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1.
J Surg Oncol ; 121(1): 85-90, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31236970

RESUMO

Secondary Angiosarcoma (Stewart-Treves Syndrome) is a rare malignant cutaneous lesion, which arises in chronic lymphedema of the extremity, often observed after breast cancer treatment. We reviewed the history and the oncological outcome of two patients with this disease. Multimodal therapy including hyperthermic isolated limb perfusion with TNF-alpha and Melphalan, combined with radical resection of the affected skin and subcutaneous tissue including the fascia, with large safety margins may probably lead to better survival.


Assuntos
Hemangiossarcoma/patologia , Hemangiossarcoma/terapia , Linfangiossarcoma/patologia , Linfangiossarcoma/terapia , Braço , Quimioterapia do Câncer por Perfusão Regional , Feminino , Hemangiossarcoma/tratamento farmacológico , Hemangiossarcoma/cirurgia , Humanos , Hipertermia Induzida , Linfangiossarcoma/tratamento farmacológico , Linfangiossarcoma/cirurgia , Melfalan/administração & dosagem , Pessoa de Meia-Idade , Fator de Necrose Tumoral alfa/administração & dosagem
3.
Medicine (Baltimore) ; 98(49): e18193, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804339

RESUMO

RATIONALE: Primary cardiac angiosarcoma is a rare malignant cardiac neoplasm with early metastasis and poor prognosis. As there are currently no guidelines or effective therapeutic strategies, management of this condition depends on previous experiences of the clinician treating and the consideration of reported cases. PATIENT CONCERNS: A 65-year-old male presented to our department with a 4-day history of chest tightness, dyspnea, lower extremity weakness and occasional dizziness, and a transthoracic echo (TTE) revealed a right atrium occupying mass. DIAGNOSES: TTE showed right atrium occupation, and the post-operative histopathology showed the tumor to be a primary cardiac angiosarcoma. INTERVENTIONS: Right atrium tumor resection and right atrium reconstruction with a bovine pericardium were performed. OUTCOMES: The patient recovered from surgery and discharged but died 10 months after surgery because of complete resection was impossible and adjuvant therapy was not performed. LESSONS: Resection of primary cardiac angiosarcomas should be integrated with a combination of chemotherapy, radiotherapy, and targeted therapy based on tumor cell gene mutation and altered expression.


Assuntos
Neoplasias Cardíacas/patologia , Hemangiossarcoma/patologia , Idoso , Ecocardiografia , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Masculino
4.
Rev. bras. cir. plást ; 34(4): 561-566, oct.-dec. 2019. ilus
Artigo em Inglês, Português | LILACS | ID: biblio-1047928

RESUMO

Introdução: O couro cabeludo é uma área de difícil reconstrução devido à sua pouca elasticidade e por sobrepor-se a uma estrutura rígida e convexa. Existem diferentes técnicas cirúrgicas para reparação dos defeitos, que podem ser produto de diversas etiologias, como: traumas, deformidades e consequência de doenças, principalmente oncológicas, como é o caso do paciente apresentada neste trabalho. O angiossarcoma cutâneo é um tumor vascular maligno raro e extremamente agressivo, que afeta principalmente idosos. É caracterizado clinicamente pelo aparecimento de placas eritêmato-violáceas e de rápida evolução. O tratamento depende da extensão da doença. A maioria dos casos são tratados com ampla ressecção cirúrgica e reconstrução. O objetivo é relatar um caso de reconstrução de grande defeito do couro cabeludo depois de uma dissecção oncológica, realizado no Hospital Central do Exército (HCE) - RJ. Métodos: O caso foi tratado com enxerto autólogo e uso de matriz dérmica, em 2 tempos cirúrgicos, até a total cobertura da área lesionada. Resultados: Obteve-se resultado satisfatório após as cirurgias de enxertia de pele na área ressecada. Conclusão: O enxerto autólogo, juntamente a matriz dérmica mostrou-se uma opção viável na reconstrução do couro cabeludo.


