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1.
Medicine (Baltimore) ; 99(35): e21721, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871890

RESUMO

The aim of this study was to provide an innovative nomogram to predict the risk of >2 positive nodes in patients fulfilling the Z0011 criteria with 1-2 sentinel lymph nodes (SLNs) only retrieved.From 2007 to 2017, at the Breast Unit of ICS Maugeri Hospital 271 patients with 1-2 macrometastatic SLNs, fulfilling the Z0011 criteria, underwent axillary dissection and were retrospectively reviewed.A mean of 1.5 SLNs per patient were identified and retrieved. One hundred eighty-seven (69.0%) had 1-2 positive nodes, and 84 (31.0%) had >2 metastatic nodes. Independent predictors of axillary status were: positive SLNs/retrieved SLNs ratio (odds ratio [OR] 10.95, P = .001), extranodal extension (OR 5.51, P = .0002), and multifocal disease (OR 2.9, P = .003). A nomogram based on these variables was constructed (area under curve after bootstrap = 0.74).The proposed nomogram might select those patients fulfilling the Z0011 criteria, with 1-2 SLNs harvested, in whom a high axillary tumor burden is expected, aiding to guide adjuvant treatments.


Assuntos
Neoplasias da Mama/patologia , Neoplasias Primárias Múltiplas/patologia , Nomogramas , Linfonodo Sentinela/patologia , Idoso , Antineoplásicos Hormonais/uso terapêutico , Área Sob a Curva , Axila , Neoplasias da Mama/terapia , Quimioterapia Adjuvante , Feminino , Humanos , Metástase Linfática , Mastectomia Segmentar , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Radioterapia Adjuvante , Carga Tumoral
2.
Anticancer Res ; 40(7): 4029-4032, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620648

RESUMO

The synchronous diagnosis of two or more primary malignancies in a patient is overall rare. This is a case report of a 70-year-old female with a history of skin squamous cell carcinoma presenting with occult hematochezia. Colonoscopy and biopsy results confirmed a microsatellite stable (MMS) adenocarcinoma in the ascending colon, and subsequent computed tomography (CT) scans identified a 3.2 cm right colonic mass and a 5.0 cm mass in the pancreatic body. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) confirmed the presence of pancreatic ductal adenocarcinoma (PDAC). The patient underwent neo-adjuvant FOLFIRINOX (folinic acid, fluorouracil, irinotecan and oxaliplatin) chemotherapy prior to the simultaneous distal pancreatectomy and right hemicolectomy for both pancreatic and colonic tumors. The pathology diagnoses included moderately differentiated pancreatic ductal carcinoma (PDAC) with histiocyte-like features (tumor stage: ypT3N1M0) and moderately differentiated colonic adenocarcinoma, intestinal type (tumor stage: ypT3N0M0). To the best of our knowledge, this is the first documented case of synchronous primary colonic adenocarcinoma and PDAC in the English literature.


Assuntos
Adenocarcinoma/diagnóstico , Carcinoma Ductal Pancreático/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Pancreáticas/diagnóstico , Adenocarcinoma/patologia , Idoso , Antineoplásicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/patologia , Carcinoma de Células Escamosas , Neoplasias do Colo/patologia , Feminino , Fluoruracila/uso terapêutico , Humanos , Irinotecano/uso terapêutico , Leucovorina/uso terapêutico , Neoplasias Primárias Múltiplas/patologia , Oxaliplatina/uso terapêutico , Neoplasias Pancreáticas/patologia , Neoplasias Cutâneas
3.
J Nippon Med Sch ; 87(3): 157-161, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32655092

RESUMO

Screening esophagogastroduodenoscopy of a 65-year-old man revealed a 4.7-cm polypoid in the gastric high body. Clinical and laboratory findings, including serum gastrin level (460 pg/mL) and biopsy findings, were consistent with a diagnosis of type I neuroendocrine tumor (NET). Histologically, the mass consisted of dilated tortuous glands at the surface and grade 1 NET in deeper tissue. Some hyperplastic glands exhibited a transition to adenocarcinoma, which invaded the NET, simulating a "tumor in tumor" appearance. Next-generation sequencing revealed that the adenocarcinoma component harbored a TP53 mutation, whereas the NET component showed no pathogenic mutation. To our knowledge, this unusual collision of adenocarcinoma and NET within a single gastric hyperplastic polyp has not been previously described. This case suggests that large gastric hyperplastic polyps should be carefully examined because of the possibility of underlying NET and malignant transformation of surface epithelium.


