51
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Chander S, Ngan C, Choong PFM. Management of Metastatic Sarcoma. Sarcoma 2021. [DOI: 10.1007/978-981-15-9414-4_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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52
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Garcia-Ortega DY, Alvarez-Cano A, Clara-Altamirano MA, Martín-Tellez KS, Caro-Sánchez CHS, Ruvalcaba-Gonzalez CDLC, Martinez-Said H, Cuellar-Hubbe M, Luna-Ortiz K. Should metastatic lymph nodes be considered at the same clinical stage as distant metastasis in soft tissue sarcomas? Cancer Treat Res Commun 2020; 26:100268. [PMID: 33340903 DOI: 10.1016/j.ctarc.2020.100268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/29/2020] [Accepted: 12/08/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Lymph node metastasis (LNM) in soft tissue sarcomas (STS) are uncommon, occurring in only 3% - 5% of all sarcomas, and are classified as Stage IV, along with distant metastasis (DM). This paper compares the prognosis of patients with lymphatic and DM, in extremity STS (eSTS). METHODS A retrospective study was carried out in a high-volume sarcoma center; 853 patients with eSTS sarcomas were identified and classified from January 1, 1997 to December 31, 2017. Cases with pathological confirmation of LNM were included. Five-year survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. RESULTS LNM was present in 46 of the cases (5.4%), with an overall survival of 21 months (95% confidence interval [CI], 16.7 - 25.2), compared to 18 months (95% confidence interval [CI], 14.2 - 21.7) in those with only DM. Median recurrence-free survival was 21 months (95% confidence interval [CI], 19.7 - 22.4), vs. 20 months (95% confidence interval [CI], 16.2- 23.7), respectively. LNM only and DM only had also a similar OS of 21 months (95% CI 16.7-25.2) vs 18 months (95% CI 14.2-21.7. N1M1 cases had the worse median OS with 15 months (95% confidence interval [CI], 10.9-19.7) CONCLUSIONS: Overall survival and recurrence free survival in patients with lymph node disease and metastatic disease are similar. However prognosis is worse in N1M1. Use of systemic treatment in patients with LNM is not as common as in metastatic cases, this difference in treatment and the fact that prognosis is similar suggests that both biological behavior and effect of treatment have been underestimated. A subclassification of clinical stage IV might be the next step.
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Affiliation(s)
| | | | | | | | | | | | - Hector Martinez-Said
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
| | - Mario Cuellar-Hubbe
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- National Cancer Institute (Instituto Nacional de Cancerología) Mexico City, Mexico
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53
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Khader M, Alyafei T, Ibrahim S, Elaiwy O. Angiomatoid fibrous histiocytoma (AFH) unusual clinical presentation and unique radiological findings. BJR Case Rep 2020; 7:20190069. [PMID: 33841896 PMCID: PMC8008459 DOI: 10.1259/bjrcr.20190069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 10/30/2020] [Accepted: 11/17/2020] [Indexed: 11/23/2022] Open
Abstract
Angiomatoid fibrous histiocytoma (AFH) are rare soft tissue mesenchymal neoplasms that commonly affect children and young adults. They are classified as “intermediate tumours of uncertain differentiation”. We present a case of an 8-year-old child with a left thigh AFH and antecedent history of minor trauma showing perilesional oedema and enhancement at MRI, leading to an initial working diagnosis of infected haematoma that contributed to the challenge in reaching the final diagnosis. Although most of the imaging features of AFH previously described in the literature are demonstrated in this case, the presence of arterial vascular channels within the tumour and feeding branch from the left profunda femoris artery is unusual and to our knowledge the first to be published in the literature.
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Affiliation(s)
- Mohammed Khader
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Tahiya Alyafei
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Sulafa Ibrahim
- Department of Radiology, Hamad General Hospital, Doha, Qatar
| | - Orwa Elaiwy
- Department of Pathology, Hamad General Hospital, Doha, Qatar
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Abstract
Primary malignant tumors in the hand are rare as compared to benign lesions; however, it is essential for orthopeadic surgeons to be familiar with their clinical presentation. The approach to working up a mass in the hand must be methodical and thorough, and clinicians must maintain high index of suspicion when evaluating these lesions. Successful identification and treatment of malignant tumors of the hand may include referral to a sarcoma center for staging, workup, and multidisciplinary treatment. Surgical treatment of malignant tumors in the hand is uniquely complicated by the increased number of critical structures that may be in close proximity to the tumor. It is therefore imperative to understand the principles of diagnosis, staging, biopsy, resection, and amputation before treating malignant tumors of the hand.
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55
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Sa HS, Rubin ML, Ning J, Li W, Tetzlaff MT, McGovern SL, Paulino AC, Herzog CE, Gill JB, Esmaeli B. Association of T and N Categories of the American Joint Commission on Cancer, 8th Edition, With Metastasis and Survival in Patients With Orbital Sarcoma. JAMA Ophthalmol 2020; 138:374-381. [PMID: 32105303 DOI: 10.1001/jamaophthalmol.2020.0039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance No previous studies to date have validated the American Joint Committee on Cancer (AJCC) 8th edition of the TNM classification for orbital sarcoma. Objectives To determine the prognostic performance of the most recent TNM classification for orbital sarcoma and to identify other prognostic factors for local recurrence, lymph node metastasis, distant metastasis, and death due to disease. Design, Setting, and Participants This single-center retrospective cohort study included 73 consecutive patients treated for orbital sarcoma from March 1, 2003, through June 30, 2018. Data were analyzed from November 1 to December 31, 2018. Main Outcomes and Measures T and N categories at presentation and disease-related outcomes, including local recurrence, lymph node metastasis, distant metastasis (DM), and death due to disease (DD). Results The 73 participants included 43 men (59%), and the median age was 21 (range, 0-77) years. The common histologic types were rhabdomyosarcoma (RMS) (35 [48%]), solitary fibrous tumor/hemangiopericytoma (10 [14%]), and Ewing sarcoma (8 [11%]). The most common TNM designations were T2 N0 M0 (26 [36%]) and T4 N0 M0 (24 [33%]). T category was associated with the risk of all disease-related outcomes, including local recurrence (hazard ratio [HR] for T2 vs T4, 0.22 [95% CI, 0.06-0.81]; HR for T3 vs T4, 0.59 [95% CI, 0.13-2.65]; P = .03), lymph node metastasis by the last follow-up (T1, 1 [14%]; T2, 0; T3, 0; T4, 12 [35%]; P = .001), DM (HR for T2 vs T4, 0.29 [95% CI, 0.08-1.07]; P = .04), and DD (HR of T2 vs T4, 0.16 [95% CI, 0.04-0.73]; HR of T3 vs T4, 0.30 [95% CI, 0.04-2.34]; P = .02). Higher risk of DM and higher risk of DD were associated with disease category of at least T3 (HR for DM, 3.24 [95% CI, 0.89-11.72; P = .06]; HR for DD, 6.32 [95% CI, 1.43-27.95; P = .005]), N1 disease (HR for DM, 13.33 [95% CI, 4.07-43.65; P < .001]; HR for DD, 7.07 [95% CI, 2.45-20.44; P < .001]), tumor size larger than 3 cm (HR for DM, 2.72 [95% CI, 0.92-8.05; P = .06]; HR for DD, 5.79 [95% CI, 1.85-18.14; P < .001]), and age of patient with RMS younger than 1 year or 10 years or older (HR for DM, 6.85 [95% CI, 0.83-56.53; P = .04]; HR for DD, 7.03 [95% CI, 0.85-57.83; P = .04]). Higher risk of local recurrence was associated with disease category of at least T3 (HR for<T3 vs≥T3, 0.20 [95% CI, 0.06-0.71]; P < .01) and tumor size greater than 3 cm (HR for ≤3 cm vs >3 cm, 0.27 [95% CI, 0.09-0.77]; P = .009). Higher risk of lymph node metastasis was associated with disease category of at least T3 (odds ratio [OR], 13.33 [95% CI, 1.77-602.30]; P = .004), alveolar RMS (OR, 9.98 [95% CI, 2.13-51.55]; P = .001), and age of patient with RMS younger than 1 year or 10 years or older (OR, 9.20 [95% CI, 1.01-458.29] P = .03). Conclusions and Relevance In patients with orbital sarcoma, T and N categories at presentation (defined by the AJCC 8th edition classification) correlate with metastasis and survival. These findings appear to support consideration of strict surveillance testing for regional nodal and systemic metastases in patients with orbital sarcoma with disease category of at least T3 and/or N1 disease.
