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1.
Anticancer Res ; 40(4): 2225-2229, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234918

RESUMO

BACKGROUND: Primary hepatic carcinosarcoma is a rare subtype of liver malignancy, with only a small number of cases described in the English literature. CASE REPORT: We report the case of a 72-year-old man with a history of hepatitis C, who presented with complaints of abdominal pain. The patient's alpha fetoprotein (AFP) level was highly elevated at 7,406 ng/ml. His albumin, total bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase levels were within normal ranges. Computer tomographic scans discovered a 12×9×8 cm mass in the left lobe of the liver, extending to the anterior gastric wall. A partial hepatectomy of segments 2 and 3 with en bloc distal gastrectomy and omentectomy, a Roux-en-Y gastrojejunostomy, and a cholecystectomy were performed. Pathology revealed the mass to be a hepatic carcinosarcoma composed of collision tumor of four malignant components: hepatocellular carcinoma, cholangiocarcinoma, osteosarcoma and rhabdomyosarcoma. One and half month post-surgery, the patient was found to have a mass confirmed by biopsy as hepatocellular carcinoma in the right lobe, nodules in his lung and bone, and his AFP level elevated to 51,027.6 ng/ml. He died after two months during hospice care. CONCLUSION: To the best of our knowledge, this is the first documented case of primary hepatic carcinosarcoma with collision tumor of four malignant entities (hepatocellular carcinoma, cholangiocarcinoma, osteosarcoma and rhabdomyosarcoma). The pathogenesis, diagnosis, treatment and prognosis of this disease are discussed.


Assuntos
Carcinoma Hepatocelular/parasitologia , Carcinossarcoma/patologia , Colangiocarcinoma/patologia , Neoplasias Hepáticas/patologia , Fígado/patologia , Idoso , Neoplasias dos Ductos Biliares/diagnóstico por imagem , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/cirurgia , Biópsia/métodos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/cirurgia , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/cirurgia , Colangiocarcinoma/diagnóstico por imagem , Colangiocarcinoma/cirurgia , Colecistectomia/métodos , Evolução Fatal , Gastrectomia/métodos , Derivação Gástrica/métodos , Hepatectomia/métodos , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/cirurgia , Masculino , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/patologia , Osteossarcoma/cirurgia , Prognóstico , Rabdomiossarcoma/diagnóstico por imagem , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia , Tomografia Computadorizada por Raios X , alfa-Fetoproteínas/metabolismo
2.
World Neurosurg ; 135: 309-315, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31863888

RESUMO

BACKGROUND: Triple-negative breast cancer (TNBC) is one of the most invasive subtypes of breast cancer, with high rates of visceral metastases and recurrence. Choroid plexus metastasis from breast cancer is infrequent despite a high incidence of brain parenchymal metastasis. METHODS: We report a case of solitary metastasis to the choroid plexus from a TNBC that masqueraded as central neurocytoma, and we review the PubMed database for similar cases focusing on their diagnostic challenges and management strategies. RESULTS: A 28-year-old woman with a history of TNBC presented with recurrent seizures, headache, and vomiting. Imaging studies depicted a well-defined lesion in the right anterior lateral ventricle that was attached to the septum pellucidum. After an initial radiological diagnosis of central neurocytoma, she deteriorated rapidly with intraventricular hemorrhage requiring emergency transcallosal microsurgical tumor decompression. Histopathological examination and immunohistochemistry confirmed breast carcinoma as the origin of the intraventricular mass. A review of the PubMed database identified only 2 case reports of choroid plexus metastases from breast cancer reported thus far. CONCLUSIONS: Choroid plexus metastases are exceedingly infrequent and can be mistaken for the more common central neurocytoma. The intraventricular milieu is inhospitable suggesting some extracranial carcinomas develop traits that help them to thrive in the acellular cerebrospinal fluid. Intraventricular mass lesions with a history of primary neoplasm should raise suspicion for choroid plexus metastases. A high index of suspicion despite excellent control of the primary tumor and the absence of systemic metastases is indispensable.


