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2.
Surg Clin North Am ; 100(3): 565-580, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402301

RESUMO

Solid tumors of the pancreas encompass a variety of diagnoses with treatments ranging from observation to major abdominal surgery. Pancreatic ductal adenocarcinoma remains one of the most common and most lethal of these differential of diagnoses and requires a multimodality approach through a multidisciplinary team of specialists. This article reviews the classification, clinical presentation, and workup in differentiating solid tumors of the pancreas and serves as an additional tool for general surgeons faced with such a clinical finding, from a surgical oncology perspective.


Assuntos
Carcinoma Ductal Pancreático/cirurgia , Linfoma/cirurgia , Tumores Neuroendócrinos/cirurgia , Neoplasias Pancreáticas/cirurgia , Carcinoma Ductal Pancreático/diagnóstico , Carcinoma Ductal Pancreático/mortalidade , Carcinoma Ductal Pancreático/patologia , Colangiopancreatografia Retrógrada Endoscópica , Diagnóstico Diferencial , Detecção Precoce de Câncer , Endossonografia , Humanos , Linfoma/diagnóstico , Linfoma/patologia , Imagem por Ressonância Magnética , Estadiamento de Neoplasias , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Pancreatectomia/métodos , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Pancreatite/diagnóstico , Pancreatite/mortalidade , Pancreatite/patologia , Pancreatite/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Prognóstico , Taxa de Sobrevida , Tomografia Computadorizada por Raios X
3.
World Neurosurg ; 139: e508-e516, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32311566

RESUMO

BACKGROUND: Intracranial primary central nervous system lymphoma (PCNSL) is a rare aggressive malignant tumor with poor prognosis. The effect of surgical resection on intracranial PCNSL is still controversial. This study investigates the efficacy and safety of surgical resection, as well as to analyze the clinical characteristics and prognostic factors of intracranial PCNSL. METHODS: The clinical materials of 89 consecutive patients with intracranial PCNSL were analyzed retrospectively. Outcome in survival was assessed by progression-free survival (PFS) and overall survival (OS). Univariate and multivariate analyses were performed for various potential prognostic factors to identify independent prognostic factors of intracranial PCNSL. RESULTS: Among the 89 patients, gross total resection (GTR) was achieved in 57 patients (64.0%), subtotal resection (STR) in 14 patients (15.8%), and biopsy in 18 patients (20.2%).The PFS and OS at 2 years were estimated at 32.3% and 74.1%, respectively. The median PFS was 20 months (95% confidence interval, 16-23) and the median OS was 32 months (95% confidence interval, 25-38). Patients with surgical resection (GTR and STR) had better PFS than those with biopsy, and the difference of PFS was statistically significant (P = 0.007). However, the difference of OS was not statistically significant (P = 0.062). Multivariate analysis showed that invasion of deep structure was the only independent risk factor for intracranial PCNSL. Eleven patients (12.4%) had surgical complications, mainly including limb weakness and visual field defect. CONCLUSIONS: For intracranial PCNSL, surgical excision can improve PFS but not OS. Invasion of deep structure was the only independent risk factor for intracranial PCNSL.


Assuntos
Neoplasias do Sistema Nervoso Central/cirurgia , Linfoma/cirurgia , Procedimentos Neurocirúrgicos/métodos , Adolescente , Adulto , Idoso , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Quimiorradioterapia , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Avaliação de Estado de Karnofsky , Linfoma/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/efeitos adversos , Segurança do Paciente , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
4.
J Clin Neurosci ; 72: 287-291, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31648968

RESUMO

PURPOSE: High dose corticosteroids are an effective tool for rapidly alleviating neurologic symptoms caused by intracranial mass lesions. However, there is concern that preoperative corticosteroids limit the ability to obtain a definitive pathologic diagnosis, particularly if imaging features suggest primary central nervous system lymphoma (PCNSL). METHODS: To explore the impact of preoperative corticosteroids in newly diagnosed PCNSL patients, from 2009 to 2018 treated at our institution. RESULTS: We identified 54 patients; 18 had received corticosteroids prior to biopsy or resection. Only in one case did the patient have a prior non-diagnostic biopsy, requiring a second procedure. The cumulative doses of preoperative dexamethasone ranged from 4 mg to 120 mg (mean 32 mg, median 24 mg), given over 1-14 days (mean 2 days, median 1 day), and the majority had received corticosteroids for only 1-2 days. There was a trend for a larger diameter of lesional T1 contrast enhancement for patients who received steroids (39 mm vs. 34 mm, p = 0.11). In this series of cases with pathologically and clinically proven PCNSL, preoperative corticosteroids had been given in a third of cases, suggesting that they may be given for symptomatic relief without compromising pathologic diagnosis. CONCLUSIONS: Despite the commonly held tenet that preoperative corticosteroids can obscure the pathologic diagnosis in PCNSL, this is likely not the case in the majority of patients who receive a short course preoperatively. Obtaining a second stereotactic scan to confirm continued presence of the lesion prior to tissue sampling may also mitigate these concerns.


