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1.
Dermatol Clin ; 41(1): 133-140, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36410974

RESUMO

Cutaneous mesenchymal sarcomas are rare malignancies that include dermatofibrosarcoma protuberans, atypical fibroxanthoma, pleomorphic dermal sarcoma, cutaneous angiosarcoma, myofibrosarcoma, and leiomyosarcoma. These tumors lack consensus guidelines on staging and management. Treatment of local disease involves complete surgical removal but recurrence rates are higher compared with more common forms of nonmelanoma skin cancer. Cutaneous angiosarcoma, pleomorphic dermal sarcoma, and subcutaneous leiomyosarcoma have increased risk of metastatic spread and lower survival rate. Further research is needed on targeted therapies for these more aggressive sarcomas.


Assuntos
Hemangiossarcoma , Histiocitoma Fibroso Maligno , Leiomiossarcoma , Sarcoma , Neoplasias Cutâneas , Humanos , Hemangiossarcoma/patologia , Leiomiossarcoma/patologia , Neoplasias Cutâneas/cirurgia , Neoplasias Cutâneas/patologia , Sarcoma/cirurgia , Sarcoma/patologia
3.
World J Surg Oncol ; 20(1): 378, 2022 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-36464677

RESUMO

BACKGROUND AND OBJECTIVES: Excessive preoperative blood orders frequently occur during the preoperative planning of resections of sarcomas. We aimed to develop a prediction score model that would be able to identify a patient cohort in which the cross-matching could be safely evaded. PATIENTS AND METHODS: We retrospectively analyzed data of 309 consecutive patients with extra-abdominal soft tissue sarcomas treated between September 2012 and December 2014. Scorecard scores for variables were calculated and summarized to a total score that can be used for risk stratification. The score was used in a logistic regression model. Results of the optimized model were described as a receiver operating characteristic curve. RESULTS: Preoperative units of red blood cells were requested for 206 (66.7%) patients, of which only 31 (10%) received them. Five parameters were identified with high predictive power. In the visualized barplot, there was an increased risk of blood transfusion with a higher score of TRANSAR. CONCLUSION: A TRANSAR score is a new tool that can predict the probability of transfusion for patients with sarcoma. This may reduce the number of preoperative cross-matching and blood product ordering and associated costs without compromising patient care.


Assuntos
Sarcoma , Neoplasias de Tecidos Moles , Humanos , Estudos Retrospectivos , Sarcoma/cirurgia , Abdome , Modelos Logísticos
4.
Lancet Oncol ; 23(12): 1547-1557, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36343656

RESUMO

BACKGROUND: The standard preoperative radiotherapy regimen of 50 Gy delivered in 25 fractions for 5 weeks for soft tissue sarcomas results in excellent local control, with major wound complications occurring in approximately 35% of patients. We aimed to investigate the safety of a moderately hypofractionated, shorter regimen of radiotherapy, which could be more convenient for patients. METHODS: This single-centre, open-label, single-arm, phase 2 trial (HYPORT-STS) was done at a single tertiary cancer care centre (MD Anderson Cancer Center, Houston, TX, USA). We administered preoperative radiotherapy to a dose of 42·75 Gy in 15 fractions of 2·85 Gy/day for 3 weeks (five fractions per week) to adults (aged ≥18 years) with non-metastatic soft tissue sarcomas of the extremities or superficial trunk and an Eastern Cooperative Oncology Group performance status of 0-3. The primary endpoint was a major wound complication occurring within 120 days of surgery. Major wound complications were defined as those requiring a secondary operation, or operations, under general or regional anaesthesia for wound treatment; readmission to the hospital for wound care; invasive procedures for wound care; deep wound packing to an area of wound measuring at least 2 cm in length; prolonged dressing changes; repeat surgery for revision of a split thickness skin graft; or wet dressings for longer than 4 weeks. We analysed our primary outcome and safety in all patients who enrolled. We monitored safety using a Bayesian, one-arm, time-to-event stopping rule simulator comparing the rate of major wound complications at 120 days post-surgery among study participants with the historical rate of 35%. This trial is registered with ClinicalTrials.gov, NCT03819985, recruitment is complete, and follow-up continues. FINDINGS: Between Dec 18, 2018, and Jan 6, 2021, we assessed 157 patients for eligibility, of whom 120 were enrolled and received hypofractionated preoperative radiotherapy. At no time did the stopping rule computation indicate that the trial should be stopped early for lack of safety. Median postoperative follow-up was 24 months (IQR 17-30). Of 120 patients, 37 (31%, 95% CI 24-40) developed a major wound complication at a median time of 37 days (IQR 25-59) after surgery. No patient had acute radiation toxicity (during radiotherapy or within 4 weeks of the radiotherapy end date) of grade 3 or worse (Common Terminology Criteria for Adverse Events [CTCAE] version 4.0) or an on-treatment serious adverse event. Four (3%) of 115 patients had late radiation toxicity (≥6 months post-surgery) of at least grade 3 (CTCAE or Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer Late Radiation Morbidity Scoring Scheme): femur fractures (n=2), lymphoedema (n=1), and skin ulceration (n=1). There were no treatment-related deaths. INTERPRETATION: Moderately hypofractionated preoperative radiotherapy delivered to patients with soft tissue sarcomas was safe and could therefore be a more convenient alternative to conventionally fractionated radiotherapy. Patients can be counselled about these results and potentially offered this regimen, particularly if it facilitates care at a sarcoma specialty centre. Results on long-term oncological, late toxicity, and functional outcomes are awaited. FUNDING: The National Cancer Institute.


