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1.
Medicine (Baltimore) ; 99(28): e20827, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664076

RESUMO

RATIONALE: Cystic lymphangioma (CL) is a rare benign tumor resulting from a failure of the lymphatic system development. It may occur at any age but it is more frequent during childhood. Its clinical presentation and location are various but abdominal CL are uncommon. Among those, mesenteric presentation is the most frequent form whereas CL of the retroperitoneum are particularly rare. PATIENT CONCERNS: Herein, we report the case of a 17-years-old patient with no medical history who presented with right-upper quadrant (RUQ) pain, but no other symptom. Physical examination showed tenderness of the RUQ without distension. Lab tests were unremarkable. DIAGNOSIS: Abdominal computed tomography (CT) highlighted a retroperitoneal cystic mass potentially infiltrating the mesenterium, raising suspicion of a CL of the retroperitoneum. Diagnosis of CL was confirmed by histological analyses. INTERVENTION: Patient underwent an exploratory laparoscopy that infirmed infiltration of the mesenterium and allowed for resection. OUTCOMES: Postoperative course was uneventful and there is no evidence of recurrence after 14 months of follow-up. LESSONS: Although CL essentially occur in children, pediatric retroperitoneal CL is a rare finding, with only 21 cases identified in the literature.In summary, CL are benign tumors rarely located in the retroperitoneum. Despite performant imaging technologies, preoperative diagnosis is challenging. Whenever possible, laparoscopic resection should be the treatment of choice. Herein, we report the largest CL pediatric case laparoscopically resected, and the first review of the literature on the topic.


Assuntos
Dor Abdominal/etiologia , Linfangioma Cístico/cirurgia , Mesentério/patologia , Neoplasias Retroperitoneais/cirurgia , Espaço Retroperitoneal/patologia , Adolescente , Assistência ao Convalescente , Criança , Pré-Escolar , Feminino , Humanos , Laparoscopia/métodos , Masculino , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Espaço Retroperitoneal/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
2.
Surg Clin North Am ; 100(3): 649-667, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402307

RESUMO

Soft tissue tumors of the abdomen and retroperitoneum encompass a wide range of benign and malignant neoplasms. Retroperitoneal sarcomas, the most common, are composed of rare malignancies with numerous histiotypes. Surgery remains the cornerstone of treatment and the only curative option for retroperitoneal sarcomas. With histiotype-dependent local and distant recurrences, it is imperative these cases are discussed in a multidisciplinary tumor board setting at specialized sarcoma centers. This review discusses the current evidence for the management of abdominal and retroperitoneal soft tissue tumors, with particular focus on retroperitoneal sarcomas and desmoid tumors.


Assuntos
Neoplasias Abdominais/cirurgia , Neoplasias Retroperitoneais/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/patologia , Terapia Combinada , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/patologia , Fibromatose Agressiva/cirurgia , Humanos , Comunicação Interdisciplinar , Colaboração Intersetorial , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/patologia , Sarcoma/diagnóstico , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/diagnóstico , Neoplasias de Tecidos Moles/patologia
3.
Anticancer Res ; 40(4): 2107-2115, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234903

RESUMO

BACKGROUND/AIM: Recently, the concept of textbook outcome (TO) has emerged as a novel effort to develop a benchmark that reflects multiple domains of quality. The aims of the current study were to define TO for retroperitoneal sarcoma (RPS), evaluate the relationship of TO with hospital volume and assess the association of TO with overall survival. PATIENTS AND METHODS: Patients who underwent resection for RPS diagnosed between 2004 and 2015 were identified in the National Cancer Database. The primary outcome was TO that was defined as: hospital length of stay<75th percentile, survival>90 days from surgery, no readmission within 30 days and grossly negative margins. RESULTS: Of the 11,032 patients analyzed, 54.0% had a TO. Among patients who had a TO, 57.8% were treated in high-volume hospitals. Undergoing surgery at high-volume centers was associated with a higher probability of a TO (p=0.009). TO were associated with significantly longer overall survival (p<0.001). In a subgroup analysis with grossly negative margins and no 90-day mortality, the association of TO with improved survival persisted (p<0.001). CONCLUSION: The concept of TO is a promising tool for measuring patient-level hospital performance and may be useful for identifying important variations in care for patients with RPS.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Adulto , Idoso , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Retroperitoneais/patologia , Espaço Retroperitoneal , Sarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Resultado do Tratamento
4.
J Surg Oncol ; 121(7): 1140-1147, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32167587