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Affiliation(s)
- Ho-Seok Sa
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston.,Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Maria Laura Rubin
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jing Ning
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Wen Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | - Michael T Tetzlaff
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston
| | - Susan L McGovern
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Arnold C Paulino
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston
| | - Cynthia E Herzog
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Jonathan B Gill
- Department of Pediatrics, The University of Texas MD Anderson Cancer Center, Houston
| | - Bita Esmaeli
- Orbital Oncology and Ophthalmic Plastic Surgery, Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston
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Affas S, Ayas MF, Mendes JM, Hadid T. Primary Leiomyosarcoma of the Mesentery: A Case Report With Review of Literature. Cureus 2020; 12:e10777. [PMID: 33033670 PMCID: PMC7532863 DOI: 10.7759/cureus.10777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Mesenteric leiomyosarcoma (LMS) is a rare gastrointestinal mesenchymal tumor. It was often misdiagnosed as a gastrointestinal stromal tumor (GIST) until the introduction of immunohistochemistry staining (IHC) in 1998. Currently, a positive IHC staining for smooth muscle markers represents the main diagnostic modality. Herein, we present a case of Mesenteric LMS in a 68-year-old woman, who presented with nausea, vomiting, and abdominal pain and was found to have a right-sided mesenteric tumor encasing the right ureter, with right hydroureteronephrosis. The patient underwent surgical removal of the tumor and IHC stains were compatible with LMS. She achieved remission until she developed recurrence 12 months after initial diagnosis and subsequently expired due to postoperative complications when re-resection was attempted. Typically, mesenteric LMS carries a poor prognosis with a propensity for hematogenous metastasis. In the absence of a standardized protocol for therapy, early surgical resection is the only known curative modality but with a high risk of recurrence.
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Affiliation(s)
- Saif Affas
- Internal Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Mohamad F Ayas
- Internal Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Juliann M Mendes
- Pathology and Laboratory Medicine, Ascension St. John Hospital and Medical Center, Detroit, USA
| | - Tarik Hadid
- Oncology, Ascension St. John Hospital and Medical Center, Detroit, USA
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57
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Basile G, Mattei JC, Alshaygy I, Griffin AM, Catton CN, Chung PW, Shultz DB, Razak ARA, Demicco EG, Ferguson PC, Wunder JS. Curability of patients with lymph node metastases from extremity soft-tissue sarcoma. Cancer 2020; 126:5098-5108. [PMID: 32910462 DOI: 10.1002/cncr.33189] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lymph node metastases (LNM) rarely occur in adult extremity soft-tissue sarcoma (STS), affecting approximately 5% of patients. To the authors' knowledge, few studies to date have evaluated the prognosis and survival of patients with LNM. METHODS A retrospective review was performed of a single-center, prospectively collected STS database. Demographic, treatment, and oncologic data for patients with STS of the extremity with LNM were obtained from clinical and radiographic records. RESULTS Of 2689 patients with extremity STS, a total of 120 patients (4.5%) were diagnosed with LNM. LNM occurred most frequently among patients diagnosed with clear cell sarcoma (27.6%), epithelioid sarcoma (21.9%), rhabdomyosarcoma (17.3%), angiosarcoma (14.0%), and extraskeletal myxoid chondrosarcoma (9.3%). A total of 98 patients (81.7%) underwent LNM surgical resection. Patients with isolated LNM had a greater 5-year overall survival (57.3%) compared with patients with American Joint Committee on Cancer (AJCC) eighth edition stage IV STS with only systemic metastases (14.6%) or both LNM and systemic disease (0%; P < .0001). Patients with isolated LNM had an overall survival rate (52.9%) similar to that of patients with localized AJCC stage III tumors (ie, large, high-grade tumors) (49.3%) (P = .8). Patients with late, isolated, metachronous LNM had a 5-year overall survival rate (61.2%) that was similar to that of patients with isolated synchronous LNM at the time of presentation (53.6%) (P = .4). CONCLUSIONS Many different types of STS develop LNM. Patients with extremity STS with isolated LNM should not be considered as having stage IV disease as they are according to the current AJCC eighth edition classification because they have significantly better survival than those with systemic metastases. Patients with isolated, late, metachronous LNM have a survival similar to that of patients with isolated synchronous LNM at the time of presentation. LAY SUMMARY The results of the current study demonstrated that patients diagnosed with isolated lymph node metastases have a prognosis similar to that of patients diagnosed with localized American Joint Committee on Cancer stage III soft-tissue sarcomas, which also equates to a significantly better overall survival compared with patients with systemic metastases. Therefore, the authors recommend modifications to the most recent eighth edition of the American Joint Committee on Cancer staging system to clearly distinguish patients with isolated lymph node metastases to acknowledge their better prognosis compared with those with systemic metastases.