Assuntos
Lesões por Radiação , Sarcoma , Neoplasias de Tecidos Moles , Adulto , Humanos , Adolescente , Teorema de Bayes , Resultado do Tratamento , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia , Sarcoma/radioterapia , Sarcoma/cirurgia , Hipofracionamento da Dose de Radiação
5.
BMC Musculoskelet Disord ; 23(1): 1012, 2022 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-36424560

RESUMO

BACKGROUND: During pelvic Sarcoma resections, Surgeons often struggle to obtain negative margins while minimizing collateral damage and maintaining limb function. These complications are usually due to the complex anatomy of the pelvis. Here we present an accurate 3D surgical approach, including pre-operative printing of models and intraoperative patient-specific instruments (PSIs) for optimizing pelvic sarcoma resections. METHODS: This single-center retrospective study (N = 11) presents surgical, functional, and oncological outcomes of patients (average age 14.6 +/- 7.6 years, 4 males) who underwent pelvic sarcoma resections using a 3D surgical approach between 2016 and 2021. All patients were followed up for at least 24 months (mean = 38.9 +/- 30.1 months). RESULTS: Our results show promising surgical, oncological, and functional outcomes. Using a 3D approach, 90.9% had negative margins, and 63.6% did not require reconstruction surgery. The average estimated blood loss was 895.45 ± 540.12 cc, and the average surgery time was 3:38 ± 0.05 hours. Our results revealed no long-term complications. Three patients suffered from short-term complications of superficial wound infections. At 24 month follow up 72.7% of patients displayed no evidence of disease. The average Musculoskeletal Tumor Society (MSTS) score at 12 months was 22.81. CONCLUSION: 3D technology enables improved accuracy in tumor resections, allowing for less invasive procedures and tailored reconstruction surgeries, potentially leading to better outcomes in function and morbidity. We believe that this approach will enhance treatments and ease prognosis for patients diagnosed with pelvic sarcoma and will become the standard of care in the future.


Assuntos
Neoplasias Ósseas , Hemipelvectomia , Osteossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Masculino , Humanos , Criança , Adolescente , Adulto Jovem , Adulto , Hemipelvectomia/métodos , Salvamento de Membro , Estudos Retrospectivos , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/cirurgia , Resultado do Tratamento , Osteossarcoma/diagnóstico por imagem , Osteossarcoma/cirurgia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Margens de Excisão
6.
Surg Oncol ; 45: 101883, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36371906

RESUMO

BACKGROUND: Soft tissue sarcomas of the buttock (BSTS) are historically associated with a poor prognosis. The literature includes retrospective studies with small sample size. It is difficult to estimate the rate of local recurrence (LR), distant metastasis (DM) and overall survival (OS). A systematic review and meta-analysis was deployed to summarize the available information on BSTS patients that underwent surgical treatment. METHODS: The PubMed, EMBASE, Scopus and Google Scholar databases were reviewed for eligible studies following PRISMA guidelines. INCLUSION CRITERIA: (1) primary BSTS confirmed by pathological biopsy (2) indication for surgical treatment (3) reporting either the rate of LR, DM, or OS at 5-year (4) articles published up to December 2021 (5) english language. The Methodological Index for Non-Randomized Studies (MINORS) was applied for the quality appraisal. RESULTS: Six eligible studies with 216 BSTS patients were identified. Most patients underwent surgical resection, associated with radiation therapy. The most represented histological types were liposarcoma (n = 43, 19,9%), rhabdomyosarcoma (n = 27, 12.5%), and undifferentiated pleomorphic sarcoma (n = 23, 10.6%). High-grade tumor rates ranged from 37% to 88.2%, marginal resection rates from 20.3% to 50%, LR rates from 0% to 62.5%, DM rates from 37.5% to 62.5%. The pooled 5-year OS from 1941 to 2002 was 41% (IC95%: 33%-49%). The average MINORS score was 9.3 (range: 6 to 11). CONCLUSIONS: Surgical resection of BSTS had on average dissatisfactory outcomes, and the 5-year overall survival was poor, with high rates of local recurrence and distant metastasis. An effort to collect new data with a higher level of evidence is warranted.


