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1.
Medicine (Baltimore) ; 99(14): e19600, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32243382

RESUMO

Slipped capital femoral epiphysis (SCFE) is a very common disorder affecting the adolescent hip. The etiology of SCFE is multifactorial and mechanical force associated with the characteristic morphology of the hip is considered one of the causes of SCFE. We investigated the characteristics of whole pelvic morphology including pelvic incidence (PI) in patients with SCFE and compared it with pelvic morphology in healthy children. We retrospectively assessed the whole pelvic morphology of 17 patients with SCFE and 51 healthy children using their pelvic computed tomography data. We measured superior iliac angle, inferior iliac angle, and ischiopubic angle as the parameters of pelvic rotation. Additionally, we measured acetabular anteversion of the superior acetabulum (AVsup) and of the center of the acetabulum (AVcen), and measured anterior acetabular sector angle (AASA), posterior acetabular sector angle, and the superior acetabular sector angle (SASA) as parameters of acetabular coverage and PI. Each measurement was compared between the 2 groups. AASA and SASA of patients with SCFE were significantly greater than that of controls, and AVsup of patients with SCFE was significantly smaller. There were no significant differences in pelvic rotation, PI, or AVcen between the 2 groups. This is the 1st report to evaluate SCFE patients' whole pelvic morphology including PI and pelvic rotation. Our results showed that patients with SCFE have excessive coverage of the anterior and superior acetabulum, and a more retroverted cranial acetabulum as compared with healthy control subjects. Such characteristic pelvic morphology may be involved in the onset of SCFE. To clarify the mechanical forces involved in SCFE onset, further investigations of pelvic morphology and alignment, including the femur and spine, are needed.


Assuntos
Acetábulo/patologia , Pelve/patologia , Escorregamento das Epífises Proximais do Fêmur/patologia , Tomografia Computadorizada por Raios X , Acetábulo/diagnóstico por imagem , Adolescente , Criança , Feminino , Humanos , Masculino , Pelve/diagnóstico por imagem , Estudos Retrospectivos , Escorregamento das Epífises Proximais do Fêmur/diagnóstico por imagem
2.
Prostate ; 80(4): 345-351, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31899555

RESUMO

BACKGROUND: The optimal extent of lymph node dissection in radical prostatectomy has not been determined. Lymph nodes in the fossa of Marcille, which is an important pelvic lymphatic pathway and candidate for additional dissection, have not been evaluated at the molecular level. Here, we assessed by molecular analysis the presence of occult positive lymph nodes in the fossa of Marcille in patients with clinically localized high-risk prostate cancer. METHODS: Fifty-two patients with clinically localized high-risk prostate cancer underwent pelvic lymph node dissection accompanied by robot-assisted radical prostatectomy. All nodal packets were dissected separately and grouped into right and left obturator, external and internal iliac regions (including common iliac region to ureter crossing), and fossa of Marcille. All lymph nodes were bisected and evaluated by histopathological or molecular analysis using a quantitative reverse transcription-polymerase chain reaction. The number of positive lymph nodes in the fossa of Marcille and the difference in detection rate were investigated using histopathological and molecular analyses. Perioperative complication rate and predictive factors for biochemical recurrence were evaluated. RESULTS: In the molecular analysis, there were seven positive lymph nodes in the fossa of Marcille in three patients, which were coexistent with positive nodes in other regions. The detection rate of positive lymph nodes was significantly higher using molecular than histopathological analysis (P < .01). Perioperative complication rate within 90 days after the operation was 25.0% and no Clavien-Dindo grade ≥3 complication was confirmed. Detection of metastasis by histopathological and molecular analysis was a significant factor related to biochemical recurrence in the Cox proportional hazards regression model. CONCLUSIONS: No case of positive lymph nodes in the fossa of Marcille that had skipped over other regions was confirmed. Additional lymph node dissection of fossa of Marcille did not lead to complete resection of molecularly positive lymph nodes.