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Affiliation(s)
- Georges Basile
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Maisonneuve-Rosemont Hospital, Montreal, Quebec, Canada
| | - Jean-Camille Mattei
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Ibrahim Alshaygy
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anthony M Griffin
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Charles N Catton
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Peter W Chung
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - David B Shultz
- Radiation Medicine Program, Princess Margaret Cancer Center, Toronto, Ontario, Canada.,Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Albiruni R A Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Elizabeth G Demicco
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Peter C Ferguson
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Jay S Wunder
- Musculoskeletal Oncology Unit, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
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58
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Okamoto M, Matsuoka M, Soma T, Arai R, Kato H, Harabayashi T, Adachi H, Shinohara T, Sagawa T, Nishiyama N, Nambu T, Sakai W, Suzuki H, Kato H, Hiraga H. Metastases of soft tissue sarcoma to the liver: A Historical Cohort Study from a Hospital-based Cancer Registry. Cancer Med 2020; 9:6159-6165. [PMID: 32648686 PMCID: PMC7476817 DOI: 10.1002/cam4.3304] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Revised: 06/02/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatic metastasis of soft tissue sarcoma is rare compared to lung metastasis, and the literature is scarce. We examined the risk of hepatic metastasis according to the site of occurrence and histological type. METHODS From a Hospital-based Cancer Registry, 658 patients registered between 2007 and 2017 with soft tissue sarcomas were evaluated. The exclusion criteria were gastrointestinal stromal tumors, tumors of unknown origin, and follow-up periods of less than 1 month. SPSS 25 was used for statistical analysis. RESULTS The risk of hepatic metastasis was significantly higher in the retroperitoneum (HR, 5.981; 95% CI, 2.793-12.808) and leiomyosarcoma (HR, 4.303; 95% CI, 1.782-10.390). Multivariate analysis showed that the risk of hepatic metastasis as first distant metastasis was high in leiomyosarcoma (HR, 4.546; 95% CI, 2.275-9.086) and retroperitoneal onset (HR, 4.588; 95% CI, 2.280-9.231). The 2-year survival rate after hepatic metastasis was 21.7%. CONCLUSIONS The onset of hepatic metastasis indicates a poor prognosis. However, hepatic metastasis from retroperitoneal sarcoma and leiomyosarcoma may be the first distant metastasis in some cases. For retroperitoneal sarcoma and leiomyosarcoma, additional screening for hepatic metastasis such as contrast CT should be considered during staging and follow-up after treatment.
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Affiliation(s)
- Masanori Okamoto
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Orthopaedic SurgeryShinshu University School of MedicineNaganoJapan
| | - Masatake Matsuoka
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Tamotsu Soma
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Ryuta Arai
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hidenori Kato
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Gynecologic OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toru Harabayashi
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of UrologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hirohumi Adachi
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Thoracic SurgeryNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toshiki Shinohara
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Gastrointestinal SurgeryNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Tamotsu Sagawa
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Medical OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Noriaki Nishiyama
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Radiation OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Toshikazu Nambu
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Diagnostic RadiologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Wataru Sakai
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Diagnostic RadiologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hiroaki Suzuki
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of PathologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
| | - Hiroyuki Kato
- Department of Orthopaedic SurgeryShinshu University School of MedicineNaganoJapan
| | - Hiroaki Hiraga
- Sarcoma CenterNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
- Department of Musculoskeletal OncologyNational Hospital Organization Hokkaido Cancer CenterSapporoJapan
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59
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Claxton MR, Reynolds G, Wenger DE, Rose PS, Houdek MT. Extraskeletal myxoid chondrosarcoma: A high incidence of metastatic disease to lymph nodes. J Surg Oncol 2020; 122:1662-1667. [PMID: 32808356 DOI: 10.1002/jso.26179] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/08/2020] [Accepted: 08/10/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Extraskeletal myxoid chondrosarcoma (ESMC) is a rare type of soft-tissue sarcoma with limited series reporting outcome of treatment. Currently there is limited data on the incidence and impact on patient outcome in those with metastatic disease to lymph nodes in ESMC. METHODS Thirty (21 males, 9 females) patients, mean age 50 ± 16 years, with ESMC were reviewed. The tumors were most commonly located in the lower extremity (n = 23, 77%) and the mean tumor size and volume were 9 ± 5 cm and 490 ± 833 cm3 . Mean follow up was 7 ± 4 years. RESULTS Six (20%) patients either presented (n = 3, 10%) or developed (n = 3, 10%) lymph node metastatic disease. When comparing patients without, with lymph node metastasis and metastasis elsewhere, patients with lymph nodes metastasis had worse survival than those without metastasis, however better 10-year disease specific survival than those with metastasis elsewhere (100% vs 62% vs 0%; P < .001). CONCLUSION There is a high incidence of lymph node metastatic disease in patients with ESMC. Although survival in these patients is worse compared to those without metastasis, their survival is better than those with metastasis elsewhere. Due to the high incidence of lymph node metastatic disease, preoperative staging of the lymph node should be considered.
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Affiliation(s)
- Matthew R Claxton
- Mayo Clinic Alix School of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Grace Reynolds
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Doris E Wenger
- Department of Radiology, Mayo Clinic, Rochester, Minnesota
| | - Peter S Rose
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Matthew T Houdek
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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60
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Metastatic myxoid liposarcoma to the tongue: a unique intraoral metastasis. Contemp Oncol (Pozn) 2020; 24:203-205. [PMID: 33235548 PMCID: PMC7670184 DOI: 10.5114/wo.2020.97483] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/10/2020] [Indexed: 12/24/2022] Open
Abstract
The first case of a myxoid liposarcoma metastatic to the tongue of a 78-year-old male patient with primary scrotal liposarcoma for the past seven years is reported. The patient presented with a firm exophytic mass of the left dorsal surface of the tongue, sized 4 to 4.5 cm, with oedema and bleeding. Myxoid liposarcoma is a malignancy with relatively good prognosis and low metastatic rate but high local recurrence. This is the second case report recorded of a metastatic liposarcoma to the oral cavity. Clinical and imaging considerations, as well pathological details concerning the myxoid liposarcoma, are described.
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61
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Kang Y, Bae J, Choi S, Jang KT, Yu J, Hong JY, Lim SY, Jeong HS. Regional Lymph Node Metastasis of Scalp Angiosarcoma: A Detailed Clinical Observation Study of 40 Cases. Ann Surg Oncol 2020; 27:3018-3027. [PMID: 32458324 DOI: 10.1245/s10434-020-08408-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND The incidence of lymph node metastasis (LNM) of angiosarcomas is reported to be less than 15%, and elective neck management has not been indicated. This study evaluated the incidence and pattern of regional LNM in patients with scalp angiosarcomas using the clinical data of its full course to understand time-event sequences of scalp angiosarcomas. METHODS This retrospective study included all consecutive cases of pathology-confirmed angiosarcomas and analyzed 40 cases of scalp angiosarcomas. The survival plots were estimated using the Kaplan-Meier method, and the results are presented mainly in a descriptive manner. RESULTS The overall survival rate for the patients was 35.8% at 2 years. In contrast to previous reports, regional LNM was observed in more than half of the patients (52.5%) with scalp angiosarcoma. Meanwhile, a direct spread to distant organs occurred in only 27.5% of the patients. Regional LNM could predict clinical manifestation of systemic disease within 3 to 6 months. No differences in survival rates between patients with and without LNM were observed in this series. Occurrence of LNM seemed to be correlated with a high mitotic rate of primary tumors, but not with tumor grade or tumor dimension. The first-echelon lymph nodes from scalp angiosarcoma were peri-parotid, post-auricular, and level 2 lymph nodes. CONCLUSIONS For a localized scalp angiosarcoma, it seems reasonable for initial curative surgery to include prophylactic evaluation of regional lymph nodes for pathologic nodal staging, prognosis estimation, and the decision for systemic treatments.
