RESUMO
Metastatic carcinoma of the spleen occurs in a setting of widespread malignant disease. Solitary parenchymal splenic metastasis of ovarian carcinoma is rare. We report a case of a 59-year-old woman who presented with an elevated serum CA125 level due to a solitary splenic metastasis after a long disease-free period. She was treated with laparoscopic splenectomy followed by chemotherapy. The literature contains 16 cases of solitary parenchymal splenic metastasis of ovarian carcinoma. Our case is the third case that was treated with laparoscopic splenectomy. We review the literature, and we focus on the laparoscopic approach in managing these cases.
Assuntos
Cistadenocarcinoma Seroso/secundário , Neoplasias Ovarianas/patologia , Neoplasias Esplênicas/secundário , Antígeno Ca-125/sangue , Cistadenocarcinoma Seroso/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Neoplasias Ovarianas/terapia , Baço/patologia , Baço/cirurgia , Neoplasias Esplênicas/cirurgiaAssuntos
Adenocarcinoma/secundário , Neoplasias Retais/patologia , Neoplasias Testiculares/secundário , Idoso , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Masculino , Recidiva Local de Neoplasia , Orquiectomia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/cirurgia , Testículo/diagnóstico por imagem , UltrassonografiaAssuntos
Carcinoma de Células Escamosas/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Constipação Intestinal , Tubas Uterinas/cirurgia , Evolução Fatal , Feminino , Humanos , Histerectomia , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Ovariectomia , Dor Pélvica , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/terapia , Fumar , Tomografia Computadorizada por Raios XRESUMO
Pure primary squamous cell carcinoma (SCC) of the breast is a rare condition. The exact histogenesis of this malignancy is unclear. The rarity of the condition makes it difficult to draw firm conclusions on the course of the disease and the overall prognosis. We report a case of pure primary SCC of the breast occurring in a 62-year-old woman and presenting as an enlarged breast lesion with bleeding. We also review the literature for all cases of pure primary SCC.
Assuntos
Neoplasias da Mama/patologia , Carcinoma de Células Escamosas/patologia , Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Feminino , Humanos , Mastectomia , Pessoa de Meia-Idade , Invasividade Neoplásica , Radioterapia AdjuvanteAssuntos
Síndrome de Budd-Chiari/diagnóstico , Hemoglobinúria Paroxística/complicações , Hemoglobinúria/complicações , Metilenotetra-Hidrofolato Desidrogenase (NAD+)/genética , Mutação , Adulto , Ascite , Fator V/genética , Hemoglobinúria/diagnóstico , Hemoglobinúria Paroxística/diagnóstico , Heterozigoto , Humanos , Coeficiente Internacional Normatizado , Masculino , Protrombina/genética , Baço/diagnóstico por imagem , Trombofilia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Varfarina/farmacologiaRESUMO
The purpose of this study was to evaluate the combination of cisplatin and vinorelbine (PVn) for relapsed and chemotherapy-pretreated metastatic breast cancer. Twenty-three patients with metastatic breast cancer and prior chemotherapy were entered in a phase II study between June 1993 and December 1994. Eleven patients were premenopausal and 12 were postmenopausal. Follow-up data up to June 1997 are presented. All patients received cisplatin at a dose of 90 mg/m2 divided over 3 days as 30 mg/m2 infused over 4 hours. Intravenous vinorelbine 25 mg/m2 was given on days 1 and 8 or 15 according to patients' blood counts. Cycles were given every 3 to 4 weeks. An overall response rate of 61% (16/23 patients) was observed. Complete remission was obtained in six patients (26%) and partial remission was obtained in nine patients (35%). The duration of response ranged from 3 to 9 months, with an average of 4 months. Stable disease was noted in 29.1% and progressive disease in 8.3%. Overall survival at 12 months was 50%, and at 36 months it was 8%. Five of 12 patients (42%) who had prior doxorubicin therapy responded well to cisplatin-vinorelbine. Of those 12, seven were refractory