Introduction: It is difficult to reconstruct the scalp due to its poor elasticity and presence of layers over a rigid convex structure. Different surgical techniques are used to repair defects that may develop due to several etiologies, such as trauma, deformities, and disease sequelae, especially cancer, as noted in the present case. Cutaneous angiosarcoma, a rare and extremely aggressive malignant vascular tumor that mainly develops in elderly individuals, is clinically characterized by the onset of rapidly evolving erythematous purple plaques. The treatment depends on disease extent. Most patients are treated with wide surgical resection and reconstruction. The objective is to report a case of reconstruction of a major scalp defect after an oncologic dissection performed at the Hospital Central do Exército in Rio de Janeiro. Methods: An autologous graft and dermal matrices were applied during two surgical periods till the damaged area was fully covered. Results: Satisfactory results were obtained after performing skin grafting surgery in the resected area. Conclusion: The autologous graft and dermal matrix proved to be a viable option for scalp reconstruction.


Assuntos
Humanos , Masculino , Idoso , História do Século XXI , Reabilitação , Couro Cabeludo , Neoplasias Cutâneas , Procedimentos Cirúrgicos Reconstrutivos , Hemangiossarcoma , Neoplasias de Tecido Vascular , Reabilitação/métodos , Reabilitação/psicologia , Couro Cabeludo/cirurgia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/terapia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Hemangiossarcoma/cirurgia , Hemangiossarcoma/terapia , Neoplasias de Tecido Vascular/cirurgia , Neoplasias de Tecido Vascular/terapia
5.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(9): 731-736, 2019 Sep 24.
Artigo em Chinês | MEDLINE | ID: mdl-31550845

RESUMO

Objective: To analyze the clinical, radiologic characteristics, and outcome of consecutive patients with primary cardiac angiosarcoma. Methods: The medical records of patients with primary cardiac angiosarcoma diagnosed through pathology at Peking Union Medical College Hospital between January 2001 and May 2018 were obtained. The results of echocardiography, coronary artery CT angiography (CTA), cardiac magnetic resonance (CMR), positron emission computed tomography (PET-CT), operation, postoperative treatment and prognosis of the patients were analyzed. Results: A total of 16 patients were included, 9 were male, 7 were female, the median age was 42.5 years (31.7, 52.5). The interval from symptoms onset to diagnosis was 4.5 months (0.5-18.0 months). Eight patients were diagnosed at non-metastatic phase, while 8 patients were in metastatic phase. The main complaints were dyspnea, short breath, chest pain, hemoptysis, syncope, edema, fever, fatigue, and cough. Three patients (18.8%) had pericardial tamponade in the course of the disease. Echocardiography was performed on all 16 patients, cardiac mass was found in 12 patients, and pericardial effusion or pericardial thickening was observed in 4 patients. In 8 cases with results of coronary CTA, 5 cases presented signs of right atrium occupation, 1 case presented sign of right ventricle occupation, and 1 case presented isolated massive pericardial effusion. None abnormality was found in 1 case. Of the 7 patients who underwent CMR, 6 presented with right atrium mass occupation and 1 mediastinal mass. Four patients received PET-CT examination and results showed that all presented with hypermetabolic lesions: 2 in right atrium, 1 in pericardium, and 1 in mediastinum, and lung metastasis was found in 2 cases. Among the 16 patients, 13 received surgical treatment, 2 received adjuvant chemotherapy, and 1 received chemotherapy and radiotherapy after biopsy. The median overall survival was 3.0 months. Conclusion: Cardiac angiosarcoma is a rare malignancy with poor prognosis, and echocardiography has only limited diagnostic value for angiosarcoma. CMR, CTA or PET-CT examinations could provide valuable clues for the diagnosis of this rare disease.


Assuntos
Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Adulto , Angiografia Coronária , Ecocardiografia , Feminino , Átrios do Coração , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Derrame Pericárdico , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico
6.
Pan Afr Med J ; 33: 134, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558933

RESUMO

Primary angiosarcoma of the breast is an extremely rare tumour with a difficult diagnosis and poor prognosis. We report a case of primary breast angiosarcoma diagnosed in the pathology department of the University Hospital of Oujda. An analysis of the epidemiological, diagnostic and therapeutic aspects of this type of tumour is made in this manuscript. Mastectomy is the standard treatment; the place of radiotherapy and chemotherapy is not well established. We report a case of a 18- year-old woman having an infectious symptomatology of the right breast for which she received an anti-infectious therapy inducing regression of inflammatory symptoms presented with a quick growing mass. Initial core needle biopsy showed a malignant vascular proliferation. The patient underwent a mastectomy. The tumor histology showed papillary formations and vascular structures lined by atypical cells with hyperchromatic nucleus and eosinophilic cytoplasm. The tumor cells expressed CD34 and CD31 but were negative for cytokeratin. The diagnosis of angiosarcoma grade I was made. The patient is now receiving chemotherapy. She is still alive.


