 6 months. Examination revealed 3 mm of left-sided proptosis, hypoglobus, and -3 impairment of supraduction. Magnetic resonance imaging of the orbits showed an avidly enhancing mass within the superolateral aspect of the orbit. Biopsy revealed a solitary fibrous tumor with STAT6 and CD34 positivity. Positron emission tomography-computed tomography was negative for metastatic disease. The tumor underwent excision. However, 4 months postoperatively, imaging revealed changes consistent with recurrence. A repeat lateral orbitotomy with orbital rim marginotomy was performed with complete gross excision of the tumor. The patient remains tumor-free 22 months after reoperation. Conclusion: Orbital solitary fibrous tumor rarely occurs in the pediatric population. Despite initial complete gross tumor excision, this case represents the youngest individual with a recurrence to the authors' knowledge. This case of rapid recurrence may have been due to tumor seeding at the time of initial biopsy or other factors. This case increases the known spectrum of orbital solitary fibrous tumors.

The liver is a highly metastasis-permissive organ, tumor seeding of which usually portends mortality. Its unique and diverse architectural and cellular composition enable the liver to undertake numerous specialized functions, however, this distinctive biology, notably its hemodynamic features and unique microenvironment, renders the liver intrinsically hospitable to disseminated tumor cells. The particular focus for this perspective is the bidirectional interactions between the disseminated tumor cells and the unique resident cell populations of the liver; notably, parenchymal hepatocytes and non-parenchymal liver sinusoidal endothelial, Kupffer, and hepatic stellate cells. Understanding the early steps in the metastatic seeding, including the decision to undergo dormancy versus outgrowth, has been difficult to study in 2D culture systems and animals due to numerous limitations. In response, tissue-engineered biomimetic systems have emerged. At the cutting-edge of these developments are ex vivo ‘microphysiological systems’ (MPS) which are cellular constructs designed to faithfully recapitulate the structure and function of a human organ or organ regions on a milli- to micro-scale level and can be made all human to maintain species-specific interactions. Hepatic MPSs are particularly attractive for studying metastases as in addition to the liver being a main site of metastatic seeding, it is also the principal site of drug metabolism and therapy-limiting toxicities. Thus, using these hepatic MPSs will enable not only an enhanced understanding of the fundamental aspects of metastasis but also allow for therapeutic agents to be fully studied for efficacy while also monitoring pharmacologic aspects and predicting toxicities. The review discusses some of the hepatic MPS models currently available and although only one MPS has been validated to relevantly modeling metastasis, it is anticipated that the adaptation of the other hepatic models to include tumors will not be long in coming.

Background and study aims: To avoid bacterial contamination and tumor seeding during gastrectomy surgery, we developed a nonexposure technique for endoscopic full-thickness resection with laparoscopic assistance. The feasibility and safety of nonexposed endoscopic wall-inversion surgery (NEWS) for gastric subepithelial tumors (SETs) were investigated. Patients and methods: For protruding gastric SETs ≤ 3 cm in diameter, NEWS was performed in the following sequence: laparoscopic seromuscular incision after endoscopic submucosal injection, laparoscopic seromuscular suturing with the lesion inverted, endoscopic mucosal and submucosal incision, and transoral retrieval. Technical outcomes and postoperative courses were investigated. Results: In all 20 consecutive cases, including six SETs with ulceration, NEWS was completed (mean procedural time, 213.5 minutes) without severe intraoperative or postoperative adverse events. R0 resection and perforation rates were 100 % and 5.0 %, respectively. During the mean observational period of 10.1 months, all patients survived without recurrence or apparent discomfort during food intake. Conclusion: NEWS for gastric SETs was feasible and safe and represents a useful option for minimally invasive local resection even in cases of SETs with ulceration or cancers.

Purpose Primary orbital schwannoma (POS) is a slow growing, benign encapsulated peripheral nerve sheath tumor that occurs infrequently within the orbit. Recurrence of POS is extremely rare. Previous speculations for reasons of recurrence include incomplete excision and tumor seeding. Observations We present the fifth case reported in the literature to date of POS that had 2 episodes of recurrences within 8 years after diagnosis, in which rapid and insidious relapses were observed after initial surgical resection. This is also the first reported recurrent POS in which topical Mitomycin-C (MMC) has been employed during surgical excision with an aim to prevent further recurrences. Conclusions AND IMPORTANCE: Whilst complete surgical excision remained the standard for management for most POS, when there are multiple recurrences and in cases where total excision is not possible, addition of topical MMC may be an option that may bring about tumour regression as demonstrated in our case.