RESUMO

BACKGROUND AND OBJECTIVES: Outcomes of palliative-intent surgery in retroperitoneal sarcomas (RPS) are not well understood. This study aims to define indications for and outcomes after palliative-intent RPS resection. METHODS: Using a retrospective 8-institution database, patients undergoing resection of primary/recurrent RPS with palliative intent were identified. Logistic regression and Cox-proportional hazards models were constructed to analyze factors associated with postoperative complications and overall survival (OS). RESULTS: Of 3088 patients, 70 underwent 87 palliative-intent procedures. Most common indications were pain (26%) and bowel obstruction (21%). Dedifferentiated liposarcoma (n = 17, 24%), leiomyosarcoma (n = 13, 19%) were predominant subtypes. Median OS was 10.69 months (IQR, 3.91-23.23). R2 resection (OR, 8.60; CI, 1.42-52.15; P = .019), larger tumors (OR, 10.87; CI, 1.44-82.11; P = .021) and low preoperative albumin (OR, 0.14; CI, 0.04-0.57; P = .006) were associated with postoperative complications. Postoperative complications (HR, 1.95; CI, 1.02-3.71; P = .043) and high-grade histology (HR, 6.56; CI, 1.72-25.05; P = .006) rather than resection status were associated with reduced OS. However, in R2-resected patients, development of postoperative complications significantly reduced survival (P = .042). CONCLUSIONS: Postoperative complications and high-grade histology rather than resection status impacts survival in palliative-intent RPS resections. Given the higher incidence of postoperative complications which may diminish survival, palliative-intent R2 resection should be offered only after cautious consideration.


Assuntos
Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Idoso , Dor do Câncer/etiologia , Dor do Câncer/cirurgia , Bases de Dados Factuais , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Complicações Pós-Operatórias , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/mortalidade , Estudos Retrospectivos , Sarcoma/complicações , Sarcoma/mortalidade , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia
5.
Anticancer Res ; 40(2): 1049-1053, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32014952

RESUMO

BACKGROUND/AIM: Retroperitoneal sarcomas represent very aggressive malignancies with high capacity of invading the surrounding vital structures. CASE REPORT: We present the case of a 46-year-old patient who had been initially diagnosed with a large retroperitoneal mass 18 months ago. At that moment the mass was resected en bloc with the inferior cava vein, which was reconstructed using a cadaveric graft, the histopathological studies demonstrating the presence of a leiomyosarcoma. One year later she was diagnosed with recurrent disease invading the abdominal aorta and a liver metastasis. This time the recurrence was resected en bloc with the abdominal aorta, which was reconstructed by placing a cadaveric graft; atypical liver resection was also performed. The postoperative course was uneventful. CONCLUSION: Extended vascular resections and cadaveric graft reconstructions might be needed in order to achieve a good local control of the disease in patients with retroperitoneal sarcomas.


Assuntos
Estenose da Valva Aórtica/etiologia , Estenose da Valva Aórtica/cirurgia , Cadáver , Leiomiossarcoma/complicações , Neoplasias Retroperitoneais/complicações , Enxerto Vascular , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Recidiva , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Resultado do Tratamento , Enxerto Vascular/métodos
6.
Isr Med Assoc J ; 22(1): 53-59, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927807

RESUMO

BACKGROUND: Primary retroperitoneal neoplasms (PRN) arise from diverse retroperitoneal tissues. Soft tissue sarcomas (STS) comprise the majority and are well studied. Other non-sarcomatous PRN are very rare and less familiar. OBJECTIVES: To evaluate the clinicopathologic and radiologic features of non-sarcomatous PRN, as well as the outcome of complete tumor resection (TR). METHODS: Retrospective data were collected on consecutive patients (June 2006 to January 2015) who underwent resection of retroperitoneal lesions at our department. Final pathology of non-sarcomatous PRN was included. RESULTS: The study population included 36 patients (26% with PRN). PRN were neurogenic (17%), fat-containing (3%), and cystic (6%). The preoperative diagnosis was correct in only 28%. All patients underwent TR via laparotomy (72%) or laparoscopy (28%), for mean operative time of 120 ± 46 minutes. En bloc organ resection was performed in 11%. Complete TR was achieved in 97%. Intra-operative spillage occurred in 8%. Intra-operative, 90-day postoperative complications, and mortality rates were 11%, 36%, and 0%, respectively. The mean length of stay was 6.5 ± 5.5 days. The median overall survival was 53 ± 4.9 months. CONCLUSIONS: Familiarity with radiologic characteristics of PRN is important for appropriate management. Counter to STS, other PRN are mostly benign and have an indolent course. Radical surgery is not required, as complete TR confers good prognosis. Expectant management is reserved for small, asymptomatic, benign neoplasms.