Assuntos
Neoplasias da Mama/diagnóstico , Hemangiossarcoma/diagnóstico , Mastectomia/métodos , Adolescente , Antígenos CD34/metabolismo , Antineoplásicos/administração & dosagem , Biópsia com Agulha de Grande Calibre , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Gradação de Tumores , Molécula-1 de Adesão Celular Endotelial a Plaquetas/metabolismo
7.
Hinyokika Kiyo ; 65(8): 333-336, 2019 Aug.
Artigo em Japonês | MEDLINE | ID: mdl-31501402

RESUMO

Angiosarcoma is a very rare tumor. The malignancy is high grade and the prognosis is extremely poor. A 51-year-old man was admitted to our hospital with the main complaint of asymptomatic macroscopic hematuria. Since right ureteral cancer was suspected by the imaging examination, laparoscopic right total nephroureterectomy was planned. However, strong adhesion was found between the tumor and the surrounding tissue, and the tumor could not be completely resected from the distal ureter. Pathological diagnosis was primary ureteral angiosarcoma, and staging was right middle ureteral angiosarcoma T3N0M0. However, since surgical findings strongly suspected that the peeled surface was positive, adjuvant radiation therapy was added. He is alive without disease recurrence at one year and eight months after surgery.


Assuntos
Hemangiossarcoma , Ureter , Neoplasias Ureterais , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Nefroureterectomia , Neoplasias Ureterais/diagnóstico , Neoplasias Ureterais/cirurgia
8.
World Neurosurg ; 130: 351-357, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31330332

RESUMO

BACKGROUND: Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data. CASE DESCRIPTION: We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy. CONCLUSIONS: Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.


Assuntos
Neoplasias Ósseas/cirurgia , Hemangiossarcoma/cirurgia , Osso Temporal/cirurgia , Neoplasias Ósseas/patologia , Traumatismos Cranianos Fechados/complicações , Traumatismos Cranianos Fechados/patologia , Hemangiossarcoma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/cirurgia , Reoperação , Osso Temporal/patologia , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
Medicine (Baltimore) ; 98(28): e16245, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305404

RESUMO

RATIONALE: Primary splenic angiosarcoma (PSA) is a rare mesenchymal malignancy of the splenic vascular origin often with a dismal prognosis. Genomic profile may provide evidence for the solution of therapy. PATIENT CONCERNS: We reported a case of a 51-year-old woman with splenectomy 4 years ago and the postoperative histopathology diagnosis revealed "splenic hemangioma" with spontaneous rupture. Two years after the operation, the patient's rechecked abdominal computed tomography (CT) showed multiple hepatic occupations. DIAGNOSES: Pathological test suggested PSA hepatic metastasis. INTERVENTIONS: The patient was treated with trans-catheter arterial chemoembolization (TACE) and a pathological diagnosis of PSA was highly suspected in the hepatic biopsy. Four somatic alterations, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA), Fos proto-oncogene, AP-1 transcription factor subunit (FOS), MCL1 apoptosis regulator (MCL1), and phosphoinositide-3-kinase regulatory subunit 1 (PIK3R1) were detected in the tumor tissue using a Next generation sequencing (NGS) technology. The results prompted that the patient may get clinical benefit from using some agents for targeted therapy, Everolimus, Temsirolimus, or Copanlisib. OUTCOMES: The patient refused targeted therapy. As a result, the patient passed away within 51 months after splenectomy. LESSONS: PSA is an aggressive disease that often presented with a high propensity for metastasis and rupture hemorrhage. Some of these mutations were first discovered in PSA and these findings added new contents to the genomic mutation profile of PSA.


