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1.
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
2.
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
3.
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
4.
Clin Nucl Med ; 44(12): 991-992, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689283

RESUMO

A 48-year-old woman with intermittent lower back pain for 9 months and known retroperitoneal neurofibroma underwent F-NaF PET/CT scan to assess possible bony lesions causing the pain. Incidentally, the images showed elevated NaF activity in the retroperitoneal neurofibroma. In addition, uterine leiomyoma with heterogeneous calcifications revealed increased NaF activity.


Assuntos
Calcinose/complicações , Radioisótopos de Flúor , Leiomioma/complicações , Neurofibroma/metabolismo , Neoplasias Retroperitoneais/metabolismo , Fluoreto de Sódio/metabolismo , Transporte Biológico , Humanos , Masculino , Pessoa de Meia-Idade , Neurofibroma/complicações , Neurofibroma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/diagnóstico por imagem
6.
Clin Nucl Med ; 44(11): e612-e613, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31524684

RESUMO

Primary retroperitoneal liposarcoma is an extremely rare malignant tumor. Herein, we report a case with an incidentally detected giant retroperitoneal liposarcoma on Ga-PSMA PET/CT during primary staging for prostate cancer.


Assuntos
Lipossarcoma/diagnóstico por imagem , Glicoproteínas de Membrana , Compostos Organometálicos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/diagnóstico por imagem , Idoso , Humanos , Achados Incidentais , Masculino , Estadiamento de Neoplasias , Neoplasias da Próstata/diagnóstico por imagem , Neoplasias da Próstata/patologia
7.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439566

RESUMO

A 57-year-old woman was referred to the emergency department after a CT scan ordered by her general practitioner to investigate her abdominal pain showed a large cystic mass. The simple cystic appearance with its location in the small bowel mesentery prompted a provisional diagnosis of cystic lymphangioma. However, concerns regarding the size, location and local involvement of neurovascular structures presented a technical surgical challenge. Here we present a case of minimally invasive laparoscopic drainage using a modified Jackson-Pratt drain that avoided a laparotomy and open resection.


Assuntos
Linfangioma Cístico/diagnóstico , Neoplasias Retroperitoneais/diagnóstico , Dor Abdominal/etiologia , Diagnóstico Diferencial , Drenagem , Feminino , Humanos , Laparoscopia , Linfangioma Cístico/complicações , Linfangioma Cístico/diagnóstico por imagem , Linfangioma Cístico/cirurgia , Pessoa de Meia-Idade , Neoplasias Retroperitoneais/complicações , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Tomografia Computadorizada por Raios X
8.
BMC Cancer ; 19(1): 748, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362708

RESUMO

BACKGROUND: Primary retroperitoneal serous adenocarcinoma (PRSA) is an extremely uncommon malignancy exclusively reported in females. Due to the rarity of the disease, it is difficult to establish a standardized treatment. CASE PRESENTATION: We describe a unique case of PRSA in a 71-year-old male who presented with right-sided lower back pain and numbness. Magnetic resonance imaging identified a mass invading the adjacent psoas muscle and twelfth rib. Tissue biopsy confirmed poorly differentiated PRSA. Patient was initially treated with neoadjuvant carboplatin and paclitaxel chemotherapy regimen. This resulted in complete radiological resolution of the tumor. However, 12 weeks later, rapid recurrence was noted on follow-up CT scan. The patient was then treated with external radiotherapy with concurrent nivolumab, an anti-PD-1 antibody. The patient displayed a positive response to treatment with reduction in primary tumor and metastases and had a sustained disease control. CONCLUSION: Treatment with radiotherapy in combination with anti-PD-1 antibody could be an effective modality of management for PRSA.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Cistadenocarcinoma Seroso/radioterapia , Cistadenocarcinoma Seroso/terapia , Imunoterapia/métodos , Nivolumabe/uso terapêutico , Neoplasias Retroperitoneais/radioterapia , Neoplasias Retroperitoneais/terapia , Idoso , Antineoplásicos Imunológicos/farmacologia , Antineoplásicos Fitogênicos/efeitos adversos , Antineoplásicos Fitogênicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carboplatina/efeitos adversos , Carboplatina/uso terapêutico , Cistadenocarcinoma Seroso/diagnóstico por imagem , Seguimentos , Humanos , Fatores Imunológicos/uso terapêutico , Imagem por Ressonância Magnética , Masculino , Terapia Neoadjuvante , Recidiva Local de Neoplasia , Nivolumabe/farmacologia , Paclitaxel/efeitos adversos , Paclitaxel/uso terapêutico , Receptor de Morte Celular Programada 1/antagonistas & inibidores , Receptor de Morte Celular Programada 1/imunologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Resultado do Tratamento
9.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289161