Assuntos
Neoplasias Retroperitoneais/diagnóstico , Idoso , Feminino , Ganglioneuroma/diagnóstico , Ganglioneuroma/diagnóstico por imagem , Ganglioneuroma/patologia , Ganglioneuroma/cirurgia , Humanos , Lipoma/diagnóstico , Lipoma/diagnóstico por imagem , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Neurilemoma/diagnóstico , Neurilemoma/diagnóstico por imagem , Neurilemoma/patologia , Neurilemoma/cirurgia , Neurofibroma/diagnóstico , Neurofibroma/diagnóstico por imagem , Neurofibroma/patologia , Neurofibroma/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/diagnóstico por imagem , Paraganglioma/patologia , Paraganglioma/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
7.
Int J Clin Oncol ; 25(5): 929-936, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31950376

RESUMO

BACKGROUND: There are only a limited number of comprehensive reports for retroperitoneal tumors (RPTs). The aim of this study was to perform an interdepartmental data collection for RPTs and to comprehensively clarify the clinical characteristics of this rare disease. METHODS: All patients who were diagnosed with RPT from January 2005 to July 2018 in a single institution were included. The analyzed factors included demographics, clinical features, treatment methods, pathological diagnosis, and prognosis. RESULTS: A total of 422 patients (215 males and 207 females) with primary RPTs were identified. Biopsy for RPT was performed in 180 patients (43%). Among the 422 patients, 239 (57%) underwent surgery. The most common tissue origin was mesodermal (n = 99, 41%), followed by neurogenic (n = 54, 23%), extragonadal (n = 27, 11%), and metastatic tumors (n = 13, 5%). Among the 99 resected mesodermal tumors, the most common pathological subtypes were liposarcoma (n = 55, 56%) and leiomyosarcoma (n = 16, 16%). The long-term outcomes after surgery were analyzed in patients with intermediate and malignant sarcomas (including liposarcoma, leiomyosarcoma, and others combined, n = 71). The 3- and 5-year disease-free survival rates in the intermediate tumors were 68.2% and 54.2%, respectively, whereas those in the malignant tumors were 48.6% and 28.9%, respectively. The 3- and 5-year overall survival rates in the intermediate tumors were 100% and 94.1%, respectively, whereas those in the malignant tumors were 78.4% and 72.8%, respectively (p = 0.009). CONCLUSIONS: The clinical manifestations of RPTs were extremely variable. Recurrence after repeating resection is commonly observed in patients with malignant retroperitoneal sarcoma.


Assuntos
Neoplasias Retroperitoneais/patologia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia , Criança , Pré-Escolar , Feminino , Humanos , Leiomiossarcoma/patologia , Lipossarcoma/mortalidade , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Neoplasias Retroperitoneais/mortalidade , Estudos Retrospectivos , Sarcoma/patologia , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
8.
Internist (Berl) ; 61(2): 217-222, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-31712872

RESUMO

In this article, the authors present the case of a 66-year-old man who was diagnosed with the first recurrence of his retroperitoneal liposarcoma 7 years after initial diagnosis. In the following 10 years, he needed a total of eight operations, chemotherapy, and radiotherapy because of another seven recurrences. This is the first report on a patient with eight recurrences of a retroperitoneal liposarcoma being in a relatively good general condition even 17 years after initial diagnosis.