Background: Although iatrogenic displacement of epithelial cells after breast instrumentation is a well-documented phenomenon, it is usually underdiagnosed. Misinterpretation of this issue results in overtreatment of patients in some instances. Additionally, the hazard of tumor seeding and dissemination after needling is a concern to both clinicians and patients. Both issues are addressed in this narrative review. Methods: We searched PubMed for abstracts of English-language publications using keywords “needle track/tract” and “displaced epithelium/epithelial displacement/iatrogenic displacement,” which resulted in 439 records restricted to human subjects. We read all the abstracts and selected 27 manuscripts with the most relevance. Results: There are some histopathologic features that can be useful in differentiating between epithelial displacement and real invasion/metastasis. The risk of seeding or metastasis after needling is shown to be trivial. Factors militating against the growth of dislodged cells are also discussed. Conclusion: Epithelial displacement is an important issue in breast pathology that should be considered in every patient with a history of breast instrumentation.

Needle tract metastases can be a rare complication following percutaneous procedures for renal malignancies. We report a case of cryoprobe tract tumor seeding following cryoablation of a small biopsy proven renal cell carcinoma.

Endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA) is a useful and relatively safe tool for the diagnosis and staging of pancreatic cancer. However, there have recently been several reports of tumor seeding after EUS-FNA of adenocarcinomas. A 78-year-old man was admitted to our hospital due to upper gastric pain. Examinations revealed a 20 mm mass in the pancreatic body, for which EUS-FNA was performed. The cytology of the lesion was adenocarcinoma, and the stage of the cancer was T3N0M0. The patient underwent surgery with curative intent, followed by adjuvant chemotherapy with S-1. An enlarging gastric submucosal tumor was found on gastroscopy at 28 mo after surgery accompanied by a rising level of CA19-9. Biopsy result was adenocarcinoma, consistent with a pancreatic primary tumor. Tumor seeding after EUS-FNA was strongly suspected. The patient underwent surgical resection of the gastric tumor with curative intent. The pathological result of the resected gastric specimen was adenocarcinoma with a perfectly matched mucin special stain result with the previously resected pancreatic cancer. This is the first case report of tumor seeding after EUS-FNA which was surgically resected and inspected pathologically.

Trans-Urethral Resection of Bladder (TURB) is one of the first endoscopic procedures executed by training residents, but the limits of classical TURB has always to be considered, i.e.: risk of tumor seeding, incomplete resection, thermal damage of specimen’s margin, and, above all, the absence of DM. As a matter of fact, being a senior surgeon, the use of both “Bladder Diagram” and “Bladder Tumour Checklist” may help to overcome these limits, performing a “Good-quality TURB”.

Vascularity is a highly essential element that is required for the growth, development, and functioning of the body and variations in it can cause pathologies. It is one of the prime features of a proliferating lesion, where it aids in the growth of the lesion through its nutrition supply. Highly increased vascularity in a disease can itself affect the prognosis of the lesion, and in malignancies, it can induce tumor seeding and secondaries. Most of the pathologies including tumors, related to blood vessels, and vascularity are well established. There are some conditions, wherein altered vascularity is one of the prime components along with other diagnostic components of an established disease. In such cases, these lesions are diagnosed with special names, with varying biological behavior and prognosis in comparison to that of established entity. However, there still are few similar conditions whose nature is uncertain due to the rarity of the lesion and the insufficient scientific evidence which eludes the diagnostician. Here is the report of two cases of ameloblastoma, an established entity, with significant vascularity whose nature is indeterminate.

Embryonal tumors with multilayered rosettes (ETMR) is a rare variant of embryonal tumor of infancy with nearly 200 cases reported in the literature. Leptomeningeal spread of this tumor is well known; however, extracranial metastasis has been sparsely reported in the literature. Our study was divided into two sections: (1) We conducted a retrospective review of our patient series of ETMR and screened for patients with evidence of ETMR over the last 10 years 2007–2017 at a single tertiary referral pediatric hospital, and (2) we conducted a systematic review according to PRISMA guidelines of all reported cases of ETMR to determine the incidence of extracranial metastasis and treatment paradigms. Here we report three cases of extracranial non-CNS spread of ETMR and conduct a systematic review of ETMR to improve our understanding of ETMR metastases and treatment paradigms. In our systematic review (n = 204), median overall survival was less than 1 year with 44.1% children surviving over 1 year. Previously, only five cases of extracranial metastasis of ETMR have been reported. Our case series (n = 3) and review demonstrate that these tumors may behave like soft tissue sarcomas and may be susceptible to tumor seeding through surgical manipulation or by CSF (ventriculoperitoneal shunt). Surgery for tumor recurrence may offer an improved local disease control, but preventative measures such as meticulous surgical resection may be necessary to reduce intraoperative contamination.

