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1.
Artigo em Chinês | MEDLINE | ID: mdl-31163537

RESUMO

Summary Low grade papillary adenocarcinoma is especially rare tumor in nasopharynx. Here we reported a patient who had low grade papillary adenocarcinoma of the nasopharynx and was diagnosed by pathology. The patient complained for bilateral nasal congestion for 10 years and was hospitalized in recent 3 years. The patient received nasopharyngeal tumor resection, and the postoperative pathological examination showed low grade nasopharyngeal papillary adenocarcinoma with squamation. The patient was followed up for 9 months without recurrence or metastasis. We reported this case and reviewed the relevant literature in order to improve the diagnosis and treatment of this disease..


Assuntos
Adenocarcinoma Papilar , Carcinoma de Células Escamosas , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/cirurgia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/cirurgia , Humanos , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/cirurgia , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/cirurgia , Recidiva Local de Neoplasia
2.
Medicine (Baltimore) ; 98(25): e16134, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232966

RESUMO

Endoscopic submucosal dissection (ESD) has increasingly been used to treat early gastric cancer (EGC); however, its efficacy in treating papillary adenocarcinoma-type EGC remains unknown.We sought to identify risk factors for lymph node (LN) metastasis in papillary adenocarcinoma-type EGC and evaluate the clinical outcome after ESD.This study retrospectively reviewed the medical records of patients who were diagnosed with EGC in our hospital from January 2009 to December 2016. In total, 85 patients had papillary adenocarcinoma-type EGC, of whom 52 and 33 underwent surgical treatment and ESD, respectively. This study analyzed the LN metastasis risk factors and clinical outcomes between these 2 groups and with those of an existing ESD indication group.LN metastasis occurred in 13 (25.0%) of 52 patients who underwent surgery. Multivariate analysis indicated that lymphovascular invasion was an independent risk factor (odds ratio: 20.624; 95% confidence interval: 19.628-21.497; P = .001). Of 33 patients who underwent ESD, 21 (63.6%) had an absolute indication and 12 (36.4%) had an expanded indication. All 3 (9.1%) patients with non-curative resection underwent additional surgery. The clinical outcomes were compared to those of 926 patients who underwent ESD of non-papillary adenocarcinoma-type EGC. There were no significant differences in curative resection rate (P = .327), procedure-related complication (P = .853), local recurrence (P = 1.000), or overall survival (P = 1.000).ESD of papillary adenocarcinoma-type EGC showed an acceptable outcome in comparison to an existing ESD indication group. However, these patients exhibit a relatively higher risk of LN metastasis.


Assuntos
Ressecção Endoscópica de Mucosa/normas , Neoplasias Gástricas/cirurgia , Adenocarcinoma Papilar/cirurgia , Idoso , Ressecção Endoscópica de Mucosa/efeitos adversos , Ressecção Endoscópica de Mucosa/métodos , Feminino , Gastrectomia/efeitos adversos , Gastrectomia/métodos , Gastrectomia/normas , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , República da Coreia , Estudos Retrospectivos , Fatores de Risco
3.
Nihon Shokakibyo Gakkai Zasshi ; 116(3): 241-248, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-30853677

RESUMO

A 71-year-old female with non-dilated pancreaticobiliary maljunction (PBM) and gallbladder polypoid lesions underwent laparoscopic cholecystectomy. Histological examination of the polypoid lesions revealed gallbladder cancer. Five years after cholecystectomy, gradual dilatation of the main pancreatic duct (MPD) led to the identification of a papillary tumor growing in the MPD of the pancreatic head. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination revealed a papillary tumor with focal invasion to the MPD. Immunohistochemically, the tumor cells were positive for MUC1 and MUC5AC and negative for MUC2. Therefore, the definitive diagnosis was pancreatobiliary-type intraductal papillary mucinous carcinoma. This case emphasizes the significance of surveillance for potential cancer of the pancreas as well as the biliary tract in patients with PBM.


Assuntos
Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Papilar/cirurgia , Colecistectomia , Neoplasias da Vesícula Biliar/cirurgia , Ductos Pancreáticos/anormalidades , Idoso , Feminino , Humanos
4.
Int. j. morphol ; 36(4): 1485-1489, Dec. 2018. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-975726

RESUMO

La neoplasia papilar intracolecística (NPIC), es un tumor compuesto por células neoplásicas preinvasivas, que forman masas de hasta 1,0 cm, clínicamente detectables. El objetivo de este estudio fue reportar un caso de NPIC y revisar la evidencia existente. Se trata de un paciente sexo masculino, de 33 años de edad, asintomático, que en el curso de un examen de salud, se realiza una ecotomografía abdominal, en la que se verifica una lesión polipoide vesicular de 32 x 19 mm de diámetro. Se programa para colecistectomía electiva, la que se realizó por vía laparoscópica, cirugía que se pudo realizar sin inconvenientes. Una vez extirpado el espécimen, se fue a estudio histopatológico en el que tras un mapeo vesicular se concluye NPIC, colecistitis crónica inespecífica, colesterolosis y pólipos colesterínicos. El paciente ha evolucionado sin inconvenientes. Presentamos un caso de NPIC en un paciente joven, cuyo diagnóstico fue confirmado por anatomía patológica tras una colecistectomía electiva, descartándose la presencia de carcinoma invasivo y displasia de alto grado, por lo que el pronóstico es favorable.


Intracholecystic papillary neoplasm (ICPN) is a tumor composed of pre-invasive neoplastic cells, with up to 1.0 cm clinically detectable masses. The objective of this study was to report a case of NPIC and review the evidence in the literature. A 33-year-old asymptomatic male patient had an abdominal ultrasonography during a health examination, in which a vesicular polyp lesion of 32 x 19 mm in diameter was verified. Thepatient was subsequently scheduled for elective cholecystectomy, which was performed laparoscopically and the surgery was uneventful. Once removed, the specimen was studied histopathologically and after performing vesicular mapping, we determined an ICPN, chronic non-specific cholecystitis, cholesteroliasis and cholesteric polyps. The patient has evolved without reported problems. We present a case of ICPN in a young patient, whose diagnosis was confirmed by pathological anatomy after an elective cholecystectomy, ruling out the presence of invasive carcinoma and high-grade dysplasia, with a favorable prognosis.


Assuntos
Humanos , Masculino , Adulto , Adenocarcinoma Papilar/patologia , Neoplasias da Vesícula Biliar/patologia , Pólipos/patologia , Adenocarcinoma Papilar/cirurgia , Colecistectomia Laparoscópica , Neoplasias da Vesícula Biliar/cirurgia
5.
Medicine (Baltimore) ; 97(52): e13905, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30593208

RESUMO

BACKGROUND: Endoscopic submucosal dissection (ESD) is a primary treatment for the early gastric cancer (EGC) who has a negligible risk of lymph node metastasis. Papillary adenocarcinoma (PAC) of stomach is a rare histologic variant of gastric cancer and categorized into EGC with differentiated-histology. However, aggressive features such as higher rate of lymphovascular invasion (LVI) or submucosal invasion have been reported, whereas comparable lymph node metastasis (LNM) rate to the lesions meeting the current ESD criteria also has been reported. This study aimed to evaluate the feasibility of ESD for EGC with PAC. METHODS: We will search the core databases (MEDLINE (through PubMed), the Cochrane Library, and Embase) from their inception to December 2018 by 2 independent evaluators. The P.I.C.O. is as follows; Patients: who have EGC with PAC, Intervention: ESD or surgery, Comparison: none, Outcome: at least one among the rate of complete resection, curative resection, en bloc resection, recurrence, procedure-related adverse event, LVI or LNM that enabled an evaluation of the feasibility of ESD. All types of study design with full text will be sought and included. The risk of bias will be assessed using the ROBINS-I tool. Descriptive data synthesis is planned, and quantitative synthesis will be used if the included studies are sufficiently homogenous. Publication bias will be assessed with quantitative analyses if more than 10 articles are enrolled. RESULTS: The results will provide evidence for efficacy and safety of ESD for EGC with PAC. CONCLUSION: This study will provide evidence of ESD for EGC with PAC.


Assuntos
Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Humanos , Metástase Linfática/patologia , Projetos de Pesquisa
6.
J Int Med Res ; 46(10): 4258-4268, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30111208

RESUMO

Objective Intraductal papillary neoplasm of the bile duct (IPNB) has been increasingly recognized and reported. However, its clinical features are still controversial because of its low incidence. In the present study, we investigated the characteristics of IPNB. Methods In total, 28 patients with IPNB were treated at our institution from January 2000 to December 2016. Clinical data were collected and a retrospective accurate database was constructed. Demographic characteristics, perioperative management, and prognosis were retrospectively analyzed. Results Abdominal discomfort was the most common symptom. Preoperative imaging revealed biliary tract dilatation in 23 patients. Left lateral or left hepatic lobectomy was the most frequently performed surgical procedure. Histological analysis revealed malignancy in 17 patients. Eighty-eight lymph nodes were swept from the patients with malignant disease, but only three were metastatic. Twenty-one patients were followed up for 3 to 60 months (mean, 29.4 ± 18.2 months). Seven patients died during the follow-up period. Patients with benign tumors had significantly greater disease-free survival. Conclusions IPNB is a rare biliary disease that occurs mainly in patients of advanced age. The most common symptom is abdominal discomfort. Lymphatic metastasis is uncommon. Patients with benign tumors may have a better prognosis than those with malignant tumors.


Assuntos
Adenocarcinoma Papilar/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Carcinoma Ductal/diagnóstico , Adenocarcinoma Papilar/mortalidade , Adenocarcinoma Papilar/cirurgia , Adulto , Idoso , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Carcinoma Ductal/mortalidade , Carcinoma Ductal/cirurgia , Feminino , Humanos , Estimativa de Kaplan-Meier , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
7.
Dermatol Online J ; 24(4)2018 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-29906012

RESUMO

A male in his twenties presented with a tender finger nodule that had been present for 3 months. Histopathological examination revealed a dermis with nodules of necrotic, athypical epithelaia cells with high nuclear to cytoplasmic ratios. Glandular formation was present with lumens lined by columnar epithelium, consistent with digital papillary adenocarcinoma. Digital papilary adenocarcinoma is a rare malignant adnexal tumor arising from sweat glands and requires further work-up.


Assuntos
Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/patologia , Neoplasias das Glândulas Sudoríparas/diagnóstico , Neoplasias das Glândulas Sudoríparas/patologia , Adenocarcinoma Papilar/cirurgia , Adulto , Dedos , Humanos , Masculino , Neoplasias das Glândulas Sudoríparas/cirurgia
8.
Cir. Esp. (Ed. impr.) ; 96(5): 276-282, mayo 2018. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176336

RESUMO

Introducción: La mutación BRAF V600E en el cáncer papilar de tiroides (CPT) parece asociarse a una resistencia al 131I. Nuestro principal objetivo fue cuantificar la respuesta al 131I tras la cirugía tanto en pacientes que presentaban la mutación (BRAF+) como en los que no presentaban el gen mutado (BRAF-). Método: Estudio prospectivo de los CPT intervenidos y tratados con 131I desde septiembre de 2015 hasta enero de 2017. Variables: edad, género, estadio tumoral, histológicas, tiroglobulina antes de 131I, a las 48h y a los 6 meses; dosis absorbida y % de actividad a los 2 y a los 7días y tiempo de eliminación. Resultados: Cuarenta y un pacientes y 67 restos tiroideos. El 61% eran BRAF+. En los estadios iii y iv, el 80% eran BRAF+. En el vaciamiento ganglionar terapéutico, el 100% eran BRAF+. El número de ganglios fue superior en BRAF+: 3,4 vs 1,2 (p = 0,01). La variante clásica fue predominante en BRAF+ (91,7% vs 8,3%; p=0,03). El 85,7% vs 14,3% de los BRAF+ tuvieron reacción desmoplásica (p = 0,02). Los BRAF+ presentaban menor dosis absorbida respecto a la actividad administrada (5,4 vs 20Gy/MBq; p = 0,02); menor % de actividad respecto a la unidad de masa a los 2 (0,046 vs 0,103%/g; p = 0,02) y a los 7 días (0,006 vs 0,034%/g, p = 0,04). Conclusiones: La mutación del gen BRAF V600E se relaciona con una mayor resistencia al tratamiento posquirúrgico con 131I desde el inicio de la enfermedad


Introduction: The BRAF V600E mutation in papillary thyroid cancer (PTC) has been associated with resistance to 131I. Our aim was to quantify the response to 131I after surgery in patients who had the mutation (BRAF+) and those who did not have the mutated gene (BRAF-). Method: A prospective cohort study was designed, from September 2015 to February 2016, which included patients with PTC receiving therapy after surgical treatment. Variables were described for age, gender, histology, tumor stage, thyroglobulin values before, 48 h after and 6months after 131I; absorbed dose and % activity on days 2 and 7 and elimination time. Results: 41 patients giving in total 67 thyroid remnants were included. 61% were BRAF+. In stagesiii and iv, 80% were BRAF+. In lateral resection, 100% were BRAF+. The number of nodes was higher in BRAF+: 3.4 vs 1.2 (P = .01). The classic variant was predominant in BRAF+ (91.7% vs 8.3%, P = .03). 85.7% vs 14.3% of BRAF+ had desmoplastic reaction (P = .02). The BRAF+ had a lower absorbed dose than the administered activity (5.4Gy/MBq vs 20Gy/MBq, P = .02); lower% activity with respect to the unit of mass at 2 (0.046%/g vs 0.103%/g, P = .02) and at 7days (0.006%/gr vs 0.034%/gr, P = .04) Conclusions: The mutation of the BRAF V600E gene is related with greater resistance to postoperative treatment with 131I since the onset of the disease


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Radioisótopos do Iodo/uso terapêutico , Mutação , Proteínas Proto-Oncogênicas B-raf/genética , Prognóstico , Estudos Observacionais como Assunto , Estudos de Coortes , Terapia Combinada , Cuidados Pós-Operatórios , Estudos Prospectivos , Proto-Oncogenes , Adenocarcinoma Papilar/cirurgia
9.
World J Surg Oncol ; 16(1): 45, 2018 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-29506526

RESUMO

BACKGROUND: The incidence of thyroid cancer in black Americans is significantly lower than that in white Americans, and the impact of race on the prognosis of thyroid cancer remains controversial. The purpose of this study was to determine the risk factors for survival in black and white patients and to compare the survival of differentiated thyroid carcinoma subtypes between these two races. We further investigated the association of lymph node and distant metastases with races. METHODS: This is a retrospective analysis using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results Program. A total of 70,346 cases were included in our study. Patients' demographics and cancer- and treatment-related characteristics were compared between the black and white Americans using chi-square and Fisher's exact tests. For multivariate analysis, Cox proportional hazards regression were used to assess the association between potential risk factors and the survival in black and white patients. RESULT: Black Americans had a worse overall survival than white Americans (HR = 1.127, P = 0.002). While disease-specific survival (DSS) was comparable, the risk factors for DSS were different between white and black Americans. Black Americans had less lymph node metastasis of classical variant papillary thyroid carcinoma (CPTC, OR = 0.476, P < 0.001) and follicular variant papillary thyroid carcinoma (FVPTC, OR = 0.522, P < 0.001), but not follicular thyroid carcinoma (FTC). However, black Americans with FVPTC, but not CPTC or FTC, had a higher potential of distant metastasis (OR = 1.715, P = 0.026). Furthermore, only white patients with tumor > 2 cm and lymph node metastasis benefited from radioactive iodine. CONCLUSIONS: The risk factors for DSS were significantly different in white and black patients. The impact of race should be considered in treatment strategy for thyroid cancer.


Assuntos
Adenocarcinoma Folicular/etnologia , Adenocarcinoma Papilar/etnologia , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Neoplasias da Glândula Tireoide/etnologia , Tireoidectomia/mortalidade , Adenocarcinoma Folicular/mortalidade , Adenocarcinoma Folicular/secundário , Adenocarcinoma Folicular/cirurgia , Adenocarcinoma Papilar/mortalidade , Adenocarcinoma Papilar/secundário , Adenocarcinoma Papilar/cirurgia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Programa de SEER , Taxa de Sobrevida , Neoplasias da Glândula Tireoide/mortalidade , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Estados Unidos
10.
World J Gastroenterol ; 24(4): 537-542, 2018 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-29398874

RESUMO

We report our experience with a synchronous case of gastrointestinal stromal tumor (GIST) and intraductal papillary neoplasm of the bile duct (IPNB) in an elderly woman with neurofibromatosis type 1 (NF-1). A 72-year-old woman presented with a 2-mo history of right upper abdominal pain unrelated to diet and indigestion. Fourteen years earlier, she had been diagnosed with NF-1, which manifested as café au lait spots and multiple nodules on the skin. Computed tomography (CT) revealed a multilocular low-density mass with septation, and mural nodules in the right hepatic lobe, as well as a 1.7-cm-sized well-demarcated enhancing mass in the third portion of the duodenum. The patient subsequently underwent right hepatectomy and duodenal wedge resection. We present here the first report of a case involving a synchronous IPNB and GIST in a patient with NF-1. Our findings demonstrate the possibility of various tumors in NF-1 patients and the importance of diagnosis at an early stage.


Assuntos
Adenocarcinoma Papilar/diagnóstico por imagem , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neurofibromatose 1/complicações , Adenocarcinoma Papilar/sangue , Adenocarcinoma Papilar/etiologia , Adenocarcinoma Papilar/cirurgia , Idoso , Neoplasias dos Ductos Biliares/sangue , Neoplasias dos Ductos Biliares/etiologia , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares/diagnóstico por imagem , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Antígeno CA-19-9/sangue , Colangiopancreatografia por Ressonância Magnética , Duodeno/diagnóstico por imagem , Duodeno/patologia , Duodeno/cirurgia , Feminino , Tumores do Estroma Gastrointestinal/sangue , Tumores do Estroma Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/cirurgia , Hepatectomia , Humanos , Neoplasias Primárias Múltiplas/etiologia , Neoplasias Primárias Múltiplas/cirurgia , Neurofibromatose 1/sangue , Tomografia Computadorizada por Raios X
11.
Cardiovasc Intervent Radiol ; 41(2): 253-259, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28770314

RESUMO

BACKGROUND: To investigate whether histologic subtyping from biopsies can predict local recurrence after thermal ablation for lung adenocarcinoma. METHODS: Patients treated with CT-guided thermal ablation for lung adenocarcinoma that had pre-ablation needle biopsy with analysis of histologic components were identified. Age, gender, smoking status, treatment indication (primary stage 1 tumor versus salvage), histologic subtype, ground-glass radiographic appearance, tumor size, ablation modality, and ablation margin were evaluated in relation to time to local recurrence (TTLR). Cumulative incidence of recurrence (CIR) was calculated using competing risks analysis and compared across groups using Fine and Grey method with clustering. Multivariate analysis was conducted with stepwise regression. RESULTS: There were 53 patients with 57 tumors diagnosed as adenocarcinoma on pre-ablation biopsy and with histologic subtype analysis. Of these, 19% (11) had micropapillary components, 14% (8) had solid components, and 26% (15) had micropapillary and/or solid components. In the univariate analysis, solid (subdistribution hazard ratio [SHR] = 4.04, p = 0.0051, 95% confidence interval [CI] = 1.52-10.7), micropapillary (SHR = 3.36, p = 0.01, CI = 1.33-8.47), and micropapillary and/or solid components (SHR = 5.85, p = 0.00038, CI = 2.21-15.5) were significantly correlated with shorter TTLR. On multivariate analysis, the presence of micropapillary and/or solid component (SHR = 11.4, p = 0.00021, CI: 3.14-41.3) was the only independent predictor of TTLR. The 1-, 2-, and 3-year CIR in patients with micropapillary and/or solid components was 33, 49, and 66% compared to 5, 14, and 18% in patients with no micropapillary or solid components on biopsy specimens. CONCLUSION: Micropapillary and/or solid histologic components identified in pre-ablation biopsy are associated with shorter TTLR after thermal ablation of lung adenocarcinoma.


Assuntos
Adenocarcinoma Papilar , Adenocarcinoma , Neoplasias Pulmonares , Recidiva Local de Neoplasia/patologia , Cirurgia Assistida por Computador , Tomografia Computadorizada por Raios X , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma de Pulmão , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Ablação por Cateter , Feminino , Seguimentos , Humanos , Neoplasias Pulmonares/classificação , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Recidiva Local de Neoplasia/classificação , Estadiamento de Neoplasias , Prognóstico , Modelos de Riscos Proporcionais , Fatores de Risco
12.
Clin Endocrinol (Oxf) ; 88(1): 114-122, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28898488

RESUMO

OBJECTIVE: To explore the potential preoperative ultrasonography (US) and cytopathological features to avoid total thyroidectomy in NIFTP. CONTEXT: Recently, it has been proposed that that noninvasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP) be classified as tumours, rather than cancer. PATIENTS: A total of 142 surgically proven follicular variant papillary thyroid carcinomas (FVPTCs; 45 NIFTP, 97 non-NIFTP; mean size: 20.4±11.0 mm, range: 10.0-65.0 mm) from 142 patients were included in this study. MEASUREMENTS: Three preoperative features of thyroid nodules (each US finding, US and Bethesda category) were compared in NIFTP and non-NIFTP groups. The preoperative decision-making process to avoid total thyroidectomy in NIFTP was evaluated based on combination of those features. RESULTS: In each US finding, there was only significantly less macrocalcification in the NIFTP group than in the non-NIFTP group (8.8% [4/45] vs 32.0% [31/97], P = .006). In US category, all of the NIFTP nodules were a low or intermediate suspicion (100% [45/45]). In Bethesda category, 26.7% [12/45] of the NIFTP was diagnosed as either suspicious malignancy or malignant, which increased the risk of a total thyroidectomy. In our study, a total thyroidectomy might be avoided in all of the NIFTP cases if lobectomy was selected for the nodules classified as a low or intermediate suspicion in US, despite being classified as a suspicious malignancy or malignant by cytopathology. CONCLUSIONS: Combining the US and cytopathological results could sensitively reduce total thyroidectomy in cases of NIFTP.


Assuntos
Adenocarcinoma Papilar/diagnóstico por imagem , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Tireoidectomia/estatística & dados numéricos , Adenocarcinoma Folicular/diagnóstico por imagem , Adenocarcinoma Folicular/patologia , Adenocarcinoma Folicular/cirurgia , Adenocarcinoma Papilar/patologia , Adenocarcinoma Papilar/cirurgia , Calcinose/patologia , Citodiagnóstico , Tomada de Decisões , Humanos , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/cirurgia , Ultrassonografia
13.
J Dermatol ; 45(3): 357-360, 2018 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29194742

RESUMO

Aggressive digital papillary adenocarcinoma (ADPA) is a rare cutaneous tumor with sweat gland differentiation. Due to the high risk of local recurrence and delayed metastasis, the wide local resection of the primary lesion and long-term follow up are recommended for ADPA. Here, we report two cases of ADPA. Case 1 had a blue-gray nodule on the tip of the right middle finger. Case 2 had had a papule on the dorsal side of the left ring finger for 13 years. In both cases, papillary proliferations of the tumor cells showed multilobular adenomatous structures with back-to-back patterns characteristic of ADPA. We amputated the finger at the proximal interphalangeal joint and performed a wide resection of the primary tumor in Case 1 and 2, respectively. Sentinel lymph node biopsy in the axilla was performed, and no sentinel lymph node metastasis was found in either case. Among the previously reported ADPA cases, clinically, most lesions were skin-colored or tan-brown to gray. The blue-gray color in Case 1 is thought to be extraordinary for ADPA. In Case 2, the patient had had the small lesion for more than 13 years and the tumor size had been stable during that long period. The present two cases suggest that ADPA shows a prominent variety of both clinical features and disease courses, and that we cannot exclude the possibility of ADPA even in cases of blue-gray nodules or small, stable, non-progressive papules.


Assuntos
Adenocarcinoma Papilar/patologia , Neoplasias das Glândulas Sudoríparas/patologia , Adenocarcinoma Papilar/diagnóstico por imagem , Adenocarcinoma Papilar/cirurgia , Adulto , Amputação , Dedos/cirurgia , Humanos , Masculino , Recidiva Local de Neoplasia/prevenção & controle , Tomografia por Emissão de Pósitrons , Biópsia de Linfonodo Sentinela , Neoplasias das Glândulas Sudoríparas/diagnóstico por imagem , Neoplasias das Glândulas Sudoríparas/cirurgia , Glândulas Sudoríparas/patologia , Glândulas Sudoríparas/cirurgia , Fatores de Tempo , Tomografia Computadorizada por Raios X
14.
Int J Pediatr Otorhinolaryngol ; 104: 51-53, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29287881

RESUMO

We report a case of low-grade nasopharyngeal papillary adenocarcinoma in a 9 year-old male that was diagnosed incidentally after an adenoidectomy procedure and treated with endonasal endoscopic nasopharyngectomy without any adjuvant therapy. The patient has been followed up for 3 years with no evidence of recurrence. We point out the importance of preoperative fiberoptic nasopharyngoscopy in the absence of longstanding symptoms in school-aged children and histopathologic examination of adenoidectomy specimens in the presence of atypical findings. We also suggest endonasal endoscopic resection in case of papillary adenocarcinoma.


Assuntos
Adenocarcinoma Papilar/cirurgia , Carcinoma/cirurgia , Endoscopia/métodos , Neoplasias Nasofaríngeas/cirurgia , Faringectomia/métodos , Adenoidectomia , Criança , Humanos , Masculino , Procedimentos Cirúrgicos Nasais/métodos , Carcinoma Nasofaríngeo , Nariz/patologia , Nariz/cirurgia
15.
Gastric Cancer ; 21(4): 680-688, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29280035

RESUMO

BACKGROUND: Current Japanese gastric cancer treatment guidelines recommend the same endoscopic resection criteria for papillary early gastric cancer (EGC) and well-differentiated (WD) or moderately differentiated (MD) EGC. To evaluate the appropriateness of this recommendation, we compared the clinicopathological characteristics of papillary EGC with those of WD, MD, poorly differentiated (PD), and signet ring cell (SRC) EGC. METHODS: A total of 6710 patients who underwent radical gastrectomy for EGC were included. Clinicopathological characteristics of papillary EGC were retrospectively reviewed and compared with those in other EGC subtypes. RESULTS: Papillary EGC accounted for 1.9% (130/6710) of total cases. Patients with papillary EGC were older and showed a male predominance compared to patients with PD or SRC EGC. Papillary EGCs showed significantly higher submucosal and lymphovascular invasion rates than WD or MD EGC or PD or SRC EGC. However, the LN metastasis rate of papillary EGC was comparable to or lower than that in other EGC subtypes. LN metastasis rates in mucosal cancers were 1.5%, 1.1%, and 4.0%, and those in submucosal cancers were 9.4%, 11.9%, and 17.6% for papillary EGC, WD or MD EGC, and PD or SRC EGC, respectively. In multivariate analysis, lymphatic invasion and PD or SRC histology were the strongest risk factors for LN metastasis. Among 63 papillary EGC that met the curative endoscopic resection criteria, no case showed LN metastasis. CONCLUSIONS: Endoscopic resection can be indicated for papillary EGC according to current guidelines. Given a considerable lymphovascular invasion rate, careful histological evaluation is required after endoscopic resection for papillary EGC.


Assuntos
Adenocarcinoma Papilar/patologia , Metástase Linfática/patologia , Neoplasias Gástricas/patologia , Adenocarcinoma Papilar/mortalidade , Adenocarcinoma Papilar/cirurgia , Idoso , Endoscopia Gastrointestinal/métodos , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/cirurgia
16.
World J Surg ; 42(2): 393-401, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-28879559

RESUMO

BACKGROUND: Since the use of robot systems in thyroid surgery was introduced in 2007, we have advanced a novel method of robotic thyroidectomy (RT) using a gasless transaxillary approach (TAA). We report our experience with this technique and detail the surgical outcome of 5000 robotic thyroidectomies. METHODS: From October 2007 to May 2016, we successfully performed 5000 robotic thyroidectomies using a gasless TAA at the Department of Surgery, Yonsei University Health System. The medical records of the patients are reviewed retrospectively, and the details of clinicopathologic characteristics, operation times, perioperative complications, and oncologic outcomes are analyzed. RESULTS: The 5000 patients with thyroid tumor (4804 with cancer and 196 with benign tumor) underwent RT using a gasless TAA. Mean operation time was 134.5 ± 122.0 min. The most common histologic subtype of thyroid cancer was papillary (98%), and the mean tumor size was 8.0 ± 6.0 mm. Stage I was found in 85.4% patients regarding tumor nodes metastasis staging. The 196 benign tumors consisted of 104 adenomatous hyperplasias (53.0%), 43 follicular adenomas (21.9%), 30 Graves' diseases (15.3%), and 19 others (9.7%). Postoperative complication occurred in 24.1% without any serious one, and overall morbidity tended to decrease over time. No disease-specific mortality was observed during the follow-up period. Locoregional recurrence was developed in 26 patients (0.5%). CONCLUSION: The authors have tried to improve RT technique using gasless TAA and achieved acceptable surgical outcomes. The rapid evolution of surgical robot technology and our constant effort to advance RT technique using gasless TAA would make it possible to reduce the perioperative morbidity and gain the best possible operative and oncologic outcomes.


Assuntos
Procedimentos Cirúrgicos Robóticos , Doenças da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/métodos , Adenocarcinoma Papilar/cirurgia , Adenoma/cirurgia , Adulto , Feminino , Doença de Graves/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Tireoidectomia/efeitos adversos
17.
Gan To Kagaku Ryoho ; 45(13): 2114-2116, 2018 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-30692302

RESUMO

We describe 14 resected cases of thyroid tumor diagnosed as Class Ⅲ by fine needle aspiration cytology(FNA). Of these, 13 cases were diagnosed as: malignant tumor(1 case), suspicion of malignant tumor(5 cases), or were hard to distinguish from benign or malignant(7 cases). The operative methods used were total or near total thyroidectomy plus D1 or D2a in 4 cases; hemithyroidectomy plus D1 in 3 cases; subtotal thyroidectomy in 3 cases; and lobectomy of the thyroid in 4 cases. The final pathological diagnoses were papillary adenocarcinoma(6 cases, all were pStage Ⅰ), follicular adenocarcinoma(1 case, pStage Ⅲ), malignant lymphoma(1 case), follicular adenoma(2 cases), and adenomatous goiter(4 cases). The results of preoperative examination and intraoperative frozen section diagnosis did not accord with the final pathological results in 2 cases(follicular adenocarcinoma: 1, adenomatous goiter: 1). FNA Class Ⅲcases should be treated surgically, because 8 of 14 FNA Class Ⅲ cases were malignant thyroid tumor. The operation method should be selected cautiously.