Assuntos
Lipossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Nádegas/patologia , Estudos Retrospectivos , Neoplasias de Tecidos Moles/cirurgia , Neoplasias de Tecidos Moles/patologia , Sarcoma/cirurgia , Sarcoma/patologia , Recidiva Local de Neoplasia/patologia
7.
BMJ Case Rep ; 15(11)2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36332932

RESUMO

Spindle cell carcinoma is a subtype of sarcomatoid carcinoma, which has previously been described in various anatomical locations, though rarely in the trachea.We present the case of a woman in her 70s who presented with a sore throat and stridor. Fibreoptic nasendoscopy demonstrated a tracheal mass occupying 80% of the airway from the cricoid cartilage to the third tracheal ring, infiltrating the thyroid gland. Subsequent CT demonstrated pulmonary emboli and vertebral metastasis. Biopsy of the infiltrated thyroid confirmed the diagnosis of spindle cell carcinoma. The length of the tumour and metastasis at presentation made this surgically unresectable, and she was referred for a palliative stent but died after an acute deterioration.This pathology has been reported only five times previously in the literature, with management strategies varying greatly between patients. Primary tracheal tumours are difficult to manage as, due to their rarity, there are no clear guidelines.


Assuntos
Carcinoma , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias da Glândula Tireoide , Neoplasias da Traqueia , Feminino , Humanos , Traqueia/diagnóstico por imagem , Traqueia/patologia , Neoplasias da Traqueia/diagnóstico por imagem , Neoplasias da Traqueia/cirurgia , Sarcoma/diagnóstico por imagem , Sarcoma/cirurgia , Carcinoma/patologia , Neoplasias de Tecidos Moles/patologia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgia , Neoplasias da Glândula Tireoide/patologia
8.
Radiat Oncol ; 17(1): 190, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401312

RESUMO

BACKGROUND: Malignant peripheral nerve sheath tumors (MPNST) are sarcomas that arise from peripheral nerves. They generally have a poor prognosis which is exacerbated by high local recurrence rates. This case report discusses the treatment of a patient with a MPNST with local recurrence. This case report is novel due to the use of intraoperative Intrabeam™ (Zeiss, Dublin, CA) radiation therapy use in the protection of neurovascular structures such as the sciatic nerve. CASE PRESENTATION: The patient was a 65-year-old male who noticed a right posterior thigh mass slowly increasing in size over two months. A planned positive margin wide-resection excision was performed due to sciatic nerve abutment. The mass was determined to be a MPNST via postoperative pathology with positive margins along the sciatic nerve. The patient began adjuvant radiation therapy to the upper and lower thigh fields over a period of three months. Thirty-two months later, the patient was found to have a hypermetabolic mass with venous congestion and hyperemia at the prior surgical site which was confirmed by core needle biopsy to be local recurrence of the MPNST. Re-excision of the tumor was planned and performed followed by intraoperative Intrabeam™ radiation therapy. At two years of follow-up, the patient was doing well with minimal pain in his right buttock region with no new or recurrent neurological deficits. Radiologic imaging was negative for local recurrence of the MPNST. CONCLUSION: We believe this case report demonstrates a novel treatment strategy for sarcoma management. The unique use of intraoperative Intrabeam™ radiation therapy, which had not previously been used for this indication, may be efficacious in cases involving neurovascular structures. In this case, focal radiation from the intraoperative Intrabeam™ radiation device was used in a way to affect the recurrent tumor yet protect the sciatic nerve.


Assuntos
Neoplasias de Bainha Neural , Neurofibrossarcoma , Sarcoma , Humanos , Masculino , Idoso , Neurofibrossarcoma/complicações , Neurofibrossarcoma/patologia , Neoplasias de Bainha Neural/radioterapia , Neoplasias de Bainha Neural/cirurgia , Neoplasias de Bainha Neural/patologia , Nervo Isquiático/patologia , Dor , Sarcoma/radioterapia , Sarcoma/cirurgia
9.
Eur J Surg Oncol ; 48(11): 2299-2307, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36195471

RESUMO

Pelvic sarcomas are a rare and heterogenous group of tumors divided into two groups: soft tissue sarcomas and bone sarcomas. Soft tissue sarcomas of the pelvis include most commonly liposarcoma, leiomyosarcoma, gastrointestinal stromal tumors, malignant peripheral nerve sheath tumors, and solitary fibrous tumors. Bone sarcomas of the pelvis most commonly include osteosarcoma and chondrosarcoma. Multidisciplinary treatment at a center experienced in the treatment of sarcoma is essential. Management is dictated by histologic type and grade. Surgical resection with wide margins is the cornerstone of treatment for pelvic sarcomas, although this is often challenging due to anatomic constraints of the pelvis. Multimodal treatment is critical due to the high risk of local recurrence in the pelvis.


