ABSTRACT
This case report describes a 62-year-old nonsmoking man with multiple pleural thickenings and a marked effusion.
Subject(s)
Mesothelioma , Pleural Neoplasms , Tongue Neoplasms , Humans , Pleural Neoplasms/secondary , Pleural Neoplasms/pathology , Tongue Neoplasms/pathology , Mesothelioma/secondary , Mesothelioma/pathology , Male , Aged , Middle AgedABSTRACT
Sarcoma can present as locally advanced disease involving pleura for which extra-pleural pneumonectomy (EPP) may be the only surgical option to ensure adequate local control. Data were collected on patients who underwent EPP between January 2009 and August 2021 at Princess Margret Hospital and SickKids (Toronto) using the CanSaRCC (Canadian Sarcoma Research and Clinical Collaboration). Ten patients with locally advanced sarcoma involving the pleura, aged 4 to 59 years (median 19.5 years) underwent EPP. Nine (90%) received pre-operative chemotherapy and eight (80%) achieved an R0 resection. Hemithoracic radiation was administered preoperatively (n = 6, 60%) or postoperatively (n = 4, 40%). Five (50%) patients were alive without disease at last follow-up (median 34.2 months) and time from EPP to last FU was median 29.2 months (range 2.2-87.5). Two patients (20%) had local recurrence, 4.3 and 5.8 months from EPP, and both died from progressive disease, 13.1 and 8.2 months from EPP, respectively. One patient died from brain metastasis (17 months), one died from radiation associated osteosarcoma (66 months), and one died from surgical complications (heart failure from constrictive pericarditis). EPP offers a feasible and life-prolonging surgical consideration for patients with locally advanced sarcoma involving the pleura in combination with chemotherapy and radiation. Consequently, EPP should be considered during multi-disciplinary tumor board discussions at high-volume centers.
Subject(s)
Mesothelioma , Neoplasms, Second Primary , Pleural Neoplasms , Sarcoma , Adult , Canada , Child , Combined Modality Therapy , Humans , Mesothelioma/pathology , Mesothelioma/secondary , Mesothelioma/surgery , Pleura/pathology , Pleura/surgery , Pleural Neoplasms/pathology , Pleural Neoplasms/surgery , Pneumonectomy , Sarcoma/surgeryABSTRACT
Mesothelioma (MESO) is an infrequent tumor derived from mesothelial cells of pleura, peritoneum, pericardium, and tunica vaginalis testis. Despite advancement in technologies and better understanding of tumor progression mechanism, the prognosis of MESO remains poor. The role of alternative splicing events (ASEs) in the oncogenesis, tumor metastasis and drug resistance has been widely discussed in multiple cancers. But the prognosis and potential therapeutic value of ASEs in MESO were not clearly studied by now. We constructed a prognostic model using RNA sequencing data and matched ASE data of MESO patients obtained from the TCGA and TCGASpliceSeq database. A total of 3,993 ASEs were identified associated with overall survival using Cox regression analysis. Eight of them were finally figured out to institute the model by lasso regression analysis. The risk score of the model can predict the prognosis independently. Among the identified 390 splicing factors (SF), HSPA1A and DDX3Y was significantly associated with 43 OS-SEs. Among these OS-SEs, SNX5-58744-AT (p = 0.048) and SNX5-58745-AT (p = 0.048) were significantly associated with bone metastasis. Co-expression analysis of signal pathways and SNX5-58744-AT, SNX5-58745-AT was also depicted using GSVA. Finally, we proposed that splicing factor (SF) HSPA1A could regulate SNX5-58744-AT (R = -0.414) and SNX5-58745-AT (R = 0.414) through the pathway "Class I MHC mediated antigen processing and presentation" (R = 0.400). In this way, tumorigenesis and bone metastasis of MESO were controlled.
