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1.
Bone Joint J ; 101-B(12): 1557-1562, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31786990

RESUMO

AIMS: The aim of this study was to present the long-term surgical outcomes, complications, implant survival, and causes of implant failure in patients treated with the modified Harrington procedure using antegrade large diameter pins. PATIENTS AND METHODS: A cohort of 50 consecutive patients who underwent the modified Harrington procedure for periacetabular metastasis or haematological malignancy between January 1996 and April 2018 were studied. The median follow-up time for all survivors was 3.2 years (interquartile range 0.9 to 7.6 years). RESULTS: The five-year overall survival rate was 33% for all the patients. However, implant survival rates were 100% and 46% at five and ten years, respectively. Eight patients survived beyond five years. There was no immediate perioperative mortality or complications. A total of 15 late complications occurred in 11 patients (22%). Five patients (10%) required further surgery to treat complications. The most frequent complication was pin breakage without evidence of acetabular loosening (6%). Two patients (4%) underwent revision for aseptic loosening at 6.5 and 8.9 years after surgery. Ambulatory status and pain level were improved in 83% and 89%, respectively. CONCLUSION: The modified Harrington procedure for acetabular destruction has low complication rates, good functional outcome, and improved pain relief in selected patients Cite this article: Bone Joint J 2019;101-B:1557-1562.


Assuntos
Acetábulo/cirurgia , Artroplastia de Quadril/métodos , Pinos Ortopédicos , Neoplasias Ósseas/cirurgia , Neoplasias Hematológicas/cirurgia , Falha de Prótese , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Artroplastia de Quadril/mortalidade , Neoplasias Ósseas/mortalidade , Neoplasias Ósseas/secundário , Carcinoma/mortalidade , Carcinoma/secundário , Carcinoma/cirurgia , Feminino , Seguimentos , Neoplasias Hematológicas/mortalidade , Humanos , Linfoma/mortalidade , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
2.
World Neurosurg ; 130: 165-169, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299306

RESUMO

BACKGROUND: Ossified chronic subdural hematoma (CSH) associated with neoplasm has rarely been reported in the literature. We describe a patient with ossified CSH and underlying large B-cell lymphoma and discuss the relationship between lymphoma and CSH, emphasizing clinical characteristics, tumorigenic mechanism, and histopathologic analysis. CASE DESCRIPTION: A 46-year-old man with a history of alcohol abuse and a right frontotemporoparietal and left frontal ossified CSH that was diagnosed 2 years previously presented with headache and memory loss over 6 days. The patient was being followed with serial imaging, which showed the static state of the mass and no other lesions 7 months before admission. He underwent right frontotemporoparietal craniectomy to remove the ossified CSH and tumor. When the bone was lifted and the thin dura was opened, a hard, thick, ossified capsule was observed. No apparent tumor invasion was noted in the skull or epidural space. Despite refusing further chemotherapy and radiation therapy, the patient has been disease-free and working for 5 years. CONCLUSIONS: Based on reported cases and relevant literature, large B-cell lymphoma may be associated with ossified CSH.


Assuntos
Dura-Máter/cirurgia , Hematoma Subdural Crônico/cirurgia , Linfoma de Células B/virologia , Linfoma/cirurgia , Calcinose/complicações , Calcinose/cirurgia , Dura-Máter/patologia , Dura-Máter/virologia , Hematoma Subdural Crônico/complicações , Hematoma Subdural Crônico/diagnóstico , Herpesvirus Humano 4/patogenicidade , Humanos , Linfoma/complicações , Linfoma/virologia , Linfoma de Células B/diagnóstico , Linfoma de Células B/cirurgia , Masculino , Pessoa de Meia-Idade
3.
Vet Surg ; 48(7): 1218-1228, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31287179

