RESUMO
Giant cell tumor is a highly aggressive tumor characterized by a marked proliferation of pleomorphic, bizarre giant cells usually observed in the lungs. The importance of histopathological imaging and the clinical course of this tumor are unknown. The objective of our report was to investigate whether these components affect treatment outcomes and prognosis compared to conventional cancers. A 40-year-old woman with cervical cancer showed leukocytosis and elevated granulocyte colony simulating factor (G-CSF). The patient underwent a radical abdominal hysterectomy. Pathology revealed a poorly differentiated squamous cell carcinoma of the cervix, similar to giant cell carcinoma. The patient recovered from the disease and is alive 37 months after concurrent chemoradiotherapy (CCRT). Leukocytosis and G-CSF were normalized after treatment. This was our second case of giant cell carcinoma of the cervix. Cumulative data on giant cell carcinoma are limited, thus we considered the prognostic significance of the presence of giant cell carcinoma in uterine carcinoma.
Assuntos
Carcinoma de Células Gigantes , Carcinoma de Células Escamosas , Neoplasias do Colo do Útero , Adulto , Feminino , Humanos , Carcinoma de Células Gigantes/patologia , Carcinoma de Células Gigantes/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Fator Estimulador de Colônias de Granulócitos , Leucocitose , Pulmão/patologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapiaRESUMO
OBJECTIVES: This study sought to better characterize patient characteristics, treatment options, and outcomes for osteoclast-like giant cell carcinoma of the pancreas, a rare subtype of pancreatic adenocarcinoma. METHODS: This is a retrospective study of all patients with osteoclast-like giant cell carcinoma of pancreatic origin treated at Mayo Clinic from 2000 to present. Baseline patient characteristics, treatment modalities utilized, and outcomes were compiled. Overall survival (OS) and progression-free survival were assessed using Kaplan-Meier analysis with a significance level of P ≤ 0.05. RESULTS: Fifteen patients met criteria for inclusion. Four patients had distant metastases at diagnosis, the remaining 11 with locoregional disease. Median OS for the entire cohort was 11 months. Metastatic disease was associated with significantly shorter OS (3.5 vs 14.1 months; P = 0.005). Three patients had no evidence of disease at time of analysis; all 3 were treated with complete resection followed by adjuvant chemotherapy. CONCLUSIONS: Osteoclast-like giant cell carcinoma of the pancreas is an aggressive malignancy with poor prognosis. For patients with locoregional disease, surgical resection followed by adjuvant chemoradiation may play a role in extended disease-free survival. Metastatic disease presents a challenging entity to treat with little data to support any effective chemotherapy regimens.
Assuntos
Carcinoma de Células Gigantes/terapia , Testes Genéticos/métodos , Osteoclastos/patologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/genética , Quimiorradioterapia/métodos , Quimioterapia Adjuvante/métodos , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/genética , Neoplasias Pancreáticas/terapia , Prognóstico , Estudos RetrospectivosRESUMO
Poorly differentiated thyroid carcinoma (PDTC) refers to a malignant tumour that displays an intermediate prognosis between well-differentiated carcinomas and anaplastic thyroid carcinomas (ATC). In the thyroid, pleomorphic giant cells are observed in ATC or in some non-neoplastic thyroid diseases. We described the case of a 43-year-old woman with a 34-mm nodule in her thyroid right lobe. Microscopic examination revealed an encapsulated tumour with a main solid growth pattern and extensive capsular invasion. Multiple images of angioinvasion were observed. There was neither necrosis nor inflammation. Most of the tumour cells were medium-sized and intermingled with pleomorphic giant tumour cells with bizarre features. The immunoprofile (keratins +, TTF1+, Pax 8+) proved their thyroid origin. By NGS, no molecular alteration was identified. The patient was treated by surgery and radioiodine therapy and she has no recurrence after a follow-up of 24 months. Our case meets all the histological criteria of the Turin proposal for PDTC but with pleomorphic giant cells and is very different from ATC according to clinical, histological and immunohistochemical features. Pleomorphic tumour giant cells in thyroid carcinomas could be present in PDTC and do not always represent dedifferentiation and more aggressive carcinoma, thyroid neoplasm.