RESUMO

Epstein-Barr virus (EBV) is implicated in the tumorigenesis of a variety of malignancies, including Burkitt's lymphoma, Hodgkin's disease and nasopharyngeal carcinoma (NPC). EBV+ lymphoepithelioma-like cholangiocarcinoma (LELCC) is a rare type of intrahepatic cholangiocarcinoma with a distinct pathology and poorly understood treatment options. Morphologically, this neoplasm resembles undifferentiated NPC, a commonly EBV+ tumour with a prominent lymphoid infiltrate. Almost all of the current literature regarding LELCC describes early stage tumours that are treated surgically and achieve good outcomes. In contrast, this report documents a late stage LELCC treated unsuccessfully with systemic chemotherapy.


Assuntos
Carcinoma/patologia , Colangiocarcinoma/patologia , Infecções por Vírus Epstein-Barr/complicações , Adulto , Carcinoma/terapia , Carcinoma/virologia , Colangiocarcinoma/terapia , Colangiocarcinoma/virologia , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/virologia , Evolução Fatal , Feminino , Hepatite B Crônica/diagnóstico , Herpesvirus Humano 4/metabolismo , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Linfadenopatia/patologia , Recidiva Local de Neoplasia , Neoplasias Retroperitoneais/diagnóstico por imagem
10.
Clin Nucl Med ; 44(8): 648-649, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31274612

RESUMO

Findings of Tc-DTPA renal scintigraphy of a retroperitoneal malignant peripheral nerve sheath tumor are reported here. The patient was a 48-year-old woman who presented discomfort and intermittent dull pain in the left upper quadrant of the abdomen for approximately 3 weeks.


Assuntos
Rim/diagnóstico por imagem , Neurofibrossarcoma/diagnóstico por imagem , Neurofibrossarcoma/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Pentetato de Tecnécio Tc 99m , Feminino , Humanos , Pessoa de Meia-Idade , Cintilografia
11.
J Coll Physicians Surg Pak ; 29(8): 778-779, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31358104

RESUMO

Teratomas are germ cell tumors arising from the embryonic germ layers. Since they originate from the germ cells, they can be found in the gonadal, sacrococcygeal, mediastinal, intracranial, retroperitoneal, and cervical regions. In this case report, a 4-year boy, brought to the hospital due to abdominal pain and fever, was diagnosed as a large and infected peritoneal teratoma by contrast-enhanced abdominal computed tomography (CT) along with abdominal CT and operative findings.


Assuntos
Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/cirurgia , Tomografia Computadorizada por Raios X , Pré-Escolar , Meios de Contraste , Diagnóstico Diferencial , Humanos , Masculino
12.
Med. clín (Ed. impr.) ; 153(2): 83-87, jul. 2019. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-183370

RESUMO

Antecedents: Perivascular epitheliod cell tumor (PEComa) is a rare mesenchymal tumor. They are rare in the field of gynecology, which makes them difficult to consider as a possible diagnostic. We aim to contribute with our experience to ease clinical practice to others gynecologists. Patients and methods: We contribute to literature with three gynecological cases; uterine, vaginal and retroperitoneal PEComas. Results: The uterine and vaginal PEComa, have required surgical treatment, and are free of disease at 9 and 5 months respectively. The retroperitoneal PEComa has recurred at 72 months of follow-up in form of retroperitoneal mass and pulmonary lymphangioleomyomatosis, continues treatment with sirolimus with good tolerance and partial response. Discussion: Given the scarcity of cases, the literature consists of case reports and mini-reviews. Some authors have categorized the PEComas based on prognostic factors, but there is no agreement regarding the follow-up and treatment. 18F-FDG-PET/CT can help characterize these lesions. The surgery is the standard. In recurrent or malignant cases, there is a lack of evidence regarding chemotherapy and radiotherapy. New therapies with inhibitory m-TOR open a hopeful therapeutic window