Assuntos
Corticosteroides/efeitos adversos , Neoplasias do Sistema Nervoso Central/diagnóstico , Erros de Diagnóstico , Linfoma/diagnóstico , Corticosteroides/administração & dosagem , Idoso , Biópsia , Neoplasias do Sistema Nervoso Central/cirurgia , Feminino , Humanos , Linfoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório
5.
Pract Radiat Oncol ; 10(2): 104-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31783172

RESUMO

PURPOSE: (1) Demonstrate feasibility of electrocardiogram-gated computed tomography with coronary angiography (E-CTA) in treatment planning for mediastinal lymphoma and (2) assess whether inclusion of cardiac substructures in the radiation plan optimization (CSS optimization) results in increased cardiac substructure sparing. METHODS AND MATERIALS: Patients with mediastinal lymphomas requiring radiation therapy were prospectively enrolled in an observational study. Patients completed a treatment planning computed tomography scan and E-CTA in the deep inspiration breath hold position. Avoidance structures (eg, coronary arteries and cardiac valves) were created in systole and diastole and then merged into a single planning organ-at-risk volume based on a cardiac substructure contouring atlas. In the photon cohort, 2 volumetric modulated arc therapy plans were created per patient with and without CSS optimization. Dosimetric endpoints were compared. RESULTS: In the photon cohort, 7 patients were enrolled. For all 7 patients, the treating physician elected to use the CSS optimization plan. At the individual level, 2 patients had reductions of 10.8% and 16.2% of the right coronary artery receiving at least 15 Gy, and 1 had a reduction of 9.6% of the left anterior descending artery receiving 30 Gy. No other differences for coronary arteries were detected between 15 and 30 Gy. Conversely, 5 of 7 patients had >10% reductions in dose between 15 to 30 Gy to at least 1 cardiac valve. The greatest reduction was 22.8% of the aortic valve receiving at least 30 Gy for 1 patient. At the cohort level, the maximum, mean, and 5-Gy increment analyses were nominally similar between planning techniques for all cardiac substructures and the lungs. CONCLUSIONS: Cardiac substructure delineation using E-CTA was feasible, and inclusion in optimization led to modest improvements in sparing of radiosensitive cardiac substructures for some patients.


Assuntos
Angiografia Coronária/métodos , Eletrocardiografia/métodos , Coração/fisiopatologia , Linfoma/diagnóstico por imagem , Linfoma/cirurgia , Neoplasias do Mediastino/diagnóstico por imagem , Neoplasias do Mediastino/cirurgia , Adolescente , Adulto , Feminino , Humanos , Linfoma/radioterapia , Masculino , Neoplasias do Mediastino/radioterapia , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
6.
World Neurosurg ; 134: e761-e770, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31712116

RESUMO

OBJECTIVE: To demonstrate the use of 3-dimensional (3D)-printed intracranial lesion models for complex neurosurgery to increase the success rate of clinical surgeries via practice in simulated surgeries. METHODS: We collected computed tomographic, magnetic resonance (MR), and computed tomographic images from patients with intracranial tumor or aneurysm, conducted multimodal image reconstruction, and then constructed a 3D-printed model with the skull base, cerebral arteries, and brain tumor or aneurysm. Forty-nine simulated surgeries were carried out on the model under a microscope, and actual surgery was carried out after validation and accumulation of experience. RESULTS: The 3D-printed brain tumor models were used to design the surgical route, to simulate piecemeal resection of tumors through keyhole approach, and to verify the extent of tumor resection. A drill was used for bone flap removal and milling of bony structures such as the anterior clinoid process, tuberculum sellae, petrous apex, and internal acoustic meatus. The tumors were removed by laser knife and cavitron ultrasonic aspiration. The 3D-printed aneurysm models were used to assess the feasibility of different keyhole approaches and to select the aneurysm clip. Actual surgery was based on the results of the simulated surgery. Postoperative MR image review showed that 84% (21/25) of patients had total tumor resection and 16% (4/25) subtotal resection. Digital subtraction angiography confirmed complete clipping of all aneurysms (24 cases/39 aneurysms). CONCLUSIONS: 3D-printed craniocerebral models provide effective simulated surgery conditions for keyhole surgeries of complex brain tumors or aneurysms and aid in preoperative surgical design, accumulation of surgical experience, and validation of surgical outcomes.