Subject(s)
Alternative Splicing/genetics , Bone Neoplasms/genetics , Bone Neoplasms/secondary , Mesothelioma/genetics , Mesothelioma/secondary , Bone Neoplasms/mortality , DEAD-box RNA Helicases/genetics , Female , Gene Regulatory Networks , HSP70 Heat-Shock Proteins/genetics , Humans , Male , Mesothelioma/mortality , Minor Histocompatibility Antigens/genetics , Prognosis , Proportional Hazards Models , Risk Factors , Sequence Analysis, RNA , Sorting Nexins/geneticsABSTRACT
The long delay between asbestos exposure and the development of mesothelioma will likely result in an increased incidence of mesothelioma in our industrialized societies. Radiation therapy is another factor known to induce these tumors. We describe a rare case of foamy looking mesothelioma in a 63-year-old patient with a long oncology history of a supposed peritoneal carcinomatosis. The pathologist was faced with a diagnostic pitfall as this peritoneal clear cell tumor expressed transcription factor binding to immunoglobulin heavy constant mu enhancer 3 (TFE3) at the nuclear level. Fortunately, the pathologist performed an extensive panel of immunomarkers, leading to a final diagnosis of epithelioid mesothelioma. Thus, we describe the first case of mesothelioma expressing TFE3. Note that there was no rearrangement of TFE3 in fluorescence in situ hybridization.
Subject(s)
Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/metabolism , Biomarkers, Tumor/metabolism , Mesothelioma/diagnosis , Peritoneal Neoplasms/diagnosis , Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/analysis , Basic Helix-Loop-Helix Leucine Zipper Transcription Factors/genetics , Biomarkers, Tumor/analysis , Biomarkers, Tumor/genetics , Carcinoma, Renal Cell/diagnosis , Carcinoma, Renal Cell/pathology , Female , Humans , Kidney Neoplasms/diagnosis , Kidney Neoplasms/pathology , Lipoma/diagnosis , Lipoma/pathology , Mesothelioma/genetics , Mesothelioma/secondary , Middle Aged , Peritoneal Neoplasms/genetics , Peritoneal Neoplasms/secondary , Peritoneum/pathology , Translocation, GeneticABSTRACT
A slaughtered 2-year-old female sika deer (Cervus nippon yesoensis) had diffusely distributed multinodular lesions on the serosal surface of the peritoneal cavity and several nodules in the pleural cavity. Histologically, they were composed of proliferating spindle-shaped neoplastic cells, arranged in a fascicular fashion. The cells in the invasive foci transitioned from a sarcomatoid to an epithelioid appearance. Immunohistochemically, both the spindle-shaped and epithelioid cells were at least focally positive for pancytokeratin, vimentin, calretinin, α-SMA, and desmin. From these findings, the deer was diagnosed with peritoneal sarcomatoid mesothelioma with metastasis to the pleural cavity. To our knowledge, this is the first reported case of peritoneal mesothelioma in a cervid species and the first case of mesothelioma in a sika deer.
Subject(s)
Abdominal Neoplasms/veterinary , Deer , Mesothelioma/veterinary , Pleural Neoplasms/veterinary , Abdominal Neoplasms/pathology , Animals , Female , Mesothelioma/pathology , Mesothelioma/secondary , Peritoneal Cavity/pathology , Pleural Cavity/pathology , Pleural Neoplasms/pathology , Pleural Neoplasms/secondaryABSTRACT
INTRODUCTION: The management of malignant mesothelioma of the tunica vaginalis (MMTVT) is not clearly defined. Retroperitoneal lymph node dissection has been reported as a potential management option. Herein we present our experience with robot-assisted retroperitoneal lymph node dissection (RARPLND) in our series of patients with MMTVT. MATERIALS AND METHODS: The Mayo Clinic cancer registry was queried from 1972-present for all patients who had a diagnosis of MMTVT. Six patients were identified, five of whom were treated with RPLND, where four underwent RARPLND. RESULTS: In five patients who underwent RPLND, the median age was 50 years (IQR 34-51). Four patients originally presented with right sided symptomatic hydroceles, while one presented with right sided chronic epididymitis. Orchiectomy (one simple, two inguinal radical) was performed in three patients prior to presentation. Preoperative cross-sectional imaging, including PET-CT scan in three patients, was negative for lymphadenopathy or metastasis. RARPLND was performed in 4/5 (80%) cases and concomitant hemiscrotectomy in 4/5 (80%) cases. Full bilateral template was performed in three patients and right modified template was performed in the remaining two. Median lymph node yield was 29 (IQR 22-32) and median blood loss was 275 cc (IQR 200-300). Positive retroperitoneal lymph nodes were found in 3/5 (60%) cases. All patients who underwent RARPLND were discharged home on postoperative day one. Mean follow up was 27 months (range 3-47). No patients recurred. CONCLUSIONS: Regardless of the approach, RPLND may provide a diagnostic benefit in patients who present with MMTVT, with the robotic approach affording a potentially expedited recovery.