Assuntos
Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/cirurgia , Idoso , Humanos , Calicreínas/sangue , Excisão de Linfonodo/métodos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Pelve/patologia , Pelve/cirurgia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/métodos
3.
Zhonghua Wai Ke Za Zhi ; 58(1): 52-56, 2020 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-31902171

RESUMO

Recently, with the development and widespread application of total mesorectal excision and neoadjuvant chemoradiotherapy, the long-term overall survival and disease-free survival of patients with middle & low rectal cancer have been greatly improved. Moreover, there are also researches in minimally invasive techniques, such as laparoscopy and robotic surgical system in the radical rectal surgery, as well as the combination of tumor molecular targeting markers and gene sequencing technology. Nowadays, the treatment of rectal cancer has entered a new era of individualized precise medicine. However, there are still some controversies in lateral lymph node dissection. The criteria of diagnosis and treatment, neoadjuvant therapy, indications of lateral lymph node dissection, the area of dissection and neuroprotection are still unsatisfactory. It is necessary to explore the personalized treatment strategies of lateral lymph node dissection in the precise medical era.


Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retais/patologia , Terapia Combinada , Humanos , Metástase Linfática , Pelve/patologia , Pelve/cirurgia , Medicina de Precisão , Neoplasias Retais/cirurgia
4.
Jpn J Clin Oncol ; 50(2): 145-151, 2020 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-31688935

RESUMO

BACKGROUND: The exact impact of full-staging lymphadenectomy on patients with primary mucinous epithelial ovarian carcinoma confined to the ovary is still unclear. In this study, we investigated the prognostic impact of lymphadenectomy covering both pelvic and para-aortic lymph nodes in patients with clinically-apparent stage I mucinous epithelial ovarian carcinoma, using data from multi-institutions under a central pathological review system and analyses with a propensity score-based method. METHODS: We conducted a regional multi-institutional retrospective study between 1986 and 2017. Among 4730 patients with malignant ovarian tumors, a total of 186 women with mucinous epithelial ovarian carcinoma were eligible. We evaluated differences in survival outcomes between patients with both pelvic and para-aortic lymphadenectomy and those with only pelvic lymphadenectomy and/or clinical lymph node evaluation. To analyze the therapeutic effects, the baseline imbalance between patients with both pelvic and para-aortic lymphadenectomy and others was adjusted with an inverse probability of treatment weighting using propensity score involving independent clinical variables. RESULTS: Fifty-five patients received both pelvic and para-aortic lymphadenectomy. With PS-based adjustment, both pelvic and para-aortic lymphadenectomy did not have additive effects regarding overall survival (P = 0.696) and recurrence-free survival (P = 0.978). Multivariate analysis similarly showed no significant impact of both pelvic and para-aortic lymphadenectomy on their prognosis. CONCLUSIONS: The effect of pelvic and para-aortic lymphadenectomy is limited for clinically-apparent stage I primary mucinous epithelial ovarian carcinoma as long as full peritoneal and clinical lymph node evaluations are conducted. The results of this study should be used as the basis for additional studies, including prospective trials.


Assuntos
Carcinoma Epitelial do Ovário/patologia , Carcinoma Epitelial do Ovário/cirurgia , Excisão de Linfonodo/métodos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Adulto , Aorta Abdominal/patologia , Carcinoma Epitelial do Ovário/mortalidade , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/mortalidade , Pelve/patologia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Análise de Sobrevida
5.
AJR Am J Roentgenol ; 214(1): 194-199, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31714843