and progressive on a doxorubicin-containing regimen, one had complete remission, and four had partial remission. Hematologic toxicity was acceptable. Treatment was delayed because of neutropenia in nine cycles (9.2%) and grade 2 leukopenia occurred in 54% of cycles. Febrile neutropenia occurred in seven cycles (7.1%), and five cycles were complicated by documented sepsis (5.1%). No treatment-related mortality occurred. Thrombocytopenia (grade 3) was seen in 27% of cycles, with no patient having a platelet count below 50,000 or bleeding episodes. Other toxicities were not major or dose-limiting. In conclusion, the combination of cisplatin and vinorelbine produced good responses: 61% response rate (16 of 23 patients) in relapsed, refractory, and heavily pretreated metastatic breast cancer, with 50% survival at 1 year, 12% at 2 years, and 8% at 3 years. In addition, a response rate of 42% (5 of 12 patients) was seen in patients resistant to anthracyclines.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/patologia , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Recidiva Local de Neoplasia/tratamento farmacológico , Adulto , Idoso , Cisplatino/administração & dosagem , Esquema de Medicação , Feminino , Humanos , Pessoa de Meia-Idade , Vimblastina/administração & dosagem , Vimblastina/análogos & derivados , VinorelbinaAssuntos
Antineoplásicos/efeitos adversos , Doxorrubicina/efeitos adversos , Extravasamento de Materiais Terapêuticos e Diagnósticos/tratamento farmacológico , Fator Estimulador de Colônias de Granulócitos e Macrófagos/administração & dosagem , Úlcera Cutânea/tratamento farmacológico , Antineoplásicos/administração & dosagem , Neoplasias da Mama/tratamento farmacológico , Doxorrubicina/administração & dosagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/etiologia , Feminino , Seguimentos , Mãos , Humanos , Injeções Subcutâneas , Pessoa de Meia-Idade , Úlcera Cutânea/induzido quimicamente , Cicatrização/efeitos dos fármacosRESUMO
Cancers seen and recorded between 1983 and 1995 in the Hospital Tumor Registry at the American University of Beirut Medical Center (AUBMC), one of the largest primary and tertiary care hospitals in Lebanon, were retrospectively reviewed and analyzed. There was a total of 10,220 cases, excluding 916 skin cancers other than skin melanoma, averaging 786 cases per year. There were 5086 cancer cases in males with the five most common cancers being: lung cancer (915 cases: 17.9%) followed by bladder cancer (503 cases: 9.8%), larynx (438 cases: 8.6%), lymphoma (393 cases: 7.7%) and leukemia (336 cases: 6.6%). As for female cancer cases, a total of 5134 cases were observed with the five most common cancers being: breast cancer (1821 cases), followed by cervical cancer (535 cases), colo-rectal cancer (256 cases: 4.9%), lymphoma (232 cases: 4.5%), and brain cancer (213 cases: 4.1%). The average age for all cancer cases was 50.5 years with a standard deviation (SD) of 18.8 years. The average age of females (48.8 yrs; SD 17.4) was relatively lower than that of males (52.2 yrs; SD 19.9) and the difference was statistically significant. 40.6% of the patients were under the age of 50 years. 49% of breast cancer patients were below 50 years of age. In children less than 15 years of age, there were 555 cases, with leukemia being the commonest (185 cases: 33.3% of childhood cases) followed by brain cancer (112 cases: 20.1%), lymphoma (63 cases: 11.3%), bone cancer (41 cases: 7.3%), soft tissue sarcoma (35 cases: 6.3%) and kidney cancer (28 cases: 5.0%). Lung cancer in males and breast cancer in females are the most common cancers in Lebanon. These cancers are amenable to prevention (cigarette cessation and anti-smoking campaigns for lung cancer) and early detection (screening, regular breast examination and mammography for breast cancer). Our paper emphasizes the importance of addressing those and other issues including bladder cancer and age at diagnosis of breast cancer. It also presents important epidemiological and historical reference data on cancer in Lebanon during the civil war and immediately after it.