Subject(s)
Lymph Node Excision/methods , Lymph Nodes/surgery , Mesothelioma/surgery , Robotic Surgical Procedures/methods , Testicular Neoplasms/surgery , Humans , Lymphatic Metastasis , Male , Mesothelioma/diagnosis , Mesothelioma/secondary , Retroperitoneal Space , Testicular Neoplasms/pathologySubject(s)
Flank Pain/etiology , Mesothelioma/diagnosis , Peritoneal Neoplasms/pathology , Sigmoid Neoplasms/diagnosis , Adenocarcinoma/diagnosis , Adenocarcinoma/pathology , Biopsy , Colon, Sigmoid/diagnostic imaging , Colon, Sigmoid/pathology , Diagnosis, Differential , Humans , Intestinal Mucosa/diagnostic imaging , Male , Mesothelioma/complications , Mesothelioma/pathology , Mesothelioma/secondary , Middle Aged , Neoplasm Invasiveness , Peritoneal Neoplasms/diagnosis , Sigmoid Neoplasms/complications , Sigmoid Neoplasms/pathology , Sigmoid Neoplasms/secondary , SigmoidoscopyABSTRACT
A 73-year-old man with a prostate cancer treated by radical prostatectomy in 2006. For a biochemical recurrence of disease (prostate-specific antigen level, 0.1 ng/mL) during hormonal therapy, patient underwent F-choline PET/CT that showed a significant uptake in a diffuse right pleural thickening. The patient was sent to pleurectomy decortication showing an epithelioid pleural mesothelioma. This case highlighted that a histopathological evaluation is mandatory in case of a significant radiolabeled choline uptake in pleural lesions.
Subject(s)
Choline/analogs & derivatives , Mesothelioma/diagnostic imaging , Mesothelioma/secondary , Pleural Neoplasms/diagnostic imaging , Pleural Neoplasms/secondary , Positron Emission Tomography Computed Tomography , Prostatic Neoplasms/pathology , Aged , Humans , Male , Prostate-Specific Antigen/metabolism , Prostatectomy , Prostatic Neoplasms/diagnostic imaging , Prostatic Neoplasms/metabolism , Prostatic Neoplasms/surgery , RecurrenceABSTRACT
This case report presents a male patient with epithelioid mesothelioma that was initially misdiagnosed as cancer of unknown primary (CUP) and correctly identified using molecular panel sequencing. The patient had a prior history of colon and breast cancer. To assess the enlarged mediastinal lymph nodes, retrosternal lymphadenectomy was performed in 2016. The lymph nodes were histologically deemed unrelated to the known breast cancer by the reference pathologist, thus leading to the diagnosis of a CUP syndrome. When the patient presented to our center, targeted deep sequencing of both breast cancer and presumed CUP was performed to address the clonal relationship between both malignancies. A missense mutation in BAP1 was revealed in both samples, with coverage data indicating a germline event. The patient was subsequently counseled by a human geneticist and underwent genetic testing, which confirmed the germline nature of this mutation. Collectively, these data led to the diagnosis of BAP1 (BRCA1-associated protein-1) tumor predisposition syndrome (TPDS). With the knowledge of an underlying BAP1 mutation and its known frequent association with epithelioid mesothelioma, the histology was reassessed and the diagnosis was revised to epithelioid mesothelioma. At this point, peritoneal involvement of mesothelioma could be diagnosed and histologically confirmed. This case illustrates the potential of integrated histopathologic and molecular diagnostics in helping to decipher CUP syndromes and establish the correct diagnosis. Additionally, this case highlights typical features of BAP1 TPDS with its general susceptibility to cancers, with pleural and peritoneal mesotheliomas as most prevalent clinical entities and the typically more benign course of these epithelioid mesotheliomas compared with BAP1-unrelated cases of mesotheliomas.