Assuntos
Adenocarcinoma/patologia , Pólipos Intestinais/patologia , Neoplasias Primárias Múltiplas/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Gástricas/patologia , Idoso , Transformação Celular Neoplásica/patologia , Humanos , Masculino
4.
Medicine (Baltimore) ; 99(27): e20941, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629697

RESUMO

RATIONALE: Tailgut cyst (TGC) is a rare congenital disease that originates from residues of the tail intestine during the embryonic period. Most TGCs are benign lesions and the malignant transition is very rare. PATIENT CONCERNS: A 50-year-old woman attended our department complaining of defecation difficulty for more than 2 months. She reported irregular defecation with a small amount of liquid stool, 3 to 4 times per day. DIAGNOSIS: Biochemical analysis showed high levels of carcinoembryonic antigen (79.89 ng/mL; normal, 0-3 ng/mL) and carbohydrate antigen 199 (57.60 U/mL; normal, 0-35 U/mL). Abdominal computer tomography and magnetic resonance imaging showed a large cystic mass with enhanced signals. Post-surgical histopathology indicated that the mass was a TGC with adenocarcinoma transition. INTERVENTIONS: The cyst was completely resected. Symptomatic treatment was further performed, and the patient recovered well. LESSONS: We reported a rare case of a large TGC with adenocarcinoma transition. CT, MRI, and histopathology are important to diagnose TGC. Complete surgical resection is the first choice to treat TGC.


Assuntos
Adenocarcinoma/diagnóstico , Cistos/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Retais/diagnóstico , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Biomarcadores Tumorais/sangue , Antígeno Carcinoembrionário/sangue , Cistos/diagnóstico por imagem , Cistos/patologia , Cistos/cirurgia , Diagnóstico Diferencial , Feminino , Proteínas Ligadas por GPI/sangue , Humanos , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Tomografia Computadorizada por Raios X
5.
Medicine (Baltimore) ; 99(29): e20865, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32702827

RESUMO

RATIONALE: Synchronous pulmonary lymphoma and carcinoma is relatively rare. And synchronous pulmonary lymphoma and adenocarcinoma in the same site is extremely rare. PATIENT CONCERNS: We presented a 69-year-old female with a tumor mass in right upper lung. DIAGNOSIS: Pathological and immunohistochemical findings revealed lung adenocarcinoma and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. INTERVENTIONS: The patient received thoracoscopic guided right upper lobectomy and focal lymph node dissection after systemic anesthesia. Besides, 6 cycles of chemotherapy were given based on meprednisone, gemcitabine and cisplatin in local hospital. OUTCOMES: In the 12-month follow-up, the patient was still alive with no local recurrence, metastasis and lymph node involvement. LESSON: A comprehensive literature research was performed, and 6 cases of synchronous pulmonary lymphoma and adenocarcinoma in the same site and 10 cases in different sites were identified since 2000. Most patients with synchronous pulmonary lymphoma and carcinoma were middle-aged and elderly with the median age was 64 years presenting a male predisposition. The most frequent type of primary pulmonary lymphoma was B-cell non Hodgkin lymphoma, especially mucosa-associated lymphoid tissue lymphoma, and the lung cancer is predominantly adenocarcinoma.


Assuntos
Adenocarcinoma/patologia , Neoplasias Pulmonares/patologia , Linfoma de Zona Marginal Tipo Células B/patologia , Neoplasias Primárias Múltiplas/patologia , Adenocarcinoma/terapia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/terapia , Excisão de Linfonodo , Linfoma de Zona Marginal Tipo Células B/terapia , Neoplasias Primárias Múltiplas/terapia , Pneumonectomia
6.
J Vasc Interv Radiol ; 31(6): 943-952, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32414570