Assuntos
Hemangiossarcoma/cirurgia , Neoplasias Hepáticas/genética , Neoplasias Hepáticas/secundário , Esplenectomia , Neoplasias Esplênicas/cirurgia , Classe I de Fosfatidilinositol 3-Quinases/genética , Evolução Fatal , Feminino , Hemangiossarcoma/genética , Hemangiossarcoma/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/terapia , Pessoa de Meia-Idade , Proteína de Sequência 1 de Leucemia de Células Mieloides/genética , Fosfatidilinositol 3-Quinases/genética , Proteínas Proto-Oncogênicas c-fos/genética , Neoplasias Esplênicas/genética , Neoplasias Esplênicas/patologia
11.
Cardiovasc Pathol ; 41: 18-20, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31005792

RESUMO

Most primary cardiac tumors are benign neoplasms, which generally can be differentiated from malignant neoplasms via certain radiological features. We present briefly a case of a 26-year-old man undergoing resection of a right atrial mass that based on preceding radiologic findings represent a myxoma. After pathologic examination, the lesion was determined to be an epithelioid angiosarcoma with unique frond-like architecture and multiple pedicular attachments to the atrial wall.


Assuntos
Células Epitelioides , Neoplasias Cardíacas/diagnóstico por imagem , Hemangiossarcoma/diagnóstico por imagem , Imagem por Ressonância Magnética , Mixoma/diagnóstico por imagem , Adulto , Biomarcadores Tumorais/análise , Biópsia , Erros de Diagnóstico , Células Epitelioides/química , Células Epitelioides/patologia , Neoplasias Cardíacas/química , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/química , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Mixoma/patologia , Valor Preditivo dos Testes
12.
Heart Surg Forum ; 22(2): E162-E164, 2019 04 12.
Artigo em Inglês | MEDLINE | ID: mdl-31013229

RESUMO

Primary cardiac neoplasms are extremely rare and often overlooked as differential diagnosis. Angiosarcomas are the most common primary malignant neoplasms of the heart often with nonspecific symptoms. We present a 43-year-old woman admitted to our hospital with chest pain and inferoposterolateral myocardial infarction. Coronary angiography indicated the distal occlusion of the left circumflex artery. Transthoracic and transoesophagic echocardiography revealed a mass in the left atrium with probable myocardial infiltration and vascularisation. The mass in the left atrium was removed by surgical resection, and histopathology confirmed angiosarcoma. We emphasize the pivotal role of transthoracic and transoesophageal echocardiography in evaluating even rare differential diagnosis of acute coronary syndrome as cardiac neoplasms.


Assuntos
Átrios do Coração/cirurgia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/cirurgia , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Adulto , Biomarcadores/sangue , Angiografia Coronária , Ecocardiografia , Eletrocardiografia , Feminino , Átrios do Coração/patologia , Neoplasias Cardíacas/diagnóstico , Neoplasias Cardíacas/patologia , Hemangiossarcoma/diagnóstico , Hemangiossarcoma/patologia , Humanos , Esternotomia , Tomografia Computadorizada por Raios X
13.
Medicine (Baltimore) ; 98(17): e15290, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027090

RESUMO

RATIONALE: Cardiac angiosarcoma is a rare malignant tumor, for which only surgery has been proven to be effective to date. Currently there are no reports as to whether a postoperative regimen of ifosfamide, epirubicin, and recombinant human endostatin is effective. PATIENT CONCERN: The patient presented to us with chest pain and dyspnea. DIAGNOSIS: Enhanced computerized tomography (CT) and positron emission tomography-computerized tomography (PET-CT) suggested pericarditis and an atrial perforation, but malignancy was suspected, so the patient underwent an operation to resect the tumor and repair. Pathology of the tumor reseccted at operation showed the tumor to be an angiosarcoma. INTERVENTION: After the surgery, the patient was stared on a paclitaxel chemotherapy regimen (135 mg/m once every 3 weeks). However, 2 cycles later, pulmonary and hepatic metastases were found. Chemotherapy was then changed to ifosfamide, epirubicin (ifosfamide 2000 mg/m days 1-3, epirubicin 70 mg/m days 1-2) and recombinant human endostatin (7.5 mg/m days 1-14) in 3 weekly cycles. OUTCOME: Three cycles later, follow-up showed that chemotherapy had delayed progression of the pulmonary metastases, but that the hepatic node was still growing. The patient has now survived 8 months post surgery and is still on follow-up. LESSONS: This case shows us that operation on late stage cardiac angiosarcomas can alleviate a patient's symptoms; postoperative paclitaxel monotherapy was insufficient and ifosfamide and epirubicin plus recombinant human endostatin has a limited effect on late stage cardiac angiosarcoma. Studies with a larger sample size are needed for verification of these findings.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Cardíacas/tratamento farmacológico , Hemangiossarcoma/tratamento farmacológico , Antineoplásicos/uso terapêutico , Endostatinas/uso terapêutico , Epirubicina/uso terapêutico , Neoplasias Cardíacas/patologia , Neoplasias Cardíacas/cirurgia , Hemangiossarcoma/patologia , Hemangiossarcoma/cirurgia , Humanos , Ifosfamida/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Proteínas Recombinantes
15.
Breast ; 45: 56-60, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30877870