Subject(s)
Biomarkers, Tumor/genetics , Lung Neoplasms/genetics , Mesothelioma/genetics , Neoplasms, Unknown Primary/genetics , Neoplastic Syndromes, Hereditary/genetics , Tumor Suppressor Proteins/genetics , Ubiquitin Thiolesterase/genetics , Aged , Genetic Predisposition to Disease , Humans , Lung Neoplasms/secondary , Male , Mesothelioma/secondary , Mesothelioma, Malignant , Mutation , Mutation, Missense , Neoplasms, Unknown Primary/pathology , Neoplastic Syndromes, Hereditary/pathologyABSTRACT
INTRODUCTION: In case of undiagnosed pleural effusions, it is necessary to conduct thoracentesis with pleural fluid (PF) cytology. Yet, sensitivity of PF cytology is widely variable as a result of sample size, experience, and preparation method. OBJECTIVES: The aim of this study was to assess whether pleural fluid (PF) cytology is correlated to visceral or parietal pleural invasion as assessed by thoracoscopy in metastatic pleural effusions. METHODS: All records of patients with pleural effusion were reviewed. The inclusion criteria were as follows: PF cytology, reported appearance of macroscopic pleural invasion during thoracoscopy and malignant diagnosis. Patients with mesothelioma were excluded. Finally, 287 patients who met all criteria were selected. According to the thoracoscopy findings, the extent of the disease on the pleura was analyzed in relation to the PF cytology. RESULTS: In this study, 160 patients (55.7%) had a positive PF cytology (Group A) while 127 (44.3%) recorded negative PF cytology (Group B). From Group A, patients with visceral pleural invasion were 120 (75%) while only 49 patients (38.5%) were found from Group B and the difference was statistically significant (P < .00001). In univariate analysis, visceral pleural invasion was strongly associated with positive PF cytology (P < .001). Other significant associations with positive PF cytology included PF bloody aspect (P = .012), and endoscopic mixed pattern of pleural invasion (P = .0039). Only visceral pleural invasion was statistically significant in multivariate analysis (P < .001). CONCLUSIONS: In patients with pleural metastatic disease, visceral pleural invasion is the only significant factor associated with positive pleural fluid cytology.
Subject(s)
Exudates and Transudates/cytology , Lung Neoplasms/secondary , Mesothelioma/secondary , Pleura/pathology , Pleural Effusion, Malignant/pathology , Pleural Neoplasms/pathology , Thoracentesis/methods , Aged , Female , Greece/epidemiology , Humans , Incidence , Lung Neoplasms/diagnosis , Male , Mesothelioma/diagnosis , Mesothelioma, Malignant , Middle Aged , Pleural Effusion, Malignant/epidemiology , Pleural Effusion, Malignant/surgery , Retrospective Studies , Survival Rate/trends , ThoracoscopyABSTRACT
Pseudomesotheliomatous carcinoma is a malignant tumor that extends along the pleura mimicking malignant mesothelioma. An 81-year-old male patient presented to our hospital with epigastralgia, and abdominal computed tomography (CT) showed a 36-mm tumor in the pancreatic tail. The laboratory data revealed a high leukocyte count (>44 000/µL). Chest CT showed left pleural thickening with pleural effusion. The cancer showed a poor response to chemotherapy, and the patient died of respiratory failure at 5 months after the onset of disease. Autopsy showed solid tumor with hemorrhage, measuring 6 cm in diameter, in the pancreatic tail, with wide invasion to the stomach, left adrenal gland, spleen, and diaphragm. The left pleura, which was circumferentially thickened by the involved tumor, macroscopically resembled pleural mesothelioma. Histologically, the primary pancreatic tumor was diagnosed as anaplastic carcinoma, due to the absence of glandular structures or other features that would indicate a definite direction of differentiation. The primary lesion and carcinoma involving the left pleura were all positive for G-CSF. We recently experienced an autopsy case of G-CSF-producing anaplastic carcinoma with pseudomesotheliomatous spread.