RESUMO

OBJECTIVE. The purpose of this study was to evaluate the utility of compression of tissues with the ultrasound transducer in decreasing distance to the biopsy target and establishing a safe percutaneous biopsy route to deep abdominopelvic targets. MATERIALS AND METHODS. Ultrasound-guided biopsies of nonsolid organ abdominopelvic targets performed from 2006 to 2017 were reviewed. Skin-to-target distance was measured on preprocedure CT scans for reference standard and on procedure ultrasound images for actual real-time distance after compression. The skin-to-target CT distance groupings were 0-3 cm, 3-6 cm, 6-10, cm, and > 10 cm. Deep targets were defined as > 6 cm. Differences in skin-to-target distance between static CT and compression ultrasound were calculated. Body mass index, procedure details, diagnostic yield, and complication rate were recorded. RESULTS. The biopsies of 389 patients (167 men, 222 women; mean age, 62.4 years; mean body mass index, 28.2) were assessed. Skin-to-target distance was 0-3 cm in 108 patients, 3-6 cm in 163 patients, 6-10 cm in 99 patients, and > 10 cm in 19 patients. A total of 118 deep targets were identified. The mean skin-to-target distance in the entire cohort was 5.0 cm on CT scans and 3.6 cm on ultrasound images with a 10% mean decrease in distance with ultrasound compression. For skin-to-target distances of 6-10 cm, distance decreased 39% at ultrasound, and for skin-to-target distances > 10 cm, distance decreased 48%. Thirty-three patients (8.5%) had no safe identifiable path for CT biopsy, most commonly because of intervening bowel, displacement of which at ultrasound allowed a safe biopsy trajectory. Ultrasound-guided biopsy had a diagnostic yield of 91.5% and a favorable safety profile. The complication rate was 1.3%. CONCLUSION. Application of compression with the ultrasound transducer decreased skin-to-target distance 40% or more for deep targets in addition to displacing bowel and establishing a safe path for biopsy in approximately 8.5% of cases.


Assuntos
Abdome/patologia , Biópsia Guiada por Imagem/métodos , Pelve/patologia , Ultrassonografia de Intervenção/métodos , Adulto , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Pele
6.
Eur Radiol ; 30(1): 328-336, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31332559

RESUMO

OBJECTIVES: Despite the advantages of prostate-specific membrane antigen (PSMA)-PET/MR over PSMA-PET/CT, its relatively long scanning time and suboptimal PET attenuation correction necessitate careful assessment of the most appropriate setting for this type of study. We assessed lesion agreement between PSMA-PET/MR and PSMA-PET/CT in patients undergoing initial evaluation of prostate cancer. METHODS: This was a prospective study of consecutive patients with histological biopsy-proven prostate cancer who underwent pelvic PSMA-PET/MR followed by whole-body PSMA-PET/CT. All conspicuous PSMA-avid foci were counted on PSMA-PET/CT and PSMA-PET/MR with CT or MR correlation. Analysis was performed for intra-prostatic lesions, capsular invasion, seminal vesicle involvement and lymph node and bone involvement. Incidental and significant findings seen on PSMA-PET/CT outside the PSMA-PET/MR field of view were also analysed. Agreements between PSMA-PET/CT and PSMA-PET/MR findings were performed using Cohen's kappa test. RESULTS: Image analysis was performed on 140 patients (mean age, 67.3 ± 8.2 years). Agreement between PSMA PET/CT and PSMA-PET/MR was very good for intra-prostatic PSMA-avid foci (K = 0.85) and pelvic lymph nodes (K = 0.98), good for PSMA-avid bone metastases (K = 0.76) and fair for prostatic capsular invasion (K = 0.25) and seminal vesicle involvement (K = 0.31). Twelve patients (8.5%) had incidental findings and two patients (1.4%) had clinically significant findings. CONCLUSION: Limited pelvic PSMA-PET/MR has very good agreement with PET/CT regarding PSMA-avid prostatic, regional lymph nodes and bone lesions, and is superior to PET/CT with regard to capsular invasion and seminal vesicle involvement. KEY POINTS: • Limited pelvic PSMA-PET/MR is superior to whole-body PSMA-PET/CT in detecting extensions of localised disease, mainly due to the high soft tissue resolution of MR. • Limited pelvic PSMA-PET/MR may be useful for initial evaluation of histological biopsy-proven prostate cancer. • Further studies are warranted to evaluate limited pelvic PSMA-PET/MR for screening and active surveillance in selected populations.


Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Imagem por Ressonância Magnética/métodos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Tomografia por Emissão de Pósitrons/métodos , Neoplasias da Próstata/diagnóstico por imagem , Idoso , Biópsia , Neoplasias Ósseas/secundário , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Pelve/diagnóstico por imagem , Pelve/patologia , Estudo de Prova de Conceito , Estudos Prospectivos , Neoplasias da Próstata/patologia , Glândulas Seminais/patologia
8.
World J Surg Oncol ; 17(1): 225, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864368

RESUMO

BACKGROUND: Pelvic lymphadenectomy (PLND) is an integral part of curative surgery for high-risk non-muscle invasive and muscle-invasive bladder cancer. The therapeutic value of extended PLND is controversial. METHODS: We conducted a comprehensive online search in PubMed, EMBASE, and the Cochrane Library databases for relevant literature directly comparing extended PLND (e-PLND) with non-extended PLND (ne-PLND) from database inception to June 2019. We performed the meta-analysis to evaluate the impact of PLND templates on recurrence-free survival (RFS), disease-specific survival (DSS), overall survival (OS), rates of postoperative major complications, and mortality within 90 days of surgery. RESULTS: A total of 10 studies involving 3979 patients undergoing either e-PLND or ne-PLND were included. The results showed that e-PLND was significantly associated with better RFS (HR 0.74, 95% CI 0.62-0.90, p = 0.002) and DSS (HR 0.66, 95% CI 0.55-0.79, p < 0.001). However, no correlation was found between e-PLND template and a better OS (HR 0.93, 95% CI 0.55-1.58, p = 0.79). Postoperative major complications were similar between e-PLND group and ne-PLND group, as was mortality within 90 days of surgery. CONCLUSION: e-PLND template is correlated with favorable RFS and DSS outcomes for patients with bladder cancer. e-PLND did not have more postoperative major complications than did ne-PLND.


Assuntos
Cistectomia/mortalidade , Excisão de Linfonodo/mortalidade , Neoplasias da Bexiga Urinária/mortalidade , Neoplasias da Bexiga Urinária/cirurgia , Cistectomia/métodos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/cirurgia , Metástase Linfática , Pelve/patologia , Complicações Pós-Operatórias/etiologia , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa de Sobrevida , Resultado do Tratamento , Neoplasias da Bexiga Urinária/patologia
9.
Am J Hum Genet ; 105(6): 1294-1301, 2019 12 05.
Artigo em Inglês | MEDLINE | ID: mdl-31761294

RESUMO

The development of hindlimbs in tetrapod species relies specifically on the transcription factor TBX4. In humans, heterozygous loss-of-function TBX4 mutations cause dominant small patella syndrome (SPS) due to haploinsufficiency. Here, we characterize a striking clinical entity in four fetuses with complete posterior amelia with pelvis and pulmonary hypoplasia (PAPPA). Through exome sequencing, we find that PAPPA syndrome is caused by homozygous TBX4 inactivating mutations during embryogenesis in humans. In two consanguineous couples, we uncover distinct germline TBX4 coding mutations, p.Tyr113∗ and p.Tyr127Asn, that segregated with SPS in heterozygous parents and with posterior amelia with pelvis and pulmonary hypoplasia syndrome (PAPPAS) in one available homozygous fetus. A complete absence of TBX4 transcripts in this proband with biallelic p.Tyr113∗ stop-gain mutations revealed nonsense-mediated decay of the endogenous mRNA. CRISPR/Cas9-mediated TBX4 deletion in Xenopus embryos confirmed its restricted role during leg development. We conclude that SPS and PAPPAS are allelic diseases of TBX4 deficiency and that TBX4 is an essential transcription factor for organogenesis of the lungs, pelvis, and hindlimbs in humans.


Assuntos
Anormalidades Múltiplas/etiologia , Doenças do Desenvolvimento Ósseo/etiologia , Ectromelia/etiologia , Quadril/anormalidades , Homozigoto , Ísquio/anormalidades , Mutação com Perda de Função , Pneumopatias/etiologia , Pulmão/anormalidades , Patela/anormalidades , Pelve/anormalidades , Proteínas com Domínio T/genética , Anormalidades Múltiplas/patologia , Adolescente , Doenças do Desenvolvimento Ósseo/patologia , Criança , Ectromelia/patologia , Feminino , Quadril/patologia , Humanos , Ísquio/patologia , Pulmão/patologia , Pneumopatias/patologia , Masculino , Patela/patologia , Linhagem , Pelve/patologia , Prognóstico
10.
PLoS One ; 14(11): e0225249, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31738788