Assuntos
Carcinoma de Células Gigantes/patologia , Diferenciação Celular , Células Gigantes/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Biomarcadores Tumorais/análise , Biomarcadores Tumorais/genética , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/genética , Carcinoma de Células Gigantes/terapia , Feminino , Células Gigantes/química , Humanos , Queratinas/análise , Fator de Transcrição PAX8/análise , Radioterapia Adjuvante , Neoplasias da Glândula Tireoide/química , Neoplasias da Glândula Tireoide/genética , Neoplasias da Glândula Tireoide/terapia , Fator Nuclear 1 de Tireoide/análise , Tireoidectomia , Resultado do TratamentoRESUMO
Pleomorphic giant cell carcinoma of the bladder is a highly malignant subtype and its prognosis is very poor. Among 22 previously reported cases, 14 cases were diagnosed as muscle-invasive tumors and the 10 patients died within 1.5 years after the initial diagnosis. We herein report a long-surviving patient with cT3bN2M0 pleomorphic giant cell carcinoma of the bladder without recurrence. A 73-year-old man presented with macroscopic hematuria and cystoscopy revealed a papillary nodular tumor 45 millimeters in diameter at the right bladder wall. Bilateral external iliac lymph node metastases were found on computed tomography (CT) and magnetic resonance imaging (MRI). The histopathological diagnosis of the transurethral resection specimen was pleomorphic giant cell urothelial carcinoma, high-grade, G3, pT2 or higher. The pleomorphic giant cells were composed of large epithelioid cells with single or multiple bizarre nuclei. The patient underwent 2 cycles of neoadjuvant chemotherapy using gemcitabine and cisplatin. Follow-up CT and MRI revealed disappearance of iliac lymph node matastases. Laparoscopic radical cystectomy and lymphadenectomy were performed. The histopathological diagnosis was pleomorphic giant cell urothelial carcinoma, ypT3aN0M0, RM0. Giant cells were found in 70% of the tumor. No recurrence has been found for 4 years after surgery. If neoadjuvant chemotherapy is effective, long-term survival without recurrence may be possible after radical cystectomy even in cases of muscle-invasive or N2 pleomorphic giant cell carcinoma of the bladder.
Assuntos
Carcinoma de Células Gigantes , Carcinoma de Células de Transição , Neoplasias da Bexiga Urinária , Idoso , Carcinoma de Células Gigantes/terapia , Cistectomia , Humanos , Masculino , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Neoplasias da Bexiga Urinária/terapiaRESUMO
INTRODUCTION: Pulmonary sarcomatoid carcinomas (PSCs) are rare tumors within the sarcomatoid carcinoma group. Giant cell carcinoma of the lung (GCCL) is a rare type of PSCs that consists entirely of highly pleomorphic tumor giant cells; the prognosis is poor. PATIENT CONCERNS: A patient presented with a single cyst and was diagnosed with GCCL. The patient was a 59-year-old male who was admitted to the hospital with a cough. A chest computerized tomography (CT) scan showed a single, thin-walled cyst containing air in the left upper lobe of the lung. Bronchoscopy revealed chronic bronchitis. The initial diagnosis was pulmonary infection and the patient was treated with antibiotics. The cyst wall increased in thickness, and the cyst eventually formed a cavity. DIAGNOSIS: Surgery was performed, and a diagnosis of GCCL was established. The stage was pT1bN1M0 (equal to stage IIB). INTERVENTIONS: The patient underwent video-assisted thoracoscopic surgery and 4 cycles of adjuvant chemotherapy consisting of cisplatin and docetaxel. After 9 months, the patient occurred mediastinal lymph node metastasis, and received radiotherapy (60Gy/30F). OUTCOMES: His prognosis was good without progression (complete response) based on serial CT scans over 9 months of follow-up evaluations, then the patient occurred mediastinal lymph node metastasis. The patient lived during 30 months of follow-up, after which he was lost to follow-up. CONCLUSION: A solitary pulmonary parenchymal cystic lesion usually suggests an infectious disease or congenital abnormality; however, a cystic lesion is occasionally encountered in GCCL.