RESUMO

OBJECTIVE: To report outcomes in cats with discrete intermediate- and large-cell gastrointestinal (GI) lymphoma masses after surgical resection. STUDY DESIGN: Retrospective clinical case series. ANIMALS: Forty client-owned cats in which intermediate- or large-cell GI lymphoma was diagnosed. METHODS: Records of 40 cats in which discrete intermediate- or large-cell GI lymphoma masses were diagnosed between 2005 and 2015 were reviewed. Cats were included if they survived curative intent surgery and had a known outcome for at least two weeks. Postoperative death was permitted. Data collected included anatomic site, surgical margins, lymphoma subtype, chemotherapy use, and postoperative and long-term outcome (beyond two weeks). RESULTS: Affected sites consisted of small intestines (n = 23), large intestines (n = 9), and stomach (n = 8). Thirty-six of 40 cats survived to discharge, and 31 cats were alive at suture removal. Median long-term follow-up of 22 cats was 111 days (range, 16-1407). Cats that survived to suture removal had a median survival time (MST) of 185 days (95% confidence interval: 72-465). Cats with large intestinal masses lived longer than those with small intestinal or gastric masses whether all cats (MST, 675, 64, 96 days, respectively; P = .03) or only those surviving to suture removal were considered. Complete surgical resection (n = 20) was positively associated with survival (370 vs 83 days, P = .016). CONCLUSION: Most cats in this population survived the perioperative period, with MST similar to those reported historically with medical management. CLINICAL SIGNIFICANCE: Surgical resection may be a reasonable consideration in cats with solitary lymphoma, particularly those with large intestinal masses.


Assuntos
Doenças do Gato/cirurgia , Neoplasias Gastrointestinais/veterinária , Linfoma/veterinária , Animais , Gatos , Feminino , Neoplasias Gastrointestinais/cirurgia , Humanos , Linfoma/cirurgia , Masculino , Período Perioperatório , Estudos Retrospectivos , Resultado do Tratamento
5.
Acta Oncol ; 58(9): 1315-1322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31286808

RESUMO

Purpose: Lymphoma survivors after high dose therapy with autologous stem cell therapy (HD-ASCT) are at high risk for late adverse effects (AEs). Information patients receive and collect throughout their cancer trajectory about diagnosis, treatment schedule and risks of AEs may influence attitudes and health-related behavior in the years after treatment. The purpose of this study was to explore level of knowledge in lymphoma survivors after HD-ASCT at a median of 12 years after primary diagnosis. Material and methods: From a national study on the effects of HD-ASCT for lymphomas, 269 survivors met for an outpatient examination, including a structured interview addressing knowledge about diagnosis and treatment. Survivors were also asked whether they knew and/or had experienced certain common late AEs. Numbers of recognized and experienced late AEs were presented as sum scores. Factors associated with the level of knowledge of late AEs were analyzed by linear regression analysis. Results: Eighty-one percent of the survivors knew their diagnosis, 99% knew the components of HD-ASCT and 97% correctly recalled having had radiotherapy. Ninety percent reported awareness of late AEs, but the level of knowledge and personal experience with specified AEs varied. Thirty-five percent of survivors stated to have received follow-up for late AEs. In multivariable analysis younger age at diagnosis, having received mediastinal radiotherapy, higher mental health related quality of life, a higher number of self-experienced late AEs and having received follow-up care for late AEs were significantly associated with a higher level of knowledge of AEs. Conclusion: The majority of lymphoma survivors treated with HD-ASCT correctly recalled diagnosis and treatment, while knowledge of late AEs varied. Our findings point to information deficits in survivors at older age and with lower mental health related quality of life. They indicate benefit of follow-up to enhance education on late AEs in lymphoma survivors.


Assuntos
Sobreviventes de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Linfoma/psicologia , Adolescente , Adulto , Fatores Etários , Idoso , Sobreviventes de Câncer/estatística & dados numéricos , Criança , Feminino , Comportamentos Relacionados com a Saúde , Transplante de Células-Tronco Hematopoéticas/métodos , Humanos , Linfoma/diagnóstico , Linfoma/radioterapia , Linfoma/cirurgia , Masculino , Rememoração Mental , Pessoa de Meia-Idade , Noruega , Educação de Pacientes como Assunto , Qualidade de Vida , Análise de Regressão , Inquéritos e Questionários , Fatores de Tempo , Condicionamento Pré-Transplante/métodos , Condicionamento Pré-Transplante/estatística & dados numéricos , Transplante Autólogo/efeitos adversos , Adulto Jovem
6.
Turk J Med Sci ; 49(4): 985-992, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31293116