Assuntos
Carcinossarcoma/diagnóstico por imagem , Neoplasias do Plexo Corióideo/diagnóstico por imagem , Neurocitoma/diagnóstico , Neoplasias de Mama Triplo Negativas/patologia , Adulto , Carcinossarcoma/secundário , Carcinossarcoma/cirurgia , Neoplasias do Plexo Corióideo/secundário , Neoplasias do Plexo Corióideo/cirurgia , Diagnóstico Diferencial , Feminino , Humanos
3.
Medicine (Baltimore) ; 98(32): e16643, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393362

RESUMO

RATIONALE: Primary carcinosarcoma of the upper urinary tract is rare. Ureteral duplication is one of the most common urinary tract malformations. Additionally, the association between ureteral duplication and malignancy is unknown. To the best of our knowledge, no cases of malignant tumors diagnosed as carcinosarcoma with ureteral duplication have been reported. We herein report the case of a patient with carcinosarcoma of the ureteropelvic junction associated with incomplete ureteral duplication. PATIENT CONCERNS: A 60-year-old Japanese woman presented with painless gross hematuria. She had a history of total hysterectomy and chemotherapy for endometrioid carcinoma 5 years before. She had no history of occupational chemical exposure. DIAGNOSES: Radiographic imaging revealed right incomplete ureteral duplication, hydronephrosis, and a polypoid tumor in the ureteropelvic junction of the lower moiety of the right kidney. Urine cytology showed a small amount of degenerated atypical epithelial and nonepithelial cells. The transureteral biopsy specimen showed dysplastic urothelial cells and atypical myoid spindle cells. These findings were indefinite for malignancy. INTERVENTIONS: The patient underwent right nephroureterectomy. Pathological examination of the resected tumor showed a biphasic neoplasm composed of carcinomatous and sarcomatous components. The sarcomatous component was immunohistochemically positive for vimentin, desmin, h-caldesmon, and α-SMA and negative for pancytokeratin (AE1/AE3), low molecular weight cytokeratin (CAM 5.2), EMA, E-cadherin, GATA3, uroplakin 2, and p63. Based on these findings, we diagnosed the tumor as carcinosarcoma. OUTCOMES: The postoperative course was uneventful. No additional therapy was administered. The patient has remained alive without recurrence for 21 months since surgery. LESSONS: Carcinosarcoma can arise from ureteral duplication. Although the majority of carcinosarcomas of the upper urinary tract are diagnosed at an advanced stage and have a poor prognosis, some can have a less aggressive course. Further studies are needed to determine the association between ureteral duplication and malignancy.


Assuntos
Carcinossarcoma/patologia , Ureter/anormalidades , Neoplasias Ureterais/patologia , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/cirurgia , Feminino , Hematúria/etiologia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X , Neoplasias Ureterais/diagnóstico por imagem , Neoplasias Ureterais/etiologia , Neoplasias Ureterais/cirurgia
4.
Dermatol Online J ; 25(6)2019 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-31329397

RESUMO

Carcinosarcomas are rare malignant tumors derived of both epithelial and mesenchymal elements. Herein, we report an elderly man originally diagnosed with a squamous cell carcinoma of the hand. Upon excision, the tumor was found to be a more aggressive carcinosarcoma. Immunohistochemical stains revealed that the sarcoma component of the lesion was vimentin positive, whereas the primary carcinoma tumor cells were positive for p63 and CK903. Both components were negative for CD34 and D2-40. This tumor was found to have angiolymphatic invasion and eventually metastasized to the axillary lymph nodes and lungs.


Assuntos
Carcinossarcoma/patologia , Mãos , Neoplasias Cutâneas/patologia , Idoso , Carcinossarcoma/cirurgia , Humanos , Masculino , Neoplasias Cutâneas/cirurgia
5.
Biomed Res Int ; 2019: 1754675, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31317023

RESUMO

Primary laryngeal carcinosarcoma is a rare type of malignancies, and the standard therapeutic protocol for its treatment has yet to be established. This retrospective study analyzed the clinical and pathological characteristics, risk factors, treatment options, and prognosis of 13 patients with primary laryngeal carcinosarcomas. This case series included 11 males and 2 females with an age range from 32 to 78 years at diagnosis. The initial clinical symptoms included hoarseness, dyspnea, and foreign body sensation in the throat. The primary tumor sites were at the glottis, supraglottis, and larynx. All these patients were active or passive smokers, and more than half of them were alcohol addictive. The surgical treatment for laryngeal carcinosarcomas included CO2 laser surgery in seven cases, partial laryngectomy and neck dissection in three cases, and total laryngectomy and neck dissection in three cases. Among them, seven cases received postoperative radiotherapy. After follow-up with a mean of 31.15-month, four cases died. Primary laryngeal carcinosarcoma is a rare but more aggressive malignancy. Contralateral lymph node metastasis can occur at the early stage of this disease. A treatment combining surgery and postoperative radiotherapy is strongly recommended.