Assuntos
Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Broncoscopia/métodos , Carcinoma de Células Gigantes/diagnóstico por imagem , Carcinoma de Células Gigantes/terapia , Quimioterapia Adjuvante , Cistos/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XAssuntos
Neoplasias Ósseas/patologia , Carcinoma de Células Gigantes/patologia , Denosumab/uso terapêutico , Vértebras Lombares/patologia , Neoplasias Pulmonares/secundário , Adulto , Dor nas Costas/etiologia , Biópsia , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Carcinoma de Células Gigantes/complicações , Carcinoma de Células Gigantes/terapia , Terapia Combinada , Denosumab/efeitos adversos , Feminino , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Pulmonary sarcomatoid carcinoma (PSC) is a rare malignancy. METHODS: A total of 69 patients with PSC treated at a single institution in southern China with long-term follow-up were evaluated in this study. We analyzed the clinical characteristics, immunohistochemical profiles, epidermal growth factor receptor mutation status, K-RAS mutation status, treatments, and prognosis. RESULTS: PSC mainly occurred in young male patients with a history of smoking. Most patients received multimodality treatments and the majority had early-stage disease. The median survival time was 19.1 months, and the 5-year survival rate was 17.4%. The patients without distant metastasis, with normal or higher body mass index (≥18.5), with normal hemoglobin, with smaller tumor size (≤4 cm), and those who received complete resection had significantly better overall survival (P<0.05). The patients with pleomorphic carcinoma had much worse prognosis. In a Cox regression model, M stage, pathology, and having received a complete resection were independent prognostic factors (P<0.05). CONCLUSIONS: PSC is a unique lung malignancy with poor prognosis. Patients receiving complete resection had better prognosis, likely a reflection of early-stage disease. Neither neoadjuvant nor adjuvant chemotherapy improved patient survival for those with early-stage disease. The retrospective design and small sample size limited the generalizability. Future multicenter collaborations may be necessary to determine the optimal treatment.
Assuntos
Carcinoma/patologia , Carcinoma/terapia , Carcinossarcoma/terapia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Blastoma Pulmonar/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/química , Carcinoma/secundário , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/secundário , Carcinoma de Células Gigantes/terapia , Carcinossarcoma/química , Carcinossarcoma/secundário , Terapia Combinada , Intervalo Livre de Doença , Receptores ErbB/genética , Feminino , Seguimentos , Humanos , Queratinas/análise , Neoplasias Pulmonares/química , Masculino , Pessoa de Meia-Idade , Mucina-1/análise , Proteínas Nucleares/análise , Prognóstico , Proteínas Proto-Oncogênicas p21(ras)/genética , Blastoma Pulmonar/química , Blastoma Pulmonar/secundário , Proteínas S100/análise , Taxa de Sobrevida , Fator Nuclear 1 de Tireoide , Fatores de Transcrição/análise , Vimentina/análise , Adulto JovemRESUMO
Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.
Assuntos
Carcinoma de Células Gigantes/secundário , Neoplasias do Íleo/secundário , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Neoplasias Pulmonares/patologia , Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/terapia , Feminino , Humanos , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/terapia , Intussuscepção/cirurgia , Pessoa de Meia-IdadeRESUMO
Small bowel obstruction (SBO) due to intussusception in adults is a rare condition. Diagnosis at the time of admission is usually challenging. More often than not, a bowel intussusception in adults is secondary to an organic condition, frequently malignancies. Therefore, a surgical approach is indicated most of the times. We report the case of a forty-nine years old lady presenting with a SBO secondary to small bowel metastases with two ileo-ileal intussusceptions, one of which was missed at initial surgical exploration. A giant cell carcinoma of the lung (GCCL) with small bowel metastases was diagnosed subsequently. The case is presented as well as a brief review of literature.
Assuntos
Carcinoma de Células Gigantes/secundário , Neoplasias do Íleo/secundário , Obstrução Intestinal/etiologia , Neoplasias Pulmonares/patologia , Carcinoma de Células Gigantes/patologia , Carcinoma de Células Gigantes/terapia , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Humanos , Doenças do Íleo , Neoplasias do Íleo/fisiopatologia , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico , Intussuscepção/etiologia , Intussuscepção/cirurgia , Laparoscopia/métodos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Radiografia Torácica , Doenças Raras , Medição de Risco , Tomografia Computadorizada por Raios XRESUMO
Combined large cell neuroendocrine carcinoma of the lungs (combined LCNEC) with giant cell carcinoma is extremely rare. A 65-year-old man was found to have an abnormal shadow in his left lung field. Computed tomography revealed a solid, round mass measuring 2.8 × 2.2 cm that was located in the left S9. The patient underwent left lower lobectomy and mediastinal lymph node dissection. Histopathological examination revealed an LCNEC, combined with giant cell carcinoma. The patient received by S-1 (TS-1, an oral fluoropyrimidine) chemotherapy, and he has been disease-free for over 8 months. Combined LCNEC with giant cell carcinoma is an extremely rare tumor with high malignant potential, and thus, multidisciplinary therapy and close follow-up are advised.
