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PubMed1992

Retroaortic left renal vein in testicular cancer patient: potential staging and treatment pitfall.

A 20-year-old man was diagnosed with a left mixed germ cell testicular tumor and clinical staging with computerized tomography suggested left para-aortic subhilar retroperitoneal adenopathy. The patient received 4 cycles of cisplatin, vinblastine and bleomycin chemotherapy but the mass in the left renal hilus area remained unchanged. Subsequent retroperitoneal lymphadenectomy revealed the mass to be a retroaoritc left renal vein type 2. Further confusion occurred during followup in differentiating this anomaly from recurrent neoplasm necessitating evaluation by magnetic resonance imaging. Retroaortic left renal vein represents a potential imaging pitfall in testicular cancer that may facilitate suboptimal staging, treatment and followup.

Adult↗
PubMed1984

Radiation-induced changes in the breast.

Thirty-six postirradiation breast tissue specimens from 30 patients with breast cancer treated by primary radiation therapy were evaluated to define the effects of therapeutic doses of ionizing radiation on the residual non-neoplastic breast tissue. Breast tissue was sampled an average of 30.4 months after completion of therapy because of the development of new clinically or mammographically detectable abnormalities within the treated breasts. The average radiation dose was 6,399 rad to the primary tumor area and 4,778 rad to the remainder of the breast. Breast tissue sections from 35 nonirradiated patients served as control specimens. The most characteristic radiation effects consisted of atypical epithelial cells in the terminal duct lobular unit ( TDLU ) associated with lobular sclerosis and atrophy. These changes were present in all of the irradiated patients but varied in severity and extent among patients and within individual patients. This variation was not related to the presence or absence of carcinoma elsewhere in the specimen, radiation dose, patient age, time to postirradiation tissue sampling, or use of adjuvant chemotherapy. Epithelial atypia in larger ducts, stromal changes, and vascular changes were less frequent but were always accompanied by prominent TDLU changes. Radiation effects could usually be clearly distinguished from carcinoma involving the TDLU by the absence of both cellular proliferation and distention of the involved TDLU and by the preservation of cellular polarity and cohesion in areas of presumed radiation-induced injury. Familiarity with these changes is of considerable practical importance in that they must be distinguished from new or recurrent neoplasms.

Adult↗
PubMed2003

[2003 update of Standards, Options and Recommandations for radiotherapy for patients with salivary gland malignant tumors (excluding lymphona, sarcoma and melanoma)].

CONTEXT: The "Standards, Options and Recommendations" (SOR) project, which started in 1993, is a collaboration between the Federation of French Cancer Centers (FNCLCC), the 20 French Regional Cancer Centers. and specialists from French public universities,general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and the outcome of cancer patients. OBJECTIVES: To update clinical practice guidelines for the management of patients with salivary gland malignant tumors previously validated in 1997. These recommendations cover diagnosis, treatment and follow-up of patients with these tumors. METHODS: The methodology is based on a literature review and critical appraisal by a multidisciplinary group of experts who define the CPGs according to the definitions of the Standards, Options and Recommendations project. Once the guidelines have been defined, the document is submitted for review by independent reviewers. RESULTS: This article presents the updated clinical practice guidelines concerning irradiation of patient with salivary gland tumors. The main recommendations are: 3 dimensional conformal radiotherapy (with or without intensity modulation) or 2D irradiation can be used; for surgical complete resected patients, postoperative photon radiotherapy should not be used in case of low grade stage I and 11 tumors(standard, level of evidence B2) but should be used for high grade stage II, II and IV tumors and for low grade stage III and IV tumors(standard, level of evidence B2). Neutron therapy should not be used in all of these cases (standard, level of evidence D); for patients presenting an incomplete macroscopic or microscopic surgical residual disease, postoperative irradiation must be delivered(standard). Neutron or photon therapy can be either delivered (options); for non operable patients neutron or photon therapy can be either delivered (options, level of evidence B2); for unresectable tumors or in case of recurrent neoplasms, exclusive neutron therapy or surgical tumor reduction combined with postoperative photon beam irradiation can be proposed (options, level of evidence C).

Combined Modality Therapy↗
PubMed1993

Surgical resection followed by brachytherapy for malignancies involving the base of the skull.