Assuntos
Carcinossarcoma/cirurgia , Neoplasias Laríngeas/cirurgia , Laringe/cirurgia , Recidiva Local de Neoplasia/cirurgia , Adulto , Idoso , Carcinossarcoma/diagnóstico por imagem , Carcinossarcoma/patologia , Carcinossarcoma/radioterapia , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/radioterapia , Laringectomia , Laringe/patologia , Lasers de Gás/uso terapêutico , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Imagem Multimodal , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/radioterapia , Prognóstico , Resultado do Tratamento
6.
BMC Cancer ; 19(1): 697, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307426

RESUMO

BACKGROUND: The clinical impact of adjuvant radiotherapy on uterine sarcoma is unclear, and may depend on the histological type. Hence, the aim of this study was to evaluate clinical outcomes of adjuvant radiotherapy after total hysterectomy in patients with leiomyosarcoma or carcinosarcoma. METHODS: Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program. Cox proportional hazards regression analyses were performed to identify risk factors for overall mortality and cancer-specific mortality. In addition, a 1:1 propensity score matching approach was performed, in which age group, disease stage, tumor grade, tumor size, and lymphadenectomy status were matched. RESULTS: A total of 566 leiomyosarcoma and 1069 carcinosarcoma patients with stage I-III disease were included. Both regular Cox regression analysis and propensity score matching analysis revealed that utilization of adjuvant radiotherapy did not affect overall and cancer-specific mortality in patients with leiomyosarcoma. In contrast, for patients with carcinosarcoma, total mortality risk was significantly decreased with EBRT, brachytherapy, and combination radiotherapy compared with no radiotherapy. Cancer-specific mortality risk was significantly decreased with brachytherapy and combination radiotherapy as compared with no radiotherapy. Propensity score matching analyses revealed similar results in overall mortality, but not cancer-specific mortality, in patients with carcinosarcoma. Furthermore, the frequency of patients who did not receive any form of adjuvant radiotherapy was four times higher than those underwent adjuvant radiotherapy. CONCLUSIONS: Adjuvant radiotherapy may provide a survival benefit for uterine carcinosarcoma, but not leiomyosarcoma. In addition, adjuvant radiotherapy is underutilized, and increased utilization of adjuvant radiotherapy may improve the survival rate of patients with carcinosarcoma.


Assuntos
Carcinossarcoma/radioterapia , Histerectomia , Leiomiossarcoma/radioterapia , Radioterapia Adjuvante , Programa de SEER , Neoplasias Uterinas/radioterapia , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/mortalidade , Carcinossarcoma/cirurgia , Feminino , Humanos , Leiomiossarcoma/mortalidade , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pontuação de Propensão , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias Uterinas/mortalidade , Neoplasias Uterinas/cirurgia
7.
JSLS ; 23(2)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31285650

RESUMO

Background and Objectives: To determine if the use of an intrauterine manipulator is associated with an increased incidence of pseudovascular invasion on pathologic evaluation of hysterectomy specimens for endometrial cancer and to assess the possible implications of pseudovascular space invasion in the treatment of endometrial cancer. Methods: We performed a retrospective cohort study of patients with early stage (I/II) endometrial cancer who underwent minimally invasive surgical staging. The following data were abstracted: race, body mass index, grade, age, stage, histology, presence or absence of lymphovascular space invasion (LVSI), peritoneal cytology, and adjuvant treatment. Slides were blindly reviewed by a gynecologic pathologist. Results: Of the104 patients meeting eligibility criteria, 74 cases were reviewed in detail (the study was terminated early based on the results of an interim analysis). Patients in the no-manipulator group were older (P = .02) and had a higher stage 1B/II (P = .01) than patients in the manipulator group. No difference was found in the incidence of pseudovascular invasion between the manipulator and the no-manipulator groups (P = .86). Subgroup analysis showed no association of pseudovascular invasion with tumor grade (P = .79). Five patients were identified to have pseudovascular invasion misdiagnosed as true LVSI-4 had endometrioid and 1 had serous histology. Of these, 3 were in the manipulator group. Two received adjuvant radiotherapy which they not have gotten, absent reported lymphovascular invasion. Conclusion: The use of a uterine manipulator does not appear to increase the rate of pseudovascular invasion in our limited data set. Misdiagnosis of pseudovascular invasion as LVSI can result in risk migration of patients with potential for harm from unwarranted adjuvant therapy.