Assuntos
Neoplasias Encefálicas/cirurgia , Aneurisma Intracraniano/cirurgia , Procedimentos Neurocirúrgicos/métodos , Modelagem Computacional Específica para o Paciente , Impressão Tridimensional , Idoso , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Neoplasias do Tronco Encefálico/diagnóstico por imagem , Neoplasias do Tronco Encefálico/cirurgia , Angiografia por Tomografia Computadorizada , Ependimoma/diagnóstico por imagem , Ependimoma/cirurgia , Feminino , Glioma/diagnóstico por imagem , Glioma/cirurgia , Hemangioblastoma/diagnóstico por imagem , Hemangioblastoma/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Aneurisma Intracraniano/diagnóstico por imagem , Terapia a Laser , Linfoma/diagnóstico por imagem , Linfoma/cirurgia , Imagem por Ressonância Magnética , Masculino , Neoplasias Meníngeas/diagnóstico por imagem , Neoplasias Meníngeas/cirurgia , Meningioma/diagnóstico por imagem , Meningioma/cirurgia , Pessoa de Meia-Idade , Plasmocitoma/diagnóstico por imagem , Plasmocitoma/cirurgia , Tomografia Computadorizada por Raios X
7.
Int Orthop ; 44(1): 187-193, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31485681

RESUMO

BACKGROUND: Treatment goals for pathologic fractures about the knee include pain relief and unrestricted weight bearing. In cases of condylar destruction, these fractures may not be amenable to internal fixation, and arthroplasty may be considered. The purpose of this study was to analyze the outcomes of knee arthroplasty for primary treatment of impending or pathologic fractures of the distal femur or proximal tibia. METHODS: Fifteen (8 males and 7 females) patients, mean age 62 ± nine years, undergoing arthroplasty for management of a pathologic peri-articular distal femur (n = 11) or proximal tibia (n = 4) fracture between 2001 and 2017 were reviewed. Implants included tumour endoprostheses (n = 11) and rotating hinged total knees (n = 4). Pathology included metastatic disease (n = 14) and lymphoma (n = 1). Eight (53%) patients presented with a fracture while the remainder had large impending lesions. RESULTS: Mean follow-up was 19 months. At final follow-up, 11 patients had died with overall five year survival of 33%. Two (13%) patients required re-operation; including wound irrigation and debridement (n = 1) and above knee amputation for local recurrence (n = 1). An additional two (13%) patients developed post-operative VTE. MSTS, KSS, and KSS-F scores improved from a mean 12 ± 16%, 30 ± 11, and 14 ± 24 pre-operatively to 69 ± 26%, 75 ± 16, and 67 ± 25 at final follow-up, respectively (P < 0.001). Thirteen (87%) patients had severe pain prior to surgery with no patients (0%, P < 0.001) reporting severe pain at last follow-up. CONCLUSION: Knee arthroplasty provided improved function and full weight-bearing making it an effective treatment for pathologic periarticular fractures of the distal femur and proximal tibia.


Assuntos
Artroplastia do Joelho , Fraturas do Fêmur/cirurgia , Fraturas Espontâneas/cirurgia , Fraturas Intra-Articulares/cirurgia , Articulação do Joelho/cirurgia , Fraturas da Tíbia/cirurgia , Idoso , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Feminino , Fêmur/lesões , Fêmur/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Prótese do Joelho , Linfoma/complicações , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Reoperação , Tíbia/lesões , Tíbia/cirurgia , Resultado do Tratamento , Suporte de Carga
8.
Asian J Surg ; 43(6): 690-695, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31668417

RESUMO

BACKGROUND: The purpose of the study was to discuss the effectiveness of mediastinoscopy for pediatric patients as the use of EBUS-EUS (Endobronchial Ultrasound-Endoscopic Ultrasound) has replaced mediastinoscopy for adult patients in evaluation of the mediastinal area. METHODS: The records of patients subject to cervical and anterior mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019 were examined and patients aged 18 years or less were included in the study. Data were acquired on the demographic characteristics of the patients, type of surgery, complications, operation times, and histopathologic diagnoses. RESULTS: Of the 1505 patients subject to intervention by mediastinoscopy at our clinic from January 1, 2000 to June 1, 2019, only 22 (1.46%) were pediatric patients aged 18 years or less. Cervical and anterior mediastinoscopies were performed on 16 and six patients, respectively. Histopathological tissue diagnoses via mediastinoscopy were obtained for 19 (86.3%) of 22 patients. The most frequently observed diagnoses were sarcoidosis (n = 10), lymphoma (n = 4), thymoma (n = 1), tuberculosis (n = 1), undifferentiated round cell sarcoma (n = 1), and reactive lymph node (n = 2); three patients could not be diagnosed. Mortality was not detected. There were no major complications requiring thoracotomy or sternotomy and none of the patients were subject to tube thoracostomy as a result of surgery. CONCLUSION: Pediatric age mediastinoscopy may be the first method of diagnosis due to low complication rates and high diagnosis rates in mediastinal area.