Antecedentes: El tumor de célula epitelioide perivascular (PEComa) es un tumor mesenquimal raro. Son entidades ginecológicas extrañas, lo que dificulta su consideración diagnóstica. Contribuimos con nuestra experiencia para facilitar la práctica clínica a otros ginecólogos. Pacientes y métodos: Aportamos 3 casos ginecológicos a la literatura: PEComas uterino, vaginal y retroperitoneal. Resultados: Los PEComas uterino y vaginal requirieron tratamiento quirúrgico y están libres de enfermedad a los 9 y 5 meses, respectivamente. El PEComa retroperitoneal recidivó a los 72 meses de seguimiento en forma de masa retroperitoneal y linfangioleiomiomatosis pulmonar, continuando tratamiento con sirolimus, con buena tolerancia y respuesta parcial. Discusión: Dada la escasez de casos, la literatura consiste en casos clínicos y mini revisiones. Algunos autores han categorizado los PEComas en base a factores pronósticos, pero no hay acuerdo respecto al seguimiento y tratamiento. La 18F-FDG-PET/TC puede ayudar a caracterizar estas lesiones. La cirugía es el tratamiento estándar. En casos de recurrencia o malignidad, hay falta de evidencia respecto a la quimioterapia y radioterapia. Nuevas terapias con inhibidores mTOR abren una ventana terapéutica esperanzadora


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias de Células Epitelioides Perivasculares/diagnóstico por imagem , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Neoplasias Uterinas/diagnóstico por imagem , Neoplasias de Células Epitelioides Perivasculares/patologia , Linfangioleiomiomatose/complicações , Linfangioleiomiomatose/tratamento farmacológico , Sirolimo/uso terapêutico , Neoplasias Uterinas/patologia , Útero/patologia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia
13.
Am J Case Rep ; 20: 833-837, 2019 Jun 13.
Artigo em Inglês | MEDLINE | ID: mdl-31189869

RESUMO

BACKGROUND Primary retroperitoneal mucinous cystadenoma (PRMC) is a rare benign tumor that occurs in the retroperitoneal space. PRMC is difficult to preoperatively diagnose, and final diagnosis requires surgical resection. CASE REPORT A 39-year-old female was referred to our hospital with a chief complaint of tension and pain in the left flank. Imaging findings revealed a large, thick-walled unilocular cystic mass dorsal to the descending colon and ventral to the left kidney. Moreover, a content-rich mural nodule measuring 20 mm was detected on the caudal wall of the cyst, which was suspected to be malignant. The tumor was successfully resected. The cystic wall was composed of thick, scarred fibrous tissue, and the inner surface was lined with a single layer of mucinous epithelium with little atypia. The mural nodule mainly comprised necrotic tissue with no epithelium. Serum carbohydrate antigen 19-9 (CA19-9) level was high (109 U/mL) preoperatively, but it returned to normal levels postoperatively. Importantly, CA19-9 expression was also confirmed using immunohistochemistry. To the best of our knowledge, this is the first case of PRMC with elevated serum CA19-9 levels confirmed by immunohistochemistry. CONCLUSIONS PRMC is only diagnosed by surgical resection. If imaging studies indicate signs of malignancy, surgeons should not hesitate to surgically confirm the diagnosis.


Assuntos
Antígeno CA-19-9/metabolismo , Cistadenoma Mucinoso/diagnóstico por imagem , Cistadenoma Mucinoso/cirurgia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/cirurgia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Biomarcadores Tumorais/metabolismo , Biópsia por Agulha , Meios de Contraste , Cistadenoma Mucinoso/parasitologia , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Laparotomia/métodos , Imagem por Ressonância Magnética/métodos , Doenças Raras , Neoplasias Retroperitoneais/patologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Anticancer Res ; 39(6): 2963-2968, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177136

