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PubMed2003

Angiosarcoma of the submandibular salivary gland: case report and review of the literature.

OBJECTIVES: The purpose of this report is to describe an example of angiosarcoma (AS) of the submandibular salivary gland. The clinical and immunohistopathologic features of these lesions are also reviewed. MATERIAL AND METHODS: A 17-year-old male high school student was admitted to our clinic with a 1-year history of a slow-growing, tender mass in the left submandibular region. Physical examination on initial presentation revealed a diffuse soft tissue mass 6 cm in diameter involving the left submandibular region. MRI analysis revealed a mass located superolateral to the submandibular salivary gland, measuring 4.0 x 2.0 cm2. The mass was excised completely together with the left submandibular salivary gland. Histopathologic analysis led to a diagnosis of AS. Immunohistochemical studies were also used to determine endothelial cell differentiation. Owing to the lateralized nature of the lesion, a left functional neck dissection was performed and postoperative radiotherapy was planned. RESULTS: AS is a malignant tumor of endothelial cell origin that may occur in any region of the body. The commonest sites include the extremities and the retroperitoneal space, with only 4% of AS tumors arising in the head and neck area. The submandibular salivary gland is an extremely rare location for this tumor. Based on a literature review, this case report represents only the second reported case of AS of the submandibular salivary gland. CONCLUSIONS: In most cases, radical surgery and postoperative radiotherapy are advocated to treat patients with AS tumors, with lymph node clearance recommended in cases of lateralized lesions In some patients, distant metastasis may occur after many years, which necessitates long-term follow-up. The prognosis is poor in most cases of AS.

Adolescent↗
PubMed1992

[Pelvic and para-aortic lymphadenectomy in primary cancer of the ovary].

The results of pelvic and para-aortic lymphadenectomy performed in 24 patients with primary ovarian cancer are reported. The lymph node invasion rate was 20 percent in stages where the disease was apparently limited to the pelvis, and 73 percent in more advanced stages. Invasion was as frequently found at postoperative second-look laparotomy (54 percent) as at initial exploratory laparotomy (46 percent). Retroperitoneal expansion equally involved the pelvic and para-aortic lymph nodes: among 12 patients with positive lymphadenectomy, 8 had combined pelvic and para-aortic invasion, 2 had exclusively pelvic invasion and 2 had exclusively para-aortic invasion. We would therefore recommend to perform lymphadenectomy during the first operation, particularly in presumed stage I or II cancer, and to dissect the lymph nodes in both the pelvic cavity and the lumbo-aortic region.

Adult↗
PubMed1994

Anatomic abnormalities of the retroperitoneum encountered during aortic and pelvic lymphadenectomy.

OBJECTIVE: Our purpose was to describe retroperitoneal abnormalities and related surgical problems encountered during lymphadenectomy. STUDY DESIGN: A prospective study was carried out on 309 consecutive patients with cervical, endometrial, and ovarian cancer treated with systematic aortic and pelvic lymphadenectomy at the Department of Gynecological Oncology of the Catholic University, Rome. RESULTS: Urinary and vascular anomalies were observed in five (1.6%) and 42 (13.6%) cases, respectively. Preoperative diagnosis was made by intravenous pyelography and computed tomographic scan in 14.9% (seven of 47) of patients with malformations. In three cases abnormal vessels were accidentally injured during lymphadenectomy with no postoperative sequelae. CONCLUSIONS: Preoperative diagnosis of retroperitoneal abnormalities is rarely made during routine preoperative workup. Thus during surgery an accurate surgical technique including adequate exposure of retroperitoneal organs and careful blunt dissection together with a knowledge of both normal and abnormal anatomy are necessary to avoid accidental injury to abnormal retroperitoneal organs.

Adult↗
PubMed1998

Hepatic subcapsular extension of pelvic lymphocele after radical retropubic prostatectomy.

Lymphoceles are a rare symptomatic complication after radical prostatectomy occurring in less than 5% of cases. We present a case of a symptomatic lymphocele that occurred after a radical retropubic prostatectomy and obturator lymphadenectomy. The lymphocele dissected along the retroperitoneum and extended into the hepatic subcapsular space and became secondarily infected with Candida albicans.

Candidiasis↗
PubMed1982

Complications of retroperitoneal lymphadenectomy in the management of nonseminomatous tumors of the testis.