RESUMO

PURPOSE: To assess feasibility, safety, and clinical outcome of simultaneous stereotactic radiofrequency (RF) ablation of multiple (≥ 4) primary and metastatic liver tumors. MATERIALS AND METHODS: This retrospective observational study included 92 patients (29 women, 62 men), 35 with ≥ 4 hepatocellular carcinomas (HCCs) and 57 with ≥ 4 metastatic liver tumors at initial stereotactic RF ablation between 2005 and 2018. The median size of 178 HCCs and 371 metastases was 2.2 cm (range, 1.0-8.5 cm) and 3.0 cm (range, 0.5-13 cm), respectively. At initial stereotactic RF ablation, 17 (48.6%) patients with HCC and 19 (33.3%) with metastases had 4 liver tumors, 11 (31.4%) and 19 (33.3%) had 5 tumors, and 7 (20%) and 19 (33.3%) had ≥ 6 tumors. RESULTS: Major complications occurred in 2 of 35 ablations (5.4%) in patients with HCCs and in 7 of 63 (10%) with metastases. The primary technical efficacy rate (ie, successful initial ablation) was 100% (178/178) in HCCs and 98.8% (363/371) in metastases. Local recurrence was observed in 4 of 178 (2.2%) HCCs and in 17 of 371 (4.6%) metastases. Overall survival (OS) rates at 1, 3, and 5 years from the date of the first stereotactic RF ablation were 88.0%, 54.0%, and 30.4% for patients with HCCs with a median OS of 38.2 months and 86.1%, 53.1%, and 37.3% for patients with metastases with a median OS of 37.4 months. CONCLUSIONS: Stereotactic RF ablation is a feasible, safe, and efficacious option in simultaneous management of multiple primary and metastatic liver tumors.


Assuntos
Neoplasias Hepáticas/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Ablação por Radiofrequência , Adulto , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Intervalo Livre de Doença , Estudos de Viabilidade , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/patologia , Segurança do Paciente , Ablação por Radiofrequência/efeitos adversos , Ablação por Radiofrequência/mortalidade , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Carga Tumoral
7.
J Cancer Res Ther ; 16(1): 60-65, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362610

RESUMO

Objective: The objective of this study is to review the multidetector computed tomography (MDCT) findings of synchronous lymphoma and other solid malignancies. Patients and Methods: This retrospective study included 18 patients confirmed with diagnosis of lymphoma and other solid malignancies. They were 8 women and 10 men (mean age, 62.5 year; range, 44-73 years). CT scanning was performed on one of the two systems: 64 MDCT in 11 patients and 6 MDCT in 7 patients. All 36 malignancies were underwent pathological evaluation. Results: All cases were confirmed pathologically. Lymphomas were Hodgkin disease ( n = 5 patients) and non-Hodgkin lymphoma ( n = 13 patients). Hepatocellular carcinoma was detected in five patients. Bronchogenic carcinoma was detected in two patients. Renal cell carcinoma was detected in two patients. Breast carcinoma was detected in two patients. Prostatic carcinoma was detected in two patients. Gastric carcinoma was detected in two patients. Endometrial carcinoma was detected in one patient. Colonic carcinoma was detected in one patient. Thyroid carcinoma was detected in one patient. Conclusions: MDCT scanning is accurately imaging modality for the evaluation of synchronous lymphoma and other solid malignancies. More reports and accumulation of such cases should help to clarify the mechanisms, contribute to a further understanding of this phenomenon, and may lead to a new treatment strategy for synchronous lymphoma and other solid malignancies.


Assuntos
Linfoma/patologia , Tomografia Computadorizada Multidetectores/métodos , Neoplasias Primárias Múltiplas/patologia , Neoplasias/patologia , Adulto , Idoso , Feminino , Humanos , Achados Incidentais , Linfoma/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico por imagem , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Estudos Retrospectivos
8.
J Cancer Res Ther ; 16(1): 180-182, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362634

RESUMO

B-cell chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL) is one of the common lymphoproliferative disorders with an increased risk of developing subsequent neoplasms of epithelial and mesenchymal origin. The decreased immunity and B-cell dysfunction in CLL probably accounts for this emergence of secondary malignancy. Breast, brain, skin and prostate tumors have been reported as usual coincident malignancies of CLL, while in occasional cases CLL may occur with malignancies of other solid organs, such as skin, lung, heart, and prostate. Synchronous CLL with urothelial carcinoma (UC) is an infrequent occurrence. We report this case because of its rarity in Indian literature and interesting hematological, immunophenotypic, histopathological, and cytopathological features of metastatic high-grade UC in a 61-year-old male with CLL.