RESUMO

BACKGROUND: Ovarian cancer is the fifth most common cancer in women worldwide. Moreover, there are no reliable minimal invasive tests to secure the diagnosis of malignant pelvic masses. Cell-free, circulating microRNAs have the potential as diagnostic biomarkers in cancer. Here, we performed and validated a miRNA panel with the potential to distinguish OC from benign pelvic masses. METHODS: The profile of plasma microRNA was determined with a panel of 46 candidates in a discovery group and a validation group, each consisting of 190 pre-surgery plasma samples from age-matched patients with malignant (n = 95) and benign pelvic mass (n = 95), by real time RT-qPCR. RESULTS: Four up-regulated (miR-200c-3p, miR-221-3p, miR-21-5p, and miR-484) and two down-regulated (miR-195-5p and miR-451a) microRNAs were discovered. From those, miR-200c-3p and miR-221-3p were further confirmed in a validation cohort. A combination of these 2 microRNAs together with CA-125 yielded an overall diagnostic accuracy of AUC = 0.96. CONCLUSIONS: We showed consistent plasma microRNA profiles that provide independent diagnostic information of late stage OC.


Assuntos
Biomarcadores Tumorais , MicroRNA Circulante , MicroRNAs/genética , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/genética , Pelve/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Perfilação da Expressão Gênica , Humanos , MicroRNAs/sangue , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Ovarianas/sangue , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Curva ROC , Transcriptoma
11.
Int J Hyperthermia ; 36(1): 1147-1159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31752562

RESUMO

Purpose: To evaluate the feasibility and assess safety parameters of magnetic resonance-guided high-intensity focused ultrasound (MRgHIFU)-mediated hyperthermia (HT; heating to 40-45 °C) in various pelvic targets in a porcine model in vivo.Methods: Thirteen HT treatments were performed in six pigs with a commercial MRgHIFU system (Sonalleve V2, Profound Medical Inc., Mississauga, Canada) to muscle adjacent to the ventral/dorsal bladder wall and uterus to administer 42 °C (±1°) for 30 min (±5%) using an 18-mm target diameter and 100 W power. Feasibility was assessed using accuracy, uniformity, and MR-thermometry performance-based metrics. Safety parameters were assessed for tissues in the targets and beam-path by contrast-enhanced MRI, gross-pathology and histopathology.Results: Across all HT sessions, the mean difference between average temperature (Tavg) and the target temperature within the target region-of-interest (tROI, the cross-section of the heated volume at focal depth) was 0.51 ± 0.33 °C. Within the tROI, the temperature standard deviation averaged 1.55 ± 0.31 °C, the average 30-min Tavg variation was 0.80 ± 0.17 °C, and the maximum difference between Tavg and the 10th- or 90th-percentile temperature averaged 2.01 ± 0.44 °C. The average time to reach ≥41 °C and cool to ≤40 °C within the tROI at the beginning and end of treatment was 47.25 ± 27.47 s and 66.37 ± 62.68 s, respectively. Compared to unheated controls, no abnormally-perfused tissue or permanent damage was evident in the MR images, gross pathology or histological analysis.Conclusions: MRgHIFU-mediated HT is feasible and safety assessment is satisfactory for treating an array of clinically-mimicking pelvic geometries in a porcine model in vivo, implying the technique may have utility in treating pelvic targets in human patients.


Assuntos
Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Imagem por Ressonância Magnética/métodos , Pelve/patologia , Animais , Estudos de Viabilidade , Febre , Humanos , Suínos
12.
Biomed Res Int ; 2019: 5958402, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781626

RESUMO

Up to one-third of fertile-age women with severe endometriosis suffer from colonic involvement. Transvaginal ultrasonography has become a first-line diagnostic tool for the study of the pelvis and more specifically for the diagnosis of pelvic endometriosis. Accuracy of pelvic ultrasound for deep endometriosis increases with operator experience, but the difficulties in the differential diagnosis with diseases that can afflict the bowel tract remain a challenge. We reviewed noteworthy cases referred for secondary level diagnosis suspected of bowel endometriosis in which the subsequent ultrasound led to an alternative diagnosis. This case series aims to highlight awareness for both experts and less-experienced operators the possible differential diagnoses of bowel lesions that initially resemble endometriosis.