Assuntos
Neoplasias Ósseas , Condrossarcoma , Osteossarcoma , Neoplasias Pélvicas , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Sarcoma/cirurgia , Sarcoma/patologia , Condrossarcoma/cirurgia , Condrossarcoma/patologia , Neoplasias de Tecidos Moles/patologia , Osteossarcoma/cirurgia , Neoplasias Pélvicas/cirurgia , Neoplasias Ósseas/cirurgia , Neoplasias Ósseas/patologia
10.
Eur J Cancer ; 176: 155-163, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36215947

RESUMO

BACKGROUND: Recurrence after resection of metastatic sarcoma is common. The gangliosides GM2, GD2 and GD3 are strongly expressed across sarcoma subtypes. We hypothesised that generation of anti-ganglioside antibodies would control micrometastases and improve outcomes in sarcoma patients who were disease-free after metastasectomy. METHODS: We conducted a randomised phase II trial of the immunological adjuvant OPT-821 with a KLH-conjugated ganglioside vaccine targeting GM2, GD2 and GD3, versus OPT-821 alone in patients with metastatic sarcoma following complete metastasectomy. Patients received 10 subcutaneous injections at Weeks 1, 2, 3, 8, 16, 28, 40, 52, 68 and 84 and were followed for evidence of recurrent disease. The primary end-point was relapse-free survival. Secondary end-points included overall survival and serologic response. RESULTS: A total of 136 patients were randomised, 68 to each arm. The mean age was 51.2, 52.2% were male, 90.4% had relapsed disease, 86.8% had high-grade tumours and 14% had ≥4 metastases resected. Histologies included leiomyosarcoma (33%), spindle cell sarcoma (14%), undifferentiated pleomorphic sarcoma (13%), osteosarcoma (10%), synovial sarcoma (9%), liposarcoma (9%) and others (12%). Most adverse events were Grade ≤2 (83.8% and 70.6% in the vaccine and adjuvant arms, respectively). The most common (≥20% of patients) were injection site reaction (89.7%), fatigue (44.1%) and pyrexia (27.9%) on the vaccine arm, and injection site reaction (69.1%) on the adjuvant only arm. The 1-year relapse-free survival rate (34.5% and 34.8% in the vaccine and OPT-821 monotherapy arm, respectively) did not differ between arms (P = 0.725). One-year overall survival rates were 93.1% and 91.5% in the vaccine and OPT-821 monotherapy arm, respectively (P = 0.578). Serologic responses at week 9 were more frequent on the vaccine arm (96.5% of patients) than in the adjuvant arm (32.8%), and the difference between groups was durable. CONCLUSIONS: A sustained serologic response to vaccination was induced with the vaccine, but no difference in recurrence-free or overall survival was observed between treatment arms. CLINICALTRIALS: gov identifier: NCT01141491.


Assuntos
Segunda Neoplasia Primária , Sarcoma , Neoplasias de Tecidos Moles , Vacinas , Humanos , Masculino , Feminino , Gangliosídeo G(M2) , Reação no Local da Injeção , Sarcoma/tratamento farmacológico , Sarcoma/cirurgia , Adjuvantes Imunológicos/uso terapêutico
11.
BMC Cancer ; 22(1): 1050, 2022 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-36207687

