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PubMedDate not supplied

A prognostic index (bladder prognostic index) for bilharzial-related invasive bladder cancer.

PURPOSE: Bladder cancer is still the most common solid tumor among adult males in Egypt because of the prevalence of bilharzial infestation, especially in the countryside. In this prospective study, we have recorded the prognostic factors for 180 patients with invasive bladder cancer for whom standard radical cystectomy had been performed to develop a prognostic index (bladder prognostic index) that defines high risk patients who are more vulnerable to disease relapse after surgery and who may benefit from additional therapy. PATIENTS AND METHODS: The study was performed between January 1997 and December 1999, in which 180 patients with histopathologically proved invasive bladder cancer associated with bilharziasis underwent radical cystectomy or anterior pelvic exenteration. After surgery, patients were regularly followed for a minimum of 2 years. RESULTS: Our patients included 141 males and 39 females. Squamous cell carcinoma was the most common type (53.3%), and most of the tumors were grade II (61.1%). A total of 173 patients had their tumors operable, while 7 were inoperable. We had 5 (2.8%) operative related mortalities. At 5 years postoperatively, free and overall survival rates for the whole group of patients were 31.44%+/-5.9% and 32.5%+/-6.8%, respectively. Tumor pathologic stage, grade, and nodal affection were the only significant factors with impact on survival (P=0.008, 0.051, and 0.004, respectively). These 3 prognostic indexes were used to design a model to predict an individual patient's risk factor for recurrence. Patients were then assigned to one of the 4 risk groups according to the score achieved in this prognostic index (0=low risk, 1=intermediate risk, and 2 or 3=higher risk). These 4 risk groups had distinctly different rates of disease-free survival, i.e., 91.7%, 53%, 13%, and 7% for low, intermediate, and higher risk groups, respectively. CONCLUSION: Although this prognostic index appears to be of a significant clinical relevance, it needs to be more validated on a larger number of patients, and it could be a surrogate variable for biologic factors responsible for the heterogeneity of bladder cancer.

Adult↗
PubMedDate not supplied

Multilocular cystadenoma and cystadenocarcinoma of the prostate.

BACKGROUND: Multicystic prostatic tumors are rare, with only a few reported cases of prostatic cystadenoma and cystadenocarcinoma in the scientific literature. METHODS: A retrospective review of our tumor registry over the last 25 years identified 2 rare cystic tumors of the prostate: 1 multilocular cystadenoma and 1 multilocular cystadenocarcinoma. RESULTS: The first case illustrates the clinical and pathologic features of prostatic multilocular cystadenoma. A 42-year-old man presented with a 16-cm suprapubic mass causing displacement of adjacent visceral organs. Pathologic examination after prostatectomy confirmed it to be a multilocular cystadenoma of the prostate. The patient's postoperative course was uneventful, and his serum prostate-specific antigen level remained at < or =0.04 ng/ml throughout the course of his disease. In the second case, we present an 80-year-old male presenting with a 12-cm cystic mass of the prostate. His serum prostate-specific antigen level remained at > or =9.0 ng/ml throughout the course of his disease. The tumor had an aggressive local growth pattern, with invasion into perirectal adipose tissue. This patient underwent a pelvic exenteration, followed by adjuvant systemic chemotherapy and complete androgen blockade. Despite aggressive treatment, he had 3 recurrences over 4 months but remains alive with disease at 23-month follow-up. CONCLUSIONS: Cystadenocarcinoma of the prostate is locally aggressive and should be included in the differential diagnosis of cystic lesions of the prostate.

Adult↗
PubMed2004

Sentinel node detection in patients with vaginal carcinoma.

OBJECTIVE: The objective was to describe sentinel ode detection in patients with primary and recurrent vaginal carcinoma. METHOD: Preoperatively 60-mBq technetium-labeled nannocolloid was injected in the mucosa at 3, 6, 9, and 12 o'clock, just adjacent to the vaginal cancer. Sentinel nodes were detected using a laparoscopic or hand-held probe (Navigator) and removed for pathological assessment. RESULTS: Sentinel nodes could be found in two of three patients with primary stage I or II carcinoma of the vagina. In the first patient the sentinel nodes, located in the groin and obturator region, proved to be negative and she was treated with a wide local excision of the tumor, pelvic and groin lymphadenectomy, and adjuvant radiotherapy. The second patient had tumor metastases in the sentinel node, which was found just below of the junction of the iliac vessels, and she underwent combined chemo- and radiotherapy. In a third patient no sentinel node could be detected at lymphoscintigraphy. A last patient with stage III carcinoma of the upper vagina was initially treated by combined chemo-radiotherapy but recurred 6 months later. During a staging procedure the sentinel nodes could be detected in the right obturator fossa and were removed laparoscopically. As they were negative, she underwent a posterior pelvic exenteration with complete resection of the tumor. CONCLUSION: Laparoscopic detection of sentinel nodes using 99mTc-labeled colloid is feasible in patients with primary and recurrent vaginal cancer and may provide important information to direct further management.