Between January 1990 and July 1991, 14 patients were referred to the University of Pittsburgh for cranial base surgery following diagnosis of end-stage primary or recurrent neoplasms of the base of the skull. The treatment approach consisted of resection of the tumor along with placement of afterloading nylon catheters for iridium-192 implantation in areas where remaining tumor was believed to be present. A median dose of 3600 cGy (range, 2500 to 6000) was delivered to the tumor bed 1 to 14 days following surgery. with a median follow-up of 9 months, three patients remain alive without disease at 18, 19 and 36 months, and two are alive with disease at 5 and 31 months. Six patients died of disease at 3, 3, 3, 7, 16, and 17 months and three patients died of intercurrent disease at 1, 5, and 11 months. Cranial base surgery followed by brachytherapy appears to be a viable alternative in patients who otherwise have exhausted other methods of treatment. Careful attention to preoperative evaluation, surgery, and postoperative recovery should be given in order to prevent major complications.

Journal Article↗
PubMed2006

Fat hypertrophy in a pharyngeal reconstruction flap presenting as an enlarging neck mass: demonstration of benign changes with PET/CT.

The patient is a 73-year-old man with a history of radioresistant recurrent squamous cell carcinoma of the larynx, treated with total laryngectomy/pharyngectomy and rectus abdominis deep inferior epigastric perforator flap reconstruction, who presented with a painless enlarging neck mass. Physical examination revealed increased neck bulk and fiberoptic nasopharyngolaryngoscopy was negative. The clinician was concerned about underlying recurrent neoplasm or adenopathy displacing the flap outward and referred the patient for PET/CT.

Adipose Tissue↗
PubMed1988

Tumor recurrence versus fibrosis in the female pelvis: differentiation with MR imaging at 1.5 T.

Twenty-two women with previous malignancies of the pelvis were examined with magnetic resonance (MR) imaging. In 21 of 22 patients, the MR imaging findings were confirmed with laparotomy on transvaginal biopsy. Twelve of the 22 patients had recurrent tumors; ten had a localized fibrotic mass, and two were found to have coexistent local fibrotic masses and distant recurrence. In 11 of the 12 patients with recurrence, MR imaging demonstrated the recurrent tumor as an area of increased signal intensity on long repetition time, long echo time spin-echo pulse sequences. Signal intensity of localized fibrosis varied with the time since initial treatment. Separate signal intensity measurements for T1- and T2-weighted images were obtained in regions of interest in recurrent tumors, early fibrosis (1-6 months after first treatment), and late fibrosis (more than 12 months). Ratios of signal intensity of muscle to that of fat were calculated, and a statistical analysis (Student t test) was performed. On heavily T2-weighted pulse sequences, the differences in signal intensity between late fibrosis and recurrent tumors were statistically significant (P less than .001). MR imaging is useful in identifying recurrent pelvic neoplasm and distinguishing it from posttreatment fibrosis.

Adult↗
PubMed1988

Cerebral astrocytomas: histopathologic correlation of MR and CT contrast enhancement with stereotactic biopsy.

Gadolinium-labeled diethylenetriaminepentaacetic acid was used as a contrast agent for stereotactic magnetic resonance (MR) imaging in six selected patients with brain tumors who underwent stereotactic biopsy. Regions of contrast enhancement demonstrated by computed tomography (CT) and MR imaging in four of the six patients correlated with areas of malignant neovascularity and endothelial proliferation within solid tumor. Radiation necrosis produced contrast enhancement indistinguishable from that of recurrent neoplasm. Isolated tumor cells within intact white matter were identified in biopsy specimens obtained outside of regions that were depicted as abnormal by contrast material-enhanced CT, as well as by precontrast and postcontrast T1- and T2-weighted MR images.

Adult↗
PubMed2006

Diffuse cystic disease of the lung associated with simultaneous bilateral spontaneous pneumothorax: an unknown component of Caroli disease?

Simultaneous bilateral spontaneous pneumothorax is an uncommon and serious medical problem frequently related to an underlying lung disease such as parenchymal lung disease, inflammatory events or neoplasms. Recurrent pneumothorax associated with persistent air leakage may pose a therapeutic dilemma in patients with underlying lung diseases. Caroli disease (CD) is a very rare congenital disorder characterised by intrahepatic biliary cystic dilatations and frequently associated with polycystic kidney and hepatic fibrosis. To date, no relation between CD and the bilateral diffuse cystic structure of pulmonary parenchyma has been described. In this paper we present a patient with the diagnosis of CD in whom simultaneous bilateral spontaneous pneumothorax was the initial finding due to severe underlying pulmonary disease. Our patient's demographic and clinical characteristics, laboratory findings and course made us exclude the other aetiologies leading to such diffuse multi-bullous pulmonary involvement. The coincidence of recurrent pneumothorax and severe pulmonary disease has led to a big therapeutic dilemma. Open or minimally invasive surgery could be morbid or even mortal because of the nature of the parenchyma and the operative risk due to CD. Therefore, we suggest a unique conservative management including tube thoracostomy by locating the correct air spaces with the aid of high-resolution computed tomography followed by talc pleurodesis in patients with severe multi-bullous lung disease associated with potential risks due to co-morbidities.