RESUMO

BACKGROUND: Uterine sarcomas are rare and aggressive gynaecologic malignancies, characterized by a relatively high recurrence rate and poor prognosis. The aim of this study was to investigate the clinicopathological features and explore the prognostic factors of these malignancies. METHODS: This was a single-institution, retrospective study. We reviewed the medical records of 155 patients with pathologically confirmed uterine sarcomas including uterine leiomyosarcoma (ULMS), low-grade endometrial stromal sarcoma (LG-ESS), high-grade endometrial stromal sarcoma (HG-ESS), undifferentiated uterine sarcoma (UUS) and adenosarcoma (AS) between 2006 and 2022. A total of 112 patients who underwent surgery between January 2006 and April 2019 were included in the survival analysis. The current study recorded the clinicopathological, treatment and outcome data to determine clinical characteristics and survival. RESULTS: The most common histopathological type was ULMS (63/155, 40.64%), followed by LG-ESS (56/155, 36.13%) and HG-ESS (16/155, 10.32%). The mean age at diagnosis of all patients was 49.27±48.50 years and 32.90% (51/155) of patients were postmenopausal. Fifteen patients underwent fast-frozen sectioning, 63(54.78%) were diagnosed with malignancy, 29(25.22%) were highly suspected of malignancy that needed further clarification and 23(14.84%) were diagnosed with benign disease. A total of 124(80%) patients underwent total hysterectomy (TH) and salpingo-oophorectomy. Multivariate analyses showed that histological type and tumour size were independent prognostic factors both for overall survival (OS) (p<0.001 and P=0.017, respectively) and progression-free survival (PFS) (p<0.001 and P=0.018, respectively). Tumour stage was only significantly associated with PFS (P=0.002). Elevated preoperative NLR, PLR and postmenopausal status were significantly correlated with shorter PFS and OS in univariate analysis, but no statistically significant difference was found in multivariate analysis. CONCLUSIONS: In patients with uterine sarcoma, in comparison to LMS and LG-ESS, UUS and HG-ESS tend to present as more aggressive tumour with poorer outcomes. Furthermore, larger tumour (>7.5 cm) were an important predictor of shorter PFS and OS.


Assuntos
Neoplasias do Endométrio , Tumores do Estroma Endometrial , Leiomiossarcoma , Neoplasias Pélvicas , Sarcoma do Estroma Endometrial , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Uterinas , Neoplasias do Endométrio/patologia , Feminino , Humanos , Leiomiossarcoma/patologia , Prognóstico , Estudos Retrospectivos , Sarcoma/diagnóstico , Sarcoma/cirurgia , Sarcoma do Estroma Endometrial/diagnóstico , Sarcoma do Estroma Endometrial/cirurgia , Neoplasias Uterinas/patologia
12.
Medicine (Baltimore) ; 101(39): e30688, 2022 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-36181081

RESUMO

The prognosis for soft tissue sarcomas (STSs) is poor, especially for highly aggressive STSs, and the details of prognostic factors are unknown. This study aimed to investigate the prognostic factors for STSs in hematologic inflammatory markers. We included 22 patients with STSs treated at our institution. The STSs were histologically classified as follows: undifferentiated pleomorphic sarcoma, 7 cases; myxofibrosarcoma, 6 cases; and malignant peripheral nerve sheath tumor, 2 cases. The average patient age was 72.06 years. The numbers of patients who underwent each procedure were as follows: wide resection, 7; wide resection and flap, 2; marginal resection, 2; wide resection and radiation, 1; additional wide resection with flap, 1; wide resection and skin graft, 1; and radiotherapy only, 1. The median follow-up period was 26 months (3-92 months). The outcomes were as follows: continuous disease free, 6 cases; no evidence of disease, 6 cases; alive with disease, 1 case; and died of disease, 2 cases. Pretreatment blood examinations for C-reactive protein (CRP) and albumin levels; neutrophil, lymphocyte, and white blood cell (WBC) counts; and neutrophil/lymphocyte (N/L) ratio were investigated and correlated with tumor size, tissue grade, and maximum standardized uptake value (SUVmax). CRP level and neutrophil and WBC counts were positively correlated with tissue grade and SUVmax. N/L ratio was positively correlated with tumor size and SUVmax. CRP level, WBC and neutrophil counts, and N/L ratio may be poor prognostic factors for highly aggressive STSs.


Assuntos
Fibrossarcoma , Histiocitoma Fibroso Maligno , Sarcoma , Neoplasias de Tecidos Moles , Idoso , Biomarcadores , Proteína C-Reativa , Humanos , Prognóstico , Estudos Retrospectivos , Sarcoma/patologia , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/patologia , Neoplasias de Tecidos Moles/cirurgia
13.
Medicine (Baltimore) ; 101(38): e30653, 2022 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-36197208