Retroperitoneal lymphadenectomy is the definitive operation for the accurate pathologic staging and treatment of Stage A, B1 and B2 nonseminomatous germ cell tumors of the testis. A review of 33 patients who underwent thoracoabdominal lymphadenectomy during a three year period yielded evidence of four minor complications and one major complication that resulted in the only operative death. The thoracoabdominal approach is preferred and allows one to palpate the ipsilateral thoracic cavity for unsuspected pulmonary metastasis to perform with greater ease bilateral dissection that includes a left suprahilar dissection, to use an extraperitoneal approach in patients without bulky abdominal disease--Stage B3 and C--and can be performed safely and with minimal morbidity and mortality by the well trained urologic surgeon.

Adolescent↗
PubMed2001

Advanced testis cancer.

Advanced testis tumors are highly curable. The treatment strategy is chemotherapy followed by the surgical exeresis of residual disease. The standard chemotherapy regimen is BEP (bleomycin, etoposide, and cisplatin); the number of cycles of chemotherapy depends upon prognostic factors, based on the primary site, histology, presence of visceral metastases, and serum tumor marker levels. Patients in the good-risk group receive three cycles of chemotherapy, whereas those in the intermediate- and high-risk groups receive four cycles. Exeresis of all residual disease and systematic postchemotherapy retroperitoneal dissection in bulky disease are mandatory. When complete exeresis of necrotic tissue, teratoma, or active germ-cell cancer has been performed, no further postsurgical treatment is warranted. A multidisciplinary approach, rigorous administration of chemotherapy, and skill in surgery of germ-cell tumors are favored in the treatment of these patients in trained centers.

Algorithms↗
PubMed1984

Yolk sac carcinoma: an immunohistochemical and clinicopathologic review.

The records of 14 children with yolk sac carcinoma were reviewed to determine if the production of specific proteins by the tumor could be used to predict the biologic potential of the neoplasm. Several marker proteins were identified by immunohistochemical staining of tissue specimens. The presence or absence of these proteins (periodic acid, Schiff-positive and diastase-resistant globules, alpha-1-antitrypsin, alpha-fetoprotein, beta-subunit of human chorionic gonadotropin and albumin) was of no prognostic significance when survivals free of disease were compared. Six patients underwent retroperitoneal node dissection as part of initial staging (group A), 1 (17 per cent) of whom had retroperitoneal lymphatic metastasis. Eight patients were not subjected to lymphadenectomy initially (group B). Retroperitoneal node dissection did not produce an increase in survival free of disease. Our findings suggest that retroperitoneal node dissection should not be used routinely in all children with yolk sac tumors. Adjunctive chemotherapy has proved extremely effective in salvaging patients in whom metastatic disease develops.

Adolescent↗
PubMed1997

Comparison of histological results from the resection of residual masses at different sites after chemotherapy for metastatic non-seminomatous germ cell tumours.

Cisplatin-based combination chemotherapy is considered standard treatment for patients with metastatic testicular cancer. However, despite the normalisation of serum tumour markers, 25-50% of patients will demonstrate residual neoplastic masses on radiological examination after completion of chemotherapy. The management of patients presenting with multiple residual masses at different localisations remains particularly difficult. This report summarises the histological findings and the clinical outcome of 27 patients with metastatic non-seminomatous germ cell tumours who underwent multiple resections for residual masses at different localisations after first-line cisplatin-based chemotherapy at Hannover University Medical School between 1980 and 1995. Fifty-six resections were performed (27 retroperitoneal interventions, 21 thoracotomies, 4 resections of hepatic lesions, 3 neck dissections, 1 craniotomy). No surgery-related mortality was observed. 8 patients (30%) showed dissimilar histological findings at sequential or one-stage resections. 5 of these demonstrated less favourable pathological features (mature teratoma or undifferentiated tumour) at the second operation, while only necrosis (n = 3) or teratoma (n = 2) had been found following the first operation. Tumour necrosis was documented more frequently at thoracotomy (n = 15/21) compared to retroperitoneal lymph node excision (n = 17/27). By univariate analysis, completeness of surgery (R0 resection) and the histological finding of necrosis or differentiated teratoma were associated with improved relapse-free and overall survival. After a median follow-up period of 33 months (range 1-167), 19 of 26 (73%) evaluable patients are alive; 18 of 27 (67%) patients have continuous no evidence of disease (1 patient with recurrent disease was lost to follow-up). Since the histological findings in postchemotherapy residuals may vary between different anatomical sites and no prediction seems possible, patients are best managed by excision of all present tumour masses if technically feasible. Necrosis identified at thoractomy should not lead to omission of retroperitoneal lymph node resection since there was, in accordance to other authors, a trend that the retroperitoneum harbours unfavourable histological findings more frequently.