RESUMO

BACKGROUND: Breast angiosarcoma is a malignant mesenchymal neoplasm, which accounts for approximately 2% of all soft tissue sarcomas. Secondary breast angiosarcoma (SBA) may be related to chronic lymphedema after a mastectomy with lymph node dissection (Stewart Treves syndrome) and previous radiotherapy for complications from breast radiation treatment. It is a very rare condition; therefore, diagnosis and management are still a challenge. METHODS: The ANISC collected SBA data by means of a survey sent to all Italian breast centres in the ANISC. The clinicopathological characteristics and the management of this disease were analysed. RESULTS: Twenty-four centres participated in this survey in which 112 cases of SBA were analysed. The median age of the women with SBA was 68.9 years and it appeared approximately 90 months after the first irradiation for breast cancer. In 92% of cases, a mastectomy was performed without axillary dissection for those patients having a high grade of SBA (74.2%). The prognosis was worse in the high-grade cases (overall survival-OS: 36 months) as compared with the low-grade cases (OS: 48 months). After a follow-up of 5 years, 50.5% of the patients were still alive. Disease-free survival (DFS) was 35 months, and there were no differences between the groups of patients with either high- or low-grade histology. CONCLUSIONS: Secondary breast angiosarcoma is a very aggressive disease associated with a short survival outcome. The surgical approach still remains an important step in the course of treatment; furthermore, an accurate histological examination is helpful in establishing the prognosis of the patient. A mastectomy is mandatory. A longer OS was observed in patients with low-grade angiosarcoma as compared to high-grade angiosarcoma (C.I. 40-57 vs. 31-41 months).


Assuntos
Neoplasias da Mama/mortalidade , Hemangiossarcoma/mortalidade , Segunda Neoplasia Primária/mortalidade , Complicações Pós-Operatórias/mortalidade , Idoso , Neoplasias da Mama/etiologia , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Hemangiossarcoma/complicações , Hemangiossarcoma/etiologia , Hemangiossarcoma/cirurgia , Humanos , Itália/epidemiologia , Excisão de Linfonodo/efeitos adversos , Linfangiossarcoma/complicações , Mastectomia/mortalidade , Segunda Neoplasia Primária/etiologia , Segunda Neoplasia Primária/cirurgia , Complicações Pós-Operatórias/etiologia , Prognóstico , Estudos Retrospectivos , Cirurgiões/estatística & dados numéricos , Inquéritos e Questionários
16.
Breast Cancer Res Treat ; 175(2): 409-418, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30820717

RESUMO

BACKGROUND: Localized breast angiosarcoma (LBA) is a rare condition with no prospective clinical trials guiding the management of afflicted patients. Management of LBA and the resulting outcomes on a nationwide scale has not been previously examined. METHODS: The National Cancer Data Base (NCDB) from 2004 to 2014 identified resected LBA patients. Treatment patterns were compared between three time periods (2004-2007, 2008-2011, and 2012-2014). Demographic and tumor characteristics, as well as treatments received-extent of surgery and adjuvant therapies-were analyzed for association with overall survival after adjustment for covariates. RESULTS: 826 resected localized breast angiosarcoma patients were identified. Mastectomy was the most common surgical approach (86%); over 60% of patients did not receive adjuvant therapies after surgery. On multivariate analysis, tumor grade, tumor size, and surgical margins were associated with worse survival. Extent of surgery (mastectomy versus lumpectomy) and radiation therapy use were not associated with improved survival. Adjuvant chemotherapy was associated with improved survival in patients with primary tumors 5 cm and greater. CONCLUSIONS: The extent of surgery is not associated with improved survival in women with LBA, and patients may consider breast-conservation surgery. Adjuvant therapies are not associated with improved survival, with the exception of possible role of adjuvant chemotherapy in large primary tumors (5 cm or greater). Further clinical studies are needed to determine the impact of these treatments on local control, progression-free survival, and patients' quality of life. Until then, the findings of our analysis will form basis for the multi-disciplinary discussion of management of women with LBA.


