Challenging retrovesical mass in men: report of a rare liposarcoma case with concurrent COVID-19 infection.

We describe a case of retrovesical liposarcoma in a male patient with concurrent COVID-19. A 50-year-old man had lower urinary tract symptoms and dull pain along his right gluteus. Due to COVID-19 infection, management was delayed. During self-isolation, the patient developed urinary retention and his pain level was an eight on the Visual Analogue Scale. A urinary catheter and an epidural catheter were inserted without any difficulty. Abdominal-pelvic MRI revealed a retrovesical mass suspected of liposarcoma with clear borders from surrounding organs. Following two consecutive negative SARS-CoV-2 PCR tests, we proceeded with surgery. Histopathology was dedifferentiated liposarcoma. Postoperatively, the patient suffered reactivation of COVID-19, and he was eventually discharged after two consecutive negative results on the PCR test on Post Operative Day (POD)-10. Retrovesical dedifferentiated liposarcoma is rare and considered as high-grade liposarcoma. Although surgery may exacerbate COVID-19 infection, surgical resection of symptomatic high-grade sarcoma is prioritised and performed as soon as no infection detected.

Long-term functional outcome of sacrococcygeal teratoma after resection in neonates and infants: a single-center experience.

PURPOSE: This study aimed to evaluate the incidence and factors associated with long-term functional outcomes of sacrococcygeal teratoma (SCT) after resection in neonates and infants. METHODS: Twenty-nine patients with a minimum of 3 years of follow-up who underwent resection and were histologically diagnosed with SCTs between 1982 and 2017 at our institution were included. RESULTS: The median age at the time of the study was 10.0 years. Functional disorders occurred after surgery in 6 (20.7%) patients. Anorectal dysfunction, urologic dysfunction, and lower-extremity motor disorders occurred in 6 (20.7%), 4 (13.8%), and 3 (10.3%) patients, respectively. One patient with all three types of functional disorders developed intestinal perforation due to ileus and died of sepsis at 13 years of age. The overall mortality rate after tumor resection was 3.4%. The patients who developed functional disorders presented a low 1-min Apgar score, larger tumors requiring abdominosacral resection, surgical injury to the pelvic organs, and immature or malignant histological findings. CONCLUSION: Although the mortality rate was low, the long-term rate of functional disorders after SCT resection was approximately 20%. SCT patients with large tumors, surgical injury to the pelvic organs, and immature or malignant histological findings require thorough follow-up.

The physical and psychological sexual well-being of women with pelvic malignancy: how can we understand and improve our practice?

How can we better understand and improve our practice around the physical and psychological well-being of women treated with radiation therapy for pelvic malignancy? In this issue, Summerfield et al report the results of a nationwide survey capturing practices around the management of radiation therapy-induced vaginal adhesions and stenosis (RTVAS) across New Zealand. This study highlights the need for oncologists to improve care around a challenging but critically important aspect of women's health beyond a cancer diagnosis.

Risk factors for surgical site infection after malignant bone tumor resection and reconstruction.

BACKGROUND: Use of an implant is one of the risk factors for surgical site infection (SSI) after malignant bone tumor resection. We developed a new technique of coating titanium implant surfaces with iodine to prevent infection. In this retrospective study, we investigated the risk factors for SSI after malignant bone tumor resection and to evaluate the efficacy of iodine-coated implants for preventing SSI. METHODS: Data from 302 patients with malignant bone tumors who underwent malignant bone tumor resection and reconstruction were reviewed. Univariate analyses were performed, followed by multivariate analysis to identify risk factors for SSI based on the treatment and clinical characteristics. RESULTS: The frequency of SSI was 10.9% (33/302 tumors). Pelvic bone tumor (OR: 4.8, 95% CI: 1.8-13.4) and an operative time ≥ 5 h (OR: 3.4, 95% CI: 1.2-9.6) were independent risk factors for SSI. An iodine-coated implant significantly decreased the risk of SSI (OR: 0.3, 95% CI: 0.1-0.9). CONCLUSION: The present data indicate that pelvic bone tumor and long operative time are risk factors for SSI after malignant bone tumor resection and reconstruction, and that iodine coating may be a promising technique for preventing SSI.

Effectiveness of sacral nerve stimulation in fecal incontinence after multimodal oncologic treatment for pelvic malignancies: a multicenter study with 2-year follow-up.