Assuntos
Linfoma/diagnóstico , Mediastinoscopia/métodos , Pediatria , Pseudolinfoma/diagnóstico , Sarcoidose/diagnóstico , Sarcoma/diagnóstico , Timoma/diagnóstico , Tuberculose/diagnóstico , Adolescente , Fatores Etários , Broncoscopia , Criança , Pré-Escolar , Endossonografia , Feminino , Humanos , Linfoma/patologia , Linfoma/cirurgia , Masculino , Pseudolinfoma/patologia , Pseudolinfoma/cirurgia , Sarcoidose/patologia , Sarcoidose/cirurgia , Sarcoma/patologia , Sarcoma/cirurgia , Timoma/patologia , Timoma/cirurgia , Tuberculose/patologia , Tuberculose/cirurgia
9.
Orbit ; 39(1): 68-70, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31020884

RESUMO

Amyloidosis and lymphoma localized to the ocular adnexa are rare, and their presentation may resemble more common inflammatory conditions such as autoimmune disease or infection, which can protract diagnostic evaluation and delay eventual therapy. In a patient with recalcitrant facial and tooth pain and ophthalmoplegia, evaluation should include careful histopathologic analysis of biopsy specimens. We report a case of orbital AL amyloidosis associated with localized lymphoma that presented with intractable dental pain and progressed to bilateral complete ophthalmoplegia.


Assuntos
Amiloidose de Cadeia Leve de Imunoglobulina/patologia , Linfoma/patologia , Linfoma/cirurgia , Doenças Orbitárias/patologia , Doenças Orbitárias/cirurgia , Biópsia por Agulha , Blefaroptose/diagnóstico , Blefaroptose/etiologia , Diplopia/diagnóstico , Diplopia/etiologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Amiloidose de Cadeia Leve de Imunoglobulina/diagnóstico por imagem , Amiloidose de Cadeia Leve de Imunoglobulina/cirurgia , Imuno-Histoquímica , Linfoma/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Pessoa de Meia-Idade , Oftalmoplegia/diagnóstico , Oftalmoplegia/etiologia , Doenças Orbitárias/diagnóstico por imagem , Doenças Raras , Medição de Risco , Odontalgia/diagnóstico , Odontalgia/etiologia , Resultado do Tratamento
10.
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
11.
World J Surg Oncol ; 17(1): 166, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590673

RESUMO

BACKGROUND: The coexistence of hematological malignancy with endometrial cancer is a rare phenomenon. We report a case of coexistence of endometrial cancer with follicular lymphoma which we suspected preoperatively and diagnosed during surgery by a multidisciplinary intraoperative assessment. CASE PRESENTATION: A 67-year-old woman was referred to our hospital due to a suspicion of an endometrial cancer. Endometrial biopsy revealed grade 1 endometrioid adenocarcinoma. MRI showed invasion of the tumor into the outer half of the myometrium, and abdominal CT showed para-aortic and atypical mesentery lymphadenopathy which was suspected to be metastasis of endometrial cancer or malignant lymphoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, and mesentery lymph node biopsy for endometrial cancer were performed. The mesentery and para-aortic lymph nodes that were sent for frozen section analysis showed no metastasis of the endometrial cancer. We simultaneously conducted an unusual intraoperative emergent four-color flow cytometry and intraoperatively diagnosed a B cell lymphoma in the mesenteric lymph nodes. Because this multidisciplinary assessment, we were able to avoid an unnecessary intestinal resection. The final pathological diagnosis was an endometrioid carcinoma (G1, FIGO stage IA), with a synchronous follicular lymphoma. CONCLUSION: Although a rare event in endometrial cancer surgery, it is necessary to be alert to the possibility of a synchronous lymphoma in cases of unusual site adenopathy.


