Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/métodos , Neoplasias do Colo/cirurgia , Histiocitoma Fibroso Maligno/cirurgia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Adenocarcinoma/irrigação sanguínea , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/cirurgia , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Aterosclerose/cirurgia , Neoplasias do Colo/irrigação sanguínea , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/patologia , Veia Femoral/diagnóstico por imagem , Veia Femoral/cirurgia , Histiocitoma Fibroso Maligno/irrigação sanguínea , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Histiocitoma Fibroso Maligno/patologia , Humanos , Intestino Grosso , Masculino , Proctocolectomia Restauradora/métodos , Neoplasias Retroperitoneais/irrigação sanguínea , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Sarcoma/irrigação sanguínea , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Tomografia Computadorizada Espiral , Resultado do Tratamento , UltrassonografiaAssuntos
Febre de Causa Desconhecida/etiologia , Histiocitoma Fibroso Maligno/irrigação sanguínea , Histiocitoma Fibroso Maligno/diagnóstico por imagem , Aumento da Imagem , Leucocitose/etiologia , Neovascularização Patológica/diagnóstico por imagem , Neoplasias Retroperitoneais/irrigação sanguínea , Neoplasias Retroperitoneais/diagnóstico por imagem , Ultrassonografia Doppler em Cores , Idoso , Biomarcadores Tumorais/análise , Biópsia , Medula Óssea/patologia , Meios de Contraste/administração & dosagem , Diagnóstico Diferencial , Análise de Fourier , Histiocitoma Fibroso Maligno/patologia , Humanos , Masculino , Neovascularização Patológica/patologia , Fosfolipídeos , Neoplasias Retroperitoneais/patologia , Hexafluoreto de Enxofre , Tomografia Computadorizada por Raios X , Imagem Corporal TotalRESUMO
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.
Assuntos
Carcinoma Hepatocelular/diagnóstico , Hemoperitônio/etiologia , Hemorragia/complicações , Histiocitoma Fibroso Maligno/diagnóstico , Neoplasias Hepáticas/diagnóstico , Fígado/patologia , Neoplasias Peritoneais/diagnóstico , Idoso , Ascite/etiologia , Diagnóstico Diferencial , Embolização Terapêutica , Evolução Fatal , Hemoperitônio/patologia , Hemoperitônio/cirurgia , Hemorragia/etiologia , Hemorragia/patologia , Histiocitoma Fibroso Maligno/irrigação sanguínea , Histiocitoma Fibroso Maligno/complicações , Histiocitoma Fibroso Maligno/patologia , Histiocitoma Fibroso Maligno/terapia , Humanos , Masculino , Invasividade Neoplásica , Metástase Neoplásica , Neoplasias Peritoneais/irrigação sanguínea , Neoplasias Peritoneais/complicações , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/terapia , Ruptura Espontânea , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
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.