RESUMO

Background/aim: High-dose chemotherapy followed by autologous stem cell transplantation (ASCT) has become the standard approach for patients with relapsed/refractory Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL). In this study, we report the outcome of the mitoxantrone-melphalan conditioning regimen for lymphoma. Materials and methods: The study group included 53 patients who were relapsed/refractory HL (n = 14) and NHL (n = 39) and received mitoxantrone and melphalan followed by ASCT. The transplant regimen consisted of mitoxantrone (60 mg/m2) and melphalan (180 mg/m2) followed by peripheral blood stem cell infusion (PBSC). Results: Prior to high-dose chemotherapy, 37.7% of the patients were in complete remission (CR) and 45.3% were in partial remission (PR), and 17% had stable or progressive disease. After high-dose chemotherapy and PBSC, 44 out of 51 patients achieved CR (86.2%). CR was achieved in 24 out of 33 patients (72.7%) who were transplanted in a marginally active phase of the disease. At a median followup of 25.4 months (1.8­131.3 months) after ASCT, 13 patients relapsed/ progressed and 8 patients died. The estimated 2-year overall survival (OS) was 81.9%, and event-free survival (EFS) was 59.3%. Conclusion: High-dose chemotherapy followed by ASCT is an effective conditioning regimen in relapsed/refractory lymphoma patients who are undergoing ASCT.


Assuntos
Antineoplásicos/uso terapêutico , Transplante de Células-Tronco Hematopoéticas/métodos , Linfoma , Melfalan/uso terapêutico , Mitoxantrona/uso terapêutico , Adolescente , Adulto , Idoso , Feminino , Humanos , Linfoma/tratamento farmacológico , Linfoma/epidemiologia , Linfoma/patologia , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
7.
J Surg Oncol ; 120(3): 431-437, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31187517

RESUMO

BACKGROUND AND OBJECTIVES: Primary colonic lymphoma (PCL) is rare, heterogeneous, and presents a therapeutic challenge for surgeons. Optimal treatment strategies are difficult to standardize, leading to variation in therapy. Our objective was to describe the patient characteristics, short-term outcomes, and five-year survival of patients undergoing nonpalliative surgery for PCL. METHODS: We performed a retrospective cohort analysis in the National Cancer Database. Included patients underwent surgery for PCL between 2004 to 2014. Patients with metastases and palliative operations were excluded. Univariate predictors of overall survival were analyzed using multivariable Cox proportional hazard analysis. RESULTS: We identified 2153 patients. Median patient age was 68. Diffuse large B-cell lymphoma accounted for 57% of tumors. 30- and 90-Day mortality were high (5.6% and 11.1%, respectively). Thirty-nine percent of patients received adjuvant chemotherapy. For patients surviving 90 days, 5-year survival was 71.8%. Chemotherapy improved survival (surgery+chemo, 75.4% vs surgery, 68.6%; P = .01). Adjuvant chemotherapy was associated with overall survival after controlling for age, comorbidity, and lymphoma subtype (HR 1.27; 95% CI, 1.07-1.51; P = .01). CONCLUSIONS: Patients undergoing surgery for PCL have high rates of margin positivity and high short-term mortality. Chemotherapy improves survival, but <50% receive it. These data suggest the opportunity for improvement of care in patients with PCL.


Assuntos
Neoplasias do Colo/mortalidade , Neoplasias do Colo/cirurgia , Linfoma/mortalidade , Linfoma/cirurgia , Idoso , Idoso de 80 Anos ou mais , Big Data , Quimioterapia Adjuvante , Estudos de Coortes , Neoplasias do Colo/tratamento farmacológico , Neoplasias do Colo/patologia , Feminino , Humanos , Estimativa de Kaplan-Meier , Linfoma/tratamento farmacológico , Linfoma/patologia , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma não Hodgkin/tratamento farmacológico , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/cirurgia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Radioterapia Adjuvante , Estudos Retrospectivos
8.
Hinyokika Kiyo ; 65(2): 49-53, 2019 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-31067843