Summary Endoresection of choroidal melanoma without neoadjuvant radiotherapy is controversial because of concerns about iatrogenic local tumor seeding and systemic metastases. However, several authors have reported that local tumor recurrence and seeding are rare. Further, there is no evidence that metastatic disease is increased following endoresection. Recent insights into uveal melanomas indicates that metastasis depends on the genetic tumor profile and not on surgical interventions. It would seem, therefore, that the large majority of patients experiencing ocular morbidity from neoadjuvant radiotherapy are doing so unnecessarily. This problem persists because those favoring neoadjuvant radiotherapy are skeptical of the results published by authors who hold a different view from their own. There is scope for randomized clinical trials of endoresection with and without neoadjuvant radiotherapy. If the required equipoise for such trials is lacking, an ethical way should be found to allow independent inspectors to review original patient case notes and verify all the scientific claims that neoadjuvant radiotherapy is unnecessary.

The use of colorectal self-expanding metal stents (SEMS) as bridge therapy for malignant colorectal obstruction was first reported more than 20 years ago. However, its use remains controversial. Objective: In this study, we aimed to compare the long-term survival of patients with potentially resectable malignant colorectal obstruction who had undergone colorectal SEMS placement and emergency surgery. Methods: This study was a retrospective analyses. Patients who received treatment between 2009 and 2017 were included. According to the eligibility criteria, 21 patients were included in the SEMS group and 67 patients were included in the surgical group.. Results: The majority of the patients in the SEMS group were female (57.1%), whereas the majority of those in the surgical group were male (53.7%). The median follow-up time was 60 months for both groups with the same interquartile range of 60 months. There was no difference in the overall survival rate (log rank p=0.873) and disease-free survival rate (log rank p=0.2821) in the five-year analysis. There was no difference in local recurrence rates (38.1% vs. 22.4%, p=0.14) or distant recurrence rates (33.3% vs. 50.7%, p=0.16) in the SEMS and the surgical groups. Technical and clinical success rates of endoscopic stenting were 95.3% and 85.7%, respectively. There were no immediate adverse events (AEs). Severe AEs included perforation (14.3%), silent perforation (4.7%), reobstruction (14.3%), and bleeding (14.3%). Mild AEs included pain (42.8%), tenesmus (9.5%), and incontinence (4.76%). The limitations of this study was retrospective and was conducted at a single center. Conclusions: No differences in disease-free and overall survival rates were observed in the five-year analysis of patients with resectable colorectal cancer who had undergone SEMS placement or colostomy for the treatment of malignant colorectal obstruction. Patients in the SEMS group had a higher rate of primary anastomosis and a lower rate of temporary colostomy than did those in the surgery group.

There is growing interest in intravitreal injections of chemotherapy for retinoblastoma. However, concerns for potential tumor seeding through the needle track has prompted the use of risk-reducing precautionary methods. Presented here is a novel technique, which can be easily replicated, requires minimal sophisticated equipment and with laboratory data supporting its concept. Sterile distilled water submersion for 3 minutes renders retinoblastoma cells nonviable and can be employed as a precautionary method following intravitreal injection in the technique described here.

Metastatic vertebral compression fractures pose a significant clinical problem to cancer patients including pain, spinal deformity, and neurologic deficit. Treatment of metastases to the spine is complex and challenging and may require local and systemic therapies. Percutaneous vertebroplasty (PVP) was adopted to treat spinal metastases since its introduction during the late 1980s. The main indications for PVP in the treatment of spinal metastases are analgesia and spinal stabilization. Complications of PVP in malignant compression fractures are more common than in nonmalignant ones. We present 1 case of tumor seeding along the needle tract of a breast cancer patient who had undergone PVP.

Summary A unique case of pilocytic astrocytoma (PCA) with leptomeningeal dissemination occurring after surgery in a 2-year-old boy who presented with progressive left-sided weakness is reported. A cranial magnetic resonance imaging (MRI) disclosed a lesion with a cystic component in the right thalamus and basal ganglia. The lesion was subtotally resected and diagnosed by the pathology department to be a PCA. An MRI 16 days after surgery revealed a residual tumor with a tumor seeding along the surgical tract and in the meninges. The patient then underwent chemotherapy and a cranial MRI. Eleven months later the patient did not disclose any residual or additional lesions. The patient continues to do well at the time of this writing. This case illustrates a unique instance of leptomeningeal dissemination through the surgical tract of a resected cerebral PCA in a child.

