Percutaneous Cementation for Improvement of Pain and Function for Osteolytic Pelvic Metastasis: A Systematic Review.

INTRODUCTION: Pelvic metastasis is a common presentation among patients presenting with skeletal metastasis. Image-guided percutaneous cementation of these lesions is becoming increasingly popular for the treatment of these lesions. The objective of this study was to conduct a systematic review that investigates clinical outcomes after percutaneous cementation for pelvic metastasis. METHODS: A systematic review was registered with International Prospective Register of Systematic Reviews and performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, SCOPUS, and Ovid MEDLINE databases. All level I to IV clinical studies published in the English language investigating the clinical outcomes after percutaneous cementation for pelvic metastasis were included. RESULTS: Fourteen studies with 579 patients (278 men, 301 women) and 631 metastatic pelvic lesions were included in the study. The mean follow-up range was 0.7 to 26.4 months. Percutaneous cementation alone was performed in 441 patients (76.2%). Supplemental ablative procedures were performed in 77 patients (13.3%), and supplemental internal fixation using cannulated screws was performed in 107 patients (18.5%). Twelve studies with 430 patients (74.2%) reported pain-related and/or functional outcome scores, of which all studies reported overall clinically notable improvement at short-term follow-up. All studies reported periprocedural complications. Local cement leakage was the most common complication (162/631 lesions, 25.7%) followed by transient local pain (25/579 patients, 4.3%). There were no reported cases of major complications. Seven patients (1.2%) underwent re-intervention for persistent symptoms. CONCLUSIONS: Percutaneous cementation may be an effective method for treating pain and function related to pelvic metastasis. The most common complication was cement leakage surrounding the lesion. The rates of major complications were low, and most complications appeared minor and transient. Additional prospective studies are needed to further assess the efficacy of this procedure. LEVEL OF EVIDENCE: IV, systematic review of level I to IV therapeutic studies.

Ureteropelvic junction obstruction caused by metastatic cholangiocarcinoma

ABSTRACT We describe the rare case of a 61-year-old female with right ureteropelvic junction (UPJ) obstruction caused by metastatic cholangiocarcinoma. Her past medical history was notable for cholangiocarcinoma treated with neoadjuvant chemoradiation and two orthotopic liver transplants six years earlier. Urology was consulted when she presented with flank pain and urinary tract infection. Diagnostic workup demonstrated right UPJ obstruction. She was managed acutely with percutaneous nephrostomy. She subsequently underwent robotic pyeloplasty and intrinsic obstruction of the UPJ was discovered. Histological examination revealed adenocarcinoma, consistent with systemic recurrence of the patient's known cholangiocarcinoma.

Metástasis pélvica inusual de carcinoma hepatocelular de células claras visto en 18F-FDG PET/TC después de trasplante hepático / Unusual isolated pelvic metastasis from a clear cell hepatocellular carcinoma demonstrated on 18F-FDG PET/CT after liver transplantation

No disponible

Extraneural metastases in medulloblastoma / Mestástases extraneurais em moduloblastoma

Medulloblastoma is the most common childhood malignant tumor of central nervous system, but it may also occur in adults. It presents high invasive growth with spreading of tumor cells into the leptomeningeal space along the neuroaxis early in the course of the disease. Extraneural metastases are rare but frequently lethal, occurring only in 1 to 5 percent of patients, and are related, in the most of cases, to the presence of ventriculoperitoneal shunt. Here we characterize the clinical profile of five cases of medulloblastoma with systemic spreading of tumor cells, also comparing them to cases already described in the literature.

O meduloblastoma é o tumor maligno mais frequente do sistema nervoso central na infância, mas também pode ocorrer em adultos. Ele apresenta crescimento altamente invasivo com disseminação de células tumorais ao longo do neuroeixo precocemente no curso da doença. Metástases extraneurais são raras mas frequentemente letais, ocorrendo apenas em 1 a 5 por cento dos pacientes, e estão relacionadas, na maioria dos casos, a presença de derivação ventriculperitoneal. Neste artigo ,apresentamos o perfil de cinco casos de meduloblastoma com disseminção sistêmica das células tumorais, comparando-os com os casos já descritos na literatura.