Subject(s)
Carcinoma/pathology , Granulocyte Colony-Stimulating Factor/biosynthesis , Lung Neoplasms/secondary , Mesothelioma/secondary , Pancreatic Neoplasms/pathology , Pleural Neoplasms/secondary , Aged, 80 and over , Autopsy , Humans , Lung Neoplasms/pathology , Male , Mesothelioma/pathology , Mesothelioma, Malignant , Pleural Neoplasms/pathologySubject(s)
Lung Neoplasms/secondary , Mesothelioma/secondary , Muscle Neoplasms/secondary , Pleural Neoplasms/pathology , Positron Emission Tomography Computed Tomography , Antimetabolites, Antineoplastic/therapeutic use , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Humans , Lung Neoplasms/diagnostic imaging , Lung Neoplasms/drug therapy , Lung Neoplasms/radiotherapy , Male , Mesothelioma/diagnostic imaging , Mesothelioma/drug therapy , Mesothelioma/radiotherapy , Mesothelioma, Malignant , Middle Aged , Muscle Neoplasms/diagnostic imaging , Muscle Neoplasms/radiotherapy , Organoplatinum Compounds/administration & dosage , Pemetrexed/administration & dosage , Pemetrexed/therapeutic use , Pleural Neoplasms/drug therapy , Radiotherapy, Adjuvant , Smoking/adverse effectsABSTRACT
INTRODUCTION: Radical Cytoreductive Surgery (CRS) with Hyperthermic Intraperitoneal Chemotherapy (HIPEC), has been proposed as the current standard of treatment for metastatic peritoneal disease by several tumors. Despite its widely utilization, there seems to be a great variability in their organization, clinical practice, and safety among centers. AIM OF THE STUDY: To obtain updated information on clinical practice in different perioperative areas of the CRS-HIPEC. PATIENTS AND METHODS: All 25 members of the Spanish Surface Peritoneal Malignancy (GECOP), were invited to answer an online survey, to describe their usual practice in different perioperative areas of the CRS-HIPEC. RESULTS: Survey was responded by 100% of centers. This study represents more than 800 patients treated annually. Seventy per cent of respondents perform CRS-HIPEC for more than 5 years. The most frequent technique was Coliseum (88%). Routinely non-invasive monitoring of cardiac output is used by 92% of centers. More than 50% of centers administer oxaliplatin (74%), or mitomycin-C (65%) in colorectal cancer; cisplatin in gastric cancer (73%) and mesothelioma (74%). Ovarian cancer is treated with cisplatin and various combinations, in 64% or paclitaxel in 54.5%. Spillage protocol was available in 100% centers. CONCLUSIONS: Data showed an important variability in volume of patients per center, selection of cytostatic agents, professional training and safety measures applied. The standardization of CRS/HIPEC procedures based on the best available evidence, the individualization of patients and the consensus among professionals, constitute an important part of the basis that will allow us to improve results of this complex procedure.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma/therapy , Cytoreduction Surgical Procedures/methods , Hyperthermia, Induced/methods , Mesothelioma/therapy , Peritoneal Neoplasms/therapy , Practice Patterns, Physicians' , Carcinoma/secondary , Cardiac Output , Cisplatin/therapeutic use , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Female , Humans , Infusions, Parenteral , Male , Mesothelioma/secondary , Mitomycin/therapeutic use , Monitoring, Intraoperative/methods , Organoplatinum Compounds/therapeutic use , Ovarian Neoplasms/pathology , Ovarian Neoplasms/therapy , Oxaliplatin , Paclitaxel/therapeutic use , Peritoneal Neoplasms/secondary , Spain , Stomach Neoplasms/pathology , Stomach Neoplasms/therapy , Surveys and QuestionnairesABSTRACT
Malignant pleural mesothelioma is a rare neoplasm of mesodermal origin. Cutaneous involvement of malignant pleural mesothelioma is a very rare entity, with only 11 cases reported in the literature. Here, we describe the case of a 75-year-old man with stage IV epithelioid pleural mesothelioma, presenting with a cutaneous eruption 5 months after initial diagnosis, which revealed sarcomatoid features on skin biopsy. Histological analysis of malignancy progression through immunohistochemical staining of the pleural, lymph node, and skin tissue revealed gradual loss of calretinin and gain of desmin, supporting a transformation from epithelioid to sarcomatoid tissue. To our knowledge, this is the first reported case of an epithelioid to sarcomatoid transformation of malignant pleural mesothelioma manifesting in a cutaneous presentation.