Assuntos
Leucemia Linfocítica Crônica de Células B/patologia , Neoplasias Hepáticas/secundário , Neoplasias Primárias Múltiplas/patologia , Neoplasias da Bexiga Urinária/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico
9.
J Cancer Res Ther ; 16(1): 189-191, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32362637

RESUMO

Coexistence of malignant melanoma and renal cell cancer (RCC) is a rare phenomenon, but this issue becomes increasingly popular. The objective of the current study is to present a case with coexistent anorectal melanoma (ANM) and papillary RCC detected. A 61-year-old female admitted to our clinic with complaints of blood in the stool. ANM diagnosed with colonoscopic biopsy and a mass lession with a size of 57 mm × 53 mm suggesting RCC was detected in the left kidney during staging procedure. Transabdominal resection and radical nephrectomy were performed and diagnoses of ANM and papillary RCC were confirmed. Adjuvant radiotherapy was applied for ANM. The patient is still under follow-up for 6 months and no recurrence or progression was detected. To the best of our knowledge, this is the first report of this interesting coexistency.


Assuntos
Neoplasias do Ânus/patologia , Carcinoma Papilar/patologia , Carcinoma de Células Renais/patologia , Neoplasias Renais/patologia , Melanoma/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Neoplasias do Ânus/radioterapia , Carcinoma Papilar/radioterapia , Carcinoma de Células Renais/radioterapia , Feminino , Humanos , Neoplasias Renais/radioterapia , Melanoma/radioterapia , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/radioterapia , Prognóstico , Neoplasias Cutâneas/radioterapia
11.
World Neurosurg ; 139: 410-414, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376377

RESUMO

BACKGROUND: Cerebral cavernomas are vascular malformations characterized by networks of abnormally dilated capillaries. They typically present as nodules with mixed signal intensity and a surrounding hemosiderin rim on magnetic resonance imaging. They may occur as multiple lesions in the autosomal-dominant familial form. In rare cases, cavernomas may form cystic masses, mimicking other pathologies. CASE DESCRIPTION: A 35-year-old man presented with recurrent seizures, aphasia, and gait disturbance with onset at age 14 years. He had previously undergone surgical drainage of multiple cysts across the brain with suspected parasitic infection. On magnetic resonance imaging, 22 cystic lesions were seen across the brain. A large cyst was located in the midline cerebellum, compressing the fourth ventricle. Occipital craniotomy and transvermian dissection allowed total resection of the cyst along with its wall. The postoperative course was uneventful and symptoms progressively improved. Histological analysis revealed cavernoma. Three more surgeries were performed for removal of large supratentorial cavernomas. CONCLUSIONS: In patients with cystic lesions of the brain, the neurosurgeon should consider the possibility of cavernoma. Total excision along with the cyst wall is crucial for timely diagnosis and therapy.


Assuntos
Neoplasias Encefálicas/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Neoplasias Primárias Múltiplas/patologia , Adulto , Neoplasias Encefálicas/cirurgia , Cistos/patologia , Cistos/cirurgia , Hemangioma Cavernoso do Sistema Nervoso Central/cirurgia , Humanos , Masculino , Neoplasias Primárias Múltiplas/cirurgia
12.
Am Surg ; 86(3): 220-227, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32223801

RESUMO

We aimed to explore the potential prognostic impact of the metastatic site on the management approach and prognosis of stage IV colorectal cancer patients with synchronous metastases. Synchronous metastatic colorectal cancer patients reported to the Surveillance, Epidemiology, and End Results Program database between 2010 and 2013 were included in this study. Overall survival (OS) was compared between patients with different treatment options using risk-adjusted Cox proportional hazard regression models. Overall, 17,776 patients with stage IV colorectal cancer were identified. Of these patients, 2,052 (11.5%) underwent surgical resection for tumors at both the primary and metastatic sites. Patients who underwent surgical resection of both primary and metastatic sites with liver, lung, and simultaneous liver and lung metastases had a longer median OS (P < 0.001) than patients who underwent nonsurgical treatments. Cox regression analysis revealed that surgical resection of both primary and metastatic sites was associated with a significantly enhanced OS (P < 0.001). Colorectal cancer patients with hepatic or pulmonary metastases, who underwent metastasectomy, even in selected patients with both hepatic and pulmonary metastases after multidisciplinary evaluation, could have a better survival benefit than patients who underwent nonsurgical treatments.