Adult↗
PubMed2004

The physician-patient relationship before cancer treatment: a prospective longitudinal study.

OBJECTIVES: To evaluate quality of life before surgery for genital cancer to determine risk factors that might influence the physician-patient relationship. METHODS: From 1993 until 2003, 129 women with cervical cancer entered this prospective study. Patients were contacted 1 to 5 days before surgery by a psychologist or psychotherapeutically trained physician on the surgical ward. The semistructured interview included questions on the patient's psychosocial well-being according to criteria of the biographic interview technique. The preoperative anxiety level was evaluated by the STAI and quality of life by the Cancer Rehabilitation Evaluation System (CARES) and EORTC questionnaires. Patients were assigned to groups undergoing pelvic exenteration (n = 62) or Wertheim procedure (n = 67). RESULTS: The preoperative anxiety level did not correlate with the treatment modality. Women with a high anxiety level complained of a lack of information which correlated with a dissatisfaction concerning the physician-patient relationship (r = 0.457, P = 0.001). Quality of life in terms of medical interaction and the need for information were indicated to be the most important aspects for cancer patients facing genital surgery. CONCLUSIONS: These data demonstrate the need for information strategies before surgery: first, to reduce anxiety by anticipating future quality of life outcome problems and, second, to improve medical interaction before stressful treatment options.

Adult↗
PubMed2006

Surgical resection of recurrent endometrial carcinoma.

OBJECTIVE: Chances of survival after the diagnosis of recurrent endometrial cancer are poor. Although total pelvic exenteration has been described as a treatment for a select subset of patients with recurrent endometrial cancer, the use of other surgical procedures in this setting has not been well described. The objective of this study was to review our experience with non-exenterative surgery for recurrent endometrial cancer. METHODS: We reviewed the medical records of all patients who underwent non-exenterative surgery for recurrent endometrial cancer between 1/91 and 1/03. Survival was determined from the time of surgery for recurrence to last follow-up. Survival was estimated using Kaplan-Meier methods. Differences in survival were analyzed using the log-rank test. The Fisher's exact test was used to compare optimal versus suboptimal cytoreduction against possible predictive factors. RESULTS: Twenty-seven patients were identified. Fifteen patients (56%) had disease limited to the retroperitoneum, 10 patients (37%) had intraperitoneal disease, and 2 patients (7%) had both intra- and retroperitoneal disease. Cytoreduction to 2 cm. There were no major perioperative complications or mortalities. The median hospital stay was 7 days (range, 1-18 days). Additional therapies included intraoperative radiation therapy in 9 patients (33%), radiation therapy in 12 patients (44%), and chemotherapy in 10 patients (37%). The median follow-up for the entire cohort was 24 months (range, 5-84 months). The median progression-free survival was 14 months (95% CI, 6-23), and the median disease-specific survival was 35 months (95% CI, 24-not reached). Size of residual disease was the only significant predictor for both progression-free and disease-specific survival. Patients with residual disease 2 cm residual (P = 0.01). CONCLUSIONS: Surgical resection for recurrent endometrial cancer may provide an opportunity for long-term survival in a select patient population. The only factor associated with improved long-term outcome was the size of residual disease remaining at the end of surgical resection.

Aged↗
PubMed2006

Surgery after concurrent chemoradiotherapy and brachytherapy for the treatment of advanced cervical cancer: morbidity and outcome: results of a multicenter study of the GCCLCC (Groupe des Chirurgiens de Centre de Lutte Contre le Cancer).