Adolescent↗
PubMed1986

Retroperitoneal lymphadenectomy in clinical stage I nonseminomatous germinal testis cancer.

Thirty-six consecutive patients underwent retroperitoneal lymphadenectomy for clinical stage I nonseminomatous germinal testis cancer from January 1980 to August 1981. Retroperitoneal lymphnode metastases were pathologically documented in 8 cases (22.2%). No patient received adjuvant therapy following surgery. The disease relapsed in 4 patients (11.1%) always in the lung, from 5 to 7 months after lymphadenectomy. The pulmonary disease was minimal in 3 cases and bulky (1 lung nodule greater than 2 cm) in 1 patient. All the relapsed patients entered continuous complete remission with cisplatin, vinblastine and bleomycin (plus surgery in one case). All the 36 patients in this series are alive and disease-free after a follow-up period of 40-60 months from lymphadenectomy. Antegrade ejaculation was lost by 10 out of 13 cases who had undergone the bilateral lymphadenectomy (77%) and by 2 of the 21 adult patients who had had the unilateral dissection (9.5%). Unilateral retroperitoneal lymphadenectomy is recommended in patients with negative intra-operative findings who undergo surgery for clinical stage I nonseminomatous testis cancer.

Adolescent↗
PubMed1998

Retroperitoneal lymphadenectomy for post-chemotherapy residual masses: is a modified dissection and resection of residual masses sufficient?

OBJECTIVE: To determine if post-chemotherapy retroperitoneal lymphadenectomy for residual masses can be limited to resection of the residual masses and a modified template dissection, without loss of therapeutic efficacy. PATIENTS AND METHODS: Between 1985 and 1995, 50 patients underwent one of three types of retroperitoneal lymphadenectomy for a residual mass after cisplatin-based chemotherapy for stages II and III testicular non-seminomatous germ cell tumour. The pre-operative imaging, operative record and pathology reports were reviewed to determine the location of the residual masses and whether tumour, defined as teratoma or viable carcinoma, was within the boundaries of the modified template and/or residual masses. The median (range) follow-up was 56 (1-140) months. RESULTS: Of 39 patients undergoing a bilateral dissection, one (2.6%) with a left testicular cancer had teratoma identified outside the boundaries of the modified template and the residual masses. The nine patients who underwent resection of residual masses and a modified-template dissection were relapse-free at a median follow-up of 55 months. One of two patients undergoing resection of residual mass alone had two recurrences arising from incomplete resection. Four of eight patients undergoing a modified dissection retained ejaculation, compared with seven of 25 (28%) undergoing a non-nerve sparing bilateral dissection. CONCLUSION: This retrospective study suggests that in patients whose tumour markers become normal and have a residual mass after chemotherapy, residual masses can be resected with a modified-template dissection with no significant risk of leaving tumour in the retroperitoneum.

Adolescent↗
PubMed1994

A new transabdominal approach to the left retroperitoneum for systematic removal of lymph nodes left of the aorta in gynecologic malignancies.

To improve the exposure of the left retroperitoneum, a peritoneal incision is made in the left paracolic gutter up to the splenic flexure. By elevating and medially displacing the left colon, the avascular plane between this and the prerenal fascia is entered and developed caudally to the aorta bifurcation, and cranially 3-4 cm beyond the left renal pedicle. Thus, the left kidney, its pedicle, the ureter, the ovarian vessels, and the aorta are adequately exposed. In 81 patients with gynecologic tumors who underwent the modified lymphadenectomy, the median number of aortic nodes removed was 29 (range 21-56). The median duration of left dissection was 35 minutes (range 25-50) and of the entire aortic lymphadenectomy 70 minutes (range 50-120). No major intraoperative injuries occurred. The frequency and type of postoperative complications were not affected by this modification. This new approach provides better exposure of the left retroperitoneum, thus permitting safe and complete dissection of the nodes left of the aorta without increased morbidity. If aortic dissection can be limited to the left side, this technique makes it possible to avoid opening the right retroperitoneum.

Adult↗
PubMed1993

An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging.