RESUMO

A 75-year-old man, highly suspected as having malignant lymphoma originating from his left testis, underwent exploratory orchiectomy for a definitive diagnosis. Laboratory examinations before the surgery showed high lactate dehydrogenase (652 IU/l), elevated serum creatinine level (1.85 mg/dl) and sIL-2R level (8,930 U/ml). As the postoperative course passed uneventfully, the patient was discharged from the hospital on the eighth day after the surgery. Ten days after the surgery the patient was transferred to the emergency room of the hospital complaining of severe abdominal pain and malaise. Laboratory examinations revealed highly elevated lactate dehydrogenase (2,807 IL/l), uric acid (24.9 mg/dl) and serum creatinine (5.31 mg/dl). Computed tomography demonstrated rapid growth of the retroperitoneal mass and occurrence of bilateral hydronephroses. Under the diagnosis of spontaneous tumor lysis syndrome, the patient was urgently treated with hemodialysis, steroidal pulse and rituximab following percutaneous nephrostomy for the right kidney. After improvement of the laboratory data, the patient was transferred to another hospital for the treatment of malignant lymphoma.


Assuntos
Linfoma , Neoplasias Testiculares , Síndrome de Lise Tumoral , Idoso , Humanos , Linfoma/complicações , Linfoma/cirurgia , Masculino , Orquiectomia , Neoplasias Testiculares/complicações , Neoplasias Testiculares/cirurgia , Síndrome de Lise Tumoral/etiologia
9.
Pediatr Surg Int ; 35(8): 879-885, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31139892

RESUMO

BACKGROUND: Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. METHODS: Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. RESULTS: We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. CONCLUSION: A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.


Assuntos
Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Laparotomia/métodos , Linfoma/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pressão Hidrostática , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Biópsia Guiada por Imagem , Intussuscepção/diagnóstico , Intussuscepção/terapia , Linfoma/diagnóstico , Linfoma/cirurgia , Masculino , Estudos Retrospectivos , Ultrassonografia
10.
J Clin Ultrasound ; 47(9): 561-563, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31141190

RESUMO

Primary cardiac lymphoma (PCL) is a very rare kind of primary heart tumor, belonging to non-Hodgkin's lymphoma whose major pathological type is diffuse large B-cell lymphoma. The common symptoms include heart failure, pericardial effusion, and malignant arrhythmias. Early diagnosis and treatment of PCL are of great importance due to its merely 7-month median survival period. Here, we report a 48-year-old male patient in whom both atria were involved and had to undergo palliative surgery because of severe clinical symptoms.


Assuntos
Ecocardiografia/métodos , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/patologia , Linfoma/diagnóstico por imagem , Linfoma/patologia , Evolução Fatal , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Neoplasias Cardíacas/cirurgia , Humanos , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
11.
Interact Cardiovasc Thorac Surg ; 29(3): 491-492, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31006020

RESUMO

Para-aortic malignant lymphoma invading the thoracic aorta can cause aortic rupture. Thoracic endovascular aortic repair (TEVAR) is a good option to treat aortic rupture associated with para-aortic malignancies. It is essential to detect the exact tumour location during TEVAR; however, it is often difficult to confirm the location with conventional 2-dimensional fluoroscopic or angiographic images. We describe successful TEVAR using syngo DynaCT (Siemens AG, Forchheim, Germany) in a 64-year-old man with para-aortic malignant lymphoma invading the descending aorta.


Assuntos
Aorta Torácica/cirurgia , Procedimentos Endovasculares/métodos , Linfoma/cirurgia , Cirurgia Assistida por Computador/métodos , Neoplasias Torácicas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Aorta Torácica/diagnóstico por imagem , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/cirurgia , Humanos , Linfoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Torácicas/diagnóstico
12.
Graefes Arch Clin Exp Ophthalmol ; 257(5): 1029-1036, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30868235