Assuntos
Carcinoma de Células Gigantes/patologia , Carcinoma de Células Grandes/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias Pulmonares/patologia , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Gigantes/complicações , Carcinoma de Células Gigantes/terapia , Carcinoma de Células Grandes/complicações , Carcinoma de Células Grandes/terapia , Carcinoma Neuroendócrino/complicações , Carcinoma Neuroendócrino/terapia , Terapia Combinada , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/terapia , Metástase Linfática , Masculino , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Pulmonary sarcomatoid carcinomas are a rare group of tumors accounting for about 1 % of non-small cell lung carcinoma (NSCLC). In 2004, World Health Organization classification united under this name all the carcinomas with sarcomatous or sarcomatous-like component with spindle cell or giant cell appearance. There are five subtypes: spindle cell carcinoma, giant cell carcinoma, pleomorphic carcinoma, carcino-sarcoma and pulmonary blastoma. Clinical characteristics are not specific from the others subtypes of NSCLC. Epithelial to mesenchymal transition pathway may play a key role. Patients are frequently symptomatic. Tumors are voluminous more often peripherical than central, with strong fixation on FDG TEP CT. Distant metastasis are frequent with atypical locations such as peritoneal or retroperitoneal sites. These tumors have poorer prognosis than the other NSCLC subtypes because of great aggressivity, and frequent chemoresistance. Here, we present a review of litterature in order to better describe these tumors.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/patologia , Neoplasias Pulmonares/patologia , Doenças Raras/patologia , Carcinoma/química , Carcinoma/patologia , Carcinoma/terapia , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/patologia , Carcinoma de Células Gigantes/terapia , Carcinoma Pulmonar de Células não Pequenas/química , Carcinoma Pulmonar de Células não Pequenas/terapia , Carcinossarcoma/química , Carcinossarcoma/patologia , Carcinossarcoma/terapia , Transição Epitelial-Mesenquimal , Humanos , Neoplasias Pulmonares/química , Neoplasias Pulmonares/terapia , Prognóstico , Blastoma Pulmonar/química , Blastoma Pulmonar/patologia , Blastoma Pulmonar/terapia , Doenças Raras/genética , Doenças Raras/terapia , Carga TumoralRESUMO
Poorly differentiated endometrial carcinomas of specific type include the rarely reported endometrial carcinoma with a malignant giant cell component [endometrial giant cell carcinoma (GCC)]. Since the initial description in 1991, there has only been 1 subsequent case report of this entity. We report another 5 cases. The patients ranged in age from 53 to 83 years, presenting with vaginal bleeding, anemia, or a pelvic mass. Four of the 5 tumors contained areas of endometrial adenocarcinoma of usual type, with a variable giant cell component. The conventional cell types present included 1 case with clear cell carcinoma (30% of tumor volume), 2 with high-grade endometrioid carcinoma (50% and 70% of tumor volume, respectively) and 1 with serous histology (10% of tumor volume). One was composed exclusively of giant cell carcinoma. The giant cell component in all cases consisted of poorly cohesive nests of bizarre multinucleated giant cells with mononuclear tumor cells. A striking peritumoral and intratumoral inflammatory cell infiltrate composed of lymphocytes, plasma cells and focal eosinophils, and neutrophils was present and emperipolesis was noted in 4 of the 5 cases. The giant cells showed focal staining for epithelial markers (AE1/AE3 and CAM 5.2). Three of the patients presented with stage 1A disease, 1 with stage 1B disease, and 1 tumor was advanced, presenting as stage IIIC2. One patient in whom the tumor was exclusively of the giant cell type, developed lung metastasis 4 years after diagnosis and 1 patient is disease free after 14 years. The remaining 3 patients showed no evidence of disease with 15 to 32 months of follow-up. As histotype supplemented by staging information is critical in selection of treatment modalities and in prognostication in uterine malignancies, accurate classification is mandated. Here, we present a series of endometrial carcinomas containing a component of GCC and discuss the spectrum of giant cell-containing uterine neoplasms. At this time, however, the cumulative data on endometrial GCC are limited and the prognostic significance of the presence and the extent of a giant cell component in endometrial carcinoma remains uncertain.