Assuntos
Neoplasias/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Países Desenvolvidos , Países em Desenvolvimento , Feminino , Hospitais Universitários , Humanos , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/terapia , Vigilância da População , Sistema de Registros , Distribuição por SexoRESUMO
A 58-year-old woman underwent abdominal hysterectomy and bilateral salpingo-oophorectomy for stage Ib, grade 2 endometrial adenocarcinoma followed by external pelvic irradiation. Five years later she presented with a 7 cm solitary infraumbilical incisional tumor recurrence that was resected. Histology of the tumor implant was similar to that of the primary cancer. The patient was then started on progestin therapy with no evidence of recurrence for four years. To our knowledge this is the fourth reported case of endometrial cancer implanting in an abdominal scar.
Assuntos
Adenocarcinoma/diagnóstico , Cicatriz/patologia , Neoplasias do Endométrio/diagnóstico , Inoculação de Neoplasia , Adenocarcinoma/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Laparotomia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Procedimentos Cirúrgicos Operatórios/efeitos adversosRESUMO
PURPOSE: Cancers recorded in the Tumor Registry at the American University of Beirut Medical Center (AUBMC), the largest tertiary care center, in Lebanon were reviewed. METHODS: Results were compared with those from the same center 30 years ago and current data from western Asia. RESULTS: Between 1983 and 1994, 9364 cases were recorded, averaging 780 cases per year, representing more than one-third of the national case-load. Cases were almost equally distributed between males and females. Average age of females was significantly younger (48.7 years) than that of males (52.2 years). Among males, the five most frequently reported cancers were of the lung, bladder, larynx, lymphoma, and leukemia. Among females, the four most frequently reported cancers were of the breast, cervix uteri, lymphoma, and brain, with leukemia and corpus uteri ranking equally as fifth. Over the past 30 years, the frequency of colorectal cancer decreased and that of lung cancer increased in both sexes. Oral cancer decreased dramatically among males. Digestive system cancers in this series were less frequent than in cumulative data from western Asia area. CONCLUSIONS: Cancer dynamics changed little since the 1950s, except regard to cancers related to smoking and diet. Diet differences may explain the lower frequencies of digestive cancers in Lebanon as compared with elsewhere in western Asia. The potential impact of cancer prevention and early detection on highly prevalent cancer types such as lung, larynx, breast, and cervix was highlighted.
Assuntos
Neoplasias/epidemiologia , Sistema de Registros , Centros Médicos Acadêmicos , Adolescente , Distribuição por Idade , Criança , Bases de Dados Factuais , Dieta/efeitos adversos , Feminino , Humanos , Incidência , Líbano/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Vigilância da População , Distribuição por Sexo , Fumar/efeitos adversosRESUMO
This is the first report of granulocyte macrophage-colony stimulating factor (GM-CSF) inducing accelerated healing of a sacral pressure ulcer in a bedridden patient with bilateral hemiplegia. GM-CSF was diluted and injected locally around and into the ulcer bed every 2-3 days for 2 weeks, then weekly for 4 weeks until complete healing occurred. A new firm granulation tissue was noted within a few days. The ulcer showed 85% healing within 2 weeks and 100% by 2 months. Healing started from the periphery and from within the ulcer bed at sites of GM-CSF injections. It was slower at areas where there was complete necrosis and detachment of skin from underlying tissue. The ulcer remained closed until the patient's sudden death 9 months later. A biopsy of granulation tissue showed inflammatory cells and reactive fibroblasts. The potential role of GM-CSF and growth factors in pressure ulcer therapy and wound healing are discussed.
Assuntos
Fator Estimulador de Colônias de Granulócitos e Macrófagos/uso terapêutico , Úlcera por Pressão/tratamento farmacológico , Cicatrização/efeitos dos fármacos , Idoso , Hemiplegia/complicações , Humanos , Injeções Intralesionais , Masculino , Úlcera por Pressão/complicações , Úlcera por Pressão/patologia , Região SacrococcígeaRESUMO
Leptomeningeal involvement is usually reported as a secondary event in advanced, already diagnosed, gastric adenocarcinoma. We report a case of leptomeningeal carcinomatosis in which identification of mucus-secreting "signet-ring" carcinoma cells in the cerebrospinal fluid allowed the diagnosis of an otherwise asymptomatic gastric cancer. This is one of the very few reported cases manifesting as such in the medical literature.