Assuntos
Neoplasias do Endométrio/diagnóstico , Cuidados Intraoperatórios , Linfoma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adenocarcinoma , Idoso , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfoma/complicações , Linfoma/cirurgia , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/cirurgia , Prognóstico
12.
Cancer Cell ; 36(3): 250-267.e9, 2019 09 16.
Artigo em Inglês | MEDLINE | ID: mdl-31526758

RESUMO

How lymphoma cells (LCs) invade the brain during the development of central nervous system lymphoma (CNSL) is unclear. We found that NF-κB-induced gliosis promotes CNSL in immunocompetent mice. Gliosis elevated cell-adhesion molecules, which increased LCs in the brain but was insufficient to induce CNSL. Astrocyte-derived CCL19 was required for gliosis-induced CNSL. Deleting CCL19 in mice or CCR7 from LCs abrogated CNSL development. Two-photon microscopy revealed LCs transiently entering normal brain parenchyma. Astrocytic CCL19 enhanced parenchymal CNS retention of LCs, thereby promoting CNSL formation. Aged, gliotic wild-type mice were more susceptible to forming CNSL than young wild-type mice, and astrocytic CCL19 was observed in both human gliosis and CNSL. Therefore, CCL19-CCR7 interactions may underlie an increased age-related risk for CNSL.


Assuntos
Envelhecimento/patologia , Neoplasias do Sistema Nervoso Central/patologia , Quimiocina CCL19/metabolismo , Gliose/patologia , Linfoma/patologia , Adolescente , Adulto , Idoso , Animais , Astrócitos/metabolismo , Astrócitos/patologia , Barreira Hematoencefálica/citologia , Barreira Hematoencefálica/diagnóstico por imagem , Barreira Hematoencefálica/patologia , Linhagem Celular Tumoral/transplante , Neoplasias do Sistema Nervoso Central/diagnóstico por imagem , Neoplasias do Sistema Nervoso Central/cirurgia , Quimiocina CCL19/genética , Quimiocina CXCL12 , Modelos Animais de Doenças , Feminino , Gliose/diagnóstico por imagem , Humanos , Microscopia Intravital , Linfoma/diagnóstico por imagem , Linfoma/cirurgia , Masculino , Camundongos , Camundongos Transgênicos , Microscopia de Fluorescência por Excitação Multifotônica , Pessoa de Meia-Idade , NF-kappa B/metabolismo , Receptores CCR7/genética , Receptores CCR7/metabolismo , Imagem com Lapso de Tempo , Adulto Jovem
13.
Am J Cardiol ; 124(8): 1190-1197, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31395298

RESUMO

Characteristics and outcomes of patients with lymphoma undergoing percutaneous coronary intervention (PCI) are unknown. Therefore, we analyzed clinical characteristics and outcomes in patients that underwent PCI and had a concomitant diagnosis of Hodgkin's (HL) or non-Hodgkin's (NHL) lymphoma. We analyzed patients with and without lymphoma diagnosis from the Nationwide Inpatient Sample in the United States who underwent PCI procedure during 2004 to 2014. Multivariable regression analysis was performed to examine the association between lymphoma diagnosis and clinical outcomes post-PCI including short-term complications and in-hospital mortality. A total of 7,119,539 PCI procedures were included in the analysis and 18,052 patients had a diagnosis of lymphoma (0.25%). These patients were likely to experience in-hospital mortality (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.25 to 1.54), stroke or transient ischemic attack (OR 1.75, 95% CI 1.61 to 1.90), and any in-hospital complication (OR 1.31, 95% CI 1.25 to 1.37), following PCI. In the lymphoma subtype-analysis, diagnosis of HL was associated with an increased odds of in-hospital death (OR 1.40, 95% CI 1.24 to 1.56), any in-hospital complication (OR 1.31, 95% CI 1.25 to 1.38), bleeding complications (OR 1.12 95% CI 1.05 to 1.20), and vascular complications (OR 1.13 95% CI 1.06 to 1.20) whereas these odds were not significantly associated with non-Hodgkin's diagnosis. Finally, both types of lymphoma were associated with increased odds of stroke/transient ischemic attack following PCI (OR 1.82, 95% CI 1.67 to 1.99 and OR 1.31, 95% CI 1.05 to 1.63, respectively). In conclusion, while the prevalence of lymphoma in the observed PCI cohort was low, a diagnosis of lymphoma was associated with an adverse prognosis following PCI, primarily in patients with the HL diagnosis.


Assuntos
Doença da Artéria Coronariana/cirurgia , Pacientes Internados/estatística & dados numéricos , Linfoma/complicações , Intervenção Coronária Percutânea/métodos , Vigilância da População/métodos , Complicações Pós-Operatórias/epidemiologia , Sistema de Registros , Idoso , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/epidemiologia , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Linfoma/epidemiologia , Linfoma/cirurgia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Estados Unidos/epidemiologia
14.
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
15.
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
16.
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
17.
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
19.
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
20.
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
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