RESUMO

PURPOSE: To determine the factors that may affect the accuracy of vitrectomy cell block technique in detecting atypical lymphoid cells in patients with vitreoretinal lymphoma (VRL). METHODS: We retrospectively reviewed 43 eyes in 39 patients who underwent vitrectomy for definitive histological diagnosis of VRL with vitrectomy cell block technique and/or smear preparation at Kyushu University Hospital from January 2001 to March 2016. The association of detection of atypical lymphoid cells using vitrectomy cell block technique with the following factors was assessed using logistic regression analysis: age at diagnosis, sex, presence or absence of concurrent cataract surgery with vitrectomy, clinical grading of vitreous haze, presence or absence of subretinal tumor infiltration, interval between initial symptoms and vitrectomy, and presence or absence of systemic corticosteroid therapy before vitrectomy. RESULTS: Atypical lymphoid cells were more significantly detected using vitrectomy cell block technique compared to that using smear preparation (p = 0.018). After adjusting for age and sex, concurrent cataract surgery (odds ratio [OR], 10.41; 95% confidence interval [CI], 1.42-76.41) and subretinal tumor infiltration (OR, 5.06; 95% CI, 1.06-24.32) were significantly associated with failure of histological analysis with vitrectomy cell blocks. In multivariable logistic regression analysis, similar results were obtained, although subretinal tumor infiltration was only marginally associated with the detective capability of the technique. CONCLUSION: Vitrectomy cell block technique significantly improved the definitive diagnosis of VRL. Concurrent cataract surgery with vitrectomy and subretinal tumor infiltration were risk factors for failure in vitrectomy cell blocks.


Assuntos
Linfoma Intraocular/cirurgia , Linfoma/cirurgia , Neoplasias da Retina/cirurgia , Vitrectomia/efeitos adversos , Corpo Vítreo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Linfoma Intraocular/diagnóstico , Linfoma/diagnóstico , Masculino , Pessoa de Meia-Idade , Neoplasias da Retina/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Falha de Tratamento , Corpo Vítreo/patologia
13.
Gan To Kagaku Ryoho ; 46(3): 521-522, 2019 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-30914601

RESUMO

The patient, a woman in her 70s, was diagnosed with occlusive ileus caused by sigmoid colon cancer.She underwent transanal stent placement to release the occlusion.Subsequent detailed testing revealed a 70×60mm mass on the dorsal side of the pancreas and PET-CT indicated an SUVmax 18.2 FDG uptake. EUS-FNA was performed twice.However, the mass was unable to be definitively diagnosed.The patient was then referred to our hospital.She underwent laparoscopic sigmoid colectomy and laparoscopic biopsy of the mass for sigmoid colon cancer.The patient progressed well postoperatively and was discharged home on postoperative day 9.The postoperative diagnosis was colon cancer(S, Type 2, 58×50 mm, tub2, pT4a [SE], pN1, Stage Ⅲa)and the biopsied mass was found to be a nodal marginal zone B-cell lymphoma according to histopathological testing.After undergoing chemotherapy at our hematology department, she has experienced no recurrence.


Assuntos
Colectomia , Laparoscopia , Linfoma , Adulto , Biópsia , Feminino , Humanos , Linfoma/diagnóstico , Linfoma/cirurgia , Recidiva Local de Neoplasia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
14.
World Neurosurg ; 126: e1436-e1448, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30904794

RESUMO

BACKGROUND: Primary central nervous system lymphomas (PCNSLs) account for 1%-2% of primary central nervous system tumors. Until recently, treatment has centered on biopsy, radiotherapy, and high-dose methotrexate, without a clear role for cytoreductive surgery. The objective of this article is to compare the impact of biopsy versus cytoreductive surgery in outcomes of patients with PCNSL, including postoperative complications and survival. METHODS: We performed a systematic review of literature published from January 1, 1968 to May 2, 2018 related to PCNSL treatment in patients undergoing biopsy or resection. Data on morbidity, progression-free survival, and overall survival were extracted and analyzed. RESULTS: A total of 1291 nonduplicate citations were identified, with 244 articles selected for full-text review. Twenty-four articles were included for data abstraction including 2 level IIb studies, 4 level IIIb studies, and the remaining 18 articles representing level IVb studies. Of these articles, 15 failed to show benefit with cytoreductive surgery; most of these articles included relatively small sample sizes and predated standardization of high-dose systemic methotrexate treatment. Larger, more recent series included 9 articles providing evidence in support of cytoreductive surgery. Patient age, functional status, and treatment with chemotherapy and/or radiation were associated with improved survival across studies. CONCLUSIONS: The treatment of PCNSL is challenging and ever-evolving. Earlier, smaller studies failed to show the benefit of cytoreductive surgery over biopsy in patients with PCNSL. Larger, more recent series seem to show the possible benefit of cytoreductive surgery in PCNSL. Future well-designed prospective studies may help further elucidate the role of resection in the modern treatment of PCNSL.


Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Linfoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Biópsia , Neoplasias do Sistema Nervoso Central/tratamento farmacológico , Humanos , Linfoma/tratamento farmacológico , Intervalo Livre de Progressão , Análise de Sobrevida , Resultado do Tratamento
15.
Vet Med Sci ; 5(3): 307-316, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30859750

RESUMO

With the exception of intestinal lymphoma, surgery is the most commonly recommended treatment for solitary feline intestinal tumours. However, there is a lack of evidence to substantiate resection margin recommendations for these tumours. The aim of this study was to add knowledge concerning resection margins for discrete intestinal masses in cats. Thirty confirmed feline intestinal tumours removed at veterinary centres across the UK from March 2017 to March 2018 underwent histological assessment at the palpable edge of the intestinal tumour and then at every 1 cm increment to the surgeon-cut tissue border in oral, aboral and mesenteric directions. Histological margin recommendations were developed for carcinoma and lymphoma tumour types and non-lymphoma intestinal tumours collectively. Seventeen intestinal lymphomas, nine carcinomas, two sarcomas and two mast cell tumours were evaluated in this study. Seven of the nine intestinal carcinomas would have been completely removed with histological margins of 4 cm in oral and aboral directions. Both sarcomas and one mast cell tumour would have been removed in their entirety with 4 cm histological margins in oral and aboral directions. There was extensive and varied microscopic invasion of intestinal tissue away from discrete intestinal lymphomas in the majority of the cases in this study. There is increasing evidence in veterinary as well as human literature supporting the role of surgical resection in the treatment of discrete intestinal lymphoma. If surgery is to be considered this study supports the removal of the gross tumour only. A histological margin of 4 cm should be considered, where possible, for intestinal masses other than lymphomas.


Assuntos
Doenças do Gato/cirurgia , Neoplasias Intestinais/veterinária , Linfoma/cirurgia , Margens de Excisão , Neoplasias de Tecidos Moles/veterinária , Animais , Doenças do Gato/patologia , Gatos , Feminino , Neoplasias Intestinais/patologia , Neoplasias Intestinais/cirurgia , Irlanda , Linfoma/patologia , Masculino , Estudos Prospectivos , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia , Reino Unido
16.
Ann Thorac Surg ; 108(1): 244-248, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30904404

RESUMO

BACKGROUND: Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNAs) are well established for staging lung cancer. A growing number of publications report on lymphoma diagnosis via EBUS-TBNA-acquired cytology; however current guidelines recommend histologic diagnosis. Research on the value of EBUS-TBNA-acquired cytology versus surgical-acquired histology in the diagnosis of lymphoma is lacking. METHODS: We conducted a retrospective review of patients with mediastinal lymphoma diagnosed between 2010 and 2016. Mediastinal lymphadenopathy was accessible through both EBUS-TBNAs and surgical procedures. All data were extracted from our clinic's medical database and analyzed. RESULTS: Fifty-one patients newly diagnosed with lymphoma in the mediastinum were identified (median age, 43.5 years; mean age, 48.6 ± 20.6 years). A minimally invasive procedure was performed as a first diagnostic step in 29 patients, whereas surgical biopsy was performed in the remaining 22. The time to final diagnosis was significantly longer if a minimally invasive procedure was performed first compared with a surgical procedure (mean, 44 days [median, 38 days] vs 16 days [median, 8 days]; p < 0.030). The number of procedures to obtain a final diagnosis ranged from one to five (median, 2 procedures per patient) in the EBUS-TBNA group. This was significantly higher than that in the surgical group (median, 1 procedure per patient; p < 0.00005). CONCLUSIONS: We demonstrate that surgical biopsies are safe and well tolerated for lymphoproliferative disease diagnosis and lead to a final diagnosis in the shortest possible time. Unnecessary procedures were significantly reduced if a surgical biopsy was performed as the first step.