Adult↗
PubMed1975

Pleuroscopy and pleural biopsy with the flexible fiberoptic bronchoscope.

Diagnostic pleuroscopy has been performed under local anesthesia in nine patients using a gas sterilized flexible fiberoptic bronchoscope inserted through a 1 to 2 cm chest incision into the pleural space. Pleuroscopy in one patient excluded recurrent neoplasm on the pleural aspect of a bronchopleural fistula. Another patient had a pleuroscopic biopsy of the lung, which was the only method successful in diagnosing a metastatic renal carcinoma. The other seven patients were studied for pleural effusions which were undiagnosed after study of pleural fluid and/or Abrams needle biopsy. In four of them pleural implants of carcinoma were visualized and proved by biopsy. Three patients had negative pleuroscopy, two of these also being negative at subsequent thoracotomy. One was not explored because of extrathoracic metastases. The procedures were performed with minimal patient discomfort and no serious complications.

Biopsy↗
PubMed1999

Cutaneous lesions of metastatic visceral malignancy mimicking pyogenic granuloma.

Cutaneous metastases may be the first sign of a previously undiagnosed visceral malignancy or the initial presentation of a recurrent neoplasm. Rarely, skin metastases can resemble a pyogenic granuloma. Three oncology patients who developed new pyogenic granuloma-like cutaneous lesions are described. Histopathologic examination showed metastatic visceral malignancy in the skin. The characteristics of the previously reported cancer patients with metastatic tumor to the skin that mimicked a pyogenic granuloma are reviewed. A biopsy of a skin lesion that clinically appears to represent a pyogenic granuloma should be performed for microscopic examination in patients with a previous visceral malignancy or in cancer-free individuals whose lesions do not resolve after conservative treatment.

Adenocarcinoma↗
PubMed1980

[Results of surgical treatment of anaplastic cerebral gliomas].

In the years 1971 through 1977 247 patients with anaplastic cerebral gliomas were treated. Out of this material a group of 119 patients was completed who were treated only surgically and had follow-up examinations or responded to an inquiry form sent to them. In the light of this follow-up study it was established that the survival time was shortest, only up to 6 months, in the patients with preclinical symptoms lasting up to 3 months. In the remaining patients the survival time was longer, reaching over one year in 11 cases and over 2 years in 3 cases. In view of the mode of spread of recurrent neoplasm the authors differentiated exophytous expansion - with the infiltration filling the postoperative tissue defect and extending beyond its margins, infiltrative expansion - with the infiltration spreading on the walls of the postoperative tissue defect, destructive expansion - with the neoplasm infiltrating and destroying the brain tissue. Two latter modes of growth were most frequent and led to death of the patients without producing signs of intracranial hypertension.

Brain Neoplasms↗
PubMed1994

Morbidity after intraperitoneal insertion of saline-filled tissue expanders for small bowel exclusion from radiotherapy treatment fields: a prospective four year experience with 34 patients.

UNLABELLED: When prolonged small bowel exclusion (SBE) from external radiotherapy (RT) fields or immediate exclusion of bowel from brachytherapy sources is required for a patient without adequate omentum, there are no simple proven methods available for accomplishing these goals. We report a prospective study of SBE by intraperitoneal, saline-filled tissue expanders (TE). Thirty-four patients had exclusion of small bowel from either external radiotherapy (RT) ports (20), afterloading catheter treatment fields (5), both (5), or from intracavitary implants (4). Twenty-seven TEs were placed in the pelvis and 7 in the iliolumbar fossa. TE volume ranged from 400-1500 cc (median 550 cc). Patients had rectal (n = 15), colon (6), endometrial (4), anal (3), and vaginal (1) cancers and sarcomas (5). Fifteen patients had recurrent neoplasms, 13 of which were in previously irradiated fields. Nine patients had colorectostomies directly behind the TE, and 12 had other bowel (6) or ureteral (3) anastomoses or bladder repairs (3) adjacent to the TE. RESULTS: TEs remained in the patients from 6 to 173 days (median 95). Morbidity included three early TE withdrawals before RT was begun, one for a prolonged ileus, one for a perineal wound dehiscence, and one for an unrelated small bowel obstruction. Two patients (5.9%) early in the series had post-withdrawal complications (non-lethal small bowel fistulas requiring reoperation), although in a recent cohort of patients no post-withdrawal complications occurred using a different placement technique (0/17 vs. 2/14, P = 0.2). The patient injury complication rate was 4/34 (11.8%). None of these limited or delayed RT, but RT was limited to less than that planned in one other by TE deflation (total complication rate 14.7%). There were no clinical infections involving the prostheses, even though one patient had an abdominal wound dehiscence, 3 had pelvic abscesses, and 2 had exposure of the TE through the vagina (1 planned, 1 at dehisced vaginal cuff) after TE placement. We noted no acute and one possible late RT complication in these patients (18 months median follow-up, range 3-43 months). Small bowel was displaced from > 95 per cent of the RT treatment volume in 70 per cent and from > 75 per cent of the treatment volume in 89 per cent of 27 evaluable patients treated with external RT. CONCLUSION: Intraperitoneal placement of a saline-filled tissue expander is a simple, safe and effective means of small bowel exclusion from RT portals.