Assuntos
Carcinoma Endometrioide/cirurgia , Carcinossarcoma/cirurgia , Neoplasias do Endométrio/patologia , Neoplasias do Endométrio/cirurgia , Histerectomia , Laparoscopia , Idoso , Carcinoma Endometrioide/patologia , Carcinossarcoma/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos
8.
BMC Cancer ; 19(1): 592, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208361

RESUMO

BACKGROUND: Pulmonary sarcomatoid carcinoma (SC) consists of both carcinomatous and sarcomatous tumors with high degree of malignancy, rapid progression, and poor prognosis. However, little is known regarding how pulmonary SC develops and progresses. CASE PRESENTATION: A 66-year-old male was initially diagnosed with stage IIIa lung cancer containing both adenocarcinoma (ADC) and SC. Adjuvant chemotherapy was administrated post-surgery, however, recurrence with SC only soon followed. Mutation profiling of the patient's microdissected ADC and SC components of the primary lesion and recurrent tumor was performed by targeted next-generation sequencing (NGS) of 416 cancer-relevant genes. Our data showed that primary SC/ADC and the recurrent SC shared multiple gene mutations including EGFR, NF1, TP53, CDKN2B, and SMARCA4, while both primary and recurrent SCs had a unique TP53 exon 4 splicing mutation frequently observed in sarcoma. Interestingly, a novel PHF20-NTRK1 fusion was acquired in the recurrent SC, which may be a potential driver for SC recurrence. CONCLUSIONS: The molecular genetic characteristics of tumor tissues at different stages reveals a linear tumor evolution model in this case, and support that the primary SC derived from the original lung ADC during the evolution of the tumor. We also identified a novel PHF20-NTRK1 fusion, which may contribute to the disease recurrence, and that can be potentially targeted with NTRK1 inhibitors for treatment.


Assuntos
Adenocarcinoma de Pulmão/complicações , Antígenos de Neoplasias/genética , Biomarcadores Tumorais/genética , Carcinossarcoma/etiologia , Fusão Gênica , Neoplasias Pulmonares/complicações , Doenças Raras/etiologia , Receptor trkA/genética , Adenocarcinoma de Pulmão/tratamento farmacológico , Adenocarcinoma de Pulmão/radioterapia , Adenocarcinoma de Pulmão/cirurgia , Idoso , Carcinogênese , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/radioterapia , Carcinossarcoma/cirurgia , Quimioterapia Adjuvante , Éxons/genética , Evolução Fatal , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/cirurgia , Masculino , Recidiva Local de Neoplasia , Doenças Raras/tratamento farmacológico , Doenças Raras/radioterapia , Doenças Raras/cirurgia
10.
World J Surg Oncol ; 17(1): 79, 2019 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-31060613

RESUMO

BACKGROUND: Bipartite combined oesophageal tumours are an exceedingly rare entity and much less is known about the natural history of these tumours following curative surgery. The authors present a case of a bipartite combined oesophageal tumour comprising of sarcomatoid carcinoma and small cell carcinoma with early postoperative recurrence. CASE PRESENTATION: A 63-year-old Chinese male with a smoking history presents with hemoptysis on a background of dysphagia and odynophagia for 1 month. An endoscopic evaluation found an exophytic oesophageal tumour with contact bleeding for which biopsy of this lesion returned as a malignant high-grade tumour where immunohistochemistry staining was unable to establish the lineage of the tumour. Differential diagnoses include sarcomatoid carcinoma and malignant undifferentiated sarcoma. With the provisional diagnosis of a high-grade oesopheageal sarcoma, the patient underwent minimally invasive McKeown's oesophagectomy. Final histological assessment was pT1bN0 with two histological types of malignancy within a single tumour-70% poorly differentiated spindle cell squamous carcinoma and small cell carcinoma. He was planned for adjuvant chemotherapy in view of the small cell carcinoma component after the resolution of the postoperative infective collections. A computed tomographic scan performed 4 months postoperatively demonstrated metastasis to the lung, pleura, thoracic nodes and liver. Biopsy of the largest lung nodule confirmed small cell neuroendocrine carcinoma with features similar to the small cell carcinoma component in the prior oesophagectomy specimen. He was thereafter initiated on palliative chemotherapy aimed at three weekly carboplatin and etoposide aimed at a total of 4 cycles with peglasta support. Etoposide was stopped during the first cycle due to asymptomatic bradycardia. The regime was then converted to carboplatin with irinotecan for 5 cycles. Repeat computed tomographic scan performed 3 weeks after the completion of chemotherapy showed a complete response of lung and liver metastasis and no evidence of local recurrence or distant metastasis. CONCLUSION: The management of bipartite combined oesophageal tumours should be guided by its more aggressive component. Bipartite combined oesophageal tumours with a small cell carcinoma component are believed to demonstrate aggressive tumour biology likened to that of primary oesophageal small cell carcinoma. Preoperative confirmation of a combined tumour may be challenging, and biopsy results may only yield one of the two components. The more aggressive component is usually a small cell carcinoma, for which the mainstay of therapy is platinum-based chemotherapy rather than surgery.