Assuntos
Adenocarcinoma/diagnóstico , Carcinoma de Células em Anel de Sinete/diagnóstico , Neoplasias Meníngeas/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/tratamento farmacológico , Antimetabólitos Antineoplásicos/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células em Anel de Sinete/tratamento farmacológico , Carcinoma de Células em Anel de Sinete/secundário , Doxorrubicina/administração & dosagem , Fluoruracila/administração & dosagem , Humanos , Masculino , Neoplasias Meníngeas/tratamento farmacológico , Neoplasias Meníngeas/secundário , Metotrexato/administração & dosagem , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Neoplasias Gástricas/tratamento farmacológicoRESUMO
The use of alkylating agents has been reported to be a cause of secondary leukemia particularly in patients surviving for 2 years or more after treatment of ovarian carcinoma. The risk of developing leukemia is possibly related to the duration of treatment and the total dose of alkylating agents administered. We report a patient with epithelial ovarian carcinoma who received chlorambucil for 130 consecutive months with no clinical or laboratory evidence of leukemia.
Assuntos
Clorambucila/uso terapêutico , Cistadenocarcinoma/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Clorambucila/administração & dosagem , Clorambucila/efeitos adversos , Cistadenocarcinoma/patologia , Cistadenocarcinoma/cirurgia , Feminino , Humanos , Leucemia/induzido quimicamente , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgiaRESUMO
The present report describes a 27-year-old woman diagnosed with Ann Arbor stage IE primary malignant lymphoma of the cervix. Radiation therapy was instituted as conventionally advocated at this early stage of the disease. Despite adequate local tumor response, central nervous system metastasis occurred a few months later. She succumbed to her condition 7 months after initial diagnosis. As occult distant foci may not be amenable to detection by available imaging techniques at the time of initial work-up, combination chemotherapy alone or in conjunction with radiation therapy may be the most appropriate first line of therapy in patients with stage IE primary malignant lymphoma of the cervix.
Assuntos
Neoplasias Encefálicas/secundário , Linfoma/radioterapia , Neoplasias do Colo do Útero/radioterapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ciclofosfamida/administração & dosagem , Ciclofosfamida/efeitos adversos , Doxorrubicina/administração & dosagem , Doxorrubicina/efeitos adversos , Feminino , Humanos , Linfoma/patologia , Estadiamento de Neoplasias , Prednisolona/administração & dosagem , Prednisolona/efeitos adversos , Couro Cabeludo , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/secundário , Neoplasias do Colo do Útero/patologia , Vincristina/administração & dosagem , Vincristina/efeitos adversosRESUMO
Acute tumor lysis syndrome (ATLS) is a rare metabolic complication in nonhematologic malignancies. We report a unique case of extensive regionally recurrent squamous cell carcinoma of the vulva who developed a picture compatible with ATLS 36 hr after the initiation of palliative chemotherapy. The patient suffered acute renal failure with hyperuricemia, hyperphosphatemia, and hypocalcemia as well as a picture suggestive of congestive heart failure. The patient responded well to adequate hydration, alkaline diuresis, and allopurinol. The potential for ATLS should be anticipated when treating metastatic or locally advanced squamous cell carcinoma of the vulva with chemotherapy.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma de Células Escamosas/complicações , Síndrome de Lise Tumoral/etiologia , Neoplasias Vulvares/complicações , Idoso , Carcinoma de Células Escamosas/tratamento farmacológico , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Fluoruracila/administração & dosagem , Fluoruracila/efeitos adversos , Humanos , Metástase Linfática , Neoplasias Vulvares/tratamento farmacológicoRESUMO
Primary malignant lymphoma of the female urethra is a rare entity. Five cases of non-Hodgkin's lymphoma of the female urethra have been previously reported. We report another case presenting with a urethral caruncle. A review of the literature is included.