BACKGROUND: To determine the extent of dissection in curative resection for cancer of the pancreatic head, the mode of recurrence was determined at autopsy and by radiographic examinations. MATERIALS AND METHODS: Records of 45 patients who had undergone macroscopically curative resection of carcinoma of the head of pancreas were analyzed to determined the mode of recurrence. The mode of recurrence was divided into four types: hepatic metastasis, peritoneal dissemination, retroperitoneal recurrence, and distant metastasis. Retroperitoneal recurrence was subdivided into lymph node metastasis and local recurrence, primarily neural invasion and lymphatic invasion. RESULTS: Thirty patients experienced disease recurrence. Patients with Stage I or II disease experienced recurrence significantly less often than did patients with Stage III or IV disease (P < 0.05). Local retroperitoneal recurrence was discovered in 12 of 15 (80%) postmortem examinations, hepatic metastasis in 10 (66%), peritoneal dissemination in 8 (53%), and lymph node recurrence in 7 (47%). In 15 antemortem studies, retroperitoneal recurrence occurred most frequently (87%), followed by hepatic metastasis (53%). Almost all patients with liver metastasis also had local retroperitoneal recurrence. CONCLUSIONS: The frequency of retroperitoneal recurrence of carcinoma of the head of the pancreas suggests that retroperitoneal resection, including nerve plexi and lymph nodes, should be included in curative resections for patients with Stage I or II pancreatic cancer.

Adenocarcinoma↗
PubMedDate not supplied

[Carcinoma of the transverse colon].

Carcinoma of the transverse colon accounts for 10% of all colorectal cancer. Diagnosis is often delayed and complicated forms (perforation, fistulization, obstruction) occur in 30-50% of cases. The progression of symptoms is often insidious and tumors may be voluminous by the time of diagnosis. Right sided tumors are typically bulky and late-stage; perforation may lead to abdominal wall or retroperitoneal abscess. Tumor can also extend or fistulize into adjacent organs. Distal transverse cancers may be small annular lesions which are prone to obstruction. Cancers present as T4 lesions in 20-40% of cases. Abdominal CT is the best test to evaluate the loco-regional extension of advanced tumors. Their central location and advanced stage at presentation results in an extensive differential diagnosis. This central location also poses difficult surgical choices for lymph node dissection, extent of resection, and re-establishment of intestinal continuity. Surgical series which focus on transverse colon cancer date from the 1970-80's; they show curative resections in only 50% with morbidity/mortality of 20% and a global five year survival of less than 35%; they were considered to have a particularly poor prognosis.

Carcinoma↗
PubMed1984

Second-look lymphadenectomy in the treatment of germ cell testis tumors.

A retroperitoneal relapse of germ cell tumors following retroperitoneal lymphadenectomy (RLA) demands a new treatment regimen aiming towards cure. The combination of primary chemotherapy and subsequent second-look operation has proved successful. The results reviewed are concerned with a revision operation (n = 22) usually following cytostasis (n = 15). In 6 cases, a nonoperable situs was discovered after false-positive findings on examination. In 7 other patients the proposed radical removal of the relapse tumor was successful. Nine times the operation only had a palliative character. After histological examination of the dissectate, we found highly malignant tumor fragments in 9 cases; five times we resected 'mature teratomas'; two times we found only necrotizing or fibrotically degenerated malignoma remnants. The result of the pathological-histological examination has a decisive meaning for the younger patient.

Adolescent↗
PubMed1978

Paratesticular rhabdomyosarcoma in childhood.

The paratesticular region was the primary site in 20 of 289 children (7%) entered on the Intergroup Rhabdomyosarcoma Study. The 20 patients were 1.7- to 19-years-old at diagnosis. Fifteen underwent retroperitoneal node dissection (12) or biopsy (3), and 6/15 (40%) had nodal involvement by tumor. Nineteen of the 20 patients had no gross local or metastatic disease after surgery. All 20 received chemotherapy, and 13 also received radiotherapy. Treatment was effective: 16 of 18 evaluable patients (89%) were free of disease at a median of 23 months from diagnosis (range, 8-43 months). Since the incidence of tumor-involved retroperitoneal nodes is high, a dissection should be performed. If the nodes are free of tumor, retroperitoneal radiotherapy may not be necessary. Reduction of morbidity in patients with paratesticular rhabdomyosarcoma is desirable, because the disease has a good prognosis.

Adolescent↗
PubMed2006

[Pleomorphic carcinoma of the lung rapidly developed multiple metastases after surgery].