Assuntos
Carcinoma de Células Pequenas/patologia , Carcinossarcoma/patologia , Neoplasias Esofágicas/patologia , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias , Carcinoma de Células Pequenas/cirurgia , Carcinossarcoma/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/cirurgia , Prognóstico
11.
J Ovarian Res ; 12(1): 32, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947745

RESUMO

BACKGROUND: Ovarian carcinosarcoma, which contains sarcomatous and carcinomatous components, is a very rare tumor. The carcinomatous component is often adenocarcinoma, and squamous cell carcinoma is extremely rare. We herein report a case of ovarian carcinosarcoma in which the carcinomatous component was squamous cell carcinoma. CASE PRESENTATION: A 68-year-old woman presented with a huge ovarian tumor with a clinical diagnosis of malignant tumor of the ovary. She underwent hysterectomy, bilateral adnexectomy, omentectomy and lymphadenectomy. Histologically, the tumor cells showed undifferentiated pleomorphic sarcoma as the sarcomatous component and squamous cell carcinoma as the carcinomatous component. The final diagnosis was ovarian carcinosarcoma with squamous cell carcinoma in the carcinomatous component, stage IIIA1. Postoperatively, the patient was treated with six cycles of combination chemotherapy with paclitaxel and carboplatin as adjuvant therapy. The patient was free of disease at 45 months' follow-up consultation. CONCLUSION: This is a rare report of ovarian carcinosarcoma with an epithelial component composed of squamous cell carcinoma. Combination chemotherapy with paclitaxel and carboplatin may be an effective choice as adjuvant chemotherapy in cases of ovarian carcinosarcoma including squamous cell carcinoma.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinossarcoma/patologia , Neoplasias Ovarianas/patologia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/cirurgia , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/cirurgia , Quimioterapia Adjuvante , Feminino , Humanos , Estadiamento de Neoplasias , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/cirurgia , Ovário/patologia , Ovário/cirurgia , Resultado do Tratamento
12.
Am J Case Rep ; 20: 597-601, 2019 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-31023997

RESUMO

BACKGROUND Anaplastic sarcomatoid carcinoma of the pancreas (ASCP) is a rare variant of pancreatic malignancies. It is a high-grade epithelial carcinoma predominated with spindle cells. CASE REPORT We report a case of a 65-year-old patient who presented with early stage, ampullary mass indicating malignancy, and who subsequently underwent pancreatoduodenectomy. Histopathology and immunohistochemistry were confirmatory for anaplastic, grade IV sarcomatoid adenocarcinoma arising from the head of the pancreas. CONCLUSIONS To our knowledge, this is a rare presentation with few cases reported in the literature.


Assuntos
Carcinossarcoma/diagnóstico , Estadiamento de Neoplasias , Neoplasias Pancreáticas/diagnóstico , Pancreaticoduodenectomia/métodos , Idoso , Carcinossarcoma/cirurgia , Diagnóstico Diferencial , Humanos , Masculino , Neoplasias Pancreáticas/cirurgia
13.
Int J Clin Oncol ; 24(8): 941-949, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30891652

RESUMO

BACKGROUND: Ovarian carcinomas sometimes grow in the pelvic cavity, adhering firmly to the pelvic sidewall. These cases are often considered as inoperable or result in the incomplete resection because the tumors are not mobile. We performed en bloc resection of the tumors along with the entire internal iliac vessel system to achieve complete resection. METHODS: Twenty of 237 consecutive patients with FIGO stage II-IV ovarian, fallopian tubal, or primary peritoneal carcinoma who underwent cytoreductive surgery at Chiba University Hospital between January 2008 and December 2016 had locally advanced tumors adhered firmly to the pelvic sidewall. We performed isolation of the tumors from the pelvic sidewall using the following procedure: the trunk of internal iliac vessels, the obturator vessels, the inferior gluteal and internal pudendal vessels were isolated and divided. The tumor together with the entire internal iliac vessel system was isolated from the sacral nerve plexus and piriform muscle. We examined the surgical outcomes, perioperative complications, and prognosis for the patients who underwent this procedure. RESULTS: All patients successfully underwent complete resection, resulting in no gross residual disease in the pelvic cavity. There was no mortality within 90 days postoperatively. Two patients had Grade IIIb complications, comprising wound dehiscence and vesicovaginal fistula. Recurrence occurred in nine of the patients. However, no recurrence was observed in the pelvic sidewall. The median progression-free survival was 43 months. CONCLUSIONS: Removal of the entire internal iliac vessel system is feasible for the complete resection of locally advanced ovarian carcinomas adhered firmly to the pelvic sidewall.