Assuntos
Lipossarcoma , Neoplasias Retroperitoneais , Idoso , Humanos , Lipossarcoma/diagnóstico , Lipossarcoma/cirurgia , Masculino , Recidiva Local de Neoplasia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia
9.
10.
J Surg Oncol ; 121(1): 75-84, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273800

RESUMO

BACKGROUND: Retroperitoneal lymphangiomatosis (RL) is a rare form of primary lymphedema featuring aberrant retroperitoneal lymphatic proliferation. It causes recurrent cellulitis, repeated interventions, and poor life quality. This study aimed to investigate proper diagnositc criteria and surgical outcomes for RL with extremity lymphedema. METHODS: Between 2012 and 2018, 44 primary lower-extremity lymphedema cases received lymphoscintigraphy, magnetic resonance imaging, and single-photon electron computed tomography to detect RL. RL patients underwent vascularized lymph node transfers (VLNT) for extremity lymphedema and intra-abdominal side-to-end chylovenous bypasses (CVB) for chylous ascites. Complications, CVB patency, and quality of life were evaluated postoperatively. RESULTS: Six RL patients (mean age of 30.3 years) had chylous ascites with five had lower-extremity lymphedema. All CVBs remained patent, though one required re-anastomosis, giving a 100% patency rate. Four unilateral and one bilateral extremity lymphedema underwent six VLNTs with 100% flap survival. Patients reported improved quality of life (P = 0.023), decreased cellulitis incidence (P = 0.041), and improved mean lymphedema circumference (P = 0.043). All patients resumed a normal diet and activity. CONCLUSIONS: Evaluating primary lower-extremity lymphedema patients with MRI and SPECT could reveal a 13.6% prevalence of RL and guide treatment of refractory extremity lymphedema. Intra-abdominal CVB with VLNT effectively treated RL with chylous ascites and extremity lymphedema.


Assuntos
Linfonodos/transplante , Linfangioma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Feminino , Humanos , Perna (Membro)/diagnóstico por imagem , Perna (Membro)/cirurgia , Linfangioma/diagnóstico por imagem , Imagem por Ressonância Magnética , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Tomografia Computadorizada de Emissão de Fóton Único , Adulto Jovem
11.
Rev. esp. investig. quir ; 23(1): 31-33, 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-FGT-3945

RESUMO

Los tumores malignos de vaina neural periférica (MPNST) se observan con mayor frecuencia en pacientes con neurofibromatosis tipo 1 (NF-1), presentando un crecimiento rápido y unas tasas de supervivencia a los 5 años alrededor del 33%. Presentamos el caso de un varón de 17 años afecto de NF-1 con un MPNST retroperitoneal gigante sometido a tratamiento quirúrgico radical, con recidiva tumoral precoz


Malignant peripheral nerve sheath tumors (MPNST) are most frequently in patients with neurofibromatosis type 1 (NF-1), with a rapid growth and 5-years survival rates around 33%. We present the case of a 17 years old male with NF-1 and a giant retroperi-toneal MPNST who undergoes a radical surgical treatment, with early tumor recurrence


Assuntos
Humanos , Masculino , Adolescente , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Neurofibromatose 1/diagnóstico por imagem , Neurofibromatose 1/cirurgia , Neoplasias Retroperitoneais/etiologia , Neurofibromatose 1/complicações , Recidiva Local de Neoplasia , Tomografia Computadorizada por Raios X
12.
Am J Case Rep ; 20: 1817-1820, 2019 Dec 06.
Artigo em Inglês | MEDLINE | ID: mdl-31806861

RESUMO

BACKGROUND Ganglioneuroma is a rare benign sympathetic chain neoplasm which rarely arise from the adrenal gland in adults and exceedingly rare for ganglioneuroma to arise from different origins in the same patient. We present a rare case of retroperitoneal ganglioneuroma concurring with an adrenal ganglioneuroma in an adult patient. CASE REPORT A 17-year-old healthy male underwent computed tomography (CT) scan after road traffic accident where he was found to have a left adrenal homogeneous hypovascular lesion with another retroperitoneal lesion seen within the right para-colic gutter with similar radiological features. Successful surgical resection was obtained, and histological diagnosis of both lesions was benign ganglioneuroma. CONCLUSIONS Adrenal and extra-adrenal ganglioneuroma can, although rare, concur together. Key findings are the similar radiological appearance of the lesions with typical hypovascular progressive pattern of enhancement. Appropriate pre-surgical diagnosis can aid to proper management since ganglioneuroma needs wide surgical resection due to its high chance of recurrence.