BACKGROUND: To assess whether sacral nerve stimulation (SNS) is an effective treatment for severe fecal incontinence (FI) after radiotherapy (RT)/chemoRT (CRT) in combination with pelvic surgery. METHODS: A multicenter study was conducted on patients with FI that developed after multimodal therapy for pelvic tumors and was refractory to non-operative management, who were treated with SNS between November 2009 and November 2012. Data were prospectively collected and retrospectively analyzed. Cleveland Clinic FI score (CCFIS), FI episodes per week, FI Quality of Life (FIQoL), anorectal manometry and pudendal nerve terminal motor latency were evaluated before and after SNS. RESULTS: Eleven patients (seven females, mean age 67.3 ± 4.8 years) were evaluated in the study period. Multimodal treatments included surgery and CRT (four rectal, two cervical and one prostate cancers), surgery and RT (one cervical and two endometrial cancers) and CRT (one anal cancer). The mean radiation dose was 5.3 Gy, and mean interval between the end of RT and onset of FI was 43.7 ± 23 months. Before SNS, the mean CCFIS and the mean number of FI episodes per week were 15.7 ± 2.8 and 12.3 ± 4.2, respectively. At 12-month follow-up, mean CCFIS improved to 3.6 ± 1.8 (p = 0.003) and the mean number of FI episodes decreased to 2.0 ± 1.9 per week (p = 0.003). These results persisted at 24-month follow-up. Significant improvement was also observed for each of the four domains of FIQoL at 12- and 24-month follow-up. Anorectal manometry values did not change significantly at follow-up. CONCLUSIONS: SNS is feasible and may be an effective therapeutic option for FI after multimodal treatment of pelvic malignancies.

Does Extracorporeal Irradiation and Reimplantation After Acetabular Resections Result in Adequate Hip Function? A Preliminary Report.

BACKGROUND: Pelvic resections are challenging, and reconstruction of the resected acetabulum to restore mobility and stability is even more difficult. Extracorporeal radiation therapy (ECRT or extracorporeal irradiation) of autograft bone and reimplantation allows for a perfect size match and has been used with some success in the extremities. Although the risk of wound complications in pelvic surgery has discouraged surgeons from using ECRT of autografts in that anatomic site, we believe it may be a reasonable option. QUESTIONS/PURPOSES: In a small series, we asked: (1) What was the median surgical time and blood loss for these procedures, and what early complications were observed? (2) Is there evidence of osteonecrosis or cartilage loss at a minimum of 2 years after ECRT of acetabular autografts, and what functional scores were achieved? (3) What were the oncologic outcomes after ECRT? METHODS: Between March 2007 and September 2016, one surgeon performed 12 ECRT acetabular autografts and reimplantations after resections of pelvic or acetabular tumors. Of those, 10 with minimum 2-year followup are reported on here with respect to oncologic, functional, and radiographic assessment; all 12 are reported on for purposes of surgical parameters and early complications. During that period, we generally performed this approach when we judged it possible to achieve a tumor-free margin, adequate bone stock, and sufficient remaining hip musculature to allow use of the bone as an autograft with restoration of hip mobility. We generally did not use this approach when we anticipated a difficult resection with uncertain margins or where remaining bone was judged of poor strength for use as a graft or if both iliopsoas and abductors were sacrificed. Since 2010, this series represents seven of the 21 pelvic resections with reconstruction that we performed (five patients in this series had the procedure performed before 2010). Followup was at a median of 65 months (range, 33-114 months) for nine patients whose functional outcomes were evaluated. The median patient age was 30 years (range, 10-64 years). Clinical parameters were recorded from chart review; radiographic analysis for assessment of cartilage was performed by looking for any obvious loss of joint space when compared with the opposite side. Functional scoring was done using the Musculoskeletal Tumor Society score, which was obtained from chart review. Oncologic assessment was determined for local recurrence as well as metastases. RESULTS: Median surgical time was 8.6 hours and median blood loss was 2250 mL. There were no perioperative wound-related complications. Two patients underwent a second surgical procedure during the postoperative period, one for a femoral artery thrombus and another for a complete sciatic nerve deficit. No patients developed avascular necrosis of the femoral head. None of the patients who underwent osteoarticular grafting showed radiographic evidence of joint space narrowing. The median Musculoskeletal Tumor Society score was 28 (range, 17-30). No fractures in the radiated segment of reimplanted bone were seen in this small series. CONCLUSIONS: Results from this small series suggest that ECRT is a potential option in selected patients who have good bone stock and adequate soft tissue coverage. Although technically challenging, ECRT is a low-cost alternative to prostheses in providing a mobile and stable hip. Although we did not observe cartilage wear on plain radiographs, followup here was short term; it may appear as we continue to follow these patients. Future studies from retrieval specimens may shed light on the actual status of cartilage on the acetabulum. LEVEL OF EVIDENCE: Level IV, therapeutic study.

Clinicopathological features and differential diagnosis of aggressive angiomyxoma of the female pelvis: 5 case reports and literature review.