Assuntos
Causas de Morte , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Neoplasias Primárias Múltiplas/cirurgia , Adulto , Idoso , Neoplasias Colorretais/cirurgia , Tratamento Conservador/métodos , Tratamento Conservador/mortalidade , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/cirurgia , Masculino , Metastasectomia/métodos , Pessoa de Meia-Idade , Invasividade Neoplásica , Metástase Neoplásica/patologia , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/patologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Programa de SEER , Análise de Sobrevida , Resultado do Tratamento
13.
J Cardiothorac Surg ; 15(1): 69, 2020 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-32326944

RESUMO

BACKGROUND: There is an increasing incidence rate of ground-glass opacity (GGO), especially for multiple GGOs (≥2). Whether it is safe and feasible to have bilateral simultaneous surgical resection remains unknown. The purpose of this study is to summarize the experience of surgical resection of patients with multiple GGOs in our Hospital in recent years, and to discuss the above questions. METHODS: Clinical datas of patients who underwent one-stage bilateral uni-portal VATS resections of multiple pulmonary ground glass opacities and had routine pathological examination were collected from May 2016 to May 2019 in our hospital. RESULTS: A total of 34 patients underwent simultaneous bilateral surgical resection of multiple GGO lesions, 28 were women,6 were men, the average age of total patients was 57.9 ± 6.7 years. All patients underwent bilateral uni-portal video-assisted thoracoscopic surgery (Uni-portal VATS), the average intraoperative blood loss was 100.9 ± 67.7 ml, the average operation time was 140 ± 74.8 min, the average thoracic drainage time was 2.8 ± 3.1 days, and the average postoperative hospital stay was 4.2 ± 4.3 days. Postoperative complications including: 2 cases of infection, 3 cases of atrial fibrillation, and 5 cases of persistent air leakage for more than 3 days. All of them improved after treatment, and there were no serious complications and deaths in perioperative period. A total of 76 GGO lesions were resected, with a total malignancy rate of 81.6%, including 40 were pure GGO, of which 28 were malignant (70%), and the average diameter of them were 9.6 ± 3.8 mm; 36 were mixed GGO, of which 34 were malignant (94.4%), the average diameter of them were 15.6 ± 6.6 mm.Mean postoperative follow-up was 28.4 (range, 3-39) months. There was neither recurrence nor deaths at final follow-up. CONCLUSION: The malignancy rate of multiple GGOs is high. Therefore, when the lung function is allowed,one-stage bilateral uni-portal VATS can be considered. According to experience of main surgeon and the frozen biopsy, either sub-lobar resection or lobectomy was acceptable. The risk of postoperative complications and the prognosis were optimal.


Assuntos
Neoplasias Pulmonares/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Cirurgia Torácica Vídeoassistida , Adulto , Idoso , China , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Primárias Múltiplas/patologia , Duração da Cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Toracotomia , Resultado do Tratamento
14.
World Neurosurg ; 139: 63-69, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32298831

RESUMO

BACKGROUND: Pituitary adenomas are the most common lesion of the sellar region. Very few cases in the literature have described their association with craniopharyngiomas in the same anatomic compartment, an entity defined as collision tumors of the sella. CASE DESCRIPTION: A 35-year-old man presented with headaches and progressive visual disturbances. Radiographic imaging initially highlighted the presence of a pituitary craniopharyngioma. An endoscopic transsphenoidal pituitary approach was performed, during which the tumor was partially resected. The pathology report was positive for 2 entities: a nonfunctioning pituitary adenoma and a papillary craniopharyngioma. This was an unexpected diagnosis based on the surgical and initial radiologic findings. CONCLUSIONS: To our knowledge, this is the first documented case of a collision tumor of the sella comprising a pituitary adenoma and a craniopharyngioma of the papillary type.