Subject(s)
Lung Neoplasms/secondary , Mesothelioma/secondary , Pleural Neoplasms/pathology , Skin Neoplasms/secondary , Aged , Cell Differentiation , Cell Transformation, Neoplastic/pathology , Humans , Male , Mesothelioma, Malignant , Sarcoma/pathologyABSTRACT
Malignant mesothelioma (MM) is an aggressive and invasive neoplasm primarily affecting the pleura, peritoneum and pericardium. While mesothelioma commonly metastasizes to visceral organs, it has rarely been documented to involve the skin and subcutaneous tissue. There is a paucity of reports of cutaneous metastatic mesothelioma, and histologic examination is often challenging because the tumor closely mimics other primary and metastatic neoplasms. We report a case of a 75-year-old man presenting with a firm, hard nodule on his upper back, which on initial histologic evaluation resembled metastatic adenocarcinoma. However, upon review of his medical history and immunohistochemical evaluation of the lesion, the diagnosis of epithelioid MM metastatic to the skin was rendered. The purpose of this case report and review of the literature is to summarize the most effective available immunostains to aid in the diagnosis of this challenging entity, highlight the histologic similarities between metastatic epithelioid MM and other primary and metastatic neoplasms of the skin, and provide prognostic information for these rare tumors.
Subject(s)
Adenocarcinoma/secondary , Lung Neoplasms/secondary , Mesothelioma/pathology , Skin Neoplasms/secondary , Skin/pathology , Adenocarcinoma/pathology , Adult , Aged , Diagnosis, Differential , Female , Humans , Immunohistochemistry , Lung Neoplasms/immunology , Lung Neoplasms/pathology , Male , Mesothelioma/immunology , Mesothelioma/secondary , Mesothelioma, Malignant , Middle Aged , Skin Neoplasms/immunology , Skin Neoplasms/pathology , Subcutaneous Tissue/pathologySubject(s)
Adenocarcinoma/genetics , Carcinoma, Squamous Cell/genetics , Lung Neoplasms/genetics , Lymph Nodes/pathology , Small Cell Lung Carcinoma/genetics , Adenocarcinoma/pathology , Adult , Aged , Aged, 80 and over , Carcinoma, Renal Cell/genetics , Carcinoma, Renal Cell/secondary , Carcinoma, Squamous Cell/pathology , Class I Phosphatidylinositol 3-Kinases/genetics , DNA Mutational Analysis , Endoscopic Ultrasound-Guided Fine Needle Aspiration , ErbB Receptors/genetics , Female , High-Throughput Nucleotide Sequencing , Humans , Lung Neoplasms/pathology , Lung Neoplasms/secondary , Male , Melanoma/genetics , Melanoma/secondary , Mesothelioma/genetics , Mesothelioma/secondary , Middle Aged , PTEN Phosphohydrolase/genetics , Prospective Studies , Proto-Oncogene Proteins p21(ras)/genetics , Retinoblastoma Binding Proteins/genetics , Sequence Analysis, DNA , Small Cell Lung Carcinoma/pathology , Tumor Suppressor Protein p53/genetics , Ubiquitin-Protein Ligases/geneticsSubject(s)
Mediastinal Neoplasms/diagnostic imaging , Mesothelioma/diagnostic imaging , Mesothelioma/secondary , Muscle Neoplasms/diagnostic imaging , Neoplasm Recurrence, Local/diagnostic imaging , Pleural Neoplasms , Humans , Intermediate Back Muscles/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Male , Mediastinal Neoplasms/secondary , Middle Aged , Muscle Neoplasms/secondary , Positron Emission Tomography Computed Tomography , Rectus Abdominis/diagnostic imaging , Time FactorsABSTRACT