Assuntos
Biópsia/métodos , Técnicas Histológicas , Linfoma/patologia , Neoplasias do Mediastino/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Feminino , Humanos , Linfoma/cirurgia , Masculino , Neoplasias do Mediastino/cirurgia , Pessoa de Meia-Idade , Estudos Retrospectivos , Cirurgia Torácica Vídeoassistida , Adulto Jovem
17.
Am J Surg ; 217(1): 78-82, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29880389

RESUMO

BACKGROUND: The purpose of this study was to describe the diagnostic value and therapeutic benefit of diagnostic splenectomy. METHODS: Retrospective review was performed of patients undergoing splenectomy with an unknown diagnosis (UD), a hematologic malignancy (HM) or idiopathic thrombocytopenic purpura. Surgical indications and postoperative outcomes were evaluated. RESULTS: 113 splenectomy patients were identified. Of the UD patients undergoing splenectomy, 46% (n = 16) received a definitive diagnosis postoperatively. A change in diagnosis occurred in 12% (n = 4) of HM patients. Complete symptom relief was observed more often in UD patients who received a definitive diagnosis after splenectomy 69% (n = 11), compared to the 47% (n = 9) who did not receive definitive diagnosis postoperatively. CONCLUSIONS: The diagnostic ability of splenectomy was 46% when the diagnosis was unknown preoperatively. Additionally, a majority of patients experienced relief of symptoms postoperatively. Splenectomy may be a useful diagnostic and therapeutic tool in select UD and HM patients.


Assuntos
Técnicas de Diagnóstico por Cirurgia , Neoplasias Hematológicas/diagnóstico , Linfoma/diagnóstico , Púrpura Trombocitopênica Idiopática/diagnóstico , Esplenectomia , Feminino , Neoplasias Hematológicas/etiologia , Neoplasias Hematológicas/cirurgia , Humanos , Linfoma/complicações , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Púrpura Trombocitopênica Idiopática/etiologia , Púrpura Trombocitopênica Idiopática/cirurgia , Estudos Retrospectivos , Esplenomegalia , Avaliação de Sintomas
18.
J Gastroenterol Hepatol ; 34(4): 693-699, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30151937

RESUMO

BACKGROUND AND AIM: The predictors of severe gastrointestinal (GI) events in GI lymphoma patients are unclear. We aimed to develop a risk scoring system for GI events requiring surgery. METHODS: In this retrospective study of 192 patients with GI lymphoma, the state of lymphoma, macroscopic findings, examination results, and International Prognostic Index were assessed. We developed a risk score for GI events that required surgery and assessed its accuracy by calculating the area under the receiver operating characteristic curve (AUC). Internal validation was performed using bootstrap resampling. RESULTS: Severe GI events occurred in 21 (11%) patients. We developed a 4-point scoring system (the FLASH score) comprising the following three independent predictors (weighted by regression coefficients): (i) focal appearance and large size (≥ 40 mm), 1 point; (ii) aggressive lymphoma of the small bowel, 2 points; and (iii) high (18)F-fluorodeoxyglucose positron emission tomography uptake, 1 point. The score predicted severe GI events with an AUC value of 0.91 (internal validation; AUC, 0.86). Risk was classified into three categories: the GI event rate was 0% in the low-risk group (0 points), 9% in the intermediate-risk group (1-2 points), and 61% in the high-risk group (3-4 points) (AUC, 0.89). CONCLUSIONS: We developed and internally validated a risk scoring system (the FLASH score) that included macroscopic findings to predict severe GI events in GI lymphoma patients. Patients with high scores are candidates for elective surgery to prevent GI events.


Assuntos
Neoplasias Gastrointestinais/cirurgia , Linfoma/cirurgia , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos , Feminino , Previsões , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/patologia , Humanos , Complicações Intraoperatórias/prevenção & controle , Linfoma/diagnóstico por imagem , Linfoma/patologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Curva ROC , Estudos Retrospectivos , Risco , Índice de Gravidade de Doença , Adulto Jovem
19.
Eur J Surg Oncol ; 45(2): 279-283, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30224248