Assuntos
Adenoma/cirurgia , Craniofaringioma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neuroendoscopia , Neoplasias Hipofisárias/cirurgia , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/patologia , Adulto , Craniofaringioma/complicações , Craniofaringioma/diagnóstico por imagem , Craniofaringioma/patologia , Cefaleia/etiologia , Hemianopsia/etiologia , Humanos , Hipogonadismo/etiologia , Hipogonadismo/metabolismo , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Proteínas Proto-Oncogênicas B-raf/genética , Osso Esfenoide , Transtornos da Visão/etiologia
15.
J Cancer Res Clin Oncol ; 146(9): 2359-2367, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32333141

RESUMO

PURPOSE: Multiple lung lesions found in a single patient at the time of diagnosis often pose a diagnostic dilemma: are these lesions independent primary tumors (IPT) or the result of intrapulmonary metastases (IPM)? While traditional pathological methods sometimes have difficulty distinguishing IPM from IPT, modern molecular profiling based on next-generation sequencing techniques may provide a new strategy. METHODS: Sixteen patients with multiple tumors were enrolled in this study. We performed targeted deep sequencing (~ 2000 × coverage) on a total of 40 tumors and matched blood samples. We compared mutational profiles between tumors within each patient and across patients to evaluate if they were genetically related. Computed tomographic images and histological staining were also used to validate tumor relationships. RESULTS: A total of 125 mutations were identified in 16 patients. Twelve out of fourteen patients whose histological diagnoses favored IPT did not have any shared mutations in their multiple tumors. The other two showed discrepancies: Pt01 had a shared EGFR exon19 deletion in the two lung tumors found, and Pt16 had one common mutation (BRAFD594G) in two out of five lung tumors. Pt14 with lung metastasis from salivary gland adenoid cystic carcinoma had shared mutations; and Pt15 with suspected intrapulmonary metastasis (IPM) had identical mutations between the two tumors. Visualized data can be readily accessed through the website: mlc.opengene.org. CONCLUSION: Analysis of overlapping mutations among different tumors assists physicians in distinguishing IPM from IPT. Our findings demonstrate that DNA sequencing can provide additional evidence in clinical practice when pathology is inadequate to make a conclusive diagnosis.


Assuntos
Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/patologia , Adulto , Idoso , Feminino , Sequenciamento de Nucleotídeos em Larga Escala/métodos , Humanos , Pulmão/patologia , Masculino , Pessoa de Meia-Idade , Mutação/genética , Análise de Sequência de DNA/métodos
16.
Medicine (Baltimore) ; 99(11): e19131, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32176038

RESUMO

A collision tumor is defined by co-existence of two adjacent tumors which are histologically distinct. Little is known about the clinical manifestation, treatment, and prognosis of cervical collision cancer. The objective of the study was to investigate the management and prognosis of patients with cervical collision cancer.We retrospectively reviewed and enrolled patients with cervical collision carcinoma from 2010 to 2018 in two institutions (West China Hospital and West China Second University Hospital). The clinical presentation, pathology, treatment, and prognosis of patients with collision carcinoma of the uterine cervix were retrospectively reviewed. Progression free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method.A total of 24 patients were included in this study. The proportion of cervical collision carcinoma was 0.4% in the cervical carcinoma cohort (24/6015). The median age of the patients with cervical collision cancer was 42 years. The most common presenting symptom was cervical contactive bleeding. There were 23 patients classified as International Federation of Gynecology and Obstetrics (FIGO) stage IA1-IIB. All patients except one received radical hysterectomy, in which 21 patients received bilateral salpingo-oophorectomy (BSO) and pelvic lymphadenectomy in addition. There were 16 patients who received adjuvant chemotherapy or chemoradiotherapy. The median follow-up time was 21 months. No patient death was observed. Recurrence only occurred in two patients. The 5-year OS rates and PFS rates were 100% and 91.7%, respectively.This study revealed that cervical collision cancer was a type of rare cervical cancer with good prognosis. Cervical collision cancer responded well to the same treatment methods as the cervical squamous cell carcinoma and was associated with few recurrence and long survival.