Assuntos
Neoplasias das Glândulas Suprarrenais/cirurgia , Ganglioneuroma/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Ganglioneuroma/diagnóstico por imagem , Humanos , Masculino , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X
13.
BMJ Case Rep ; 12(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31796439

RESUMO

Extragastrointestinal stromal tumour (EGIST) occurs outside the gastrointestinal tract and has histopathological and molecular characteristics similar to gastrointestinal stromal tumour (GIST). This tumour is rare and aggressive. A male patient was admitted with anaemia and lower limb oedema. CT scan showed a tumour in the mesentery and retroperitoneum, suspected to be a small bowel GIST. During laparotomy an unresectable mass was found compressing the retroperitoneal structures. Pathology and immunohistochemistry (CD117) confirmed an EGIST. EGIST arises from Cajal-like cells or from pluripotent stem cells outside the gastrointestinal tract. It is aggressive and has a worse prognosis than GIST. Immunohistochemistry is crucial for diagnosis. Surgery aimed at debulking as much of a tumour mass as possible is the cornerstone of treatment. The role of imatinib is not clear. EGIST is rare and has a bad prognosis, and there is no consensus on grading and management. A low threshold of suspicion is crucial for early diagnosis.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias Retroperitoneais/patologia , Idoso , Anemia/etiologia , Evolução Fatal , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Artérias Mesentéricas/patologia , Invasividade Neoplásica , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia
14.
Zhonghua Zhong Liu Za Zhi ; 41(12): 943-948, 2019 Dec 23.
Artigo em Chinês | MEDLINE | ID: mdl-31874553

RESUMO

Objective: To investigate the relevant prognostic factors of liposarcoma (LPS). Methods: The data of 78 patients with LPS treated in our hospital from July 2009 to March 2017 were reviewed. The 78 patients included 41 males and 37 females, and the average age was (60.5 ±13.4) years (ranged from 18 to 85 years). Among the 78 LPS patients, 27 were well-differentiated LPS, 13 were myxoid LPS, 35 were dedifferentiated LPS and 3 were pleomorphic LPS.The distribution of lesion location included 40 cases of extremities and 38 cases of retroperitoneal. 21 cases were treated with radical excision, 57 cases were treated with marginal resection. 7 patients were treated with postoperative radiotherapy and 9 patients with postoperative chemotherapy. Progression free survival (PFS) and overall survival (OS) of LPS patients were analyzed as clinical outcomes. Prognostic factors were analyzed by univariate and multivariate analyses. Results: 43 patients had local recurrence (9 of extremities/ 34 of retroperitoneal), 18 patients with metastasis (4 of extremities/ 14 of retroperitoneal). The 5-year PFS rate was 31.4% and 5-year OS rate was 44.3%. Univariate analysis showed that the histological subtype and the tumor location were related with PFS (P<0.05), while the histological subtype, the tumor location, the tumor size, the recurrence and metastasis were related with OS (P<0.05). Multivariate cox regression analysis showed that the tumor location was the independent prognostic factor of PFS (P<0.05), while the histological subtype and metastasis were the independent prognostic factors of OS (P<0.05). The median PFS of patients with myxoid LPS treated with radiotherapy was 34.6 months, which was significantly longer than 28.3 months of myxoid LPS patients without radiotherapy (P<0.05). Conclusions: The tumor location is an independent prognostic factor of PFS in LPS patients.Retroperitoneal LPS is more prone to relapse and metastasize. OS is affected by pathological subtype and metastasis. Radiotherapy can improve the PFS of patients with myxoid LPS.


Assuntos
Lipossarcoma/cirurgia , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Intervalo Livre de Doença , Feminino , Humanos , Lipossarcoma/mortalidade , Lipossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Prognóstico , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
15.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
18.
World J Surg Oncol ; 17(1): 180, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684956