Assuntos
Adenocarcinoma de Células Claras/patologia , Carcinoma Endometrioide/patologia , Carcinoma de Células Gigantes/patologia , Neoplasias do Endométrio/patologia , Células Gigantes/patologia , Adenocarcinoma de Células Claras/química , Adenocarcinoma de Células Claras/terapia , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Carcinoma Endometrioide/química , Carcinoma Endometrioide/terapia , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/secundário , Carcinoma de Células Gigantes/terapia , Erros de Diagnóstico/prevenção & controle , Intervalo Livre de Doença , Neoplasias do Endométrio/química , Neoplasias do Endométrio/terapia , Feminino , Células Gigantes/química , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Fatores de Tempo , Resultado do TratamentoRESUMO
Virtually all primary peritoneal carcinomas (PPCs) are of serous papillary type. We report an unusual histologic type of PPC composed of anaplastic giant cells, which exhibited an aggressive clinical course. A 72-year-old woman presented with lower abdominal pain. Computed tomography showed a diffuse omental thickening. The patient underwent an exploratory laparotomy with omentectomy, total hysterectomy, bilateral salpingo-oophorectomy, and appendectomy. Pathologic examination revealed extensive omental replacement by tumor but only superficial surface cortical involvement of both ovaries, a disease distribution consistent with a typical müllerian-derived PPC. However, this neoplasm was composed of diffuse anaplastic tumor giant cells, rather than serous carcinoma, which is the usual histologic type encountered in PPC. The patient died within 1 month after surgery. We report this unusual histologic variant of PPC to raise awareness that anaplastic giant cell carcinoma may arise in the pelvic peritoneum as a primary tumor.
Assuntos
Carcinoma de Células Gigantes/patologia , Ductos Paramesonéfricos/patologia , Neoplasias Peritoneais/patologia , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/terapia , Terapia Combinada , Evolução Fatal , Feminino , Humanos , Neoplasias Peritoneais/química , Neoplasias Peritoneais/terapiaRESUMO
Herein is presented the case of an esophageal pleomorphic giant cell carcinoma combined with small cell carcinoma (SCC). The patient, a 77-year-old man, initially presented with dysphagia and hoarseness, and endoscopy indicated a large esophageal tumor. Despite chemoradiation therapy, the patient died from widespread local extension of the tumor and distant metastases approximately 8 months after onset of the symptoms. Histologically, the primary tumor was composed of pleomorphic tumor components, SCC components, and a tiny focus of squamous cell carcinoma. The pleomorphic tumor cells, consisting of solid sheets of poorly cohesive epithelioid cells and numerous multinucleated giant cells with abundant eosinophilic cytoplasm, were immunohistochemically positive for vimentin and desmin, with scattered positivity for epithelial membrane antigen (EMA) and neuron-specific enolase (NSE), but negative for myoglobin. These findings were histopathologically compatible with pleomorphic giant cell carcinoma occurring at other sites such as the lung. SCC cells, morphologically similar to their pulmonary counterpart, were positive for EMA and some neuroendocrine markers such as chromogranin A and NSE, and occasionally positive for vimentin and desmin. Esophageal pleomorphic giant cell carcinoma can occur in close association with SCC, and should be included in the differential diagnosis of esophageal tumors showing pleomorphism.