Assuntos
Neoplasias Primárias Múltiplas/patologia , Neoplasias do Colo do Útero/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Adulto , Idoso , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/mortalidade , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , China , Terapia Combinada , Feminino , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/mortalidade , Neoplasias Primárias Múltiplas/terapia , Panicum , Intervalo Livre de Progressão , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/terapia
17.
Rev Mal Respir ; 37(3): 275-279, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32171443

RESUMO

INTRODUCTION: Haemangiomas are vascular malformations, frequently cutaneous, hepatic and splenic. Respiratory involvement and multiple localisations are uncommon. CASE REPORT: We present a rare case of multiple cavernous haemangiomas in a 35 year old woman presenting with repeated haemoptysis. Thoracic CT scanning showed a mass in the left lower lobe associated with lymph node enlargement above and below the diaphragm, heterogeneous splenomegaly and a single spinal lesion without hypermetabolism on PET scanning. Enbronchial ultrasound-guided trans-bronchial needle aspiration was not contributory. Histopathological diagnostic was made firstly by splenectomy with lumbar-aortic curettage and then by lobectomy for haemostasis. A final diagnosis of multiple cavernous haemangiomas involving lung, lymph nodes, spleen and bone was made. CONCLUSIONS: Bronchopulmonary cavernous haemangiomas associated with extra-thoracic lesions are exceptionally rare and their presentation, suggesting, a malignant cause, often leads to surgical resection for diagnostic and, eventually, therapeutic management. We report an original case of cavernous haemangiomas involving lung, lymph nodes, spleen and bone.


Assuntos
Neoplasias Ósseas/diagnóstico , Hemangioma Cavernoso/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Esplênicas/diagnóstico , Adulto , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Feminino , Hemangioma Cavernoso/patologia , Hemangioma Cavernoso/cirurgia , Hemoptise/diagnóstico , Hemoptise/etiologia , Hemoptise/cirurgia , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Imagem por Ressonância Magnética , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Esplenectomia/efeitos adversos , Neoplasias Esplênicas/patologia , Neoplasias Esplênicas/cirurgia , Esplenomegalia/etiologia , Esplenomegalia/cirurgia , Tomografia Computadorizada por Raios X
18.
J Cardiothorac Surg ; 15(1): 51, 2020 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-32216825

RESUMO

BACKGROUND: Primary pulmonary malignant melanoma (PPMM) is an extreme rarity in clinic practice, accounting for only 0.01% of all primary pulmonary tumors. And its diagnosis should meet clinical and pathological diagnosis criteria in addition to excluding the possibility of metastatic melanoma. The mainstay of treatment is surgery. The concurrence of primary pulmonary malignant melanoma and invasive pulmonary adenocarcinoma has not been reported before. CASE PRESENTATION: Herein we report the case of a 39-year-old woman who was asymptomatic and accidently found to have the concurrence of PPMM with invasive pulmonary adenocarcinoma. Before considering the diagnosis of primary pulmonary malignant melanoma, a systemic positron emission tomography-computed tomography (PET-CT) was done to excluding primary tumor metastasis from other sites. The pathological biopsy proved that two lesions in the right middle lobe were invasive pulmonary adenocarcinomas and the mass in the right lower lobe was malignant melanoma. She underwent right middle and lower lobectomy of the lung with mediastinal and hilar lymph dissection. She refused adjuvant chemotherapy, genetic molecular testing or immunotherapy. Fifteen months later she had brain metastasis. Then she received brain radiotherapy and underwent follow-up at the outpatient clinic regularly. CONCLUSIONS: We experienced a case of concurrent PPMM and invasive pulmonary adenocarcinoma. The patient reported here is the first case of primary pulmonary malignant melanoma combined with invasive pulmonary adenocarcinoma. This patient remained disease-free 15 months after lung surgery.


Assuntos
Adenocarcinoma de Pulmão , Neoplasias Encefálicas/secundário , Neoplasias Pulmonares , Pulmão/patologia , Melanoma , Neoplasias Primárias Múltiplas , Adulto , Biópsia , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/radioterapia , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/cirurgia , Imagem por Ressonância Magnética , Melanoma/diagnóstico por imagem , Melanoma/patologia , Melanoma/cirurgia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/cirurgia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
19.
Nat Commun ; 11(1): 837, 2020 02 13.
Artigo em Inglês | MEDLINE | ID: mdl-32054861

RESUMO

Localized prostate cancers are genetically variable and frequently multifocal, comprising spatially distinct regions with multiple independently-evolving clones. To date there is no understanding of whether this variability can influence management decisions for patients with prostate tumors. Here, we present a single case from a clinical trial of neoadjuvant intense androgen deprivation therapy. A patient was diagnosed with a large semi-contiguous tumor by imaging, histologically composed of a large Gleason score 9 tumor with an adjacent Gleason score 7 nodule. DNA sequencing demonstrates these are two independent tumors, as only the Gleason 9 tumor harbors single-copy losses of PTEN and TP53. The PTEN/TP53-deficient tumor demonstrates treatment resistance, selecting for subclones with mutations to the remaining copies of PTEN and TP53, while the Gleason 7 PTEN-intact tumor is almost entirely ablated. These findings indicate that spatiogenetic variability is a major confounder for personalized treatment of patients with prostate cancer.