Assuntos
Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/cirurgia , Hemangiossarcoma/tratamento farmacológico , Hemangiossarcoma/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Quimioterapia Adjuvante/métodos , Terapia Combinada/métodos , Intervalo Livre de Doença , Feminino , Hemangiossarcoma/patologia , Humanos , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Qualidade de Vida , Radioterapia Adjuvante/métodos
19.
Vet Surg ; 48(S1): O91-O98, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30666685

RESUMO

OBJECTIVE: To determine laparoscopic accessibility of liver lobes and access to the hilus and describe laparoscopic microwave ablation (LMWA) in 2 dogs with hepatic neoplasia. STUDY DESIGN: Experimental/descriptive case series. SAMPLE POPULATION: Six canine cadavers and 2 clinical dogs. METHODS: Cadavers in dorsal recumbency underwent laparoscopic assessment of the liver. A 17 gauge MWA probe was inserted to create an ablation zone at the most proximal aspect of the hilus. The distance from the center of each ablation zone to the most proximal aspect of the corresponding hilus was determined. Two dogs with hepatic neoplasia underwent LMWA. RESULTS: All lobes of the canine liver were accessible via laparoscopy. The median (interquartile range) distances from the ablation zones to the hilus for the caudate process, left lateral, left middle, quadrate, right lateral, and right middle lobes were 2.2 (1.2-2.6), 2.1 (1-4.4), 1.5 (1.4-3.7), 2, 1, 2.5 (1-4.1) cm, respectively. Histopathologic diagnoses treated by LMWA included metastatic hemangiosarcoma and primary hepatocellular carcinoma. Laparoscopic microwave ablation was technically feasible, and no complications from the procedure resulted. CONCLUSION: Laparoscopic access to the hilus of each liver lobe is possible via a ventrodorsal approach provided reverse Trendelenburg and lateral rotation is used, especially for the right lateral lobe. Laparoscopic microwave ablation is feasible in some dogs with hepatic neoplasia. The indications for and efficacy of LMWA for hepatic neoplasia in dogs requires additional investigation. CLINICAL SIGNIFICANCE: Laparoscopic access to all liver lobes and MWA of some neoplastic lesions is feasible in a canine pilot study.


Assuntos
Carcinoma Hepatocelular/veterinária , Neoplasias Hepáticas/veterinária , Micro-Ondas , Ablação por Radiofrequência/veterinária , Animais , Carcinoma Hepatocelular/cirurgia , Cães , Hemangiossarcoma/cirurgia , Laparoscopia/métodos , Neoplasias Hepáticas/cirurgia , Masculino , Projetos Piloto , Resultado do Tratamento
20.
BMC Surg ; 19(1): 5, 2019 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-30630447

RESUMO

BACKGROUND: Primary hepatic angiosarcoma (PHA) is a rare tumor entity. Radical surgical resection is currently considered the best treatment choice. The aim of this analysis is to report our experience with surgery for PHA. METHODS: All resections of PHA from 01/2002 until 06/2017 were identified from our prospective institutional database. All cases were re-confirmed by a second pathologist. We analyzed completeness of resection, overall (OS) and disease-free survival (DFS). RESULTS: Nine patients with PHA underwent hepatic resection. Median follow-up after surgery was 15.5 months (range: 3-144). At last follow-up 4/9 patients were alive, three of them without recurrence 15, 21 and 144 months after surgery. Five patients developed PHA recurrence. Four of these died 3 to 17 months after surgery. One patient with PHA recurrence is alive 15 months after surgery. Another patient without PHA recurrence died 59 months after surgery from pancreatic cancer. Median OS and DFS after resection was 18 months (range: 3-144 months) and 10 months (range: 2-144 months), respectively. After R-0 resection (n = 8), the median OS and DFS was 59 and 11 months. CONCLUSIONS: Resection of PHA is the only approach to achieve complete tumor removal and offers a chance for long-term survival and should be evaluated in cases of PHA.


Assuntos
Hemangiossarcoma/cirurgia , Neoplasias Hepáticas/cirurgia , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
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