RESUMO

RATIONALE: Perivascular epithelioid cell tumor (PEComa) is a mesenchymal tumor that arises from perivascular epithelioid cells and can differentiate into melanocytes and smooth muscle cells. Malignant renal perivascular epithelioid cell tumor is extremely rare. Due to the lack of specific clinical manifestations and imaging features, diagnosing PEComa depends on postoperative pathology and immunohistochemistry. Surgery is the primary treatment for malignant PEComa because the efficacy of radiotherapy and chemotherapy is uncertain. There is still a lack of unified diagnostic criteria and treatment guidelines for renal malignant PEComa, especially with vascular invasion. Hence, the treatment experience depends on a small number of cases reported worldwide. PATIENT CONCERNS: A 68-year-old woman was admitted to our hospital due to intermittent hematuria for over 8 months. The color Doppler ultrasound and computed tomography scan revealed a mass in the lower middle part of the left kidney. DIAGNOSIS: Rare renal malignant perivascular epithelioid cell tumor with renal vein cancerous thrombosis. INTERVENTIONS: A laparoscopic radical left nephroureterectomy in the oblique supine lithotomy position was performed. OUTCOMES: The operation process went smoothly, and no pulmonary embolism occurred after the operation. The final pathological diagnosis was a renal malignant perivascular epithelioid cell tumor. After a 12-month follow-up, no recurrence or metastasis was found. LESSONS: Renal malignant PEComa is an extremely rare mesenchymal tumor diagnosed mainly based on pathology. Surgery is currently the effective treatment for malignant PEComa. For the surgical treatment of malignant renal PEComa with vascular invasion, laparoscopic radical nephroureterectomy in the oblique supine lithotomy integrative position has many benefits, as exemplified by our current case.


Assuntos
Nefropatias , Laparoscopia , Tumores Neuroendócrinos , Neoplasias de Células Epitelioides Perivasculares , Sarcoma , Trombose , Idoso , Feminino , Humanos , Rim/patologia , Nefropatias/cirurgia , Nefroureterectomia , Tumores Neuroendócrinos/cirurgia , Neoplasias de Células Epitelioides Perivasculares/diagnóstico , Neoplasias de Células Epitelioides Perivasculares/patologia , Neoplasias de Células Epitelioides Perivasculares/cirurgia , Veias Renais/patologia , Sarcoma/cirurgia , Trombose/cirurgia
14.
Curr Oncol ; 29(10): 7598-7606, 2022 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-36290877

RESUMO

BACKGROUND AND OBJECTIVES: Functional outcomes are important for oncology patients undergoing lower extremity reconstruction. The objective of the current study was to describe patient reported function after surgery and identify predictors of postoperative function in musculoskeletal oncology patients undergoing lower extremity endoprosthetic reconstruction. METHODS: We performed a cohort study with functional outcome data from the recently completed Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial. We utilized the 100-point Toronto Extremity Salvage Score (TESS), which was administered pre-operatively and at 3, 6 and 12 months post-operatively. Higher scores indicate better physical functioning, and the minimally important difference is 11 points. We calculated mean functional scores at each timepoint after surgery and developed a logistic regression model to explore predictors of failure to achieve excellent post-operative function (TESS ≥ 80) at 1 year after surgery. RESULTS: The 555 patients included in our cohort showed important functional improvement from pre-surgery to 1 year post-surgery (mean difference 14.9 points, 95%CI 12.2 to 17.6; p < 0.001) and 64% achieved excellent post-operative function. Our adjusted regression model found that poor (TESS 0-39) pre-operative function (odds ratio [OR] 3.3, 95%CI 1.6 to 6.6); absolute risk [AR] 24%, 95%CI 8% to 41.2%), older age (OR per 10-year increase from age 12, 1.32, 95%CI 1.17, 1.49; AR 4.5%, 95%CI 2.4% to 6.6%), and patients undergoing reconstruction for soft-tissue sarcomas (OR 2.3, 95%CI 1.03 to 5.01; AR 15.3%, 95%CI 0.4% to 34.4%), were associated with higher odds of failing to achieve an excellent functional outcome at 1-year follow-up. Patients undergoing reconstruction for giant cell tumors were more likely to achieve an excellent functional outcome post-operatively (OR 0.40, 95%CI 0.17 to 0.95; AR -9.9%, 95%CI -14.4% to -0.7%). CONCLUSIONS: The majority of patients with tumors of the lower extremity undergoing endoprosthetic reconstruction achieved excellent function at 1 year after surgery. Older age, poor pre-operative function, and endoprosthetic reconstruction for soft tissue sarcomas were associated with worse outcomes; reconstruction for giant cell tumors was associated with better post-operative function. LEVEL OF EVIDENCE: Therapeutic Level IV.