Assuntos
Endometriose/diagnóstico por imagem , Endometriose/patologia , Intestinos/diagnóstico por imagem , Intestinos/patologia , Ultrassonografia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento Tridimensional , Pólipos Intestinais/diagnóstico por imagem , Pólipos Intestinais/patologia , Itália , Pelve/diagnóstico por imagem , Pelve/patologia , Estudos Retrospectivos
13.
Cancer Invest ; 37(10): 524-530, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31597501

RESUMO

The oncological benefit of pelvic lymph node dissection (PLND) is still debatable because data on clinical outcomes of radical prostatectomy (RP) without PLND are lacking. In this study, we reported oncological outcome in consecutive 146 patients who underwent RP without PLND. Although 27% of our patients developed biochemical recurrence, the estimated 5-year overall survival rates were 100%, 96.3%, and 95.7% in the low-, intermediate-, and high-risk groups, respectively. These data in our patients were not inferior to those in previous reports that investigated the survivals in patients who received PLND during RP. The therapeutic significance of PLND should be re-evaluated.


Assuntos
Linfonodos/cirurgia , Pelve/patologia , Neoplasias da Próstata/cirurgia , Idoso , Seguimentos , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Metástase Linfática/patologia , Masculino , Pessoa de Meia-Idade , Pelve/cirurgia , Próstata/patologia , Próstata/cirurgia , Prostatectomia/métodos , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida , Resultado do Tratamento
14.
J Radiol Case Rep ; 13(3): 28-36, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31565175

RESUMO

Castleman Disease is a lymphoid disorder characterized by the presence of an enlarged or abnormal lymph node/lymphatic tissue. The disease is classified into unicentric or multicentric variants. The unicentric form is a benign disorder that is usually asymptomatic and consists of a single lymphoid mass that is predominantly located in the mediastinum, but can also rarely develop in the neck or abdomen. The multicentric type involves more than one lymphatic station and is related to the presence of type B symptoms (fevers, night sweats and weight loss), HIV/HHV8 infection and increased serum IL-6 levels. We present the case of an unusual pelvic intraperitoneal manifestation of Castleman Disease in a 52-year-old caucasian woman who showed clinical, radiological, histological and laboratory findings common to both Unicentric and Multicentric Castleman Disease.


Assuntos
Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Pelve/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/patologia , Feminino , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Pessoa de Meia-Idade , Pelve/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Ultrassonografia
15.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 937-942, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630490

RESUMO

The anorectum is a complex region, whose anatomic structure is the basis and premise of intersphincteric resection (ISR) for low rectal cancer. With the development of pelvic surgery and minimally invasive surgery, the anatomic approaches, surgical planes, extent of excision and reconstruction strategies of ISR have been better understood. Surgeons can furthest preserve anal function as well as adhere to the principles of radical resection. However, the anatomy of the anorectum has not been fully understood. We hope further exploration of the anal canal anatomy, including the perirectal fascia, rectourethral muscle, anococcygeal ligament, hiatal ligament, levator ani muscle, internal and externals phincter, intersphincteric nerves, conjointed longitudinal muscle, intersphincteric spaces and the surgical approaches, by reviewing relevant literatures combined with the experiences of our clinical practice and applied anatomy, will help to improve the accuracy of the surgeries and increase the oncologic and functional outcomes of ISR.


Assuntos
Canal Anal/patologia , Canal Anal/cirurgia , Pelve/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Canal Anal/anatomia & histologia , Canal Anal/inervação , Fáscia/anatomia & histologia , Humanos , Diafragma da Pelve/anatomia & histologia , Diafragma da Pelve/patologia , Diafragma da Pelve/cirurgia , Pelve/anatomia & histologia , Pelve/patologia
16.
Biopreserv Biobank ; 17(6): 562-569, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31618057