BACKGROUND: Peritoneal carcinomatosis represents widespread metastatic disease throughout the abdomen and/or pelvis. Cytoreductive surgery/hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) improves the overall survival compared to standard therapy alone. The role palliative care (PC) plays however, remains poorly studied among these patients. METHODS: Patients who had previously undergone HIPEC and who underwent an inpatient admission from 7/1/2013 to 6/30/2014 were identified to determine which patients were referred for inpatient or outpatient palliative consultation. Multivariable logistic regression analysis was performed to identify risk factors associated with the use of PC. RESULTS: Of the 60 patients analyzed, 23 (38.3%) had a PC consultation with a median time to PC referral of 310 (IQR: 151-484 days). Patients who were prescribed opioids (no PC referral versus PC referral: 46.0% versus 91.3%, P < 0.001), patients who reported the use of a cancer-related emetic (35.1% versus 87.0%, P < 0.001), patients reporting the use of total parenteral nutrition (16.2% versus 39.1%, P = 0.046), and patients dependent on a gastric tube for nutrition (5.4% versus 43.5%, P < 0.001) were more likely to be referred to a PC consultation. On multivariable analysis, use of opioids, use of a cancer-related antiemetic, and the use of a G-tube were independently associated with a greater odds for being referred to PC (all P < 0.05). CONCLUSIONS: Approximately one-third of patients were referred to PC following cytoreductive surgery/hyperthermic intraperitoneal chemotherapy. Palliative care referrals were most commonly used for patients with chronic symptoms, which are difficult to manage, especially toward the end of life.
Subject(s)
Chemotherapy, Cancer, Regional Perfusion , Cytoreduction Surgical Procedures , Hyperthermia, Induced , Palliative Care/statistics & numerical data , Peritoneal Neoplasms/secondary , Peritoneal Neoplasms/therapy , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Appendiceal Neoplasms/pathology , Colonic Neoplasms/pathology , Combined Modality Therapy , Female , Follow-Up Studies , Humans , Logistic Models , Male , Mesothelioma/secondary , Mesothelioma/therapy , Middle Aged , Ovarian Neoplasms/pathology , Referral and Consultation/statistics & numerical data , Retrospective Studies , Sarcoma/secondary , Sarcoma/therapy , Stomach Neoplasms/pathologyABSTRACT
OBJECTIVE: To describe clinical management and outcomes of a cohort of patients with malignant mesothelioma of the tunica vaginalis testis (MMTVT) who received treatments beyond radical orchiectomy. METHODS: Patients with confirmed MMTVT at a single tertiary care institution were identified. Treatments, pathologic outcomes, and survival were recorded. Prognostic variables associated with survival were analyzed with a Cox proportional hazards model and Kaplan-Meier curves. RESULTS: Overall, 15 patients were included. Initial presentation was a scrotal mass in 7 of 15 (47%) and hydrocele in 5 of 15 (33%) patients. Clinical staging revealed enlarged nodes in 5 of 15 (33%) patients. Radical orchiectomy was the initial treatment in 5 of 15 (33%) patients. Positive surgical margins were found in 6 of 14 (43%) radical orchiectomies and were associated with worse survival (P = .007). The most frequent histologic subtype was epithelioid, associated with better survival (P = .048). Additional surgeries were performed on 12 of 15 (80%) patients. Pathologic examination revealed MMTVT in 6 of 12 (50%) hemiscrotectomies, 7 of 8 (88%) retroperitoneal lymph node dissections, 1 of 7 (14%) pelvic lymph node dissections, and 10 of 10 (100%) groin dissections. Five patients received adjuvant chemotherapy. Two also received adjuvant radiation therapy. Three patients with lymph node involvement remain no evidence of disease over 6 years after diagnosis. After a median follow-up of 3.5 years (interquartile range: 1.2-7.2), 5 patients have died, all of MMTVT; the median overall survival has not been reached. Common sites of relapse were lungs (5 of 7) and groin (3 of 7). CONCLUSION: The pattern of metastatic spread of MMTVT is predominantly lymphatic. Nodes in the retroperitoneum and the groin are commonly involved. Prognosis is poor, but there may be a role for aggressive surgical resection including hemiscrotectomy, and inguinal and retroperitoneal lymph nodes.