Pleomorphic carcinoma of the lung is a type of carcinoma with spindle and/or giant cells with a poor diagnosis. A 73-year-old male was referred to our hospital because of the pulmonary tumor. Lung biopsy revealed that the tumor was poorly differentiated adenocarcinoma. No distant metastasis were observed by systemic examination. A right middle lobectomy with partial resection of the right upper lobe and lymph node dissection were performed, because the tumor (5.3 x 4.0 x 4.0 cm) was located in peripheral S' and invaded S3 via the interlobular space. Histological findings showed adenocarcinoma comprised of spindle cell components that reacted positively to epithelial membrane antigen (EMA) and no lymph node metastasis. Therefore, he was diagnosed with pleomorphic carcinoma of the lung, pT2N0M0, stage IB. But metastatic lesions newly appeared in the thoracic skin, the liver, the diaphragm, the bilateral adrenal glands, and the retroperitoneal space on the 30th postoperative day. He died of peritonitis and pleuritis on only 60 days after the operation.

Adenocarcinoma↗
PubMedDate not supplied

[Preliminary data on our laparoscopy experience in urinary pathology].

We studied laparoscopic urological procedures in 14 cases between July 1995 and October 1996. We applied retroperitoneal lomboscopic technique for 2 cases with symptomatic renal cyst (over 500 ml) and laparoscopic retroperitoneal lymphadenectomy in 12 cases (adenocarcinoma of the prostate-5 cases, pT2-3bMo, Gleason score between 3-9, PSA between 11-46 ng/ml and invasive bladder tumors-7 cases, pT2-3bMoG2-3). For the renal cyst we used extraperitoneal approach and for the pelvic lymph nodes we used in 8 cases intraperitoneal approach and in 4 cases extraperitoneal approach (patients with multiple prior abdominal surgeries). Lymph node tissue was present in 11 cases. For the bladder tumors we did first iliac lymph nodes dissection and for the prostate adenocarcinoma we did first obturator lymph nodes dissection. We didn't describe complications. For our patients it was 3 days long hospitalization. So, we consider that laparoscopic lymphadenectomy is essential for evaluation of the patients with prostate adenocarcinoma having markedly elevated prostate specific antigen, high Gleason grade, large clinical burden of tumor. For the invasive bladder tumors, radical cystectomy and especially bladder replacement surgery need absolutely evaluation of regional lymph nodes. For the symptomatic renal cysts (over 500 ml) laparoscopic surgery is with very good results, minimally invasive.

Adenocarcinoma↗
PubMed2005

Histologic survey of neuroblastomas after intensive induction chemotherapy.

BACKGROUND: Histology after intensive induction chemotherapy is expected to become a beacon indicating when and how extensively radical surgery and lymph node dissection should be performed in advanced neuroblastoma. A thorough histologic review of surgical specimens was undertaken. PROCEDURE: All specimens from 34 patients who were pretreated intensively (> or =3 cycles) with recent chemotherapy were reviewed. Thirty patients were >12 months of age with stage 3/4 disease, and 4 were <12 months of age but with MYCN-amplified stage 4 diseases. After 3 to 7 cycles (mean, 4.3 cycles) of induction chemotherapy, patients underwent radical surgery of the primary tumor and lymph nodes in all retroperitoneal sections. A single pathologist reviewed all of the specimens, and histologic chemotherapeutic effects were graded as: (+++), <1% viable tumor; (++), 1%-10% viable tumor; (+), 11%-50% viable tumor; (+/-), 51%-90% viable tumor; and (-), >91% viable tumor. RESULTS: Grade (+++) effects were observed in 56% of patients treated with the new regimens, whereas grade (+++) was seen in only 20% treated with regimens before 1991. Operation time and blood loss were 7 hr and 6 min (P = 0.087) and 646 ml (P = 0.064), respectively, in patients with >5 cycles (mean, 5.3 cycles) of chemotherapy, while they were 7 hr and 50 min and 1,168 ml, respectively, in those with approximately 3 cycles (mean, 3.2 cycles). Histologically, metastases were found in the contralateral nodes beyond the aorta in 92% of those whose tumor originated on the left, and in 80% of those with tumors occurring on the right. CONCLUSIONS: Five cycles of induction chemotherapy did not improve histologic chemotherapeutic effects, but helped to facilitate a shorter operation time and less blood loss than 3 cycles of chemotherapy. Surgery after 5 cycles of (98)A(3) also appears to be easier to perform than that after 3 cycles of A(1)/new A(1). Only 14% of the children treated before 1985 with the St. Jude protocols experienced grade (+++) chemotherapeutic effects, and 22% of the patients treated before 1991 with regimen A(1), or new A(1) of the Study Group of Japan showed grade (+++) effects, whereas 56% of the patients treated after 1991 with either regimen A(3) or (98)A(3) exhibited grade (+++) chemotherapeutic effects. Histologic chemotherapeutic effects were roughly parallel with a good prognosis.

Abdominal Neoplasms↗