Assuntos
Tumores de Células Gigantes , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Salvamento de Membro , Estudos de Coortes , Resultado do Tratamento , Sarcoma/cirurgia , Sarcoma/patologia , Extremidade Inferior/cirurgia , Extremidade Inferior/patologia , Tumores de Células Gigantes/cirurgia , Antibacterianos
15.
Niger J Clin Pract ; 25(10): 1766-1768, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36308253

RESUMO

Soft-tissue sarcoma (STS) is a rare tumor that may occur in the upper extremity. Its presentation is delayed by slow growth and lack of symptoms. Lesions are discovered via physical and radiologic examinations, and definitive diagnosis is conducted histopathologically. We present the case of a 63-year-old man with swelling of the dorsum of the arm,nocturnal hyperhidrosis, and weight loss. Radiologic examination revealed possible malignancy and metabolically active left axillary lymph nodes. The tumor was excised, and the defect was covered using a pedicled myocutaneous latissimus dorsi flap. The distal portion of the muscle was attached to the remnant tricep brachii tendon. Postoperative histopathology revealed a highly malignant STS. The patient remained relapse-free after a regimen for adjuvant chemotherapy. Satisfactory aesthetic results and modest elbow extension were evident during the 11-month follow-up. Properly managing upper extremity STS is crucial for preventing recurrence and metastasis.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos , Sarcoma , Lesões dos Tecidos Moles , Masculino , Humanos , Pessoa de Meia-Idade , Lesões dos Tecidos Moles/cirurgia , Braço/cirurgia , Recidiva Local de Neoplasia/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Sarcoma/cirurgia , Resultado do Tratamento
16.
J Plast Reconstr Aesthet Surg ; 75(12): 4361-4370, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36266210

RESUMO

INTRODUCTION: Limb-sparing surgery combined with radiation has become the standard treatment for soft tissue sarcomas. Despite the many advantages of reconstruction procedures, such as muscle-sparing flap and local reconstruction, the use of pedicled perforator flaps remains non-consensual due to doubts about their reliability when associated with radiotherapy. This study evaluated their surgical reliability in reconstructive surgery for limb and trunk soft tissue sarcomas, in terms of healing time, wound disorders, and postoperative complications, regardless of radiation timing. PATIENTS AND METHODS: We realized a retrospective, observational, bi-center study (Cancer University Institute of Toulouse Oncopole, France and Bergonié Institute Bordeaux, France) and describes pedicled perforator flaps performed between January 2015 and January 2021. RESULTS: A total of 74 flaps were included. The median age of the population was 70-year-old. The group consisted of 68.8% (n = 51/74) propeller flaps. We found a partial necrosis rate of 28.4% (n = 21/74), scar disunion of 48.6% (n = 36/74), local infection of 10.8% (n = 8/74), and venous congestion of 13.5% (n = 10/74). Only 16.2% (n = 12/74) required secondary surgical repair to a local complication. The average length of stay was 7.3 days  [1.0-25.0]. The mean operating time of our flaps was 133.4 min [38.0-280.0]. CONCLUSIONS: Pedicled perforator flaps are a surgical technique that can be used in reconstructive surgery for limb and trunk soft tissue sarcomas in adults, regardless of radiation timing. However, these flaps carry a high rate of postoperative complications so they should be reserved for expert surgeons in referral centers.


Assuntos
Retalho Perfurante , Procedimentos Cirúrgicos Reconstrutivos , Sarcoma , Lesões dos Tecidos Moles , Neoplasias de Tecidos Moles , Humanos , Adulto , Idoso , Retalho Perfurante/cirurgia , Estudos Retrospectivos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reprodutibilidade dos Testes , Neoplasias de Tecidos Moles/radioterapia , Neoplasias de Tecidos Moles/cirurgia , Sarcoma/cirurgia , Lesões dos Tecidos Moles/cirurgia , Complicações Pós-Operatórias/cirurgia
17.
Plast Reconstr Surg ; 150(5): 1082e-1094e, 2022 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-36288255

RESUMO

LEARNING OBJECTIVES: After studying this article, the participant should be able to: 1. Discuss the natural history and pathophysiology of sarcoma. 2. Summarize the most up-to-date multidisciplinary management of soft-tissue sarcoma. 3. Provide a synopsis of reconstructive modalities based on anatomical location. 4. Highlight some novel strategies for treatment of lymphedema and phantom limb pain that are common sequelae following treatment and resection of soft-tissue sarcomas. SUMMARY: The management of soft-tissue sarcoma presents unique challenges to the reconstructive surgeon. The optimal management mandates a multidisciplinary approach; however, reconstruction must take into account the extent of the resection and exposed vital structures, but often occurs in the setting of adjuvant treatments including chemotherapy and radiation therapy. Reconstruction is based on the extent of the defect and the location of the primary tumor. As such, an evidence-based, algorithmic approach following the reconstructive ladder is warranted to minimize the risks of complications and maximize success, which varies from head and neck to torso to breast to extremity sarcomas. Aside from reconstruction of the defect, advances in the surgical treatment of lymphedema and neuropathic pain resulting from treatment and extirpation of soft-tissue sarcoma are critical to maintain function and patients' quality of life.