Adult↗
PubMed1988

Full thickness abdominal wall resection for recurrent and metastatic neoplasms. A report of three cases.

Full thickness infiltration of the abdominal wall by intraabdominal cancer, especially after effective prior therapy, is frequently considered a sign of inoperability. Such patients are treated with irradiation, chemotherapy, or locally destructive means (laser, cryosurgery) with limited success. Full thickness resection of portions of the abdominal wall has not been widely used in such settings because of concerns regarding abdominal wall reconstruction and also because of the perceived noncurative nature of such "radical" procedures. While long-term prognosis in patients with abdominal wall infiltration by cancer depends upon various factors, technical considerations regarding reconstruction need not prevent effective local palliative therapy. Bridging large defects can be successfully accomplished by using available synthetic material of a durable, inert nature. Polyprophylene (Marlex) mesh, a readily available and inexpensive inert fabric, meets all desirable features for such use. This paper details the successful treatment of three patients in whom recurrent carcinoma infiltrated the full thickness of the abdominal wall and caused intractable pain. In all three, full thickness portions of the abdominal wall were resected, segments of intestine and of urinary bladder were also excised, and the defects were closed using a double layer of polypropylene mesh. Complete relief of pain was accomplished and the cosmetic and functional results were excellent. Illustration A depicts procedure in patients one and two. Illustration B depicts procedure in patient three.

Abdominal Muscles↗
PubMed1999

[Experimental studies on hyperthermic distilled water combining with saline and dextran for preventing intraperitoneal cancer recurrence due to neoplasm seeding].

In order to know the efficacy of hyperthermic distilled water combining with saline and dextran (DSD) to prevent intraperitoneal cancer from recurrence due to neoplasm seeding, we carried out the experimental studies, including an observation on inhibiting cancer cells from implantation in vivo by abdominal cavity lavation, cytotoxic test and attachment test in vitro. The results of the tests in vitro showed no viable tumor cell exposed to 45 degrees C distilled water for 20 minutes in the tissue culture wells, meanwhile, dextran-40 partially blocked attachment of B16-F10 cells to gelatinized wells. In vivo test, DSD effectively prevented neoplasm seeding of B16-F10 viable melanoma cells in C57BL/6j mouse abdominal cavity and had no obvious toxicity. The efficiency was 70%; when cisplatin was added, the efficiency was enhanced to 88.9% with slight toxicity. These data indicate that the local application of hyperthermic distilled water combined with saline and DSD may prevent intraperitoneal neoplasm from recurring.

Animals↗
PubMedDate not supplied

[Tumor markers in the early diagnosis of recurrence in gynecologic neoplasms: combined determination of CA-125, CA 15-3, CA 72.4, SCC, 90 K].

In 156 patients with gynecologic neoplasia the sieric levels of tumor markers (CA 125, CA 15-3, CA 72.4, SCC and 90 K) before the primary treatment and during the follow-up have been evaluated. In the patients with ovarian cancer elevated levels of CA 125 (80%), CA 72.4 (62%), 90 K (49%) and CA 15-3 (16.6) were found. The integrated evaluation of CA 125 and 90 K sieric levels was positive in the 86% of cases. The evaluation of CA 125 in combination with 90 K seems to facilitate the earlier detection of ovarian cancer recurrences. Elevated levels of SCC (89%) were found in the patients with cervical cancer. In the patients with endometrial or vulvar cancer the evaluation of these tumor markers was not significant.

Antigens, Neoplasm↗