Assuntos
Procedimentos Cirúrgicos de Citorredução/mortalidade , Neoplasias das Tubas Uterinas/cirurgia , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Ovarianas/cirurgia , Neoplasias Pélvicas/cirurgia , Neoplasias Peritoneais/cirurgia , Adulto , Idoso , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias das Tubas Uterinas/patologia , Estudos de Viabilidade , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias Ovarianas/patologia , Neoplasias Pélvicas/patologia , Período Perioperatório , Neoplasias Peritoneais/patologia , Prognóstico , Taxa de Sobrevida
14.
Taiwan J Obstet Gynecol ; 58(2): 288-291, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30910155

RESUMO

OBJECTIVE: Carcinosarcomas also known as malignant mixed mullerian tumors (MMMTs) contain both carcinomatous and sarcomatous elements. Most MMMTs are arising from female genital tract, including ovaries, uterus and fallopian tubes. Extragenital carcinosarcomas are extremely rare, with an estimation less than 40 cases so far. CASE REPORT: We report two cases of primary peritoneal carcinosarcomas. An 81-year-old woman with pelvic peritoneal carcinosarcoma, heterologous type, was treated with incomplete surgery without further chemotherapy, and died of disease soon. The other one was a 76 year-old woman with abdominal peritoneal carcinosarcoma, homologous type. After optimal debulking surgery and subsequent 6 cycles of combination of paclitaxel and carboplatin chemotherapy, the patient is free of tumor half of year. CONCLUSION: Active therapy, including complete cytoreduction surgery and carboplatin-paclitaxel chemotherapy might offer a chance of disease control for these unusual primary peritoneal carcinosarcomas.


Assuntos
Neoplasias Abdominais/cirurgia , Carcinossarcoma/cirurgia , Tumor Mulleriano Misto/cirurgia , Neoplasias Peritoneais/cirurgia , Neoplasias Abdominais/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos Fitogênicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica , Carboplatina/uso terapêutico , Carcinossarcoma/tratamento farmacológico , Carcinossarcoma/patologia , Evolução Fatal , Feminino , Humanos , Tumor Mulleriano Misto/tratamento farmacológico , Paclitaxel/uso terapêutico , Neoplasias Peritoneais/patologia
16.
Int J Gynecol Cancer ; 29(2): 312-319, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30718312

RESUMO

OBJECTIVE: To determine the incidence of long term lymphadenectomy complications in primary surgery for endometrial cancer and to elucidate risk factors for these complications. METHODS: A retrospective chart review was carried out for all patients with endometrial cancer managed at Parma University Hospital Unit of Gynecology and Obstetrics between 2010 and 2016. Inclusion criteria were surgical procedure including hysterectomy and lymphadenectomy (pelvic or pelvic and aortic). We identified patients with postoperative lymphocele and lower extremity lymphedema. Logistic regression analysis was used to identify predictive factors for postoperative complications. RESULTS: Of the 249 patients tested, 198 underwent pelvic lymphadenectomy (79.5%), and 51 (20.5%) of those underwent both pelvic and para-aortic lymphadenectomy. Among the 249 patients, 92 (36.9 %) developed lymphedema while 43 (17.3%) developed lymphocele. Multivariate analysis showed that addition of para-artic lymphadenectomy was an independent predictor for both lymphedema (odds ratio (OR) 2.764, 95% confidence interval (CI) 1.023 to 7.470) and lymphocele (OR 5.066, 95% CI 1.605 to 15.989). Moreover, postoperative adjuvant radiotherapy (OR 2.733, 95% CI 1.149 to 6.505) and identification of any positive lymph node (OR 19.391, 95% CI 1.486 to 253.0) were significantly correlated with lymphedema, while removal of circumflex iliac nodes (OR 8.596, 95% CI 1.144 to 65.591) was associated with lymphoceles occurrence. CONCLUSION: Although sentinel lymph node navigation is a promising option, lymphadenectomy represents the primary treatment in many patients with endometrial cancer. However, comprehensive nodal dissection remains associated with a high rate of long term complications, such as lymphedema and lymphocele. Avoiding risk factors that are related to the development of these postoperative complications is often difficult and, therefore, the strategy to assess lymph nodal status in these women must be tailored to obtain the maximum results in terms of oncological and functional outcome.