Assuntos
Carcinoma de Células Gigantes/secundário , Carcinoma de Células Pequenas/secundário , Neoplasias Esofágicas/patologia , Neoplasias Primárias Múltiplas , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Gigantes/química , Carcinoma de Células Gigantes/terapia , Carcinoma de Células Pequenas/química , Carcinoma de Células Pequenas/terapia , Terapia Combinada , Neoplasias Esofágicas/química , Neoplasias Esofágicas/terapia , Evolução Fatal , Humanos , Imuno-Histoquímica , MasculinoRESUMO
BACKGROUND & OBJECTIVE: Lung pleomorphic (spindle/giant cell) carcinoma is a rare epithelial malignant tumor. This study was to investigate its clinicopathologic and prognostic characteristics. METHODS: Clinicopathologic records of 17 patients with lung pleomorphic (spindle/giant cell) carcinoma were reviewed and compared with those of the patients with other histopathologic types of lung cancer treated in the same period. All patients underwent surgical resection. Kaplan-Meier method was used for survival analysis. Cox proportional hazards model was used for prognostic analysis. RESULTS: The 17 patients consisted of 15 men and 2 women with median age of 58 (45-78)û 5 at stage I, 3 at stage II, and 9 at stage III by pathologic TNM staging. Of the 17 cases of lung pleomorphic (spindle/giant cell) carcinoma, 2 were lung exclusive spindle cell carcinoma, 5 were lung carcinoma with spindle cells (combined with one kind of epithelial components, such as squamous cell carcinoma in 3 cases, adenocarcinoma in 1 case, and large cell carcinoma in 1 case), 10 were lung carcinoma with giant cell carcinoma (combined with one kind of epithelial components in 5 cases, two kinds in another 5 cases). Four patients at stage I survived free of tumor for more than 5 years. The median survival time was significantly shorter in lung pleomorphic (spindle/giant cell) carcinoma patients than in lung squamous cell carcinoma patients (36 months vs. 61 months, P=0.027), and was also significantly longer in patients with carcinoma containing spindle cells (including spindle cell carcinoma) than in patients with carcinoma containing giant cells (64 months vs. 18 months,P=0.026). Lymph node metastasis and carcinoma containing giant cells were poor prognostic factors of lung pleomorphic (spindle/giant cell) carcinoma. CONCLUSION: Lung carcinoma containing giant cells has multiple cells components, and has worse prognosis than lung carcinoma containing spindle cells and spindle cells carcinoma do.
Assuntos
Carcinoma de Células Gigantes/patologia , Carcinoma/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Idoso , Carcinoma/terapia , Carcinoma de Células Gigantes/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/terapia , Excisão de Linfonodo , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Pneumonectomia , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia Adjuvante , Taxa de SobrevidaRESUMO
BACKGROUND: Primary neoplasms of the sphenoid sinus are a rare occurrence, accounting for approximately 1-2% of all paranasal sinus tumors. Here we report a series of four such patients. METHODS: Four patients with sphenoid sinus neoplasms were identified (1%), all treated during the year 2003. RESULTS: The four patients included two women and two men (mean age 61 years, range 44-70 years). Two patients presented with unilateral abducens cranial nerve (CN) palsies; one had trigeminal facial numbness and dizziness; another had headache, epistaxis, and partial third and fourth CN palsies. MRIs in all patients demonstrated large sphenoid sinus masses with partial clival and sellar bone erosion but with clear visualization of the pituitary gland above the mass. Cavernous sinus invasion was present in all four cases, including one patient with tumor in the ethmoid sinus and intra-tumoral hemorrhage. No patients had endocrinopathy. All patients underwent subtotal tumor removal via an endonasal transsphenoidal route. Tumor histology included neuroendocrine carcinoma, sinonasal undifferentiated carcinoma, mucoepidermoid carcinoma, and giant cell tumor. Post-operatively, all four patients had improved symptoms with complete resolution of diplopia in 3 of 3 patients. Metastatic work-ups were negative in all patients, and all received fractionated stereotactic radiotherapy; three received chemotherapy. One patient required a second endonasal tumor debulking 15 months after the first for new visual loss that then resolved. At a median follow-up of 21 months, all patients are alive and functional. CONCLUSIONS: Intra-sphenoidal tumors are locally invasive tumors that include a wide pathological spectrum. In this small series, they presented with cavernous sinus symptoms and headache but not endocrinopathy. Recognizing their distinctive clinical presentation and MRI features is helpful in differentiating them from primary sellar tumors. Their aggressive nature warrants a multimodality treatment plan including surgical debulking, radiotherapy, and chemotherapy in some cases.