RESUMO

BACKGROUND/AIM: This study aimed to report the location of abdominal relapse in patients with testicular cancer. MATERIALS AND METHODS: This is a retrospective cross-sectional study including patients who underwent abdominal magnetic resonance imaging (MRI) after treatment of testicular germ cell cancer. MRI reports were classified as negative or positive, and positive results were cross-checked with follow-up imaging and biopsy results. Positive histology or cytology defined a true-positive finding. The location of relapse was registered according to the anatomical site. RESULTS: In a 2-year period, 2,315 MRI examinations were performed. Relapse was detected in 0.7% (95% CI=0.4-1.1) of the examinations. Among these, 75% were seminomas and 25% were non-seminomas. Retroperitoneal lymph nodes were affected in 88% of cases, and pelvic and inguinal lymph nodes affected in 12% of cases. No metastases were found in parenchymatous organs or bony structures. CONCLUSION: All cases of abdominal relapse occurred in retroperitoneal or pelvic lymph nodes. This suggests that MRI should be directed towards the retroperitoneum and pelvis only.


Assuntos
Neoplasias Pélvicas/secundário , Neoplasias Retroperitoneais/secundário , Neoplasias Testiculares/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos Transversais , Humanos , Metástase Linfática , Imagem por Ressonância Magnética/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Pélvicas/diagnóstico por imagem , Neoplasias Pélvicas/patologia , Recidiva , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/patologia , Estudos Retrospectivos , Neoplasias Testiculares/patologia , Adulto Jovem
15.
J Pediatr Surg ; 54(7): 1495-1499, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31239061

RESUMO

BACKGROUND: Retroperitoneal teratoma is uncommon and carries considerable surgical risks. Some preoperative clinical and radiographic features could be predictive of surgical complication risk. We aimed to identify surgical risk factors that predicted perioperative complications. METHODS: Childhood retroperitoneal teratoma cases operated on at Guangzhou Women and Children's Medical Center were retrospectively reviewed. Demographic features; clinical, laboratory, radiographic, and intraoperative findings; perioperative complications; and pathology results were assessed. RESULTS: Between May 2000 and December 2017, 152 childhood retroperitoneal teratomas were resected from 102 female patients (median age 5.75 months). Sixty-three patients (41%) experienced perioperative complications (79 intraoperative and 5 postoperative), including kidney excision (4 patients) and adrenal gland excision (1 patient). Among 113 patients with preoperative computed tomography/magnetic resonance images, 112 (99%), 111 (98%), and 113 (100%) demonstrated artery, vein, and organ distortion, respectively, and 28 (25%) had vessels encased by tumors. Patients with perioperative complications had more veins and organs distorted by tumors. In multivariate analysis, the numbers of vessels encased and organs distorted by tumors were significantly associated with perioperative complications (odds ratio = 1.45 and 1.69, 95% confidence interval: 1.00-2.10 and 1.19-2.41, respectively). CONCLUSIONS: Retroperitoneal teratoma resection has a high perioperative complication rate. Teratomas encompassing the vasculature and distorting organs were associated with increased surgical risk. Additional studies aiming to better define the surgical approach to retroperitoneal teratoma are warranted. LEVELS OF EVIDENCE: III.


Assuntos
Neoplasias Retroperitoneais/cirurgia , Teratoma/cirurgia , Criança , Feminino , Humanos , Lactente , Masculino , Neoplasias Retroperitoneais/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Teratoma/diagnóstico por imagem
16.
Pediatr Blood Cancer ; 66(9): e27825, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31135092

RESUMO

Neonatal neuroblastoma may require chemotherapy either due to mass effect or unfavourable cytogenetics. This case focuses on using pharmacokinetic (PK) guided chemotherapy to treat neonatal neuroblastoma. A newborn baby was noted to have left leg immobility. Imaging showed a retroperitoneal tumour with spinal canal extension causing spinal cord compression. PK-guided carboplatin was given after conventionally dosed chemotherapy demonstrated no improvement. After initiation of PK therapy, clinical and radiological improvement was seen. We discuss our decision to use PK-guided chemotherapy despite guidelines recommending weight-based dosing and discuss the benefits in terms of clinical efficacy without increased toxicity.