OBJECTIVES: To evaluate the morbidity and therapeutic value of surgery after concurrent chemoradiotherapy and brachytherapy in a multicentric series of patients with advanced cervical cancer. METHODS: Patients with stage IB2 to IVA cervical cancer treated with concurrent chemoradiotherapy and pelvic radiotherapy followed by brachytherapy and surgery from seven participating French comprehensive cancer centers were enrolled. The surgical treatment consisted of a hysterectomy, which ranged from radical hysterectomy to anterior pelvic exenteration, and lymph node resection. Acute toxicity, pathological response, overall, and disease-free survival were assessed for each pathological response to therapy. RESULTS: One hundred seventy-five patients were enrolled from September 1987 to June 2002. The median age was 44 years [27;75]. Patients distribution according to clinical classification was as follows: 41 stage IB2, 18 IIA, 77 IIB, 12 IIIA, 14 IIIB, and 13 IVA. Forty-six patients experienced 51 postoperative complications. Thirty-three patients experienced grade 2 morbidity (18.9%, 33/175), among whom 19 experienced urinary complications (57.5%, 19/175). No post treatment mortality was observed. Grade 3 toxicity rate was 6.9% (12/175). Pathological complete response rate was 38% (67/175). After a median follow-up of 36 months, overall survival and disease-free survival were significantly better in patients who had a pathological complete response to therapy than those who achieved a partial pathological response (P < 0.0001). CONCLUSION: Surgery after concurrent chemoradiotherapy and brachytherapy for advanced cervical cancer leads to an acceptable morbidity. Furthermore, surgery allows evaluation of the pathological response to therapy and improves local control in the case of partial pathological response.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2006

Adenocarcinoma of the urinary bladder presenting as locally advanced endometrial carcinoma. Case report and review of the literature.

BACKGROUND: Carcinoma of the urinary bladder that occurs after urinary diversion is a rare entity. We report a case of an adenocarcinoma arising in a defunctionalized bladder that presented as locally advanced endometrial carcinoma. CASE: A 77-year-old presented with postmenopausal bleeding and mucous vaginal discharge. She had a prior history of urinary diversion via a Koch pouch. Examination revealed a mass protruding through the cervix and possibly involving the bladder anteriorly. The patient underwent anterior pelvic exenteration for a locally advanced mucinous carcinoma thought to be arising from the uterus and invading into the bladder. Final pathology, however, was consistent with a primary bladder carcinoma. CONCLUSION: Carcinoma developing in the bladder after urinary diversion presents at an advanced stage and has associated poor overall survival.

Adenocarcinoma↗
PubMed2006

Laparoscopic radical parametrectomy and partial vaginectomy for recurrent endometrial cancer.

BACKGROUND: Endometrial cancer recurrences in the vagina after surgery and radiation therapy are traditionally treated with pelvic exenteration. However, this operation is associated with significant morbidity and mortality, and thus alternative surgical options should be explored. CASE: We present a case of laparoscopic resection of recurrent endometrial cancer at the vaginal apex in the setting of prior brachytherapy and 32P intraperitoneal therapy. CONCLUSION: Laparoscopic radical parametrectomy and partial vaginectomy may be an option for patients with small central recurrences of endometrial cancer.

Endometrial Neoplasms↗
PubMed1976

Infiltrative carcinoma of the vulva: results of surgical treatment.

During a 40 year period 374 patients with infiltrative carcinoma of the vulva were evaluated. Some form of radical surgery was the treatment chosen for 278 patients. The absolute 5 year survival rates for all clinical stages treated with some form of radical surgery was 66.8 per cent with a corrected rate of 73.9 per cent. The corrected 5 year survival rate for patients treated with radical vulvectomy and groin lymphadenectomy approximated 80 per cent and if the regional lymph nodes were negative, it approximated 93 per cent. The size of the primary lesion and the incidence of regional lymph node metastases seemed directly related. Lymph node involvement itself significantly reduced the chance for survival. Furthermore, the inaccuracy of preoperative evaluation of the groin lymph nodes approximated 25 per cent. The assumption that a lesion is "early" does not justify less than radical surgery. Conversely, the "advanced" lesion when geographically localized can be treated quite satisfactorily with pelvic exenteration. The treatment of choice is discussed.

Adult↗
PubMed1988

Inflammatory pseudotumors in children.

Inflammatory pseudotumors are so named because they mimic malignant tumors clinically and radiologically. Most often seen in the lungs of young adults, they consist of localized proliferations of mononuclear inflammatory cells and myofibroblasts. There are scattered reports of these tumors occurring in various sites in children. We report five cases of these rare lesions in children; four arising intraabdominally and one in the lung. In contrast to the usual presentation in adulthood, these children were all previously healthy. One child, with the tumor arising from the urinary bladder, was originally diagnosed as having a malignant sarcoma and underwent pelvic exenteration and chemotherapy for this subsequently-proven benign lesion. Local recurrence occurred in one case. Total excision is indicated and is usually possible without unacceptable morbidity. Our cases and a review of the literature point out the importance of pathologic differentiation of these lesions from malignancy with early appropriate surgery.

Child↗
PubMed1993

Giant multilocular prostatic cystadenoma: a rare clinical entity and review of the literature.