RESUMO

Introduction: Personalized treatment, supported by biomarkers, would improve survival of ovarian cancer patients. RNA molecules are potentially important biomarkers. The Danish CancerBiobank provides an infrastructure for handling and storage of biological material, including RNA, from Danish cancer patients. The aim of this study was to investigate the effects of handling-time and fresh-freezing versus RNAlater® fixation on RNA degradation in solid tissue from pelvic mass samples. Materials and Methods: We evaluated RNA quality in surgical tissue from patients with a pelvic mass. Corresponding samples were either fresh-frozen or fixed in RNAlater, at eight different time points after the surgery. Integrity was measured using a bioanalyzer, and the amount and quality were further investigated by quantitative reverse transcription-polymerase chain reaction measuring the expression of housekeeping genes B2M and HPRT1. Results: Our results show that tissue RNA is stable up to at least 180 minutes after the surgery, as the quality was comparable to the quality of RNA handled immediately. Likewise, patient RNA was of acceptable quality after both fresh-frezing and RNAlater fixation, but RNAlater fixation was slightly more effective for RNA preservation. Discussion and Conclusion: Our data suggest that RNA in pelvic mass samples is relatively stable. Knowledge about RNA stability is an important prerequisite for research in RNA biomarkers, where the challenge is to balance the need for careful RNA handling and storage with the need for effective large-scale biobanking in a busy clinical setting where patient treatment is the main priority.


Assuntos
Congelamento/efeitos adversos , Pelve/patologia , RNA/química , RNA/normas , Fixação de Tecidos/métodos , Adulto , Idoso , Dinamarca , Feminino , Genes Essenciais , Humanos , Pessoa de Meia-Idade , Medicina de Precisão , RNA/efeitos adversos , Estabilidade de RNA , Microglobulina beta-2/genética
17.
Anticancer Res ; 39(10): 5617-5621, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31570458

RESUMO

BACKGROUND/AIM: Involvement of lymph nodes (LNs) and their surgical resection in low-grade ovarian cancer remains a field of discussion. The aim of this study was to determine the incidence and pattern of distribution of lymph node metastases in patients with low-grade serous ovarian cancer. PATIENTS AND METHODS: A retrospective analysis was carried out in patients with primary low-grade serous ovarian cancer who underwent primary surgery including systematic lymphadenectomy. Analysis of the affected LNs along with pattern of lymphatic spread was performed. RESULTS: Thirty-seven patients who underwent systematic pelvic and para-aortal LN dissection were identified. The median age was 48 years (range=26-76 years). The majority of patients had International Federation of Gynecology and Obstetrics stage III (89.2%). A median of 41 (range=10-97) LNs were resected. LN metastases were found in 27 (72.9%) patients. In 15 (55.5%) patients, both pelvic and para-aortic LNs were affected concomitantly, in isolated para-aortal and pelvic lymph nodes in three (11.1%) and eight (29.6%) patients, respectively. The most frequently affected region was the right obturator fossa, found in 14 (51.8%) patients, followed by the left obturator fossa in 11 (40.7%) patients. CONCLUSION: Low-grade serous ovarian cancer exhibits a high percentage of lymphatic spread, with more confinement to the pelvic compared to the para-aortic region.


Assuntos
Cistadenocarcinoma Seroso/epidemiologia , Cistadenocarcinoma Seroso/patologia , Linfonodos/patologia , Metástase Linfática/patologia , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/patologia , Adulto , Idoso , Feminino , Humanos , Incidência , Excisão de Linfonodo/métodos , Pessoa de Meia-Idade , Estadiamento de Neoplasias/métodos , Pelve/patologia , Estudos Retrospectivos
18.
Oncol Res Treat ; 42(11): 553-563, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31533125

RESUMO

BACKGROUND: The aim of this study was to determine the prognostic role of obesity on oncological outcomes, surgical complications, and postoperative morbidity of patients with early-stage cervical cancer. METHODS: Between 2000 and 2016, we enrolled 500 patients with early-stage cervical cancer who underwent radical hysterectomy with pelvic node dissection (RHND) at Songklanagarind Hospital. For analysis, patients were divided based on their body mass index (BMI) into under-normal weight (<25 kg/m2), overweight (25-29.99 kg/m2), and obese (≥30 kg/m2) groups. RESULTS: The median age was 47 years, and the median BMI was 24.3 kg/m2 (25% quartile, 22.0 kg/m2; 75% quartile, 27.4 kg/m2). Patients in the obese and overweight groups were more likely to have comorbidities and adenocarcinoma than patients in the under-normal weight group. The median operative time (OT) was significantly longer in the obese and overweight groups than in the under-normal weight group. The 5-year recurrence-free survival (RFS) of the under-normal weight, overweight, and obese groups was 87.5, 86.2, and 97.6%, respectively, and the 5-year overall survival (OS) times were 95.8, 97.8, and 100%, respectively. There were no significant differences in RFS or OS among the 3 weight groups. Multivariate analysis did not identify BMI as a prognostic factor for RFS and OS. CONCLUSIONS: A high BMI was not associated with increased surgical complications or postoperative morbidity; furthermore, it was not associated with the prognosis of patients with early-stage cervical cancer after RHND. However, it was associated with adenocarcinoma and longer OT.