Assuntos
Neoplasias do Endométrio/cirurgia , Excisão de Linfonodo/efeitos adversos , Linfonodos/cirurgia , Linfedema/epidemiologia , Linfocele/epidemiologia , Pelve/cirurgia , Complicações Pós-Operatórias , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/cirurgia , Idoso , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/patologia , Feminino , Seguimentos , Humanos , Incidência , Itália/epidemiologia , Linfonodos/patologia , Linfedema/etiologia , Linfocele/etiologia , Pessoa de Meia-Idade , Pelve/patologia , Prognóstico , Fatores de Risco
17.
Int J Surg Pathol ; 27(5): 547-552, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30767589

RESUMO

Carcinosarcoma of the upper urinary tract is very rare. In this article, we report a case of upper urinary tract carcinosarcoma with rhabdomyoblastic differentiation showing distinct transition between the epithelial and mesenchymal components confirmed by morphology and immunohistochemistry. An 81-year-old female underwent radical nephroureterectomy under the diagnosis of left ureteral urothelial carcinoma (UC). Multiple invasive tumors showed combined histology with UC and rhabdomyosarcomatous elements (pT2-ureter and pT3-renal pelvis, pN0, u-lt0, ly0, v0, RM0). Each element demonstrated typical epithelial or mesenchymal staining patterns (positive for AE1/AE3 in the former and positive for vimentin and myogenin in the latter). Notably, immunohistochemical transition patterns of GATA-3, p63, SOX2, and myogenin between UC and rhabdomyosarcomatous elements were observed, implying possible involvement of neoplastic stem cells in the process of carcinosarcoma formation. The patient did not receive any adjuvant therapy and eventually succumbed to multiple visceral metastases (lungs and liver) at 11 months postoperatively. No autopsy was performed.


Assuntos
Carcinoma de Células de Transição/diagnóstico , Carcinossarcoma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Rabdomiossarcoma/diagnóstico , Neoplasias Urológicas/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma de Células de Transição/patologia , Carcinoma de Células de Transição/cirurgia , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Evolução Fatal , Feminino , Humanos , Rim/patologia , Rim/cirurgia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Nefroureterectomia , Rabdomiossarcoma/patologia , Rabdomiossarcoma/cirurgia , Ureter/patologia , Ureter/cirurgia , Bexiga Urinária/patologia , Bexiga Urinária/cirurgia , Neoplasias Urológicas/patologia , Neoplasias Urológicas/cirurgia
18.
Int J Gynecol Cancer ; 29(1): 53-59, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640684

RESUMO

OBJECTIVE: To identify factors that affect successful adaptation of sentinel lymph node mapping and those that lead to unintended adipose-only sentinel lymph node identification. METHODS: Surgical and pathological data were prospectively collected on patients with endometrial cancer who underwent sentinel lymph node mapping with indocyanine green with or without pelvic and/or para-aortic lymph node dissection between November 2013 and April 2017. All mapping cases were performed with the robotic system. Adipose-only specimens were defined as a sentinel lymph node without a pathologically identified lymph node after ultrastaging. RESULTS: A total of 202 patients were included: 83% had endometrioid pathology, 12% serous, 3% carcinosarcoma, and 2% clear cell, with mixed pathology noted in 2%. The bilateral sentinel lymph node detection rate was 66%, and the rate of mapping at least a unilateral sentinel lymph node was 86%. Neither the bilateral nor the unilateral sentinel lymph node mapping rate changed with increased surgeon experience. The rate of adipose-only sentinel lymph node identification was more frequent when comparing the first 10 cases (37%), cases 11 - 30 (28%), and > 30 cases (9%) (P = 0.006). Body mass index > 30 kg/m2, uterine fibroids, The International Federation of Gynecology and Obstetrics (FIGO) grade, and histology were not found to have a statistically significant impact on either sentinel lymph node identification or adipose-only sentinel lymph node identification. Adipose-only sentinel lymph nodes were more likely with increased time from cervical injection to identification of the sentinel lymph node in the right hemipelvis. The median range was 28 min (14-73) for true sentinel lymph node identification vs 33 min (23-74) for adipose-only sentinel lymph node identification (P = 0.02). CONCLUSION: Patient and surgeon factors did not impact the identification of sentinel lymph nodes over time. Adipose-only sentinel lymph nodes were more frequently identified in the initial cases and represent a potential complication to adapting sentinel lymph node biopsy without lymphadenectomy. The increase in adipose-only sentinel lymph node identification that was associated with time from cervical injection may represent delayed or disrupted uptake of indocyanine green.


Assuntos
Tecido Adiposo/patologia , Algoritmos , Neoplasias do Endométrio/patologia , Verde de Indocianina , Linfonodo Sentinela/patologia , Adenocarcinoma de Células Claras/patologia , Adenocarcinoma de Células Claras/cirurgia , Tecido Adiposo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Corantes , Cistadenocarcinoma Seroso/patologia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Seguimentos , Humanos , Histerectomia , Excisão de Linfonodo , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos , Linfonodo Sentinela/cirurgia
19.
Int J Gynecol Cancer ; 29(1): 102-107, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640690