RESUMO

BACKGROUND: Perforation is the most common surgical complication in pediatric intestinal lymphoma. During operation, many surgical decisions are debatable. AIM: To assess the outcome of surgical management of perforated pediatric intestinal lymphoma. PATIENTS AND METHODS: This is a retrospective analysis of all pediatric patients (<18 years old) with intestinal lymphoma treated in our hospital between July 2007 and June 2017. Risk factors for perforation, type of management and outcome in cases of intestinal perforation were analyzed. RESULTS: The study included 240 patients with intestinal lymphoma. Perforation developed in 16 patients (6.7%) with a median age of 5.3 (range: 2.8-15.7) years. Most of the patients (92.5%) had Burkitt lymphoma. The ileum was the most common site of perforation (n = 10). Perforation occurred at presentation (n = 2), during induction (n = 10), during maintenance chemotherapy (n = 2), or at relapse (n = 2). Primary resection anastomosis was done in 12 patients. The resected specimen showed a viable tumor in ten patients. Wound infection (25%) and dehiscence (12.5%) were the most common postoperative complications. The 5-year overall and event-free survivals of patients with perforation were 78.6% and 71.4%, respectively, compared with 85.5% and 81.2% in non-perforated patients; the difference was not significant (p = 0.374 and p = 0.270, respectively). CONCLUSION: Perforation is not an adverse prognostic factor for survival in pediatric intestinal lymphoma patients. Primary resection anastomosis seems to be a safe option if complete tumor resection is feasible.


Assuntos
Doença Iatrogênica , Neoplasias Intestinais/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Linfoma/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
20.
Ann Vasc Surg ; 54: 72-83, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30267915

RESUMO

BACKGROUND: Safe resection of intraabdominal and retroperitoneal malignancies with a goal of negative margins may require vascular surgical assistance with grafting of the aorta and/or vena cava. The current report reviews malignancies associated with major vascular reconstructions at a single tertiary referral center. METHODS: Adults with abdominal or retroperitoneal tumors involving the aorta, vena cava, or iliac arteries that underwent reconstruction with vascular grafts at the University of Michigan from 2010 to 2016 were reviewed retrospectively. The initial presentation, surgical management, and outcomes were analyzed. RESULTS: Twelve patients with tumors involving the abdominal aorta, vena cava, or iliac arteries underwent major vascular reconstruction in this seven-year study period. Tumor pathology included solid tumors (leiomyosarcoma [n = 7], germ cell tumor [n = 3], and intravascular lymphoma [n = 2]). Surgical treatment included grafting of the vena cava (n = 6), aorta (n = 3), iliac artery (n = 4), or both the aorta and vena cava (n = 1). Patients with intravascular lymphoma were identified incidentally during treatment of abdominal aortic aneurysm or on pathological analysis of thromboembolism from an aortic source. Other patients had planned resection. Follow-up ranged from 9 to 86 months (median: 28.9). There were no graft occlusions. Tumor metastasized or recurred in patients with sarcoma (n = 2; 28.6%), germ cell tumor (n = 1; 33.3%), and intravascular lymphoma (n = 2; 100%). Both patients with lymphoma had multiple anastomotic or tumor-embolic pseudoaneurysms for <14 months after vascular reconstruction. Both lymphoma patients died during follow-up. CONCLUSIONS: This single-center review suggests that sarcoma and germ cell tumors may be safely resected in conjunction with major vascular reconstruction in carefully selected patients. In comparison, intravascular lymphoma identified incidentally at the time of aortic reconstruction resulted in a more malignant course with pseudoaneurysm formation of anastomoses or native vessels, cancer recurrence, and 100% mortality. Aneurysm contents and emboli should be carefully reviewed perioperatively by pathologists.


Assuntos
Neoplasias Abdominais/cirurgia , Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Procedimentos Endovasculares , Artéria Ilíaca/cirurgia , Leiomiossarcoma/cirurgia , Linfoma/cirurgia , Neoplasias Embrionárias de Células Germinativas/cirurgia , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/cirurgia , Neoplasias Abdominais/diagnóstico por imagem , Neoplasias Abdominais/mortalidade , Neoplasias Abdominais/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Angiografia por Tomografia Computadorizada , Procedimentos Endovasculares/efeitos adversos , Procedimentos Endovasculares/mortalidade , Feminino , Humanos , Artéria Ilíaca/diagnóstico por imagem , Artéria Ilíaca/patologia , Achados Incidentais , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/mortalidade , Leiomiossarcoma/patologia , Linfoma/diagnóstico por imagem , Linfoma/mortalidade , Linfoma/patologia , Masculino , Michigan , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/mortalidade , Neoplasias Embrionárias de Células Germinativas/patologia , Fenótipo , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/mortalidade , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia de Intervenção , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia
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