Treatment of metastatic squamous cell carcinoma arising in sacrococcygeal pilonidal sinus: a case report series.

Background: Squamous cell carcinoma (SCC) arising in a sacrococcygeal pilonidal sinus is rare, with cases of metastatic disease being even rarer. Among published cases, almost none have reported on systemic treatment. Objective: This disease has a poorer prognosis than other forms of cutaneous SCC; therefore, our objective is to shed some light on the treatment of metastatic disease. Methods: We present a series of nine cases treated at a single center, four of whom received systemic treatment. Additionally, other previously reported cases of metastatic disease are included in an attempt to draw stronger conclusions. Results: Four patients were treated under several treatment regimens, with a median progression-free survival of only 2 months and two instances of partial response (18%). The best result was achieved with cemiplimab. Across all the cases, there was a trend toward a benefit of the use of systemic treatment (HR 0.41, 95% CI 0.15-1.12, p = 0.083; median overall survival 13 vs. 8 months). Limitations: Limitations include the significant lack of information on previously published cases and the extremely heterogeneous nature of the existing information. Conclusion: The initial systemic treatment should be an anti-PD-1, as with other SCCs. After progression on anti-PD-1, there is no strong evidence to support the recommendation of a specific treatment or sequence: options include cetuximab and/or chemotherapy (platinum, paclitaxel, 5-fluorouracyl).

125I Radioactive Seed Localization vs. Conventional Surgery for the Treatment of Mesenchymal Tumours: A Propensity Score Matching Analysis.

PURPOSE: Radioguided localization can assist the surgery of hard-to-find lesions. The aim was to evaluate the results of the 125I Radioactive Seed Localization (RSL) technique to guide a margin-free tumoral resection of mesenchymal tumours compared to conventional surgery and its influence in oncological outcomes. METHODS: Retrospective observational study of all consecutive patients who underwent 125I RSL for the surgery of a mesenchymal tumour from January 2012 to January 2020 in a tertiary referral centre in Spain. The control group was formed by patients with conventional surgery in the same period and centre. A Propensity Score matching at 1:4 ratio selected the cases for analysis. RESULTS: A total of 10 lesions excised in 8 radioguided surgeries were compared to 40 lesions excised in 40 conventional surgeries, with equal proportion of histological subtypes in each group. There was a higher proportion of recurrent tumours in the RSL group (80 % [8/10] vs. 27.5 % [11/40]; p: 0.004). An R0 was achieved in 80 % (8/10) of the RSL group and 65 % (26/40) of the conventional surgery group. The R1 rate was 0 % and 15 % (6/40), and the R2 rate was 20 % (2/10 and 8/40) in the RSL group and conventional surgery group, respectively (p: 0.569). No differences were detected in disease-free or overall survival between the different histological subtypes in the subgroup analysis. CONCLUSION: The 125I RSL technique of a challenging sample of mesenchymal tumours achieved a similar margin-free tumoral resection and oncological outcomes as conventional surgery.

Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico / Impact of unplanned resection and re-excision of a soft tissue sarcoma on prognosis

INTRODUCCIÓN: Hasta un 40% de los sarcomas de partes blandas (SPB) son resecados de forma no planificada, dejando tumor residual en más del 50% de los casos. La implicación pronóstica de estas resecciones no está claramente definida, dado que existen escasos estudios comparativos que demuestren cómo afecta a la tasa de recurrencia local, de metástasis y de supervivencia. MÉTODOS: Revisión retrospectiva de pacientes intervenidos de un SPB de enero de 2000 a enero de 2016 clasificándolos respecto a intervención planificada o no planificada. Se compararon las tasas de recurrencia y metástasis en global y por estadios. RESULTADOS: Ceintitrés pacientes con SPB fueron tratados de forma planificada y 16 de forma no planificada, con 13 reintervenciones. El 40% del grupo planificado presentó un estadio avanzado respecto al 20% del grupo no planificado. El 77% de los pacientes con resección no planificada reintervenidos presentaron tumor residual en la pieza. La tasa de recidiva local en el grupo de no planificados fue considerablemente más alta (73,5% frente al 43,8%). La tasa de metástasis en no planificados fue del 45,5%, frente al 56,3% en planificados (p > 0,05). En el grupo de no planificados el patrón de recidiva fue más errático con peores resultados en estadios precoces. Concusiones: La resección no planificada de los SPB asocia mayores tasas de recurrencia local y peores resultados funcionales a pesar del manejo oncológico posterior. En las lesiones de partes blandas es fundamental reconocer los signos de alarma que sugieren malignidad para llevar a cabo un estudio diagnóstico específico y evitar resecciones inadecuadas

INTRODUCTION: Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. METHODS: Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. RESULTS: Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision.40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages.77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs.43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. CONCLUSION: The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections

Impact of unplanned resection and re-excision of a soft tissue sarcoma on prognosis. / Impacto de la resección no planificada y la reintervención de sarcomas de partes blandas en su pronóstico.

INTRODUCTION: Up to 40% of all initial operations for soft tissue sarcoma (STS) are unplanned, which would leave residual macroscopic tumor in more than 50% of the cases. The effect this has on local recurrence rate, metastases rate and survival has never been fully established, due to the lack of randomized studies. METHODS: Retrospective review of patients with STS treated in our unit between January 2001-January 2016. We classified them whether they had been treated by initial planned or unplanned operation. Outcomes were compared in both groups globally and stage-matched. Endpoints were local recurrence and distant metastases. RESULTS: Twenty-three patients of STS underwent a planned excision and 16 an unplanned excision, 13 of them underwent further re-excision. 40% of patients with planned excision had an advanced stage in regard to the unplanned excision group which presented earlier stages. 77% of patients with unplanned excision had residual tumor identified after surgical re-excision. Local recurrence rate in the unplanned excision group was considerably higher 73,5% vs. 43,8%. Metastases rate was lower in planned excision group, 45,5% vs 56,3% (P > .05). The recurrence pattern in the unplanned excision group was unstable, with worse outcomes in earlier stages. CONCLUSION: The unplanned excision of a soft tissue sarcoma may compromise disease local control, with higher rates of local recurrence and metastases, and worse functional out- comes, despite further oncological treatment. We need to recognize the clinical features for malignancy risk in soft tissue lumps for a safe diagnosis to avoid inadequate resections.

Perforación intestinal secundaria a linfoma intestinal B difuso de células grandes en un paciente con enfermedad celiaca / Intestinal perforation secondary to intestinal diffuse large b-cell lymphoma in a patient with coeliac disease

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Conservative treatment for infiltrating breast cancer. Ten years follow-up experience.

INTRODUCTION: We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient's satisfaction. MATERIAL AND METHODS: From January 1984 to 31st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. RESULTS: Average age when diagnosed was 50.42 years old (24-87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60-198 months), 13 women (6.91%) presented local -regional recurrence and the disease-free time was 48.4 months (8-108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. CONCLUSIONS: The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It's a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy.