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1.
Medicine (Baltimore) ; 100(35): e27133, 2021 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-34477161

RESUMO

RATIONALE: Gastrobronchial fistula (GBF) is a rare but life-threatening complication of esophagectomy with gastric conduit reconstruction, and airway management during fistula repair is challenging. Here, we describe airway management in a patient undergoing left-sided GBF repair using video-assisted thoracoscopic surgery. PATIENT CONCERNS: A 63-year-old man diagnosed with esophageal carcinoma underwent esophagectomy with reconstruction by gastric pull-up and tabularization of the gastric conduit. Subsequently, about 8 weeks later, the patient presented with repeated pneumonia and a 1-week history of cough with significant sputum, dysphagia, and repeated fever. DIAGNOSIS: GBF, a rare postoperative complication, was located on the left main bronchus at 2 cm below the carina and was diagnosed based on findings from gastroscopy, flexible bronchoscopy, and thoracic computed tomography scan with contrast. INTERVENTIONS: We performed left-sided one-lung ventilation (OLV) under total intravenous anesthesia instead of inhalational anesthetics. The left-sided OLV, with positive end-expiratory pressure (PEEP) and nasogastric tube decompression, generated positive pressure across the fistula. It prevented backflow into the left main bronchus. Total intravenous anesthesia preserved hypoxic pulmonary vasoconstriction and prevented adverse effects associated with inhalational anesthetics. A right-sided, double-lumen endotracheal tube was inserted after anesthesia induction, and surgical repair was performed through a right-sided video-assisted thoracoscopic surgery. OUTCOMES: Intraoperative hemodynamics remained relatively stable, except for brief tachycardia at 113 beats/min. Arterial blood gas analysis revealed pH 7.17 and PaO2 89.1 mmHg upon 100% oxygenation, along with hypercapnia (PaCO2 77.1 mmHg), indicating respiratory acidosis. During OLV, pulse oximetry remained higher than 92%. The defect in the left main bronchus was successfully sutured after dissecting the fistula between the left main bronchus and the gastric conduit, and subsequently, OLV resulted in ideal ventilation. LESSONS: A left-sided GBF could lead to leakage from the OLV during surgery. Possible aspiration or alveolar hypoventilation due to this leakage is a major concern during airway management before surgical repair of the main bronchus.


Assuntos
Manuseio das Vias Aéreas , Fístula Brônquica/cirurgia , Carcinoma/cirurgia , Neoplasias Esofágicas/cirurgia , Fístula Gástrica/cirurgia , Complicações Pós-Operatórias/cirurgia , Anestesia Endotraqueal , Esofagectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia
3.
Virchows Arch ; 479(3): 515-521, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34218288

RESUMO

Urothelial carcinoma is subdivided into luminal (L), basal (B), and p53-wild-type (WT) molecular subtypes, with basal and p53-WT groups showing more aggressive course and poor treatment response, respectively. The literature on molecular subtypes of UC includes a mixture of different stages. We investigated the molecular profile and outcome of pure cohort of muscle invasive bladder carcinoma (MIBC) considering two distinct patterns of muscularis propria (MP) invasion. Forty-three cystectomies harboring stage pT2 were retrospectively identified in 18 years. MP invasion was subclassified into patterns 1 (tumor encasing intact detrusor muscle bundles) and 2 (tumor dissecting/replacing detrusor muscle). Using IHC, B/L phenotypes, p53, and Ki67 were assessed, and survival data was collected. Pattern 1 invasion was noted in 16 (37%) and pattern 2 in 27 (63%), with mean age of pattern 1 being 10 years younger. B/L phenotypes were successfully determined in 83.7%; 48.8% and 34.8% revealed L and B phenotypes, respectively (indeterminate phenotype in 16.4%). Pattern 1 was associated with L phenotype (GATA3 and HER-2 expressions: p = 0.02 & p = 0.04, respectively). Ki67 ≥ 5/10HPF was noted in pattern 2 and B phenotype (p = 0.03). B phenotype showed association with p53-WT (p = 0.007). In median follow-up of 60.7 months, 63.6% of pattern 1 cases were alive without disease compared to 32% of pattern 2 (not significant). A panel of CK20 and GATA3 for luminal and CK5/6 and CK14 for basal subtypes can provide reliable molecular classification in UC. Also, morphology of MIBC can predict the molecular phenotype and the behavior of the UC.


Assuntos
Biomarcadores Tumorais/análise , Carcinoma/química , Neoplasias da Bexiga Urinária/química , Urotélio/química , Idoso , Carcinoma/classificação , Carcinoma/patologia , Carcinoma/cirurgia , Cistectomia , Bases de Dados Factuais , Feminino , Fator de Transcrição GATA3/análise , Humanos , Imuno-Histoquímica , Queratina-14/análise , Queratina-20/análise , Queratina-5/análise , Queratinas Específicas do Cabelo/análise , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Fenótipo , Valor Preditivo dos Testes , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias da Bexiga Urinária/classificação , Neoplasias da Bexiga Urinária/patologia , Neoplasias da Bexiga Urinária/cirurgia , Urotélio/patologia , Urotélio/cirurgia
4.
J Surg Oncol ; 124(7): 1200-1206, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34270098

RESUMO

OBJECTIVE: To explore the safety, feasibility and clinical effect of transvaginal natural orifice specimen extraction surgery (NOSES) in 3D laparoscopic nephroureterectomy (LNU) for upper tract urothelial carcinoma (UTUC). METHODS: A retrospective analysis was made of 16 female patients who underwent 3D LNU and NOSES in the Department of Urology, Cancer Hospital, Chinese Academy of Medical Sciences from June 2019 to December 2020. The basic clinical data, perioperative related data, perioperative complications, visual analogue pain score (VAS), postoperative scar assessment questionnaire (PSAQ) at 3 months, female pelvic floor dysfunction questionnaire (PFDI-20) and female sexual function index questionnaire (FSFI) at preoperative and postoperative 3 months were analyzed and evaluated. RESULTS: The surgery was successfully completed in all 16 patients, and none of them was converted to open surgery. No postoperative complications, such as abdominal incision-related infection. No cases of local recurrence and distant metastasis were observed during follow-up of 3 to 21 months. The VAS scores at 24 h and 48 h after operation were 2.9 ± 0.7, 1.3 ± 0.6, respectively. PSAQ scores at 3 months after operation were 34.3 ± 3.3. PFDI-20 scores of women preoperative and postoperative 3 months were 6.25 ± 1.75, 6.3 ± 1.8, respectively, and the difference was not statistically significant (p = 0.924). There was no significant difference in FSFI scores between preoperative and postoperative 3 months (p = 0.892). CONCLUSION: Transvaginal NOSES in 3D LNU for UTUC is safe, feasible and practical. The successful development of this technique has laid a solid foundation for further clinical application and promotion.


Assuntos
Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Nefroureterectomia/métodos , Idoso , Idoso de 80 Anos ou mais , Carcinoma/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias Urológicas/cirurgia , Vagina , Escala Visual Analógica
6.
J Nippon Med Sch ; 88(3): 238-241, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34193744

RESUMO

Epithelial-myoepithelial carcinoma (EMC) is a rare malignant salivary gland tumor that occurs mostly in the parotid gland. We report a case of EMC of the submandibular gland in a young man. The patient was aware of a slow-growing mass in the right submandibular gland for 1 year. Clinical examination and ultrasound confirmed a right submandibular mass, 2.5 × 3 cm2 in size. Ultrasound-guided fine-needle aspiration indicated a diagnosis of pleomorphic adenoma, which was also suggested by magnetic resonance imaging. The submandibular gland tumor was excised. Immunohistochemical analysis showed carcinoma ex pleomorphic adenoma with a major epithelial-myoepithelial component. The patient was not treated with radiotherapy after surgery. No recurrence was observed during 24 months of follow-up. Because the morphology of EMC is similar to that of a benign tumor, it is frequently initially misdiagnosed. Surgery is always the most effective diagnostic and therapeutic measure for salivary gland tumors, especially those that grow slowly. Resection with negative margins is the treatment of choice for EMC; use of adjuvant radiotherapy is controversial.


Assuntos
Adenoma Pleomorfo/cirurgia , Carcinoma/cirurgia , Mioepitelioma/cirurgia , Neoplasias Primárias Múltiplas/terapia , Neoplasias da Glândula Submandibular/cirurgia , Glândula Submandibular/cirurgia , Adenoma Pleomorfo/diagnóstico por imagem , Adenoma Pleomorfo/patologia , Adulto , Carcinoma/diagnóstico por imagem , Carcinoma/patologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Humanos , Imageamento por Ressonância Magnética , Masculino , Mioepitelioma/diagnóstico por imagem , Mioepitelioma/patologia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Glândula Submandibular/diagnóstico por imagem , Glândula Submandibular/patologia , Neoplasias da Glândula Submandibular/diagnóstico por imagem , Neoplasias da Glândula Submandibular/patologia , Resultado do Tratamento
7.
Zhonghua Wai Ke Za Zhi ; 59(6): 502-506, 2021 Jun 01.
Artigo em Chinês | MEDLINE | ID: mdl-34102735

RESUMO

Objective: To examine the correlation factors of contralateral central lymph node metastasis in unilateral papillary thyroid carcinoma with lateral cervical lymph node metastasis. Methods: The clinical data of patients with unilateral papillary thyroid carcinoma who underwent total thyroidectomy and bilateral central lymph node dissection and ipsilateral cervical lymph node dissection from June 2016 to June 2018 at Department of Thyroid Surgery, West China Hospital, Sichuan University were analyzed retrospectively. A total of 317 patients, including 87 males and 230 females, aged (41.4±12.1) years (range: 16 to 75 years), were enrolled in this study. The risk factors of contralateral central lymph node metastasis were analyzed by χ2 test and Spearman correlation analysis. Results: There were 116, 69, 269, and 181 cases of pretracheal lymph node, prelaryngeal lymph node, ipsilateral central lymph node and contralateral central lymph node metastasis, respectively, and 16 cases of skipping metastasis. Univariate analysis showed that contralateral central lymph node metastasis was associated with gender, maximum tumor diameter, capsule invasion, pretracheal lymph node metastasis, prelaryngeal lymph node metastasis, and ipsilateral central lymph node metastasis (all P<0.05). Spearman correlation analysis showed that male (rs=0.162, P=0.004), maximum tumor diameter>10 mm (rs=0.184, P=0.001), capsule invasion (rs=0.135, P=0.016), pretracheal lymph node metastasis (rs=0.394, P<0.01), prelaryngeal lymph node metastasis (rs=0.272, P<0.01) and ipsilateral central lymph node metastasis (rs=0.203, P<0.01) were independent correlation factors for contralateral central lymph node metastasis. Conclusion: For patients with unilateral papillary thyroid carcinoma with ipsilateral cervical lymph node metastasis, bilateral central lymph node dissection should be considered if male, tumor diameter>10 mm, capsule invasion, pretracheal lymph node metastasis, prelaryngeal lymph node metastasis, or ipsilateral central lymph node metastasis.


Assuntos
Carcinoma Papilar , Carcinoma , Neoplasias da Glândula Tireoide , Carcinoma/cirurgia , Carcinoma Papilar/cirurgia , China , Feminino , Humanos , Linfonodos , Metástase Linfática , Masculino , Esvaziamento Cervical , Estudos Retrospectivos , Câncer Papilífero da Tireoide , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia
8.
BMC Gastroenterol ; 21(1): 247, 2021 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078293

RESUMO

BACKGROUND: Undifferentiated carcinoma with osteoclast-like giant cells (UCOGCs) is a rare and aggressive non endocrine pancreatic carcinoma characterized by the presence of osteoclastic giant cells mixed with mononuclear cell. Very few cases have been reported in the literature and the histogenesis is controversial as, at the time of diagnosis, the tumor is often of advanced size and stage and it is difficult to pathologically observe its relationship with the pancreatic duct. CASE PRESENTATION: We present a case of 65-year-old male patient presenting with abdominal pain, nausea, and weight loss, which was treated with surgical resection. Histological examination revealed an undifferentiated pancreatic carcinoma with osteoclast-like giant cells. The patient underwent to a routine pylorus preserving pancreatoduodenectomy. Actually, the patient was in good performance status and disease-free five months. CONCLUSIONS: Based on the present case and limited previous data, further researches preferably with large cohorts are necessary to clarify the pathogenesis of the neoplasm. However, as show in this case, histopathological and immunohistochemically studies are the gold standard for the diagnosis of UCPOGC. Investigation of the genomic alterations in UPOGCs could help to explain the histologic diversity of variant tumor and could provide a genetic basis for prognosis and treatment.


Assuntos
Carcinoma , Neoplasias Pancreáticas , Idoso , Carcinoma/diagnóstico , Carcinoma/cirurgia , Células Gigantes , Humanos , Masculino , Osteoclastos , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia
9.
Am J Surg Pathol ; 45(7): 969-978, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34105518

RESUMO

The 2019 World Health Organization (WHO) classification of colorectal carcinoma (CRC) profoundly reclassified CRC subtypes and introduces tumor budding as a second major grading criterion, while condensing conventional grade into a 2-tiered system. So far it remains largely unexplored how these parameters interact with each other and whether they truly have an independent impact on patient prognosis. We reclassified a large single-center cohort of 1004 CRCs spanning 2 decades for adjusted WHO grade (low vs. high), tumor budding (Bd1/Bd2/Bd3), and CRC subtype (adenocarcinoma not otherwise specified, micropapillary, mucinous, serrated, medullary, adenoma-like, signet-ring cell, mixed adenoneuroendocrine carcinoma/neuroendocrine carcinoma, undifferentiated) according to the criteria of the 2019 WHO classification. We investigated the interaction of these parameters, their connection to stage/microsatellite status, and their significance for patient survival in the different subgroups. Specific subtypes other than adenocarcinoma not otherwise specified represented one third of all CRCs and were unevenly distributed throughout stage and microsatellite subgroups. Subtypes, WHO grade and tumor budding profoundly impacted all survival parameters (P<0.001 for all analyses), with CRC subtypes and tumor budding-but not WHO grade-being stage-independent prognosticators for all survival comparisons. WHO grade had very limited prognostic value in CRC subtypes, while tumor budding retained its strong prognostic impact in most scenarios. Accurate delineation of CRC subtypes introduced in the 2019 WHO classification provides strong stage-independent prognostic information, arguing that they should be considered in pathology reports and in clinical trials. Of the morphology-based grading schemes included in the 2019 WHO, tumor budding outperforms WHO grade.


Assuntos
Carcinoma/patologia , Movimento Celular , Neoplasias Colorretais/patologia , Idoso , Biópsia , Carcinoma/classificação , Carcinoma/mortalidade , Carcinoma/cirurgia , Colectomia , Neoplasias Colorretais/classificação , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Masculino , Instabilidade de Microssatélites , Gradação de Tumores , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Organização Mundial da Saúde
10.
World Neurosurg ; 153: e28-e35, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34139354

RESUMO

OBJECTIVES: To investigate the effect of surgical stabilization for patients with metastatic spinal disease on objective mobility metrics. METHODS: A retrospective chart review identified patients who had mechanical back pain from metastatic spinal disease and underwent spinal stabilization during 2017. Mobility metrics, the Activity Measure for Post-Acute Care (AM-PAC) inpatient mobility short form (IMSF) and the Johns Hopkins Highest Level of Mobility (JH-HLM), were reviewed. RESULTS: A total of 26 patients were included in the analysis with median hospital stay of 8 days. Preoperative JH-HLM scores were available for 17 patients with a mean score of 5.4, increasing to mean score of 6.6 at last follow-up (P = 0.036). Preoperative AM-PAC IMSF scores were available for 14 patients with a mean score of 19.4, decreasing slightly to a mean score of 18.7 at last follow-up (P = 0.367). Last follow-up with mobility metrics occurred a median of 6.5 days postoperatively (range: 3-66 days). Multivariable analysis showed that American Spinal Injury Association and Karnofsky Performance Status scores were significantly associated with both JH-HLM and AM-PAC mobility scores at last follow-up. A higher JH-HLM or AM-PAC score was significantly associated with direct home discharge and a higher AM-PAC score was associated with shorter hospital stay. CONCLUSIONS: Surgical stabilization for patients with mechanical back pain secondary to metastatic spinal disease might lead to an objective improvement in JH-HLM score. JH-HLM and AM-PAC scores may be correlated with length of hospital stay and discharge disposition. Future studies are encouraged to further characterize the role of these mobility metrics in the management plan of these patients.


Assuntos
Dor nas Costas/cirurgia , Carcinoma/cirurgia , Laminectomia , Mieloma Múltiplo/cirurgia , Sarcoma/cirurgia , Fusão Vertebral , Neoplasias da Coluna Vertebral/cirurgia , Atividades Cotidianas , Idoso , Dor nas Costas/etiologia , Dor nas Costas/fisiopatologia , Neoplasias da Mama/patologia , Carcinoma/complicações , Carcinoma/fisiopatologia , Carcinoma/secundário , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/secundário , Carcinoma de Células Renais/cirurgia , Estudos de Coortes , Descompressão Cirúrgica , Feminino , Humanos , Avaliação de Estado de Karnofsky , Neoplasias Renais/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/fisiopatologia , Mieloma Múltiplo/secundário , Procedimentos Neurocirúrgicos , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Sarcoma/complicações , Sarcoma/fisiopatologia , Sarcoma/secundário , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/fisiopatologia , Neoplasias da Coluna Vertebral/secundário
11.
J Cardiothorac Surg ; 16(1): 128, 2021 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-33980268

RESUMO

BACKGROUND: The aim of this study was to assess the ability of using mean computed tomography (mCT) values to predict non-small cell lung cancer (NSCLC) tumor recurrence. METHODS: A retrospective study was conducted on 494 patients with stage IA NSCLC. Receiver operating characteristics analysis was used to assess the ability to use mCT value, C/T ratio, tumor size, and SUV to predict tumor recurrence. Multiple logistic regression analyses were performed to determine the independent variables for the prediction of tumor recurrence. RESULTS: The m-CT values were - 213.7 ± 10.2 Hounsfield Units (HU) for the recurrence group and - 594.1 ± 11.6 HU for the non-recurrence group (p < 0.0001). Recurrence occurred in 45 patients (9.1%). The tumor recurrence group was strongly associated with a high CT attenuation value, high C/T ratio, large solid tumor size, and SUV. The diagnostic value of mCT value was more accurate than the C/T ratio, excluding the pure ground-glass opacity and pure solid (0 < C/T ratio < 100) groups. The SUV and mCT are independent predictive factors of tumor recurrence. CONCLUSIONS: The evaluation of mCT values was useful for predicting recurrence after the limited resection of small-sized NSCLC, and may potentially contribute to the selection of suitable treatment strategies.


Assuntos
Carcinoma Pulmonar de Células não Pequenas/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Pneumonectomia , Tomografia Computadorizada por Raios X , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/patologia , Carcinoma/cirurgia , Carcinoma Pulmonar de Células não Pequenas/patologia , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Feminino , Seguimentos , Humanos , Modelos Logísticos , Pulmão/patologia , Pulmão/cirurgia , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento
12.
J Cardiothorac Surg ; 16(1): 121, 2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-33933129

RESUMO

BACKGROUND: The overall survival (OS) remains unsatisfactory in patients with esophageal squamous cell carcinoma (ESCC) after extended esophagectomy with two-field lymphadenectomy. Therefore, this retrospective study aimed to identify the risk factors that contribute to the low survival of patients with pT1-3N0M0 ESCC. METHODS: Patients with pT1-3N0M0 ESCC who only underwent R0 esophagectomy with two-field lymphadenectomy in our department from January 2008 to December 2012 were retrospectively enrolled in this study and medical records were reviewed. Postoperative OS, disease-free survival (DFS), recurrence-free survival (RFS), and locoregional recurrence-free survival (LRFS) were analyzed sequentially. RESULTS: This study recruited a total of 488 patients, whose follow-up visits were completed at the end of December 2019. The five-year OS, DFS, RFS and LRFS rates were 62.1, 53.1, 58.3 and 65.6%, respectively. Multivariate Cox analysis identified patient age, site of the lesion, small mediastinal lymph nodes in CT imaging (SLNs in CT), dissected lymph nodes (LNs), and stage of esophageal malignancy as independent risk factors for OS of the patients. Of these factors, the site of the lesion, SLNs in CT and stage of the cancer were determined to be independent factors for DFS, RFS and LRFS. Based on all five factors, the recursive partitioning analysis (RPA) score system was developed to stratify the patients into low-, medium- and high-risk groups, which were found to possess significantly different rates of OS, DFS, RFS and LRFS (p < 0.001). CONCLUSIONS: Several factors were associated with the survival of patients with pT1-3 N0M0 ESCC who underwent extended esophagectomy with two-field lymphadenectomy. These factors contributed to the RPA scoring system, which could stratify the risk of postoperative survival and may expedite the initiation of postoperative adjuvant therapy.


Assuntos
Neoplasias Esofágicas/cirurgia , Carcinoma de Células Escamosas do Esôfago/cirurgia , Esofagectomia/métodos , Excisão de Linfonodo/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinoma/mortalidade , Carcinoma/cirurgia , Terapia Combinada , Intervalo Livre de Doença , Neoplasias Esofágicas/mortalidade , Carcinoma de Células Escamosas do Esôfago/mortalidade , Feminino , Humanos , Linfonodos/patologia , Masculino , Mediastino/patologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Estadiamento de Neoplasias , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
Anticancer Res ; 41(5): 2719-2726, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952503

RESUMO

BACKGROUND/AIM: We present a case of uterine dedifferentiated mesonephric-like adenocarcinoma (MLA). CASE REPORT: A 54-year-old woman underwent total hysterectomy for a uterine mass under the impression of a uterine sarcoma. Histologically, MLA exhibited various growth patterns including tubular and glandular architecture. Undifferentiated carcinoma (UC) displayed discohesive tumor cells without any obvious architecture. Immunohistochemically, UC was positive for epithelial markers in very few scattered tumor cells. MLA exhibited the wild-type p53 expression pattern, whereas UC showed a uniform and strong p53 immunoreactivity. Targeted sequencing analysis revealed an identical Kirsten rat sarcoma viral oncogene homolog (KRAS) mutation in both components. A pathogenic missense tumor protein 53 (TP53) mutation was detected in UC, but not in MLA. CONCLUSION: The mutant p53 expression pattern exclusively detected in UC was concordant with the presence of missense TP53 mutation. Our observations suggested that TP53 mutation is associated with the possible transformation from MLA to UC.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma/diagnóstico , Sarcoma/diagnóstico , Doenças Uterinas/diagnóstico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Carcinoma/genética , Carcinoma/patologia , Carcinoma/cirurgia , Desdiferenciação Celular/genética , Feminino , Humanos , Histerectomia , Pessoa de Meia-Idade , Sarcoma/genética , Sarcoma/patologia , Sarcoma/cirurgia , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia , Ductos Mesonéfricos/diagnóstico por imagem , Ductos Mesonéfricos/patologia , Ductos Mesonéfricos/cirurgia
14.
Int J Surg Oncol ; 2021: 2476527, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33953982

RESUMO

Background: The standard treatment for breast cancer is breast-conserving surgery (BCS) with radiotherapy. If external beam radiation therapy (EBRT) can be safely replaced with intraoperative radiotherapy (IORT), it will help patients to save their breast and to have equivocal or better results in DFS and overall survival (OS). Methods: A total of 2022 patients with breast cancer treated during 6 years were enrolled in the current study. A total of 657, 376, and 989 patients received EBRT, radical, and boost dose by IORT, respectively, according to the IRIORT consensus protocol. The primary endpoint was recurrence and death. The secondary endpoint was the role of variables in recurrence and death. Results: With a mean follow-up of 34.5 and 40.18 months for the IORT and EBRT groups, respectively, there was a significant difference in DFS between electron boost and X-ray boost groups (P=0.037) and the electron radical group compared with EBRT (P=0.025), but there was no significant difference between other boost and radical groups in DFS and OS. Conclusions: IORT can be a preferred treatment modality because of its noninferior outcomes, and in some special conditions, it has superior outcomes compared to EBRT, particularly in delivering radical dose with IORT.


Assuntos
Neoplasias da Mama/radioterapia , Neoplasias da Mama/cirurgia , Carcinoma/radioterapia , Carcinoma/cirurgia , Cuidados Intraoperatórios/métodos , Mastectomia Segmentar/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/mortalidade , Carcinoma/mortalidade , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/prevenção & controle , Doses de Radiação , Radioterapia Adjuvante , Fatores de Risco , Análise de Sobrevida , Resultado do Tratamento
15.
J Surg Res ; 266: 160-167, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34000639

RESUMO

BACKGROUND: The incidence of thyroid cancer is increasing at a rapid rate. Prior studies have demonstrated financial burden and decreased quality of life in patients with thyroid cancer. Here, we characterize patient-reported financial burden in patients with thyroid cancer over a 28y period. MATERIALS AND METHODS: Patients who underwent thyroidectomy for thyroid cancer from 1990-2018 completed a phone survey assessing financial burden and its related psychological financial hardship. Descriptive statistics were performed to characterize these outcomes and correlation with sociodemographic data was assessed. RESULTS: Respondents (N = 147) were 73% female, 75% white, and had a median follow up of 7 y. The majority had a full-time job (59%) and private insurance (81%) at the time of diagnosis. Overall, 16% of respondents reported financial burden and 50% reported psychological financial hardship. Those reporting financial burden were disproportionately impacted by psychological financial hardship (87% versus 43%, P < 0.001). One in four (25%) respondents reported not being adequately informed about costs. CONCLUSIONS: Financial burdens are important outcomes of thyroid cancer which occur even among patients with protective financial factors, suggesting an even greater impact on the general population of patients with thyroid cancer. Further research is needed to explore the intersection of financial burden, cost, and quality of life.


Assuntos
Carcinoma/economia , Carcinoma/psicologia , Efeitos Psicossociais da Doença , Gastos em Saúde/estatística & dados numéricos , Neoplasias da Glândula Tireoide/economia , Neoplasias da Glândula Tireoide/psicologia , Tireoidectomia/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Sobreviventes de Câncer/psicologia , Carcinoma/cirurgia , Estudos Transversais , Emprego/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Seguro Saúde/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Autorrelato , Estresse Psicológico/economia , Estresse Psicológico/etiologia , Neoplasias da Glândula Tireoide/cirurgia , Tireoidectomia/psicologia , Estados Unidos
16.
Taiwan J Obstet Gynecol ; 60(3): 463-467, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33966729

RESUMO

OBJECTIVE: Minimally invasive radical hysterectomy has been shown to be associated with poorer outcome in an influential prospective, randomized trial. However, many centers worldwide performing minimally invasive radical hysterectomy have data and experience that prove otherwise. We aim to review surgical and oncologic outcomes of patients operated by Laparoscopic Radical Hysterectomy in a tertiary hospital, by experienced surgeons and standardization in radicality, for cervical carcinoma Stage 1A1-1B1 from January 2009 to May 2014. MATERIALS & METHODS: Standardised surgical technique with Parametrium & Paracolpium resection approach was adopted by qualified and experienced Gynecologic/Gyne-Oncologic Endoscopic & Minimally Invasive Surgeons in performing Laparoscopic Radical Hysterectomy for Cervical Cancer stage 1A1-1B1 from January 2009-May 2014, involving 53 patients. Electronic Medical Record system (EMR) Of Chang Gung Memorial Hospital(Tertiary Referral Centre), Department of Obstetrics & Gynecology was accessed for surgical and oncologic outcomes. RESULTS: Fifty-Three patients operated from January 2009 to May 2014 were followed up for an average of 96.7 months with longest follow-up at 127 months. There were no cases of recurrence or death reported. 5 Year - Survival Rate and 5 Year Disease-Free Survival Rate were 100%. Two patients received post-operative pelvic radiation concurrent with chemotherapy using Cisplatin due to greater than 1/3 cervical stromal invasion. CONCLUSION: It is vital to standardize minimally invasive surgical techniques for early stage cervical cancer, with focus on adequate radicality and resection which may contribute to excellent survival outcomes. Further international multi-center randomized trial (Minimally Invasive Therapy Versus Open Radical Hysterectomy In Cervical Cancer) will provide justification for continued practice of MIS in early stage cervical cancer.


Assuntos
Carcinoma/cirurgia , Competência Clínica/normas , Histerectomia/mortalidade , Laparoscopia/mortalidade , Neoplasias do Colo do Útero/cirurgia , Adulto , Carcinoma/mortalidade , Carcinoma/patologia , Intervalo Livre de Doença , Feminino , Humanos , Histerectomia/métodos , Histerectomia/normas , Laparoscopia/métodos , Laparoscopia/normas , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Padrões de Referência , Taxa de Sobrevida , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/patologia
17.
Clin Transl Gastroenterol ; 12(3): e00303, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33939382

RESUMO

INTRODUCTION: Molecular lymph node (LN) staging in early colorectal cancer (CRC) has demonstrated to be more precise than conventional histopathology pN staging. Tumor budding (TB) and poorly differentiated clusters (PDCs) are associated with LN metastases, recurrences, and lower survival in CRC. We evaluated the correlation between the total tumor load (TTL) in LNs from CRC surgical specimens with patient outcome, TB, and PDC. METHODS: In this retrospective multicentre study, 5,931 LNs from 342 stage I-III CRC were analyzed by both hematoxylin and eosin and molecular detection of tumor cytokeratin 19 mRNA by one-step nucleic acid amplification. TB and PDC were evaluated by hematoxylin and eosin and cytokeratin 19 immunohistochemistry. RESULTS: One-step nucleic acid was positive in 38.3% patients (n = 131). Tumor Budding was low in 45% cases, intermediate in 25%, and high in 30%. Poorly Differentiated Clusters were low-grade G1 in 53%, G2 in 32%, and G3 in 15%. TB and PDC correlated with TTL, high-grade, lymphovascular and perineural invasion, pT, pN and stage (P < 0.001). TB, PDC, and TTL ≥ 6,000 copies/µL were associated with worse overall survival (P = 0.002, P = 0.013, and P = 0.046) and disease-free survival (P < 0.001). DISCUSSION: The implementation of more sensitive molecular methods to assess LN status is a promising alternative approach to pN staging, which could be integrated to other factors to help risk stratification and management of patients with early-stage CRC. This study demonstrates the correlation of the amount of LN tumor burden with TB and PDCs. TTL is related to the outcome and could be used as a new prognostic factor in CRC (see Visual Abstract, Supplementary Digital Content 2, http://links.lww.com/CTG/A512).


Assuntos
Carcinoma/mortalidade , Neoplasias Colorretais/mortalidade , Linfonodos/patologia , Metástase Linfática/diagnóstico , Recidiva Local de Neoplasia/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Carcinoma/diagnóstico , Carcinoma/secundário , Carcinoma/cirurgia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Feminino , Humanos , Excisão de Linfonodo/estatística & dados numéricos , Linfonodos/cirurgia , Metástase Linfática/patologia , Metástase Linfática/terapia , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Carga Tumoral
18.
J Cardiothorac Surg ; 16(1): 86, 2021 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-33858470

RESUMO

BACKGROUND: A rare cause of primary hyperparathyroidism (PHPT) is a parathyroid carcinoma. Hypercalcemia with an elevated parathyroid hormone (PTH) level seen in recurrent and metastasis disease cases is often refractory to medical therapy, thus surgical resection is recommended when possible. We performed debulking surgery for pleural dissemination of parathyroid cancer for improvement of symptoms in a patient with hypercalcemia. CASE PRESENTATION: A 30-year-old male with hypercalcemia was diagnosed with parathyroid cancer. Following surgery, intact PTH level elevation and hypercalcemia progression due to recurrent disease were noted. An active status of functional left pleural dissemination was revealed in 99mTc-methoxyisobutylisonitrile and somatostatin receptor scintigraphy results, but not in the area of pulmonary metastasis, and debulking surgery was performed. Thereafter, the PTH level was decreased temporarily and activities of daily living improved. CONCLUSION: Aggressive resection of metastatic disease in patients with a parathyroid carcinoma is taken into consideration to control hypercalcemia.


Assuntos
Carcinoma/cirurgia , Procedimentos Cirúrgicos de Citorredução , Neoplasias das Paratireoides/patologia , Neoplasias Pleurais/cirurgia , Adulto , Cálcio/sangue , Carcinoma/sangue , Carcinoma/diagnóstico por imagem , Carcinoma/secundário , Procedimentos Cirúrgicos de Citorredução/métodos , Evolução Fatal , Humanos , Hipercalcemia/sangue , Hipercalcemia/etiologia , Hipercalcemia/terapia , Hiperparatireoidismo Primário/sangue , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/terapia , Masculino , Hormônio Paratireóideo/sangue , Neoplasias das Paratireoides/sangue , Neoplasias das Paratireoides/terapia , Neoplasias Pleurais/sangue , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/secundário , Reoperação
19.
J Med Case Rep ; 15(1): 184, 2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33879216

RESUMO

INTRODUCTION/BACKGROUND: Although central nervous system tumors are the most common etiology of malignancies in the pediatric age group, choroid plexus carcinomas are rare, with an annual incidence rate of 0.10 per 100,000 children. CASE PRESENTATION: We report the case of an adolescent male belonging to central India who had presented with a history of persistent headache, projectile vomiting, neck stiffness, and an episode of generalized tonic-clonic seizure. Neurological examination was suggestive of a space-occupying lesion. Further neuroimaging was suggestive of a large left-sided choroid plexus carcinoma, later confirmed on pathological examination. Gross total resection was achieved and followed by radiation therapy. His recovery was satisfactory without any major events despite suffering from such a malignancy with a poor prognosis. CONCLUSION: In the absence of a global consensus on choroid plexus carcinoma management, our patient underwent a successful gross total resection and received postoperative radiotherapy. He made a satisfactory recovery with a further plan to review with gadolinium-enhanced neuroimaging at a later date. We conclude that, when possible, achieving gross total resection is of utmost importance.


Assuntos
Carcinoma/terapia , Neoplasias do Plexo Corióideo/radioterapia , Neoplasias do Plexo Corióideo/cirurgia , Radioterapia Adjuvante , Adolescente , Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Índia , Masculino , Neuroimagem , Resultado do Tratamento , Vômito/etiologia
20.
World Neurosurg ; 152: e45-e50, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33892166

RESUMO

BACKGROUND: Choroid plexus carcinoma is a central nervous system tumor pathologically corresponding to World Health Organization grade III. Choroid plexus carcinoma mainly affects pediatric patients with a poor prognosis. Due to its rarity, standardized treatment has not yet been outlined. METHODS: We retrospectively analyzed 11 patients with histopathologically diagnosed choroid plexus carcinoma between January 2008 and December 2016. They were treated with surgical resection with or without adjuvant therapies. The clinical profiles and outcomes were analyzed. RESULTS: The mean age at diagnosis was 16.0 years (median, 7.0 years; range, 4 months to ∼59 years). Gross total resection was achieved in 9 cases, and subtotal resection in 2 cases. Seven patients received adjuvant radiotherapy, and 2 patients underwent chemotherapy. The mean overall survival was 34.8 months, and the mean progression-free survival was 24.5 months. During the follow-up period, 4 patients succumbed to central nervous system dissemination of choroid plexus carcinoma including 2 patients with malignant transformation from atypical choroid plexus papilloma to choroid plexus carcinoma and 1 patient treated with the combined chemotherapy protocol. CONCLUSIONS: In this study, we described the clinicoradiologic characteristics of choroid plexus carcinomas. Surgical resection is the mainstream treatment. Due to the paucity of clinical evidence, the standard regimen of adjuvant therapies still needs further research.


Assuntos
Carcinoma/diagnóstico por imagem , Carcinoma/cirurgia , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Neoplasias do Plexo Corióideo/cirurgia , Adolescente , Adulto , Carcinoma/mortalidade , Criança , Pré-Escolar , Neoplasias do Plexo Corióideo/mortalidade , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Taxa de Sobrevida/tendências
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