RESUMO

OBJECTIVES: To determine if linear measurements of adiposity from pre-operative imaging can improve anticipation of surgical difficulty among endometrial cancer patients. METHODS: Eighty patients with newly diagnosed endometrial cancer were enrolled. Routine pre-operative imaging (MRI or CT) was performed. Radiologic linear measurements of the following were obtained: anterior-to-posterior skin distance; anterior skin to anterior edge of L5 distance (total anterior); anterior peritoneum to anterior edge of L5 distance (visceral obesity); and posterior edge of L5 to posterior skin distance (total posterior). Surgeons completed questionnaires quantifying preoperative anticipated operative difficulty and postoperative reported operative difficulty. The primary objective was to assess for a correlation between linear measurements of visceral fat and reported operative difficulty. RESULTS: Seventy-nine patients had questionnaires completed, preoperative imaging obtained, and surgery performed. Univariate analysis showed all four linear measurements, body mass index, weight, and anticipated operative difficulty were associated with increased reported operative difficulty (P< 0.05). Multivariate analysis demonstrated that body mass index and linear measurements visceral obesity and total posterior were independently associated with increased reported operative difficulty (P< 0.05). Compared with body mass index, the visceral obesity measurement was more sensitive and specific for predicting increased reported operative difficulty (visceral obesity; sensitivity 54%, specificity 91 %; body mass index; sensitivity 38%, specificity 89%). A difficulty risk model combining body mass index, visceral obesity, and total posterior demonstrated better predictive performance than any individual preoperative variable. CONCLUSIONS: Simple linear measurements of visceral fat obtained from preoperative imaging are more predictive than body mass index alone in anticipating surgeon-reported operative difficulty. These easily obtained measurements may assist in preoperative decision making in this challenging patient population.


Assuntos
Carcinossarcoma/diagnóstico por imagem , Cistadenocarcinoma Seroso/diagnóstico por imagem , Neoplasias do Endométrio/diagnóstico por imagem , Gordura Intra-Abdominal/diagnóstico por imagem , Obesidade/complicações , Complicações Pós-Operatórias , Tomografia Computadorizada por Raios X/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Carcinossarcoma/cirurgia , Cistadenocarcinoma Seroso/cirurgia , Neoplasias do Endométrio/cirurgia , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos
20.
Int J Gynecol Cancer ; 29(1): 188-194, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30640703

RESUMO

OBJECTIVES: To evaluate the clinical outcomes of epithelial ovarian carcinoma patients who underwent cardiophrenic lymph node resection. METHODS: We retrospectively reviewed the records of all surgically treated patients with advanced epithelial ovarian carcinoma (stages IIIC-IV) who underwent cardiophrenic lymph node resection between 2002 and 2018. Only those in whom cardiophrenic lymph node involvement was the only detectable extra-abdominal disease were included. Patients with suspected cardiophrenic lymph node metastasis on staging images underwent a transdiaphragmatic incision to access the para-cardiac space after complete abdominal cytoreduction achievement. Data on disease-free survival, overall survival, and surgical procedures performed concurrently with cardiophrenic lymph node resection were collected. RESULTS: Of the total 456 patients, 29 underwent cardiophrenic lymph node resection; of these, 24 patients met the inclusion criteria. Twenty-two, one, and one patients had high grade serous epithelial ovarian carcinoma, low grade epithelial ovarian carcinoma, and ovarian carcinosarcoma, respectively. Ten patients had recurrent disease (recurrence group). Fourteen patients underwent cytoreduction during primary treatment (primary debulking group); four underwent cytoreduction after neoadjuvant chemotherapy. Cardiophrenic lymph node resection was performed on the right side in 19 patients, left side in three, and bilaterally in two. The average procedural duration was 28 minutes, with minimal blood loss and no severe complications. Twenty-one patients had cardiophrenic lymph node positivity. The median disease-free intervals were 17 and 12 months in the recurrent and primary debulking surgery groups, respectively. The mediastinum was the first recurrence site in 10 patients. Five patients developed brain metastases. Five patients had an overall survival beyond 50 months. CONCLUSIONS: Although rare, the cardiophrenic lymph nodes may be a site of metastasis of ovarian cancer. Although their presence might indicate future recurrence, some patients may achieve long-term survival. Resection should be considered in cases of suspicious involvement to confirm extra-abdominal disease and achieve complete cytoreduction.


Assuntos
Procedimentos Cirúrgicos de Citorredução/mortalidade , Excisão de Linfonodo/mortalidade , Linfonodos/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Ovarianas/cirurgia , Pericárdio/cirurgia , Adulto , Idoso , Carcinossarcoma/secundário , Carcinossarcoma/cirurgia , Cistadenocarcinoma Seroso/secundário , Cistadenocarcinoma Seroso/cirurgia , Diafragma , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Ovarianas/patologia , Pericárdio/patologia , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
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