Aggressive angiomyxoma (AAM) is a rare mesenchymal tumor that usually occurs in the pelvis and perineum of young females. AAM can simulate Bartholin's gland cyst, abscess, lipoma, simple labial cyst, or other pelvic soft tissue tumors. Here we present five cases of AAM with mean age of 42. The patients mainly presented slow-growing mass in the abdomen and perineum (3 cases in the pelvis, 1 in the vulva, and 1 in the buttock). Color Doppler flow imaging revealed blood flow for the 3 pelvic lesions. Enhanced computed tomography and magnetic resonance imaging of the other 2 cases showed the typical "swirled" or "layered" structure characteristic. Through the pathological examination, its positivity to estrogen and progesterone receptors can justify enlargement and recurrence, confirming the tumor is AAM. All 5 patients underwent local tumor resection. Two patients recurred 8 and 15 months after surgery, respectively. The longest follow-up was 42 months. Although few cases are reported, early recognition demands high index of suspicion for both gynaecologists and pathologists. Wide surgical excision with tumor free margins is the basis of curative treatment. Adjuvant therapy may be necessary for residual or recurrent tumors. Long-term follow-up is recommended.

Neurolytic sympathectomy in the management of cancer pain-time effect: a prospective, randomized multicenter study.

CONTEXT: Sympathectomy is currently used as the fourth step of the modified World Health Organization (WHO) analgesic ladder. Sympathectomy can be performed early, before the second step on the ladder. OBJECTIVES: We hypothesized that early sympathectomy would reduce pain and opioid consumption and improve quality of life. METHODS: One hundred nine patients, with inoperable abdominal or pelvic cancer, reporting visceral pain of 40-70 on a visual analogue scale and taking nonopioid analgesics were allocated randomly into two groups: either blocks were performed before Step 2 of the WHO ladder, then analgesics were managed according to the ladder (Group I) or analgesics were given according to the WHO ladder, and blocks were performed as the fourth step after failure of strong opioids to control pain (Group II). Visual analogue scale scores, responder analysis, daily opioid consumption, related side effects, and quality of life were assessed. RESULTS: Responders were significantly higher in Group I (P < 0.0001), and partial responders and nonresponders significantly increased in Group II (P < 0.0001 and 0.006, respectively). Opioid consumption significantly decreased in Group I (P < 0.0001 during first 12 months and 0.007 at the last assessment time), with concomitant significant reduction in related side effects. The number of patients who had a good analgesic response on tramadol significantly increased in Group I during the first five months (P < 0.05). European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 global quality-of-life subscale scores revealed significant improvement until the fifth month in Group I (P < 0.05). CONCLUSION: Sympathectomy before Step 2 on the WHO analgesic ladder seems to lead to better pain control, less opioid consumption, and better quality of life in cancer patients.

Optimal surgical treatment and urological outcomes in boys with pelvic and urogenital rhabdomyosarcomas and soft tissue sarcomas.

BACKGROUND: Soft tissue sarcomas (STS) of pelvic origin in boys often involve the urogenital organs. The optimal extensiveness of radical surgery has long been an issue of discussion, since exenterative surgeries result in severe urogenital adverse effects. We conducted a retrospective review of patients with pelvic STS treated in two regional center hospitals and assessed the radicality of surgery and the functional outcome of the bladder. PATIENTS: Medical records and surgical reports of nine cases (embryonal rhabdomyosarcoma 6, malignant triton tumor 2, suspected rhabdomyosarcoma 1) treated within 1997-2012 were reviewed. Site of origin was prostate in seven, retroperitoneal in two. Average follow-up period was 96 months. TREATMENT AND OUTCOME: All cases were subjected to neoadjuvant chemotherapy. Response was PR in four, SD in two, and PD in two. Radical surgery resulted in gross total resection in eight, and partial resection in one. Three underwent cystoprostatectomy, two cases underwent prostatectomy, and bladder-preserving tumor resection was carried out in four cases. At the last follow-up, three retained a functional bladder. Two required augmentation cystoplasty with intestinal conduits. CONCLUSIONS: The majority of the on-going clinical trials recommend conservative surgery for bladder/prostate rhabdomyosarcoma, and to preserve the bladder function particularly in chemosensitive tumors. Some other groups, however, advocate the importance of radical surgery to prevent local relapse. These reports include heterogenous group of patients in the cohort, and therefore it is difficult to draw a conclusion of which approach truly contributes to the survival of the patients better. Future studies should evaluate bladder and sexual function objectively to establish reliable evidence regarding the benefit and adverse effects of different surgical approaches. These data would be informative to optimize the treatment balance for children with pelvic rhabdomyosarcomas.

Cancer department nurses' attitudes and practices in response to the sexual issues of pelvic radiation patients: a survey in Sichuan, China.