Giant multilocular prostatic cystadenoma is a pathologically benign entity. To our knowledge only 3 cases have been reported in the literature, of which 2 were treated by means of pelvic exenteration. These lesions can occur in men of various ages, arise from the prostate and grow to massive proportions. Histologically the tumor is comprised of benign cysts lined with cuboidal and columnar epithelium. The lesions do not invade contiguous structures but they can be adherent to viscera in their proximity. Giant multilocular prostatic cystadenoma as demonstrated by our case is a benign entity that can be definitively treated by carefully planned complete surgical excision.

Cystadenoma↗
PubMed1992

Adenoid cystic carcinoma of Cowper's gland.

We report an additional case of primary adenoid cystic carcinoma of Cowper's gland in an otherwise healthy asymptomatic 66-year-old man. Based on a review of similar lesions presenting in the head and neck, our treatment plan entailed pelvic exenteration followed by radiation therapy. Whether adenoid cystic carcinoma of Cowper's gland behaves as aggressively as it does in the head and neck remains unclear. However, in view of the extensive local invasion in our patient and a previously successful outcome, a combined surgical and radiation approach appears to be the most appropriate therapy.

Aged↗
PubMed1990

Radiation-induced prostatic sarcoma: a case report.

A 64-year-old man had a prostatic sarcoma 8 years after transurethral prostatectomy and radical bilateral pelvic lymph node dissection with insertion of 125iodine implants for stage B1N carcinoma of the prostate. Therapy for the sarcoma consisted of isolated pelvic perfusion and then pelvic exenteration with creation of an ileal conduit and colostomy. The pathology report showed well encapsulated grade 2 spindle cell sarcoma of the prostate. Multiple small metallic particles were embedded in the tumor specimen.

Adenocarcinoma↗
PubMed1990

Clear cell adenocarcinoma of the urethra: evidence for origin within paraurethral ducts.

We report a case of clear cell adenocarcinoma arising in a paraurethral duct treated by anterior pelvic exenteration. Immunohistochemical stains for prostate specific acid phosphatase and prostate specific antigen were positive in the primary tumor and regional metastases. Focal positive staining also was noted in normal paraurethral duct epithelium. Our observations suggest that clear cell adenocarcinoma arises from the female paraurethral ducts, rather than embryonic remnants. These ducts appear to be homologous to the prostate and in some cases may be misinterpreted as urethral diverticula.

Adenocarcinoma↗
PubMed1989

Simultaneous diversion of the urinary and fecal streams utilizing a single abdominal stoma: the double-barreled wet colostomy.

A new technique to achieve simultaneous diversion of the urinary and fecal streams using a single abdominal stoma is described. The procedure consists of the construction of a diverting loop colostomy with division of the colon approximately 10 to 15 cm. distal to the stoma. The segment of colon distal to the stoma, the urine limb, acts as a urinary conduit. To date 3 patients have undergone the procedure with followup of 3, 13 and 18 months. Neither upper tract infection nor upper tract deterioration has occurred. The potential role of this procedure to treat a difficult group of patients is discussed.

Aged↗
PubMed1984

Perineal liposarcoma: diagnosis and management.

Perineal liposarcoma is excessively rare. Its clinical and pathological behavior can only be predicted by comparison with the behavior of liposarcoma in other parts of the body. We describe the management of a man who presented with symptoms related to bladder outlet obstruction and was found to have a prostatic mass on digital examination of the rectum. A needle biopsy was performed and the tissue was histologically consistent with sarcoma of the prostate. Computerized tomography suggested that the mass extended through the urogenital diaphragm and was contiguous with the corpus spongiosum and corpora cavernosa of the penis. Complete surgical extirpation was achieved through a perineal approach, although local extension of the growth beneath the internal anal sphincter and the urogenital diaphragm necessitated reconstruction of these structures. The surgical margins were free of tumor. We advocate local surgical extirpation rather than pelvic exenteration in these cases.

Adult↗
PubMed1993

Extended resection for carcinoma of colon and rectum.

Although surgery has been the mainstay of treatment for patients with colorectal carcinoma for more than a century, debate continues regarding the appropriate magnitude of operation for optimal survival. Invasion of contiguous organs is a legitimate indication for extended en bloc resection, including pelvic exenteration, in appropriately selected individuals. Extended lymphadenectomy, especially in resections for carcinoma of the rectum, is being reexamined with renewed enthusiasm. Improved perioperative care has permitted performance of more aggressive operative intervention, with improved cure rates for patients with colorectal neoplasms.

Colorectal Neoplasms↗