Assuntos
Procedimentos Neurocirúrgicos , Neoplasias dos Seios Paranasais/patologia , Neoplasias dos Seios Paranasais/terapia , Seio Esfenoidal/patologia , Adulto , Idoso , Carcinoma/metabolismo , Carcinoma/patologia , Carcinoma/terapia , Carcinoma de Células Gigantes/metabolismo , Carcinoma de Células Gigantes/patologia , Carcinoma de Células Gigantes/terapia , Carcinoma Mucoepidermoide/metabolismo , Carcinoma Mucoepidermoide/patologia , Carcinoma Mucoepidermoide/terapia , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Neoplasias dos Seios Paranasais/metabolismo , Radioterapia Adjuvante , Tomografia Computadorizada por Raios XRESUMO
The aim of this study was to compare the efficacy of trisacryl gelatin microspheres versus polyvinyl alcohol particles (PVA) in the preoperative embolization of bone neoplasms, on the basis of intraoperative blood loss quantified by the differences in preoperative and postoperative hematic levels of hemoglobin, hematocrit and erythrocytes count. From January 1997 to December 2002, preoperative embolization of bone tumors (either primary or secondary) was carried out in 49 patients (age range 12/78), 20 of whom were treated with trysacril gelatin microspheres (group A) and 29 with PVA particles (group B). The delay between embolization and surgery ranged from 1 to 13 days in group A and 1 to 4 days in group B. As used in international protocols, we considered hematic levels of hemoglobin, hematocrit and erythrocytes count for the measurement of intraoperative blood loss then the differences in pre- and postoperative levels were used as statistical comparative parameters. We compared the values of patients treated with embospheres (n = 10) and PVA (n = 18) alone, and patients treated with (group A = 10; group B = 11) versus patients treated without other additional embolic materials in each group (group A = 10; group B = 18). According to the Student's t-test ( p < 0.05), the difference of hematic parameters between patients treated by embospheres and PVA alone were significant; otherwise there was no significant difference between patients treated with only one embolic material (embospheres and PVA) versus those treated with other additional embolic agents in each group. The patients treated with microspheres had a minor quantification of intraoperative blood loss compared to those who received PVA particles. Furthermore, they had a minor increase of bleeding related to the delay time between embolization and surgery. The use of additional embolic material did not improve the efficacy of the procedure in either group of patients.
Assuntos
Resinas Acrílicas/uso terapêutico , Neoplasias Ósseas/terapia , Embolização Terapêutica , Terapia Neoadjuvante/métodos , Álcool de Polivinil/uso terapêutico , Hemorragia Pós-Operatória/prevenção & controle , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Neoplasias Ósseas/cirurgia , Carcinoma de Células Gigantes/terapia , Criança , Feminino , Gelatina/uso terapêutico , Hemangiossarcoma/terapia , Humanos , Leiomiossarcoma/terapia , Masculino , Microesferas , Pessoa de Meia-Idade , Hemorragia Pós-Operatória/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We report 2 cases of pulmonary pleomorphic carcinoma. The patient in case 1 was a 44-year-old man who was admitted to our hospital complaining of dry cough and dyspnea on exertion. Chest radiography and CT showed a huge tumor with left pleural effusion. Percutaneous biopsy suggested malignancy. As distant metastasis was not found and as cytological examination of pleural effusion gave a result of class II, we attempted to perform left pneumonectomy. However, we performed partial resection of the tumor because it had invaded the aorta, pulmonary artery, pericardium and pleura. The pathological diagnosis was pleomorphic carcinoma, p-T4 N2 M0. After the operation, we performed systemic chemotherapy, including cisplatin and irinotecanm with little effect (PD). The patient died of progression of the tumor. Case 2 was a 34-year-old man who was admitted to our hospital complaining of fever and general malaise. Chest radiography and CT showed a tumor in the left upper lobe. As no distant metastasis was found, we tried left upper lobectomy. However, we performed left upper segmentectomy and lymph node dissection because of invasion of the aorta and the chest wall, and because of hypersegmentation of the left upper lobe. Pathological diagnosis was pleomorphic carcinoma, p-T4 N0 M0. After the operation, the mediastinum was subjected to radiation therapy. However, a metastatic tumor was found in the pelvis after this radiation was given. We performed systemic chemotherapy with substances including cisplatin, gemcitabine and vinorelbine, but with little effect (PD). The patient died of peritonitis and pleuritis due to the recurrence and progression of the tumor. Both cases had rapidly growing neoplasms showing little sensitivity to chemotherapy or radiotherapy. Pulmonary pleomorphic carcinoma is suggested to be type of lung cancer with a poor prognosis when the tumor is not resected in the early stages.
