Asunto(s)
Adenocarcinoma/cirugía , Anastomosis Quirúrgica/métodos , Neoplasias del Colon/cirugía , Histiocitoma Fibroso Maligno/cirugía , Neoplasias Retroperitoneales/cirugía , Sarcoma/cirugía , Adenocarcinoma/irrigación sanguínea , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Anciano , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/cirugía , Aterosclerosis/diagnóstico por imagen , Aterosclerosis/patología , Aterosclerosis/cirugía , Neoplasias del Colon/irrigación sanguínea , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/patología , Vena Femoral/diagnóstico por imagen , Vena Femoral/cirugía , Histiocitoma Fibroso Maligno/irrigación sanguínea , Histiocitoma Fibroso Maligno/diagnóstico por imagen , Histiocitoma Fibroso Maligno/patología , Humanos , Intestino Grueso , Masculino , Proctocolectomía Restauradora/métodos , Neoplasias Retroperitoneales/irrigación sanguínea , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias Retroperitoneales/patología , Sarcoma/irrigación sanguínea , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Tomografía Computarizada Espiral , Resultado del Tratamiento , UltrasonografíaAsunto(s)
Fiebre de Origen Desconocido/etiología , Histiocitoma Fibroso Maligno/irrigación sanguínea , Histiocitoma Fibroso Maligno/diagnóstico por imagen , Aumento de la Imagen , Leucocitosis/etiología , Neovascularización Patológica/diagnóstico por imagen , Neoplasias Retroperitoneales/irrigación sanguínea , Neoplasias Retroperitoneales/diagnóstico por imagen , Ultrasonografía Doppler en Color , Anciano , Biomarcadores de Tumor/análisis , Biopsia , Médula Ósea/patología , Medios de Contraste/administración & dosificación , Diagnóstico Diferencial , Análisis de Fourier , Histiocitoma Fibroso Maligno/patología , Humanos , Masculino , Neovascularización Patológica/patología , Fosfolípidos , Neoplasias Retroperitoneales/patología , Hexafluoruro de Azufre , Tomografía Computarizada por Rayos X , Imagen de Cuerpo EnteroRESUMEN
Malignant fibrous histiocytoma (MFH) is a pleomorphic mesenchynal sarcoma. It is uncommonly arises primarily from the intra-peritoneal cavity. Primary peritoneal MFH with tumor bleeding and rupture is rare. We describe the imaging features of a 70-year-old patient presenting with ruptured hemorrhagic peritoneal MFH at subhepatic area, accompanied by massive hemoperitoneum, mimicking a ruptured pedunculated hepatocellular carcinoma. Computed tomography (CT) revealed a large heterogeneous enhanced subhepatic mass with adjacent liver, gallbladder and colon invasion. Tumor hemorrhage and rupture complicated with peritoneal seeding and massive bloody ascites were also detected. Angiography showed a hypervascular tumor fed by enlarged right hepatic arteries, cystic artery and omental branches of gastroepiploic artery. The patient underwent laparotomy for tumor resection, but the tumor recurred one month after operation. To our knowledge, the CT appearance of ruptured intraperitoneal MFH complicated by hemoperitoneum has not been previously described.
Asunto(s)
Carcinoma Hepatocelular/diagnóstico , Hemoperitoneo/etiología , Hemorragia/complicaciones , Histiocitoma Fibroso Maligno/diagnóstico , Neoplasias Hepáticas/diagnóstico , Hígado/patología , Neoplasias Peritoneales/diagnóstico , Anciano , Ascitis/etiología , Diagnóstico Diferencial , Embolización Terapéutica , Resultado Fatal , Hemoperitoneo/patología , Hemoperitoneo/cirugía , Hemorragia/etiología , Hemorragia/patología , Histiocitoma Fibroso Maligno/irrigación sanguínea , Histiocitoma Fibroso Maligno/complicaciones , Histiocitoma Fibroso Maligno/patología , Histiocitoma Fibroso Maligno/terapia , Humanos , Masculino , Invasividad Neoplásica , Metástasis de la Neoplasia , Neoplasias Peritoneales/irrigación sanguínea , Neoplasias Peritoneales/complicaciones , Neoplasias Peritoneales/patología , Neoplasias Peritoneales/terapia , Rotura Espontánea , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
PURPOSE: To investigate the value of serial arteriography to assess tumor response, predict necrosis, and individualize the duration of a combined intravenous (IV) and intraarterial (IA) neoadjuvant chemotherapy protocol in patients with biopsy-proven high-grade osteosarcoma or malignant fibrohistiocytoma of bone. MATERIALS AND METHODS: Between July 1987 and March 2003, 109 patients completed a chemotherapy protocol of neoadjuvant IV doxorubicin and IA cisplatin. Patients were eligible regardless of age, disease stage, or disease site. A minimum of three IA cycles followed by definitive surgery was required for inclusion in the final analysis. IA dose and duration were increased for tumors larger than 10 cm. Initial arteriograms were scored as indicating mild, moderate, or marked tumor neovascularity (TNV). Subsequent arteriograms were prospectively compared with the baseline image for percent change in TNV. Treatment continued until a maximum of five cycles were administered or one of three criteria were met: (i) at least 90% decrease in TNV, (ii) plateau of effect, or (iii) no response. RESULTS: Of 408 IA procedures, 42 patients underwent three cycles, 53 underwent four, and 14 required five cycles of neoadjuvant therapy. There was a 2.5% minor complication rate. Eighty-six percent of patients exhibited at least 90% decrease in TNV and 82% exhibited good histologic response (> or =90% tumor necrosis). Serial arteriography predicted a good histologic response with an accuracy of 90% and a sensitivity of 97%. CONCLUSIONS: Serial arteriography was highly sensitive and accurately predicted good responses. This individually modified, dose-intensified neoadjuvant protocol yielded an excellent histologic response rate with minimal complications. Future endeavors should involve a multiinstitutional study of this unique approach.