Giant retroperitoneal leiomyosarcoma. Multiorgan block removal.

INTRODUCTION: Retroperitoneal tumors are rare, mostly malignant. Locally aggressive, and more frequent in women in their 5th decade of life. Its symptoms are nonspecific, including abdominal pain and palpable mass. To diagnosis is helpful computed tomography and biopsy. It needs surgery for absolute healing. PRESENTATION OF CASE: 67 years old man was admitted with back pain and fever. Abdominal imaging tests showed a 15cm abdominal mass without clear organodependencia. Endoscopy with biopsies evidenced mesenchymal neoplasia of undetermined origin. In surgery we confirm its resecability and was necessary multiorgan resection. Pathologic diagnosis: well differentiated retroperitoneal leiomyosarcoma. Started adjuvant radiotherapy. In subsequent tests showed the presence of liver metastases. DISCUSSION: Retroperitoneal tumors are developed from nerve, vascular, muscular, connective, supportive and fibroareolar tissue from this space. Its size does not modificate survival or resectability. We used TC and biopsy for its diagnose. Adjuvant therapy does not affect survival or quality of life, surgery remains the only curative option. Locoregional recurrence is the most influential figure in the prognosis. A large percentage of patients required a second surgery (between 45 and 82%). CONCLUSION: The only curative option of retroperitoneal sarcomas is surgery, which usually requires multiple organ resection. Chemotherapy and radiotherapy are mostly a surgical supplement. Chemotherapy has not shown significant increase in survival.

[Local recurrence after non-small cell lung cancer surgery: prognosis variables]. / Recidiva local tras la cirugía del cáncer de pulmón no microcrítico: factores pronósticos.

OBJECTIVES: Retrospectively to analyse the influence of clinical and histo-pathological characteristics in the local recurrence after non-small cell lung cancer surgery. METHOD: 146 patients were included and studied during a minimum of two years. The free survival of disease function (FSD) was constructed according to the Kaplan-Meier method. The univariant comparison of the FSD by Mantel-Haenszel means of logarithmic ranks test and the multivariant analysis by Cox regression model. RESULTS: In the univariant analysis 20 months of FSD and the following predicting factors of a smaller FSD: Radiological contact of the tumour with the pleura (p=0.005), peritumoral margin affectation (p=0.001), pleural affectation (p=0.006), T stratification factor (p=0.04) and N factor (p=0.002). Other factors like age, initial symptoms, second neoplasias, radiological spiculations or cavitations, transtoracic puncion, type of surgery, peribronquial affectation, so large margin tumorlike and histological type, did not show statistically significant differences in the FSD. In the multivariant study they maintain its value prognosis the pleural affectation (p=0.0014), ganglionary affectation (p=0.02) and degree of differentiation (p=0.03). CONCLUSIONS: The most important prognosis factor of local recurrence after surgery in these patients were the infiltration of the pleura, followed of the hilio-mediastinic ganglionary affectation and the degree of histological differentiation.

Recidiva local tras la cirugía del cáncer de pulmón no microcrítico. Factores pronósticos / Local recurrence after non-small cell lung cancer surgery. Prognosis variables

Objetivos: Analizar retrospectivamente la influencia de características clínicas e histo-patológicas en la recidiva local tras cirugía del carcinomano microcítico de pulmón. Método: Se incluyeron en el estudio 146 pacientes seguidos durante un mínimo de 2 años. La función de supervivencia libre de enfermedad (SLE) se construyó según el método de Kaplan-Meier. La comparación univariante de la SLE se realizó mediante test de los rangos logarítmicos de Mantel-Haenszel y para el análisis multivariante se aplicó el modelo de regresión de Cox. Resultados: La mediana de la SLE fue de 20 meses En el análisis univariante, se encontraron los siguientes factores predictores de una menor SLE: contacto radiológico del tumor con la pleura (p = 0,005), grado de indiferenciación histológica (p = 0,03), afectación del margen peritumoral (p = 0,001), afectación pleural (p = 0,006), estadificación T(p = 0,04) y estadificación N (p = 0,002). Otros factores como la edad, presencia inicial de síntomas, segundas neoplasias, presencia radiológica de espiculaciones o cavitación, punción transtorácica, tipo de cirugía, afectación del margen peribronquial, tamaño tumoral y tipo histológico, no mostraron diferencias estadísticamente significativas en la SLE. En el estudio multivariante mantienen su valor pronóstico la afectación pleural (p = 0,0014), afectación ganglionar (p = 0,02) y grado de diferenciación (p = 0,03). Conclusiones: El factor pronóstico más importante de recidiva local tras cirugía en estos pacientes fue la infiltración de la pleura, seguido de la afectación ganglionar hilio-mediastínica y el grado de diferenciación histológica

Objetives: Retrospectively to analyse the influence of clinical and histo-pathological characteristics in the local recurrence after non-smallcell lung cancer surgery. Method: 146 patients were included and studied during a minimum of two years. The free survival of disease function (FSD) was constructed according to the Kaplan-Meier method. The univariante comparison of the FSD by Mantel-Haenszel means of logarithmic ranks test and the multivariante analysis by Cox regression model. Results: In the univariante analysis 20 months of FSD and the following predicting factors of a smaller FSD: Radiological contact of the tumour with the pleura (p = 0.005), peritumoral margin affectation (p =0.001), pleural affectation (p = 0.006), T stratification factor (p = 0.04) and N factor (p = 0.002). Other factors like age, initial symptoms, second neoplasias, radiological spiculaciones or cavitations, transtoracic puncion, type of surgery, peribronquial affectation, so large margin tumor like and histological type, did not show statistically significant differences in the FSD. In the multivariante study they maintain its value prognosis the pleural affectation (p = 0.0014), ganglionary affectation (p = 0.02) and degree of differentiation (p = 0.03). Conclusions: The most important prognosis factor of local recurrence after surgery in these patients were the infiltration of the pleura, followed of the hilio-mediastínica ganglionary affectation and the degree of histological differentiation

Hemorragia digestiva secundaria a un leiomiosarcoma de íleon: tratamiento laparoscópico / Digestive hemorrhage secondary to leiomyosarcoma of the ileum: laparoscopic management

Las neoplasias malignas del intestino delgado representan únicamente el 2 por ciento de los tumores gastrointestinales. En su mayoría corresponden a adenocarcinomas y tumores carcinoides. Los tumores originados en la musculatura lisa intestinal se engloban dentro de la denominación de tumores estromales. Predominantemente se localizan en yeyuno e íleon. El tratamiento de esta entidad sigue siendo fundamentalmente quirúrgico, aunque su tratamiento laparoscópico sólo ha sido comunicado de forma ocasional. Describimos un caso de leiomiosarcoma de íleon cuyo tratamiento quirúrgico consistió en una resección laparoscópica (AU)