Assuntos
Carcinoma de Células Gigantes/diagnóstico , Carcinoma de Células Gigantes/terapia , Carcinoma/diagnóstico , Carcinoma/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Neoplasias Primárias Múltiplas , Adenocarcinoma/diagnóstico , Adenocarcinoma/terapia , Adulto , Fatores Etários , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Progressão da Doença , Evolução Fatal , Humanos , Excisão de Linfonodo , Masculino , Invasividade Neoplásica , Estadiamento de Neoplasias , Pneumonectomia , Radioterapia AdjuvanteRESUMO
Anaplastic (giant cell) thyroid carcinoma (ATC), is one of the most aggressive malignancies in humans with a median survival time after diagnosis of 3-6 months. Death from ATC was earlier seen because of local growth and suffocation. ATC is uncommon, accounting for less than 5 % of all thyroid carcinomas. The diagnosis can be established by means of multiple fine needle aspiration biopsies, which are neither harmful nor troublesome for the patient. The cytological diagnosis of this high-grade malignant tumour is usually not difficult for a well trained cytologist. The intention to treat patients with ATC is cure, although only few of them survive. The majority of the patients are older than 60 years and treatment must be influenced by their high age. We have by using a combined modality regimen succeeded in achieving local control in most patients. Every effort should be made to control the primary tumour and thereby improve the quality of remaining life and it is important for patients, relatives and the personnel to know that cure is not impossible. Different treatment combinations have been used since 30 years including radiotherapy, cytostatic drugs and surgery, when feasible. In our latest combined regimen, 22 patients were treated with hyper fractionated radiotherapy 1.6Gy x 2 to a total target dose of 46 Gy given preoperatively, 20 mg doxorubicin was administered intravenously once weekly and surgery was carried out 2-3 weeks after the radiotherapy. 17 of these 22 patients were operated upon and none of these 17 patients got a local recurrence. In the future we are awaiting the development of new therapeutic approaches to this aggressive type of carcinoma. Inhibitors of angiogenesis might be useful. Combretastatin has displayed cytotoxicity against ATC cell lines and has had a positive effect on ATC in a patient. Sodium iodide symporter (NIS) genetherapy is also being currently considered for dedifferentiated thyroid carcinomas with the ultimate aim of making radio-iodine therapy possible.
Assuntos
Carcinoma de Células Gigantes/terapia , Neoplasias da Glândula Tireoide/terapia , Idoso , Idoso de 80 Anos ou mais , Antibióticos Antineoplásicos/uso terapêutico , Carcinoma de Células Gigantes/diagnóstico , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Radioterapia , Dosagem Radioterapêutica , Glândula Tireoide/efeitos dos fármacos , Glândula Tireoide/efeitos da radiação , Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Tireoidectomia , Resultado do TratamentoRESUMO
BACKGROUND & OBJECTIVE: Telomerase has been thought to play an important role in the carcinogenesis in recent years. Human telomerase reverse transcriptase (hTERT) is a limiting component for telomerase activity. This study was designed to explore the effect of transfection of the full-length cDNA of antisense hTERT on the malignant phenotype of human pulmonary giant cell carcinoma cell line (PLA-801D) and its potential role in the gene therapy for cancers. METHODS: An antisense hTERT cDNA eukaryotic expression vector pcDNA3.1(-)-hTERT including the full length of hTERT cDNA sequence was constructed using recombinant DNA technique and transfected into human pulmonary giant cell carcinoma cells (PLA-801D) with liposome. The effect of antisense hTERT on the cellular proliferation capacity of PLA-801D cells was analyzed by the growth curve. The expression of hTERT mRNA was examined by reverse transcription polymerase chain reaction (RT-PCR). The telomerase activity was determined by telomeric-repeat amplification protocol enzyme-linked immunoassay (TRAP-ELISA). RESULTS: Antisense pcDNA3.1 (-)-hTERT eukaryotic expression have been constructed and was successfully transfected into the PLA-801D cells. The growth speed of PLA-801D transfected with antisense hTERT was significantly inhibited compared with the control cells, and the hTERT mRNA expression was inhibited, the relatively expression was only 15.7% of control cells, and telomerase activity was down-regulated about 82.4%. CONCLUSION: Full-length antisense hTERT cDNA can suppress hTERT mRNA expression and telomerase activity, and restrict the growth speed of tumor cells.