A 5 yr old castrated male miniature dachshund presented with clinical signs attributable to carcinoma involving the bladder neck and prostate. On day 84 following diagnosis, the dog developed bilateral ureteral obstruction and ureteral stenting was attempted. The stents were inserted in a normograde fashion via percutaneous puncture of the dilated renal pelvises. Two wk later, the dog developed nodules at both sites of renocentesis. En block resection of the masses was performed, and histologic examination confirmed that the masses were urothelial carcinoma, likely caused by iatrogenic tumor seeding. Ureteral stenting is a useful technique to relieve malignant ureteral obstruction; however, risk of iatrogenic tumor seeding must be considered.

Object Intracranial germ cell tumors (GCTs) frequently present with bifocal lesions in both the suprasellar and pineal areas. The pathogenesis of these bifocal GCTs has been the subject of controversy. Bifocal GCTs may be caused by synchronous tumors or by metastatic spread of tumor cells from one site to the other. The prognosis associated with bifocal GCTs has also been a cause of concern. Methods The authors constructed a single-institution patient cohort comprising 181 patients with intracranial GCTs. The clinical characteristics of bifocal GCTs were compared with those of suprasellar and pineal GCTs. Results Bifocal GCTs were observed in 23 patients (12.8%). Eighteen patients presented with bifocal GCTs that were diagnosed as germinomas, but 5 patients exhibited mixed GCTs. Analyses of age distributions and comparisons of tumor sizes were compatible with a model of a metastatic origin of bifocal GCTs. Eleven patients (47.8%) presenting with bifocal GCTs exhibited tumor seeding at presentation. Tumor seeding was significantly associated with bifocal lesions (p < 0.001). Patients with bifocal germinomas showed significantly shorter event-free survival and overall survival than did those presenting with germinomas from a single site of origin. Conclusions Bifocal GCTs are not restricted to germinomas, as had been previously reported, but do include mixed GCTs. The authors hypothesize that bifocal GCTs may result from the metastatic spread of suprasellar or pineal GCTs. The bifocal presentation of germinomas may be a poor prognostic sign and should alert clinicians to the possibility of a disseminated disease.

A 75-year-old woman with abdominal pain and vomiting was admitted to our hospital. Colonoscopy showed an advanced colon cancer that encompassed the entire circumference of the descending colon’s lumen. The patient was diagnosed with occlusive ileus associated with the colon cancer. She had been watched for liver cirrhosis due to the hepatitis C virus and received radiofrequency ablation therapy for hepatocellular carcinoma (HCC) 6 years previously. Although she exhibited a gradual increase in serum levels of α-fetoprotein and PIVKA-II starting 2 years before admission, no tumors were detected in the liver by abdominal ultrasonography and computed tomography. On admission, contrast-enhanced computed tomography revealed not only the colon cancer but also a tumor adjacent to the cecum. Both tumors were successfully removed by surgery and a pathological analysis revealed that the cecum tumor was poorly-differentiated HCC. The serum levels of α-fetoprotein and PIVKA-II declined markedly after the operation and no masses considered as peritoneal metastasis have been detected to date. This is the first report of the simultaneous resection of disseminated HCC and colon cancer.

Aim: To reveal the impact of preoperative endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) of pancreatic ductal adenocarcinoma (PDAC). Materials and Methods: We retrospectively reviewed 242 patients who underwent surgery for PDAC at our institution between January 1996 and July 2012. Among them, there were three patients with R2 resection and 30 patients with a follow-up period of less than 1 year, who were excluded because they did not meet the conditions for evaluating recurrence. Consequently, 209 patients were enrolled in the present study. The patients were divided into two groups: 126 patients who underwent preoperative EUS-FNA (FNA group) and 83 patients who did not (non-FNA group) undergo preoperative EUS-FNA. Results: There were no significant differences in baseline characteristics between FNA and non-FNA groups except mean age (66.6 ± 8.9 years vs. 63.5 ± 8.9 years, respectively, P = 0.02) and the administration rate of gemcitabine as adjuvant chemotherapy (42.9% vs. 18.1%, P < 0.01). Sampling adequacy of preoperative EUS-FNA was 99.2% (125/126) and sensitivity for diagnosis was 92.9% (117/126). The rate of complications related to EUS-FNA was 1.6% (2/126); two patients experienced reduction in hemoglobin (≥2.0 g/dL). These two patients did not have any apparent bleeding and could be managed conservatively. No severe complications were seen. We evaluated long-term outcomes of preoperative EUS-FNA, especially disease-free survival, needle-track seeding and recurrence. Kaplan-Meier analysis indicated no significant difference in disease-free survival between the two groups (P = 0.12). The site of recurrence was not significantly different between groups. Needle-track seeding was not observed in this study. Multivariate analysis of recurrence factors showed that preoperative EUS-FNA did not affect postoperative recurrence. Conclusion: Preoperative EUS-FNA for PDAC was shown to be a safe procedure with high diagnostic ability, and not a risk factor for postoperative recurrence.