Assuntos
Linfedema , Procedimentos Cirúrgicos Reconstrutivos , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Qualidade de Vida , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias de Tecidos Moles/cirurgia , Sarcoma/cirurgia , Linfedema/cirurgia
18.
J Orthop Surg (Hong Kong) ; 30(3): 10225536221132403, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36207771

RESUMO

BACKGROUND: Mechanical failure of the endoprostheses is a concern in paediatric patients with primary bone sarcoma. Their long-term results are variable in the Asian population, thus we aim to investigate the outcome by assessing the mechanical failure, its risk factors and the functional results. METHODS: We retrospectively reviewed 38 paediatric patients (mean 13.29, range 6-18) with primary bone sarcoma of lower extremity undergone chemotherapy and limb salvage surgery with tumor endoprosthesis between 2003 and 2016. All hospital notes were reviewed for any type of failures. Risk factors for implant loosening like stem size, remaining bone length, stem length, extracortical bone bridge ingrowth (EBBI), the ratio of resected bone length to whole bone length, bone stem ratio and custom-made versus modular were analyzed. The limb function was recorded by Musculoskeletal Tumor Society (MSTS) score. Median follow-up time was 7.42 years (3.0-15.4 years) and minimum follow-up for surviving patients was 2 years. RESULTS: Endoprosthesis survivorship, according to Kaplan Meier was 94.7%, 85.4% and 66.2% at 2, 5 and 10 years respectively. Type II failure occurred in three patients (7.9%). Type III failure occurred in four patients (10.5%). Type IV failure occured in two patients (5.2%). Only EBBI independently predicted implant loosening (p = .007). Risk factors like stem size, remaining bone length, stem length, the ratio of resected bone length to whole bone length and custom-made versus modular were not associated with increase in implant loosening (p > .05). The mean stem size was 9.41 mm in asymptomatic group, comparable with 9.22 mm in the failure group (p = .79). The MSTS score was 29.62. CONCLUSIONS: Our data suggests that paediatric Chinese patients with small body built had good and excellent mid-term results in implant survival and limb function respectively. EBBI is important in preventing loosening in tumor endoprosthesis. In contrast to the reported higher failure risk with stem size <12 mm, we found no increased loosening rate with smaller stem size endoprosthesis. LEVEL OF EVIDENCE: Class III.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Sarcoma , Neoplasias de Tecidos Moles , Neoplasias Ósseas/patologia , Criança , Humanos , Extremidade Inferior , Osteossarcoma/cirurgia , Desenho de Prótese , Falha de Prótese , Estudos Retrospectivos , Fatores de Risco , Sarcoma/cirurgia , Resultado do Tratamento
19.
J Surg Oncol ; 126(5): 896-901, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36087086

RESUMO

Early studies of the management of soft tissue sarcoma at Memorial Sloan Kettering Cancer Center were influenced by development of robust prospective long-term databases. Increasing capacity for molecular diagnostics has identified a myriad of subtypes with definable natural history. Accurate identification of tissue-specific risk of recurrence and disease-specific survival have increasingly allowed selective use of surgery, radiation therapy, and target-specific cytotoxic and immune therapies.


Assuntos
Antineoplásicos , Sarcoma , Neoplasias de Tecidos Moles , Humanos , Estudos Prospectivos , Sarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia
20.
J Coll Physicians Surg Pak ; 32(9): 1212-1215, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36089724

RESUMO

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare and aggressive inflammatory myofibroblastic tumour (IMT) variant. This report identifies the first case of EIMS with leukemoid reaction. This is also the first case in which pancreatic infiltration occurred from the disease onset. A 14-year male patient presented with an 18×18×10 cm mass at the retroperitoneal space and a white blood cell (WBC) count of 85×109/L. The mass and the invaded tissues were surgically removed with tumour-free margins. Histopathology and bone marrow aspiration confirmed the diagnosis of EIMS with leukemoid reaction. The tumour recurred with hepatic and pulmonary metastasis one month after the surgery. WBC count also increased progressively with the tumour recurrence. There is no consensus on the treatment of EIMS. Since ALK rearrangement presents in all the EIMS cases, surgical resection combined with crizotinib or other targeted drugs may improve the prognosis. Key Words: Sarcoma, Soft tissue neoplasms, Leukemoid reaction, Crizotinib.


Assuntos
Reação Leucemoide , Sarcoma , Neoplasias de Tecidos Moles , Crizotinibe/uso terapêutico , Humanos , Reação Leucemoide/diagnóstico , Reação Leucemoide/etiologia , Masculino , Recidiva Local de Neoplasia , Sarcoma/diagnóstico , Sarcoma/cirurgia
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