Assuntos
Adenocarcinoma Papilar , Neoplasias da Glândula Tireoide , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/cirurgia , Biópsia por Agulha Fina , Secções Congeladas , Humanos , Estudos Retrospectivos , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
18.
Chirurg ; 88(11): 918-926, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-28871376

RESUMO

Due to improvements in imaging modalities the diagnosis of branch duct intraductal papillary mucinous neoplasms (BD-IPMN) has been significantly increased in recent years. A BD-IPMN is frequently diagnosed as an incidental finding in asymptomatic patients. The optimal management of BD-IPMN is the subject of controversial discussions. Numerous studies have shown that an individualized therapeutic strategy with a follow-up observation of most BD-IPMNs is feasible and safe, considering age, comorbidities and patient preference. An accurate evaluation of BD-IPMN with a detailed anamnesis, high-resolution imaging techniques and endoscopic ultrasound is necessary. Symptomatic patients as well as patients with so-called high-risk stigmata should undergo resection. Asymptomatic patients with so-called worrisome features can either undergo surveillance or surgical resection, taking age and comorbidities into account. For BD-IPMN patients without high-risk stigmata and worrisome features and showing no symptoms, surveillance of the pancreatic lesion is the preferred approach. The high prevalence of BD-IPMN, limitations in differential diagnostics, an overestimation of the risk of malignancy due to an overrepresentation of symptomatic and suspected BD-IPMN in resected cohorts, an overestimated role of BD-IPMN as precursor lesions for pancreatic carcinoma and evidence of the safety of follow-up surveillance, underline the enormous importance of surveillance. Based on this and considering the background of a notable mortality and morbidity of pancreatic surgery, aggressive management with prophylactic surgical resection is not justified for all BD-IPMN, in particular for low-risk lesions.


Assuntos
Adenocarcinoma Mucinoso/cirurgia , Adenocarcinoma Papilar/cirurgia , Carcinoma Ductal Pancreático/cirurgia , Neoplasias Pancreáticas/cirurgia , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/epidemiologia , Adenocarcinoma Mucinoso/patologia , Adenocarcinoma Papilar/diagnóstico , Adenocarcinoma Papilar/epidemiologia , Adenocarcinoma Papilar/patologia , Idoso , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/epidemiologia , Carcinoma Ductal Pancreático/patologia , Colangiopancreatografia por Ressonância Magnética , Contraindicações , Diagnóstico Diferencial , Fidelidade a Diretrizes , Humanos , Achados Incidentais , Imagem por Ressonância Magnética , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/epidemiologia , Neoplasias Pancreáticas/patologia , Prevalência , Prognóstico , Fatores de Risco , Sensibilidade e Especificidade , Conduta Expectante
20.
Int J Dermatol ; 56(10): 1061-1064, 2017 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-28832985

RESUMO

BACKGROUND: Aggressive digital papillary adenocarcinoma (ADPA) is a rare adenocarcinoma of the sweat glands. AIMS: We wish to report the treatment of two cases of ADPA with Mohs micrographic surgery and review the presentation, management, and prognosis of this rare malignancy. MATERIALS & METHODS: Cases of ADPA were identified from recent surgery logs. Demographic, tumor, and treatment characteristics were extracted. A PubMed database search for English language full-text articles of aggressive digital papillary adenocarcinoma was performed, and relevant articles were summarized. RESULTS: Two cases of ADPA were identified. A 53-year-old man presented with ADPA on his right third fingernail, and a 65-year-old man presented with ADPA on his right thumb. Both patients underwent Mohs micrographic surgery and negative sentinel lymph node biopsy, remaining recurrence free at 34 and 9 months, respectively. DISCUSSION: ADPA frequently presents as a solitary mass on the digit. Treatment of ADPA with local excision or amputation has historically been fraught with high recurrence rates. Regional lymph node spread and distant metastasis have been reported. Mohs micrographic surgery may be an alternative treatment for ADPA. CONCLUSION: Mohs micrographic surgery is a viable option for ADPA and warrants further exploration. Long-term follow-up is important, and additional studies will need to identify the role of sentinel lymph node biopsy.


Assuntos
Adenocarcinoma Papilar/cirurgia , Neoplasias Cutâneas/cirurgia , Adenocarcinoma Papilar/patologia , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Cirurgia de Mohs , Neoplasias Cutâneas/patologia , Polegar
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