Assuntos
Carboplatina , Recém-Nascido Prematuro , Neuroblastoma , Neoplasias Retroperitoneais , Compressão da Medula Espinal , Carboplatina/administração & dosagem , Carboplatina/farmacocinética , Feminino , Humanos , Recém-Nascido , Neuroblastoma/diagnóstico por imagem , Neuroblastoma/tratamento farmacológico , Neuroblastoma/metabolismo , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Retroperitoneais/metabolismo , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/tratamento farmacológico , Compressão da Medula Espinal/metabolismo
17.
Chirurgia (Bucur) ; 114(2): 300-306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060665

RESUMO

Introduction: We report a rare case of testicular teratoma combined with a neuroendocrine tumour, emphasizing the difficulty of the following aspects: the clinical and laboratory diagnosis, the treatment options and the evolution of patients suffering from this disease. Case presentation: The patients with testicular neuroendocrine tumours represent a rarity, considering that as of 2017, only 22 cases had been reported in the literature. The case operated on in our clinic presents an association between a testicular teratoma and a neuroendocrine tumour. A 39-year-old patient was admitted in our Department for a non-painful abdominal tumour and concomitant testicular tumour. The serum tumour markers (-human chorionic gonadotropin, -phetoprotein and lactate dehydrogenase) were within normal limits. Lung and bone metastases were diagnosed CT scan. The histopathological diagnosis consisted of immunohistochemical study of the orchidectomy specimen as well as of the bioptic material from bone marrow puncture. Conclusions: The diagnosis of testicular carcinoids is based on immunohistochemistry study. Radical orchidectomy is the only potentially curative treatment for this type of malignancy. Adjuvant chemotherapy determined size reduction of the lung and bone metastases and the disappearance of the lymph node metastases.


Assuntos
Tumores Neuroendócrinos/terapia , Neoplasias Retroperitoneais/terapia , Teratoma/terapia , Neoplasias Testiculares/terapia , Adulto , Antineoplásicos/administração & dosagem , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Quimioterapia Adjuvante , Humanos , Imuno-Histoquímica , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/secundário , Neoplasias Pulmonares/terapia , Metástase Linfática , Masculino , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/secundário , Orquiectomia , Radioterapia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/secundário , Teratoma/diagnóstico por imagem , Teratoma/secundário , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/patologia , Resultado do Tratamento
19.
Cancer Imaging ; 19(1): 28, 2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31142361

RESUMO

BACKGROUND: Testicular germ cell tumour is the commonest malignancy affecting males aged between 15 and 35, with an increased relative risk amongst those with a history of cryptorchidism. In patients presenting with locoregional metastatic disease, retroperitoneal and pelvic soft tissue masses are common findings on ultrasound and computed tomography, which has several differential diagnoses within this demographic cohort. On staging 18F-FDG-PET/CT, understanding the typical testicular lymphatic drainage pathway facilitates prompt recognition of the pathognomonic constellation of unilateral absence of testicular scrotal activity, and FDG-avid nodal masses along the drainage pathway. We describe the cases of three young males presenting with abdominopelvic masses, in whom FDG-PET/CT was helpful in formulating a unifying diagnosis of metastatic seminoma, retrospectively corroborated by a history of testicular maldescent. CASE PRESENTATIONS: In all three cases, the patients were males aged in their 30s and 40s who were brought to medical attention for back and lower abdominal pain of varying duration. Initial imaging evaluation with computed tomography and/or ultrasound revealed large abdominopelvic soft tissue masses, with lymphoproliferative disorders or soft tissue sarcomas being high on the list of differential diagnoses. As such, they were referred for staging FDG-PET/CT, all of whom demonstrated the pathognomonic constellation of, 1) unilateral absence of scrotal testicular activity, and 2) FDG-avid nodal masses along the typical testicular lymphatic drainage pathway. These characteristic patterns were corroborated by a targeted clinical history and examination which revealed a history of cryptorchidism, and elevated ß-hCG in two of three patients. All were subsequently confirmed as metastatic seminoma on biopsy and open resection. CONCLUSION: These cases highlight the importance of clinical history and examination for the clinician, as well as a sound knowledge of the typical testicular lymphatic drainage pathway for the PET physician, which would assist with prompt recognition of the characteristic imaging patterns on FDG-PET/CT. It further anecdotally supports the utility of FDG-PET/CT in evaluating undiagnosed abdominopelvic masses, as well as a potential role in the initial staging of germ cell tumours in appropriately selected patients.


Assuntos
Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Testiculares/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Masculino , Compostos Radiofarmacêuticos
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