Assuntos
Obesidade/complicações , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/mortalidade , Adulto , Idoso , Terapia Combinada , Comorbidade , Feminino , Seguimentos , Humanos , Histerectomia/métodos , Estimativa de Kaplan-Meier , Excisão de Linfonodo , Linfonodos/patologia , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pelve/patologia , Prognóstico , Fatores de Risco , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/terapia
19.
Technol Cancer Res Treat ; 18: 1533033819874788, 2019 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31510886

RESUMO

Knowledge models in radiotherapy capture the relation between patient anatomy and dosimetry to provide treatment planning guidance. When treatment schemes evolve, existing models struggle to predict accurately. We propose a case-based reasoning framework designed to handle novel anatomies that are of same type but vary beyond original training samples. A total of 105 pelvic intensity-modulated radiotherapy cases were analyzed. Eighty cases were prostate cases while the other 25 were prostate-plus-lymph-node cases. We simulated 4 scenarios: Scarce scenario, Semiscarce scenario, Semiample scenario, and Ample scenario. For the Scarce scenario, a multiple stepwise regression model was trained using 85 cases (80 prostate, 5 prostate-plus-lymph-node). The proposed workflow started with evaluating the feature novelty of new cases against 5 training prostate-plus-lymph-node cases using leverage statistic. The case database was composed of a 5-case dose atlas. Case-based dose prediction was compared against the regression model prediction using sum of squared residual. Mean sum of squared residual of case-based and regression predictions for the bladder of 13 identified outliers were 0.174 ± 0.166 and 0.459 ± 0.508, respectively (P = .0326). For the rectum, the respective mean sum of squared residuals were 0.103 ± 0.120 and 0.150 ± 0.171 for case-based and regression prediction (P = .1972). By retaining novel cases, under the Ample scenario, significant statistical improvement was observed over the Scarce scenario (P = .0398) for the bladder model. We expect that the incorporation of case-based reasoning that judiciously applies appropriate predictive models could improve overall prediction accuracy and robustness in clinical practice.


Assuntos
Modelos Teóricos , Pelve/efeitos da radiação , Planejamento da Radioterapia Assistida por Computador , Radioterapia de Intensidade Modulada , Algoritmos , Humanos , Órgãos em Risco , Pelve/diagnóstico por imagem , Pelve/patologia , Radiometria , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia Guiada por Imagem , Radioterapia de Intensidade Modulada/métodos , Reprodutibilidade dos Testes
20.
World Neurosurg ; 132: 118-128, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31476476

RESUMO

Spinal alignment, particularly with respect to spinopelvic parameters, is highly correlated with morbidity and health-related quality-of-life outcomes. Although the importance of spinal alignment has been emphasized in the deformity literature, spinopelvic parameters have not been considered in the context of spine oncology. Because the aim of oncologic spine surgery is mostly palliative, consideration of spinopelvic parameters could improve postoperative outcomes in both the primary and metastatic tumor population by taking overall vertebral stability into account. This review highlights the relevance of focal and global spinal alignment, particularly related to spinopelvic parameters, in the treatment of spine tumors.


Assuntos
Procedimentos Neurocirúrgicos/métodos , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Coluna Vertebral/cirurgia , Coluna Vertebral/patologia , Coluna Vertebral/cirurgia , Humanos , Pelve/patologia , Pelve/cirurgia , Neoplasias da Coluna Vertebral/secundário
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