Analysis of the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinoma

OBJECTIVE: To describe the clinicopathological characteristics of patients with upper urinary tract transitional cell carcinomas who are treated surgically and to analyze the occurrence of bladder tumors as well as the development of metastases outside the urinary tract. MATERIALS AND METHODS: The study comprised a retrospective analysis of 25 patients treated between February 1994 and August 2006. The variables analyzed were: patient age, gender, and clinical presentation; diagnostic methods; pathologic characteristics at the primary site of the tumor (pelvis or ureter); tumor stage and grade; and presence of carcinoma in situ, microvascular invasion and squamous differentiation. The Kaplan-Meier method and the Log-Rank test were used for statistical analysis of bladder recurrence-free survival. RESULTS: Eighty-four percent of patients were male, and macroscopic hematuria was the most common clinical presentation. The majority of cases (56 percent) were infiltrative (T2-T3) and high-grade (76 percent) tumors. Synchronous or metachronous bladder tumors were found in 72 percent of cases. Five (20 percent) patients had a history of bladder tumor before the diagnosis of upper urinary tract transitional cell carcinomas. The mean follow-up period was 36 months (range: 1.5 to 156). During the follow-up period, eleven (44 percent) patients developed bladder tumors. After five years, the probability of being free of bladder tumor recurrence was 40 percent. No pathological variable was predictive for bladder tumor recurrence. Four patients presented disease recurrence outside the urinary tract. CONCLUSIONS: The presence of metachronous bladder tumors is more often observed after the diagnosis of upper urinary tract transitional cell carcinomas. All of these patients should undergo rigorous follow-up during the postoperative period. Only patients with infiltrative and high-grade tumors developed metastases outside the urinary tract.

Fatores de risco não habituais para metástase linfonodal no câncer do colo do útero / Unusual risk factors for lymph node metastasis in cancer of the uterine cervix

OBJETIVO: Verificar as variáveis associadas às metástases nos linfonodos pélvicos em pacientes com carcinoma do colo do útero nos estádios IB e IIA. MÉTODOS: Estudaram-se 289 pacientes admitidas no Departamento de Ginecologia do Centro de Tratamento e Pesquisa Hospital do Câncer A. C. Camargo com carcinoma invasor do colo do útero (IB e IIA) no período de 1980 a 1999 e que foram submetidas à cirurgia radical. A coleta de dados foi realizada a partir dos prontuários e da revisão de cortes histológicos dos colos de útero e dos linfonodos, sendo registrados dados sociodemográficos (idade ao diagnóstico, cor da pele), clínicos (estádio da doença, taxa de hemoglobina pré-operatória e índice de massa corpórea) e histopatológicos (tipo histológico, grau histológico, índice mitótico, embolização em capilares linfáticos e/ou sangüíneos, invasão perineural, profundidade de invasão do tumor no estroma cervical, intensidade da reação inflamatória no colo do útero, necrose tumoral, tamanho do tumor, invasão dos ligamentos cervicais laterais e do corpo do útero e status linfonodal). A associação entre a presença de metástase linfonodal e as diversas variáveis foi avaliada pelo teste de Qui-quadrado, pelo teste exato de Fisher e pela regressão logística múltipla. RESULTADOS: Encontrou-se metástase nos linfonodos pélvicos em 65 pacientes (22,5 por cento). Foram identificados os seguintes fatores de risco para metástase linfonodal na análise multivariada: taxa de hemoglobina < 10,0 g por cento (OR=3,6; IC95 por cento:1,210,7), invasão tumoral do terço médio (OR=3,3; IC95 por cento:1,110,7) e profundo do colo do útero (OR=5,4; IC95 por cento:1,717,3), reação inflamatória ausente ou de intensidade leve no colo do útero (OR=2,4; IC95 por cento:1,15,2) e carcinoma epidermóide queratinizante (OR=3,3; IC95 por cento:1,47,6). CONCLUSÕES: Este estudo identificou quatro fatores de risco para metástase nos linfonodos pélvicos em pacientes com carcinoma do colo...

OBJECTIVE: To investigate the variables associated with pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA. METHODS: The study was carried out with 289 patients with invasive carcinoma of the uterine cervix (IB and IIA) who underwent radical surgery, admitted to the Gynecology Department of the Treatment and Research Center of the Hospital do Câncer A. C. Camargo, between 1980 and 1999. Data were collected from patient's records and from review of the histological sections from the uterine cervices and the lymph nodes, including sociodemographic data (age at diagnosis, skin color), clinical data (disease stage, preoperative hemoglobin level, body mass index) and histopathological data (histological type, histological grade, blood and/or lymphatic capillary embolization, perineural invasion, depth of tumor invasion into cervical stroma, intensity of inflammatory reaction in the uterine cervix, tumor necrosis, tumor size, invasion of the lateral cervical ligaments and uterine body, and lymph node status). Associations between lymph node metastasis and the different variables were evaluated by means of the chi-square test, Fisher's exact test and multiple logistic regression. RESULTS: Pelvic lymph node metastasis was found in 65 patients (22.5 percent). The following risk factors for lymph node metastasis were identified by multivariate analysis: hemoglobin level <10.0 g percent (OR = 3.6; 95 percent CI: 1.210.7), tumor invasion of the middle third (OR = 3.3; 95 percent CI: 1.110.7) and deep third of the uterine cervix (OR = 5.4; 95 percent CI: 1.717.3), absent or slight inflammatory reaction in the uterine cervix (OR = 2.4; 95 percent CI: 1.15.2) and keratinizing squamous cell carcinoma (OR = 3.3; 95 percent CI: 1.47.6). CONCLUSIONS: This study identified four risk factors for pelvic lymph node metastasis in patients with carcinoma of the uterine cervix at stages IB and IIA. Of these, three...