Assuntos
Neoplasias Primárias Múltiplas/tratamento farmacológico , Neoplasias da Próstata/tratamento farmacológico , Idoso , Antagonistas de Androgênios/uso terapêutico , Resistencia a Medicamentos Antineoplásicos , Deleção de Genes , Humanos , Masculino , Mutação , Terapia Neoadjuvante , Gradação de Tumores , Neoplasias Primárias Múltiplas/genética , Neoplasias Primárias Múltiplas/patologia , PTEN Fosfo-Hidrolase/deficiência , PTEN Fosfo-Hidrolase/genética , Neoplasias da Próstata/genética , Neoplasias da Próstata/patologia , Análise de Sequência de DNA , Proteína Supressora de Tumor p53/deficiência , Proteína Supressora de Tumor p53/genética
20.
J Thorac Cardiovasc Surg ; 160(2): e71-e79, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32007245

RESUMO

OBJECTIVE: Multifocal non-small cell lung cancer has historically been separated into synchronous primary lung cancers or intrapulmonary metastases with the use of histopathology. We hypothesize that using targeted next-generation sequencing of key driver mutations in multifocal non-small cell lung cancer will improve our ability to differentiate intrapulmonary metastases from synchronous primary lung cancers. METHODS: We identified patients who underwent surgery for non-small cell lung cancer between 2013 and 2018 with multifocal tumors. Archived specimens were reviewed with a 4-gene next-generation sequencing panel identifying mutations of EGFR, KRAS, BRAF, and NRAS. Synchronous primary lung cancers were classified as lesions with different histopathologic subtypes or driver mutations. Tests of hypotheses were performed with the Fisher exact test. Calculations were performed in Stata (v13.0; StataCorp LLC, College Station, Tex). RESULTS: A total of 18 patients had non-small cell lung cancer tumor specimens (n = 41) available from 2 or more sites. The pathologic diagnosis was predominantly adenocarcinoma (39/41 specimens). We detected a driver mutation in 68.3% (28/41) of all tumors. The most common mutations observed were in KRAS (n = 17/41) and EGFR (n = 7/41). Eleven patients had synchronous primary lung cancers, and 4 patients had intrapulmonary metastases based on combined histopathologic and molecular profiling results. Three lacked driver mutations in either lesion. Eight synchronous primary lung cancers (8/18, 44%) were downstaged when compared with their original diagnosis (P = .08). Of these, 4 patients received adjuvant chemotherapy unnecessarily in hindsight. CONCLUSIONS: Molecular non-small cell lung cancer profiling using a 4-gene next-generation sequencing panel allows for better distinction between synchronous primary lung cancers and intrapulmonary metastases than histopathology alone. Routine use of next-generation sequencing for multifocal lesions prevents unnecessary adjuvant treatment for patients with histologically similar synchronous primary lung cancers.


Assuntos
Biomarcadores Tumorais/genética , Carcinoma Pulmonar de Células não Pequenas/genética , Análise Mutacional de DNA , Perfilação da Expressão Gênica , Neoplasias Pulmonares/genética , Mutação , Neoplasias Primárias Múltiplas/genética , Transcriptoma , Idoso , Idoso de 80 Anos ou mais , Carcinoma Pulmonar de Células não Pequenas/secundário , Carcinoma Pulmonar de Células não Pequenas/terapia , Quimioterapia Adjuvante , Tomada de Decisão Clínica , Receptores ErbB/genética , Feminino , GTP Fosfo-Hidrolases/genética , Sequenciamento de Nucleotídeos em Larga Escala , Humanos , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Pneumonectomia , Valor Preditivo dos Testes , Proteínas Proto-Oncogênicas B-raf/genética , Proteínas Proto-Oncogênicas p21(ras)/genética , Reprodutibilidade dos Testes , Estudos Retrospectivos
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