RESUMO

BACKGROUND: Guidelines recommend treatment of retroperitoneal sarcomas (RPS) at high-volume centers. However, high-volume centers may not be accessible locally. This national study compared outcomes of RPS resection between local low-volume centers and more distant high-volume centers. METHODS: Patients treated for RPS were identified from the National Cancer Database (1998-2012). Travel distance and annual hospital volume were divided into quartiles. Two groups were identified: (1) short travel to low-volume hospitals (ST/LV), (2) long travel to high-volume hospitals (LT/HV). Outcomes were adjusted for clinical, tumor, and treatment characteristics. RESULTS: Two thousand five hundred ninety-nine patients met the inclusion criteria. The LT/HV cohort was younger and more often white (p < 0.01). The LT/HV group had more comorbidities, higher tumor grade, and more often radical resections and radiotherapy (all p < 0.05). The ST/LV group underwent significantly more R2 resections (4.4% vs. 2.6%, p = 0.003). Thirty-day mortality was significantly lower in the LT/HV group (1.2% vs. 2.8%, p = 0.0026). Five-year survival was better among the LT/HV group (63% vs. 53%, p < 0.0001). After adjustment, the LT/HV group had a 27% improvement in overall survival (HR 0.73, p = 0.0009). CONCLUSIONS: This national study suggests that traveling to high-volume centers for the treatment of RPS confers a significant short-term and long-term survival advantage, supporting centralized care for RPS.


Assuntos
Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Hospitais com Baixo Volume de Atendimentos/estatística & dados numéricos , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Viagem/estatística & dados numéricos , Idoso , Bases de Dados Factuais/estatística & dados numéricos , Intervalo Livre de Doença , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Neoplasias Retroperitoneais/mortalidade , Estudos Retrospectivos , Sarcoma/mortalidade
19.
Medicine (Baltimore) ; 98(47): e18081, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764841

RESUMO

Retroperitoneal desmoid-type fibromatosis (RPDF) is a rare mesenchymal neoplasm, and it covers a broad spectrum of aggressive monoclonal, fibroblastic proliferation. There is no evidence-based or established optimal treatment available for this intriguing disease yet. Therefore, we here investigated the clinicopathological characteristics, surgical, and survival outcomes in RPDF among Chinese patients.Patients with histologically confirmed RPDF were retrospectively studied from 2010 to 2018 within the West China Hospital of Sichuan University. Demographics, clinicopathological characteristics, treatment, and survival outcome data were collected.Of the 29 cases of RPDF, 19 were females. Tumor diameter ranged from 4 to 40 cm, with a median of 10 cm. Of these patients, surgical resection was the primary treatment adopted for RPDF in 26 cases; while 3 patients underwent watchful waiting. In surgical group, complete and incomplete macroscopic resection was achieved in 21 (80.77%) and 6 (19.23%) cases, respectively. Totally, 21 (80.77%) cases underwent multi-visceral resection. With a median follow-up duration of 48 months, 11 patients experienced tumor progression for the entire cohort. Tumor progression was observed for those patients with incomplete and complete macroscopic resection in 2/5 (40.0%) and 6/21 (28.6%) cases, respectively. In the watchful waiting group, there were no documented cases of RPDF regression. The progression-free survival rate was 86.1%, 71.5%, and 62.3% at 1-, 2-, and 3-years, respectively.RPDFs are rare types of tumor, which have characteristically varied natural histories. Surgical resection had a relative favorable outcome, but some patients were associated with burden of significant surgical complications.


Assuntos
Fibromatose Agressiva , Neoplasias Retroperitoneais , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , China/epidemiologia , Feminino , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/mortalidade , Fibromatose Agressiva/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/mortalidade , Neoplasias Retroperitoneais/cirurgia , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
20.
BMC Surg ; 19(1): 148, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640656

RESUMO

BACKGROUND: We are a reporting a rare case of retroperitoneal schwanomma with atypical pre and postoperative manifestations. Retroperitoneal schwannomas are rare tumors that are difficult to preoperatively diagnose. CASE PRESENTATION: This is a case report of a male patient, 41 years old, with symptoms of hipogastric and lower right member pain, as well as a history of a papilliferous thyroid tumor. Computerized tomography exams were inconclusive, showing a mass in the presacral region with dimensions of 4.4 × 3.9 × 3.4 cm. Removal was carried out by laparoscopic surgery, with self-limited postoperative complications. Diagnosis was carried out by anatomopathological examination, and syndromic hypotheses were discarded. CONCLUSIONS: The postoperative complications of schwanomma are little reported in the literature. In the simultaneous occurrence of schwanomma and other endocrine tumors, further studies are warranted to better differentiate the cases that need investigation of syndromic causes.


Assuntos
Laparoscopia/métodos , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/cirurgia , Adulto , Humanos , Masculino , Neurilemoma/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Neoplasias da Glândula Tireoide/patologia , Tomografia Computadorizada por Raios X
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