Our aim was to investigate cancer department nurses' attitudes and practices in response to pelvic radiation patients' sexual issues in Sichuan, China. A self-made questionnaire survey was conducted with 150 registered nurses of six hospitals in China. Nurses were asked about their experiences regarding consultation about sexual issues and attitudes toward the sex-related statements of pelvic radiation patients. We analyzed the correlation factors for the attitudes about dealing with patients' sexual issues by using the χ(2)-test. Of the survey sample, 128 nurses (85.33%) responded. Of the respondents, 46.88% had been consulted about sexual issues by patients or families. In addition, 87.5% of the nurses believed that 'reliable information on sexual in pelvic radiotherapy is lacking', and 77.34% reported having 'an interest in undertaking education of knowledge about pelvic radiation patients' sexual issues'; yet only 4.69% had completed professional sexual education about pelvic radiation patients. The hospital type and bed number as well as nurse age and seniority also affected the responses. This study shows that discussing sexuality is still repressed in the patient-nurse relationship, and most nurses' in Chinese cancer departments lack knowledge about pelvic radiation patients' sexual problems.

Hipbone biomechanical finite element analysis and clinical study after the resection of ischiopubic tumors.

OBJECTIVE: To investigate the changes of hipbone biomechanics after the resection of ischiopubic tumors and their relationships with the complications in the convalescent stage, and directing the postoperative pelvic reconstruction. METHODS: DICOM data were used to create an intact hipbone finite element model and postoperative model. The biomechanical indices on the same region in the two models under the same boundary condition were compared. The differences of displacement, stress, and strain of the two models were analyzed with statistical methods. RESULTS: The distribution areas of the hipbone nodes' displacement, stress, and strain were similar before and after the simulated operation. The sacroiliac joint nodes' displacement (P=0.040) and strain (P=0.000), and the acetabular roof nodes' stress (P=0.000) and strain (P=0.005) of two models had significant differences, respectively.But the sacroiliac joint nodes' stress (P=0.076) and the greater sciatic notch nodes' stress (P=0.825) and strain (P=0.506) did not have significant differences. CONCLUSIONS: The resection of ischiopubic tumors mainly affect the biomechanical states of the homolateral sacroiliac joint and acetabular roof. The complications in the convalescent stage are due to the biomechanical changes of the sacroiliac joint and the acetabular roof and disappearances of the stabilization and connection functions of the pubic symphysis and superior ramus of pubis.

Assessment of sexual function in patients with cancer undergoing radiotherapy--a single centre prospective study.

AIM: The main objective was to delineate the rates and clinical course of sexual function and depression in cancer patients undergoing radiotherapy. PATIENTS AND METHODS: Forty-eight male and 90 female radiotherapy-naive outpatients with breast or pelvic cancer completed the International Index of Erectile Function (IIEF) or the Female Sexual Function Index (FSFI), and the Hamilton Depression Scale (HDS) prior to (phase 1), at the end of (phase 2) and 12 months after radiotherapy (phase 3). RESULTS: Overall, the majority of patients (93.8% of males and 80% of females) experienced intense sexual dysfunction. At presentation, males reported severe erectile dysfunction that was significantly associated with age. However, only in sexual desire was the difference between baseline and phase 3 significant. In females, an improvement was observed in all parameters of FSFI between phase 1 and 3. Females with stage III disease achieved lower scores in almost all parameters of FSFI than those with stage II. Finally, although a quarter of patients reported elevated depression scores, depression was not related to sexual function. CONCLUSION: A significant proportion of cancer patients experience intense levels of sexual dysfunction and depression throughout radiotherapy and the subsequent year. Pelvic radiotherapy affected sexual function to a higher degree than did breast radiotherapy.

Synchronous colonic adenocarcinoma and pelvic schwannoma.

Pelvic schwannomas are rare; it is even more rare for a pelvic schwannoma to occur concurrently with a colon cancer. The authors report the case of a 62-year-old woman with a cecal mass that was surgically removed and the histopathologic diagnosis was adenocarcinoma of the colon. Meanwhile, aretroperitonealpelvic nodalmasswas detected as questionable metastasis of the primary tumor. A subsequent computed tomography-guided fine-needle biopsy was carried out to establish the tumor stage. Surprisingly, the fine-needle biopsy revealed a benign schwannoma. This unusual case posed a dilemma in postoperative staging of the colon cancer.

[A modern view on the problem of the chronic pelvic pain at the women].

The article contains the basic causes and consequences of chronic pelvic pain (HPP) at the women. Shown that HPP - serious medical and social problem, which changes the psyche and behavior of women, violates her social adaptation. Pathogenesis HPP associated with persistent violations intraorganic and regional hemodynamics and hypoxia and acidosis that occur at the same time, cause degeneration of receptors and conduction system of pelvic organs, malnutrition solar cells and aortic nerve plexuses. Briefly described stages of HPP and this characteristic psychogenic pain as a diagnosis of exclusion. These basic ways to eliminate pain and pharmacological methods, physio and psychological action at HPP.