Laparoscopic resection of metastatic pelvic liposarcoma

We report a pelvic liposarcoma originating from the left spermatic cord that recurred following inadequate excision. In our case, the tumor was resected without performing orchiectomy previously. The patient was managed by laparoscopic resection, before undergoing radical orchiectomy in the left inguinal region. To our knowledge, no case of laparoscopic resection for the recurrent liposarcoma has been described. In addition, the present case serves to demonstrate that radical orchiectomy with wide excision is needed for paratesticular tumor.

PET-TAC con 18F-FDG en la estadificación inicial de una neoplasia de pelvis renal. A propósito de un caso / PET/CT with 18FFDG in the initial staging of a pelvic kidney neoplasm. A case report

Presentamos el caso de una mujer de 58 años remitida a nuestro servicio para la realización de un estudio PET-TAC con 18F-FDG de estadificación inicial tras ser diagnosticada de una masa en la pelvis de riñón derecho compatible con un proceso neoproliferativo. La PET-FDG mostró una masa en riñón derecho, una lesión sospechosa de metástasis versus un segundo tumor primario en la cortical del propio riñón y signos de infiltración adenopática tumoral en situación paracaval. El estudio histológico tras la exéresis de las lesiones confirmó dichos hallazgos como metastásicos. En este artículo realizamos un breve repaso de la bibliografía publicada al respecto, valorando la utilidad de la PET en la caracterización y estadificación inicial de las neoplasias de riñón y vías urinarias. Asimismo enfatizamos la importancia de valorar cuidadosamente cualquier imagen hipodensa o depósito de glucosa en riñones y vías urinarias visualizado en un estudio PET-TAC con 18F-FDG(AU)

We report a case of 58-year-old woman referred to our service for an 18FFDG PET/CT study of initial staging after being diagnosed of a pelvic kidney mass consistent with malignancy. The FDG-PET showed an abnormal mass in the right kidney, a suspicious metastasis versus a second primary tumor in the cortex of the kidney and lymph node infiltration in the paracaval nodes. The histological analysis verification after exeresis of the lesions confirmed the diagnosis of renal metastases. In this article, we present a brief review of the literature published on the role of PET in the characterization and initial staging of kidney and urinary tract tumors. We also stress the clinical importance of carefully evaluating any low attenuation lesion or focal glucose uptake detected in these structures in a PET/CT study with 18FFDG(AU)

Valor de la tomografia computada en la recidiva del cáncer rectal / Value of the tomography in rectal cancer recidivation

La certeza de una recidiva perineal en un paciente operado de un cáncer de recto, se hace muy difícil a través de la clínica o de los métodos convencionales de diagnóstico. La tomografía computada de periné puede suministrar información sobre tamaño, altura y relación del tumor con las estructuras vecinas. Pero fundamentalmente su importancia es asegurar sobre la existencia o no de la enfermedad recurrente, evitando muchas veces intervenciones quirúrgicas o tratamientos que en nada beneficiarían al paciente

Valor de la tomografia computada en la recidiva del cáncer rectal / Value of the tomography in rectal cancer recidivation

La certeza de una recidiva perineal en un paciente operado de un cáncer de recto, se hace muy difícil a través de la clínica o de los métodos convencionales de diagnóstico. La tomografía computada de periné puede suministrar información sobre tamaño, altura y relación del tumor con las estructuras vecinas. Pero fundamentalmente su importancia es asegurar sobre la existencia o no de la enfermedad recurrente, evitando muchas veces intervenciones quirúrgicas o tratamientos que en nada beneficiarían al paciente (AU)

Decisiones ético-clínicas en el caso de un paciente terminal con cáncer metastásico: el problema de la eutanasia / Ethical and clinical decisions in a terminal patient with metastasic cancer: the euthanasia problem

The easiness of medical technology to prolong life in patients with severe cognitive or biological deterioration, the existence of cultural tendencies that underscore the importance of patient's self determination and economical considerations have posed the problem of euthanasia among patients, their families, society and medical teams. A propos of an exemplary patient, the ethical principles that allow the distinction between passive euthanasia and with drawal of life support measures ane analysed. The analysis of active euthanasia, leads to the conclusion that it is not comptible with the ethical principles that classically have inspired medical actions