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Affiliation(s)
- Yungjee Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juyoung Bae
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sangjoon Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jeongil Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jung Yong Hong
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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Collaud S, Stork T, Schildhaus HU, Pöttgen C, Plönes T, Valdivia D, Zaatar M, Dirksen U, Bauer S, Aigner C. Multimodality treatment including surgery for primary pulmonary sarcoma: Size does matter. J Surg Oncol 2020; 122:506-514. [PMID: 32410271 DOI: 10.1002/jso.25979] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND AND OBJECTIVES Primary pulmonary sarcoma (PPS) accounts for less than 1.1% of all pulmonary tumors. Few outcome data are reported. We evaluated outcome and prognostic factors in our series. METHODS We retrospectively reviewed all patients who underwent resection for PPS in our center from 2002 to 2018. Survival was calculated from the date of surgery until last follow-up. Impact on survival of gender, type of lung resection, completeness of resection, grade, size, and TNM staging for lung cancer and soft tissue sarcoma (STS) was assessed. RESULTS Thirteen patients were included. Eight (61.5%) patients received neoadjuvant treatment. Median tumor size at diagnosis was 11.5 cm (1-30 cm). Type of lung resection was wedge (n = 2, 15%), lobectomy (n = 4, 31%), intrapericardial (n = 3, 23%), and extrapleural pneumonectomies (n = 4, 31%). In-hospital mortality was 8%. Overall 5-year survival was 60%. Median disease-free survival was 17 months. Tumor size was a predictor for survival (P = .02) and recurrence (P = .05). Gender (P = .04) and type of lung resection (P = .04) were predictors of survival. T stage for STS of trunk and extremity, and TNM stage for lung cancer were predictors for recurrence (P = .03 and P = .04, respectively). CONCLUSION Surgical resection within a multimodality therapy concept in highly selected patients can offer good long-term outcome.
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Affiliation(s)
- Stéphane Collaud
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Theresa Stork
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Hans-Ulrich Schildhaus
- Institute of Pathology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Christoph Pöttgen
- Department of Radiation Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Till Plönes
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Daniel Valdivia
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Mohamed Zaatar
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Uta Dirksen
- Department of Pediatrics III, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Sebastian Bauer
- Department of Oncology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, University of Duisburg-Essen, Ruhrlandklinik, Essen, Germany.,German Cancer Consortium (DKTK), Center Essen, Germany
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63
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Park S, Moon SK, Lim JW. Mechanism of metastasis to the spermatic cord and testis from advanced gastric cancer: a case report. BMC Gastroenterol 2020; 20:119. [PMID: 32312237 PMCID: PMC7171798 DOI: 10.1186/s12876-020-01269-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/05/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The spermatic cord and testis are very rare sites for metastasis from gastric cancer. Although several mechanisms have been suggested to explain this unusual metastasis, the actual mechanism remains unclear. We report a case of right spermatic cord and testicular metastasis, review its imaging findings, and suggest a mechanism of tumor spread. CASE PRESENTATION A 61-year-old man complained of a palpable mass in the right inguinal area. He had been treated with distal gastrectomy with chemotherapy for advanced gastric cancer 5 years ago. Computed tomography, ultrasound, and magnetic resonance imaging showed a mass surrounding the right spermatic cord, involving the right testis. Another mass was observed in the aortocaval space, presumed to be a metastatic lymph node. The imaging features of the right testicular lesion were different than those of the primary testicular cancer. The lesions at both sites showed similar radiologic features of abundant internal necrosis, which is consistent with metastatic lesions. Pathology confirmed metastatic adenocarcinoma. He underwent a series of chemotherapy sessions, and all metastatic masses had partially decreased in size at the 5-month outpatient follow-up. CONCLUSIONS The imaging features of testicular mass and spermatic cord involvement are important clues for accurate differential diagnosis of metastasis from other primary tumors in patients with a history of stomach cancer. This unusual metastasis can be explained via retrograde tumor spread along the lymphatic channels in terms of concurrent aortocaval lymph node metastasis. A suspicion of metastasis should not be overlooked, even if a patient has undergone curative treatment, including surgery and adjuvant chemotherapy, many years ago.
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Affiliation(s)
- Soyoung Park
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
| | - Sung Kyoung Moon
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea.
| | - Joo Won Lim
- Department of Radiology, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, 23, Kyung Hee Dae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea
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64
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Frezza AM, Sbaraglia M, Lo Vullo S, Baldi GG, Simeone N, Frenos F, Campanacci D, Stacchiotti S, Pasquali S, Callegaro D, Gambarotti M, Barisella M, Palomba A, Mariani L, Casali PG, Dei Tos AP, Gronchi A. The natural history of epithelioid sarcoma. A retrospective multicentre case-series within the Italian Sarcoma Group. Eur J Surg Oncol 2020; 46:1320-1326. [PMID: 32307188 DOI: 10.1016/j.ejso.2020.03.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 03/11/2020] [Accepted: 03/23/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION This case-series is aimed to describe the natural history of epithelioid sarcoma (ES) and to provide insights into the differential clinical behaviour of its two variants ("classic-type" and "proximal-type"). The value of a subtype-adapted grading system based on pathological features is explored. METHODS Data from consecutive, primary, localised, INI1-deleted ES operated at three Italian sarcoma reference centres (1995-2015) were included. Centralised pathological review was performed. Classic-type ES was broken down into "high-grade" and "low-grade", according to number of mitoses, evidence of necrosis and nuclear atypia. Five- and 10-year overall survival (OS) and crude cumulative incidence (CCI) of local recurrence (LR) and distant metastasis (DM) were estimated. RESULTS Fifty-two patients were included. 5- and 10-year OS estimates were 70% and 47% in the whole series, 57% and 37% in patients with proximal-type ES, 77% and 54% in patients with classic-type ES (P = 0.02). In classic-type ES, 5- and 10-year OS was higher for low-grade (95% and 72%, respectively) than high-grade tumours (P = 0.002). 5- and 10-year CCI estimates for LR were 21% and 33% in the whole series. 5- and 10-year CCI estimates for DM were 35% and 39% in the whole series, both 28% in classic-type ES, 47% and 59% in proximal-type ES (P = 0.03). CONCLUSIONS Suffering from a proximal- or a classic-type is the stronger predictor of outcome in patients with localised ES, with proximal-type ES patients having lower survival due to a higher tendency toward metastatic spreading. However, the "high-grade" classic-type ES was associated with outcomes close to proximal-type ES.
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Affiliation(s)
- Anna Maria Frezza
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy.
| | - Marta Sbaraglia
- Department of Pathology, Padua University Hospital, Padua, Italy
| | - Salvatore Lo Vullo
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | | | - Noemi Simeone
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Filippo Frenos
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Campanacci
- Department of Orthopaedic Oncology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Silvia Stacchiotti
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Sandro Pasquali
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Dario Callegaro
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marco Gambarotti
- Department of Surgical Pathology, IRCCS-Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marta Barisella
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Annarita Palomba
- Department of Pathology, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Luigi Mariani
- Unit of Clinical Epidemiology and Trial Organization, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy
| | - Paolo G Casali
- Department of Medical Oncology, IRCCS Fondazione Istituto Nazionale Tumori, Milan, Italy; University of Milan, Department of Oncology and Hemato-oncology, Milan, Italy
| | | | - Alessandro Gronchi
- Sarcoma Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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65
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Lim SY, Jeong HS. ASO Author Reflections: Pattern and Frequency of Lymph Node Metastasis in Scalp Angiosarcoma. Ann Surg Oncol 2020; 27:3028-3029. [PMID: 32246308 DOI: 10.1245/s10434-020-08411-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Indexed: 12/26/2022]
Affiliation(s)
- So Young Lim
- Department of Plastic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Han-Sin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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66
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Axillary Lymph Node Dissection in Angiosarcomas of the Breast: An Asian Institutional Perspective. Sarcoma 2020; 2020:4890803. [PMID: 32300278 PMCID: PMC7136812 DOI: 10.1155/2020/4890803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 02/25/2020] [Indexed: 12/29/2022] Open
Abstract
Angiosarcomas of the breast (ASB) are rare, making up to less than 8% of all angiosarcomas. The surgical management for this disease continues to vary throughout centres worldwide due to the current limited evidence. We aim to examine the necessity of axillary lymph node dissection in this pathology through a retrospective study of axillary metastasis and recurrence patterns in patients treated at our institution. A retrospective review of a prospectively-maintained database was performed. All adult patients with a histologically confirmed diagnosis of ASB seen at the National Cancer Centre Singapore between 2006 and 2019 were identified. Axillary lymph node status, treatment, survival, and recurrence data were collated. Thirteen patients were identified with a confirmed diagnosis of ASB, of which there were 11 primary and 2 secondary angiosarcoma cases. Eight patients had some form of axillary lymph node dissection and 5 did not. No positive nodes were found in any examined axillary nodes despite high median number of nodes harvested (13, range 8–24). 5/13 patients had disease progression, of whom none had locoregional recurrence to the axilla. ASB continues to be rare and recurrent and presents as a challenge to treat. Axillary lymph node involvement is most likely not present in a majority of patients. Prophylactic removal is unwarranted in patients presenting without lymph node involvement due to the lack of axillary metastasis.
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67
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Nodal metastases of soft tissue sarcomas: risk factors, imaging findings, and implications. Skeletal Radiol 2020; 49:221-229. [PMID: 31444522 DOI: 10.1007/s00256-019-03299-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 02/02/2023]
Abstract
Soft tissue sarcomas (STS) are malignancies derived from connective tissue, and regional lymph node metastasis (RLNM), while not common, is an important aspect of prognosis and treatment. Various risk factors, in particular the histological subtype, affect the likelihood of nodal involvement, which can be characterized by imaging features such as nodal dimension and morphology. Currently, surveillance and management vary by institution, as concrete societal guidelines have not been established. Common nodal status assessment strategies include physical exam, US CT, MRI, sentinel lymph node biopsy (SLNB) and radical lymphadenectomy. This article summarizes data regarding relevant risk factors of RLNM, imaging features, and any available data regarding surveillance recommendations.
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68
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Spencer RMSSB, de Camargo VP, Silva MLG, Pinto FFE, Costa FD, Cequeira WS, Munhoz RR, Mello CA, Schmerling RA, Filho WJD, Coelho TM, Ambrosio AVA, Leite ETT, Hanna SA, Nakagawa SA, Baptista AM, Pinheiro RN, de Oliveira JL, de Araújo MS, de Araujo RLC, Laporte GA, de Almeida Quadros C, de Oliveira AF, Lopes A. Brazilian consensus on the diagnosis and treatment of extremities soft tissue sarcomas. J Surg Oncol 2020; 121:743-758. [PMID: 31970785 DOI: 10.1002/jso.25847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 01/05/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Soft tissue sarcomas (STSs) are rare tumors and constitute only 1% of all tumors in adults. Indeed, due to their rarity, most cases in Brazil are not treated according to primary international guidelines. METHODS This consensus addresses the treatment of STSs in the extremities. It was made by workgroups from Brazilian Societies of Surgical Oncology, Orthopaedics, Clinical Oncology, Pathology, Radiology and Diagnostic Imaging, and Radiation Oncology. The workgroups based their arguments on the best level of evidence in the literature and recommendations were made according to diagnosis, staging, and treatment of STSs. A meeting was held with all the invited experts and the topics were presented individually with the definition of the degree of recommendation, based on the levels of evidence in the literature. RESULTS Risk factors and epidemiology were described as well as the pathological aspects and imaging. All recommendations are described with the degree of recommendation and levels of evidence. CONCLUSION Recommendations based on the best literature regional aspects were made to guide professionals who treat STS. Separate consensus on specific treatments for retroperitoneal, visceral, trunk, head and neck sarcomas, and gastrointestinal stromal tumor, are not contemplated into this consensus.
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Affiliation(s)
- Ranyell M S S B Spencer
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Veridiana P de Camargo
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Maria L G Silva
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Fabio F E Pinto
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | | | - Wagner S Cequeira
- AC Camargo Cancer Center, Department of Diagnosis and Imaging, São Paulo, Brazil
| | - Rodrigo R Munhoz
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Celso A Mello
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Rafael A Schmerling
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Waldec J D Filho
- Department of Directory, Brazilian Society of Clinical Surgical (BSCO), São Paulo, Brazil
| | - Tharcisio M Coelho
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Alexandre V A Ambrosio
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Elton T T Leite
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Samir A Hanna
- Department of Directory, Brazilian Society of Radiation Oncology (BSRO), São Paulo, Brazil
| | - Sueli A Nakagawa
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Andre M Baptista
- Department of Directory, Brazilian Society of Orthopaedics and Traumatology (BSOT), São Paulo, Brazil
| | - Rodrigo N Pinheiro
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Jadivan L de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Marcelo Sá de Araújo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Raphael L C de Araujo
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Gustavo A Laporte
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | | | - Alexandre F de Oliveira
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
| | - Ademar Lopes
- Department of Directory, Brazilian Society of Surgical Oncology (BSSO), Rio de Janeiro, Brazil
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Early Lymph Node Metastasis May Predict Poor Prognosis in Soft Tissue Sarcoma. Int J Surg Oncol 2019; 2019:6708474. [PMID: 31915549 PMCID: PMC6930751 DOI: 10.1155/2019/6708474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/19/2019] [Accepted: 10/25/2019] [Indexed: 11/25/2022] Open
Abstract
Background Lymph node metastasis (LNM) is a relatively rare event in soft tissue sarcoma. An association between the timing of LNM detection and patient prognosis is presently unknown. Patients and Methods We retrospectively analyzed the clinicopathological features of 33 patients with LNM between 2001 and 2015. Analysis of the timing of LNM diagnosis was grouped according to patients presenting LNM in either <8 months (the median time from primary tumor diagnosis to LNM) or ≥8 months after primary tumor diagnosis. Results A relationship between the primary tumor size and the timing of the LNM was not significantly found (Rs = 0.0088, p=0.96). Sixteen patients had an LNM detection duration of <8 months, and 17 patients had a duration of ≥8 months. The 5-year survival for patients with an LNM detection duration of <8 months and ≥8 months was 19% and 71%, respectively (p=0.0016). There were 19 patients with pulmonary metastases. Among them, there were 13 patients with a duration of primary tumor diagnosis to LNM of <8 months and 6 with a duration of ≥8 months (p=0.01). Conclusion Early LNM (<8 months) may predict poor prognosis in soft tissue sarcoma.
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70
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Shichijo S, Uedo N, Yanagimoto Y, Yamamoto K, Kono M, Fukuda H, Shimamoto Y, Nakagawa K, Ohmori M, Arao M, Iwatsubo T, Iwagami H, Inoue S, Matsuno K, Matsuura N, Nakahira H, Maekawa A, Kanesaka T, Takeuchi Y, Higashino K, Ohmori T, Ishihara R. Endoscopic full-thickness resection of gastric gastrointestinal stromal tumor: a Japanese case series. Ann Gastroenterol 2019; 32:593-599. [PMID: 31700236 PMCID: PMC6826078 DOI: 10.20524/aog.2019.0413] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are potentially malignant and are indicated for resection. The standard treatment for resectable GISTs is surgery, although endoscopic resection has been reported outside Japan. This study retrospectively analyzed the results of endoscopic resection of GISTs in Japan. METHOD We identified patients with GISTs treated only by endoscopic resection in our institute between January 2016 and December 2018, and analyzed their clinical and pathological characteristics. RESULTS During the study period, 8 GISTs were resected only by endoscopy: 7 were located in the upper third of the stomach and 1 in the middle. All were intraluminal growth type. Median (range) tumor diameter was 20 (10-35) mm. All tumors were resected en bloc with a median (range) operation time of 67.5 (50-166) min. Complete perforation occurred in 5 cases, but the serosa remained in 2 and the outer layer of the muscularis propria remained in 1. The defect was endoscopically closed with clip-and-endoloop purse-string suturing (n=3), simple endoclipping (n=2), or over-the-scope clipping (n=2), and 1 did not require closure because the outer longitudinal muscle was preserved. Oral feeding was commenced on postoperative day (POD) 3 (median; range 2-4), and the patient was discharged on POD 6 (median; range 4-11). No serious adverse event developed after the procedures. CONCLUSION Endoscopic resection for selected cases of small intraluminal GISTs is feasible, making it a viable alternative treatment option to laparoscopic surgery.
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Affiliation(s)
- Satoki Shichijo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriya Uedo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoshitomo Yanagimoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Mitsuhiro Kono
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiromu Fukuda
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yusaku Shimamoto
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kentaro Nakagawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masayasu Ohmori
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Masamichi Arao
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Taro Iwatsubo
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroyoshi Iwagami
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Shuntaro Inoue
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Kenshi Matsuno
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Noriko Matsuura
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Hiroko Nakahira
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Akira Maekawa
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takashi Kanesaka
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Yoji Takeuchi
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Koji Higashino
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
| | - Takeshi Ohmori
- Department of Gastroenterological Surgery (Yoshitomo Yanagimoto, Kazuyoshi Yamamoto, Takeshi Ohmori), Osaka International Cancer Institute, Japan
| | - Ryu Ishihara
- Department of Gastrointestinal Oncology (Satoki Shichijo, Noriya Uedo, Mitsuhiro Kono, Hiromu Fukuda, Yusaku Shimamoto, Kentaro Nakagawa, Masayasu Ohmori, Masamichi Arao, Taro Iwatsubo, Hiroyoshi Iwagami, Shuntaro Inoue, Kenshi Matsuno, Noriko Matsuura, Hiroko Nakahira, Akira Maekawa, Takashi Kanesaka, Yoji Takeuchi, Koji Higashino, Ryu Ishihara)
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Regional Lymph Node Involvement Is Associated With Poorer Survivorship in Patients With Chondrosarcoma: A SEER Analysis. Clin Orthop Relat Res 2019; 477:2508-2518. [PMID: 31283732 PMCID: PMC6903832 DOI: 10.1097/corr.0000000000000846] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Regional lymph node involvement is thought to be rare in patients with chondrosarcoma, but its actual prevalence is unclear. Additionally, it is often not considered when prognostic factors are analyzed in patients with chondrosarcoma. However, it has been well established that lymph node involvement is a poor prognostic marker in patients with many types of bone and soft tissue sarcoma, including rhabdomyosarcoma, osteosarcoma, and Ewing's sarcoma. Although lymph node metastases are rare among all sarcoma types, it is important to consider whether lymph node metastases should be assessed in patients with chondrosarcoma because these metastases may impact survival. QUESTIONS/PURPOSES (1) What is the reported prevalence of regional lymph node involvement in patients with chondrosarcoma? (2) Do patients who have chondrosarcomas with regional lymph node involvement have different clinicopathologic presentations and survival than patients without regional lymph node involvement? (3) Is regional lymph node involvement independently associated with prognosis in patients with chondrosarcoma? METHODS The data of patients with chondrosarcoma registered in the Surveillance Epidemiology and End Results database (SEER) (1988-2015) were analyzed for the reported prevalence of regional lymph node involvement and its relationship with clinicopathologic features and the 5-year overall survival rate. From 1988 to 2015, 5528 patients with chondrosarcoma were registered in the SEER database. After screening by the inclusion criterion-chondrosarcoma as the first primary tumor, diagnosis with histology confirmation, patients with active followup and available information about regional node status-3374 patients met the inclusion criteria and were analyzed. Demographics and clinicopathologic data were compared using chi-square or Fisher's exact tests. Logistic regression analysis was used to assess the adjusted odds ratio. The overall survival rate was estimated with Kaplan-Meier curves and log-rank tests. Univariate and multivariate analyses of overall survival were performed with Cox proportional hazard models. In addition, a series of sensitivity analyses were performed to assess the robustness of the final Cox proportional hazard model. RESULTS Forty-four patients (1.3%) were recorded in the database as having regional lymph node involvement at the time of the primary diagnosis. Lymph node metastases were more likely to be reported in an extraskeletal primary site (3% [13 of 426] versus 1% [31 of 2948], adjusted odds ratio [OR] = 2.9, 95% CI, 1.5-5.8; p = 0.003) for bone primary sites and tumors with maximum diameter ≥ 8 cm (2% [26 of 1045] versus 1% [10 of 1075], adjusted OR = 2.9, 95% CI, 1.3-6.3; p = 0.008) and poorer differentiation (4% [24 of 608] versus 1% [14 of 2308], adjusted OR = 4.0, 95% CI, 2.0-8.2; p < 0.001), and in those with distant metastases (7% [14 of 203] versus 1% [30 of 3148], adjusted OR = 3.5, 95% CI, 1.7-7.1, p = 0.001). The 5-year overall survival rates of patients with and without regional lymph node involvement were 28% (95% CI, 15-42%) and 77% (95% CI, 75-78%), respectively (p < 0.001). After controlling for age, sex, race, grade, metastatic status, size, and histologic subtype, the presence of regional lymph node involvement was associated with poorer survival (hazard ratio, 2.20; 95% CI, 1.50-3.24; p < 0.001); this finding was confirmed in several sensitivity analyses. CONCLUSION The prevalence of regional lymph node involvement in patients with chondrosarcoma was 1.3% in the SEER database. Although chondrosarcomas are rare, patients with chondrosarcomas who have regional node metastases have a poorer prognosis than those who have not reported to have them. This may underrepresent the true proportion of patients with lymph node metastases given the inaccuracies of reporting in this database, but we believe these findings indicate that clinicians should examine patients more carefully for chondrosarcoma with lymph node metastases. Future studies are needed to assess potential treatment strategies to improve the prognosis of these patients. LEVEL OF EVIDENCE Level III, prognostic study.
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Miccio JA, Jairam V, Gao S, Augustyn A, Oladeru OT, Onderdonk BE, Chowdhary M, Han D, Khan S, Friedlaender G, Lindskog DM, Desphande HA, Osborn H, Roberts KB, Patel KR. Predictors of Lymph Node Involvement by Soft Tissue Sarcoma of the Trunk and Extremity: An Analysis of the National Cancer Database. Cureus 2019; 11:e6038. [PMID: 31824805 PMCID: PMC6886621 DOI: 10.7759/cureus.6038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background and Objectives Lymph node metastases (LNM) in soft tissue sarcoma (STS) of the trunk and extremity are rare but are associated with worse survival. Established risk factors for LNM in this group are based on small institutional retrospective reviews. This study identifies the risk factors associated with LNM in otherwise non-metastatic trunk/extremity STS patients using the National Cancer Database (NCDB) and sought out to delineate a high-risk group that may be considered for pathologic nodal evaluation. Methods The files of 10,731 patients with STS of the trunk/extremity without distant metastasis from 2004 - 2015 were evaluated. Exclusion criteria included neoadjuvant therapy and a lack of pathologic nodal evaluation. Univariate and multivariable logistic regression models were performed to evaluate variables associated with LNM. Results Of the total of 10,731 patients, 223 (2.1%) had LNM. On multivariable analysis, LNM was associated with Grade 3 tumors (odds ratio (OR) 15.6, 95% confidence interval (CI) 6.36 - 38.04, p < 0.001) and clear cell/angiosarcoma/rhabdomyosarcoma/epithelioid (CARE) histology (OR 4.72, 95% CI 3.35 - 6.66, p < 0.001), lymphovascular invasion (LVI) (OR 5.86, 95% CI 3.33 - 10.31, p < 0.001, and bone invasion (BI) (OR 2.73, 95% CI 1.32 - 5.61, p = 0.006). Patients with Grade 3 CARE tumors (n = 402) had an 11.9% risk of LNM vs. 1.7% of adults without all these characteristics (p < 0.001). Patients with Grade 3 CARE tumors and either LVI or BI (n = 36) had a 33.3% risk of LNM. Conclusions High-grade and CARE histology are associated with LNM in STS. Adult patients with both features have an overall 11.9% risk of LNM and may be considered for pathologic LN assessment, particularly with the presence of LVI or BI.
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Affiliation(s)
- Joseph A Miccio
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Vikram Jairam
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Sarah Gao
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
| | - Alexander Augustyn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Oluwadamilola T Oladeru
- Department of Radiation Oncology, Massachusetts General Hospital/Harvard Medical School, Boston, USA
| | - Benjamin E Onderdonk
- Department of Radiation and Cellular Oncology, University of Chicago Medical Center, Chicago, USA
| | - Mudit Chowdhary
- Department of Radiation Oncology, Rush University Medical Center, Chicago, USA
| | - Dale Han
- Department of Surgical Oncology, Oregon Health and Science University, Portland, USA
| | - Sajid Khan
- Department of Surgery, Yale School of Medicine, New Haven, USA
| | - Gary Friedlaender
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA
| | - Dieter M Lindskog
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, USA
| | - Hari A Desphande
- Department of Medical Oncology, Yale School of Medicine, New Haven, USA
| | - Heather Osborn
- Department of Otolaryngology, Yale School of Medicine, New Haven, USA
| | - Kenneth B Roberts
- Department of Radiation Oncology, Yale School of Medicine, New Haven, USA
| | - Kirtesh R Patel
- Department of Therapeutic Radiology, Yale School of Medicine, New Haven, USA
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A challenging diagnosis of mesenchymal neoplasm of the colon: colonic dedifferentiated liposarcoma with lymph node metastases-a case report and review of the literature. Int J Colorectal Dis 2019; 34:1809-1814. [PMID: 31501928 DOI: 10.1007/s00384-019-03394-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE We report a case of primitive colonic dedifferentiated liposarcoma along with lymph node metastases. METHODS The patient's clinical, radiologic, surgical, and histologic data were reviewed, as well as the literature on colonic dedifferentiated liposarcoma with a focus on the incidence of lymph node metastasis in gastrointestinal sarcomas and on the differential diagnosis with other spindle cell tumors in the gastrointestinal tract. RESULTS A 53-year-old man was referred to our hospital with a 3 year-history of pain on the right back that was refractory to drugs. He performed an abdominal computed tomography scan which revealed a colonic wall thickening in the hepatic flexure and a few serosal nodularities. With these findings, the patient underwent an extended right hemicolectomy. On histopathologic examination, it turned out to be a colonic dedifferentiated liposarcoma with lymph node metastases. CONCLUSIONS The present case was a challenging diagnosis both at presurgical and histopathological level because it strongly mimicked a colonic adenocarcinoma. This was due to non-specific clinical and radiological presentation, to the non-characteristic histologic morphology and to the misleading presence of lymph node metastases. Malignant stromal tumors of the gastrointestinal tract beyond gist are fairly rare entities. Colonic dedifferentiated liposarcoma must be kept in mind and must be considered in the differential diagnosis of gastrointestinal tumors.
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Brenneman RJ, Sharifai N, Fischer-Valuck B, Hassanzadeh C, Guzelian J, Chrisinger JSA, Michalski JM, Oppelt P, Baumann BC. Abscopal Effect Following Proton Beam Radiotherapy in a Patient With Inoperable Metastatic Retroperitoneal Sarcoma. Front Oncol 2019; 9:922. [PMID: 31616634 PMCID: PMC6775241 DOI: 10.3389/fonc.2019.00922] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/03/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Retroperitoneal sarcomas (RPS) are rare and primarily managed with surgery, which improves local recurrence-free and overall survival. Radiation can improve local control or provide palliation for inoperable or metastatic RPS by eliciting tumor cell death via irreparable DNA damage. In extraordinary circumstances radiation-induced cell death promotes immune-mediated regression of non-irradiated lesions in a process termed the abscopal effect. Abscopal effects are rare and incompletely understood, involving a balance of radiation's immunogenic and immunosuppressive effects. There are currently no methods to predict abscopal responses following radiotherapy. Case reports documenting post-radiotherapy abscopal effects provide additional information to better characterize these responses and to inform ongoing and future clinical trials attempting to harness radiation-induced immune responses to improve outcomes with systemic therapy, such as SARC-032, a cooperative group trial of pre-operative radiation ± pembrolizumab. We present a case of inoperable metastatic RPS treated with proton radiotherapy with complete responses of un-irradiated metastases. Case Presentation: A 67 year-old female with inoperable metastatic unclassified round cell RPS was treated with palliative proton radiotherapy only to the primary tumor. Following completion of radiotherapy, the patient demonstrated complete regression of all un-irradiated metastases, and near complete response of the primary lesion without additional therapy. Conclusions: Metastatic RPS is typically managed with first-line chemotherapy, with objective response rates <50%. We present a case of inoperable metastatic RPS treated with palliative proton radiotherapy for rapidly progressive disease who had complete regression of non-irradiated metastases consistent with the abscopal effect. To our knowledge this is the first case report describing abscopal effects in inoperable metastatic RPS treated with proton radiation and is among the first case reports of an abscopal effect in a patient treated with proton therapy regardless of disease site. Further investigation is warranted regarding the benefit of proton radiation to primary tumors for inoperable metastatic RPS.
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Affiliation(s)
- Randall J Brenneman
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Nima Sharifai
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Benjamin Fischer-Valuck
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, United States
| | - Comron Hassanzadeh
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeffrey Guzelian
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO, United States
| | - John S A Chrisinger
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
| | - Jeff M Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
| | - Peter Oppelt
- Division of Medical Oncology, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Brian C Baumann
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, MO, United States
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Kono S, Kumamoto T, Kurahashi Y, Niwa H, Ishida Y, Shinohara H. A novel surgical strategy for the resection of duodenal gastrointestinal stromal tumours located close to the duodenal ampulla: a case report. Ann R Coll Surg Engl 2019; 102:e29-e32. [PMID: 31508985 DOI: 10.1308/rcsann.2019.0112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although the optimal surgical procedure for the resection of duodenal gastrointestinal stromal tumours has not yet been characterised due to the low prevalence of these tumours and the anatomical complexity of the duodenopancreatic region, difficult surgical procedures such as pancreaticoduodenectomy are often proposed for stromal tumours located in the second portion of the duodenum. Our case report highlights a novel surgical strategy that can be implemented as an alternative to pancreaticoduodenectomy for such tumours close to the duodenal ampulla. A 70-year-old man incidentally diagnosed with a stromal tumour close to the duodenal ampulla in the second portion of the duodenum underwent local resection guided by an endoscopic nasobiliary drainage tube with primary closure. This tube was converted to a percutaneous trans-small intestinal biliary drainage tube during the procedure to prevent biliary leakage biliary stasis due to swelling of the duodenal ampulla. He also underwent a simple distal gastrectomy with Roux-en-Y reconstruction. This resulted in successful R0 resection. There were no procedure-related complications or post-surgery weight changes. Our simple novel surgical strategy may therefore be useful for avoiding pancreaticoduodenectomy and maintaining quality of life in patients with stromal tumours close to the duodenal ampulla.
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Affiliation(s)
- S Kono
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - T Kumamoto
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Y Kurahashi
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - H Niwa
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Y Ishida
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - H Shinohara
- Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
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Miyazaki C, Shiozawa M, Koike R, Ogihara K, Sasaki Y, Shiba S, Nishida S, Sakuragi M, Mizunuma H, Fujita T, Fukushima N, Lefor AK, Kitayama J, Sata N. Neoadjuvant chemotherapy for primary sarcoma of the breast: a case report. J Med Case Rep 2019; 13:289. [PMID: 31488201 PMCID: PMC6728953 DOI: 10.1186/s13256-019-2197-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 07/09/2019] [Indexed: 11/17/2022] Open
Abstract
Background Primary sarcoma of the breast is rare. Surgery has been the only curative treatment available. Recently, neoadjuvant chemotherapy including anthracycline/ifosfamide has been reported effective for patients with high-risk sarcomas in a prospective trial. Case presentation A 52-year-old Japanese woman presented with a mass in her left breast. The 10 cm tumor was fixed to her chest wall on examination. A skin biopsy was performed which showed leiomyosarcoma. Neoadjuvant chemotherapy was given and the tumor became mobile. A mastectomy and axillary dissection were performed with surgically negative margins. After neoadjuvant chemotherapy, the amount of necrosis was profoundly influenced by chemotherapy, and the histological effect of neoadjuvant chemotherapy was assessed in reference to pre-neoadjuvant chemotherapy magnetic resonance imaging. Conclusion In contrast to many other cancers, the evaluation of various treatments and of the histological effect of neoadjuvant chemotherapy for sarcoma has been difficult due to the rarity of these tumors. We report the case of a patient with a breast sarcoma, treated with neoadjuvant chemotherapy and discuss the appropriate pathological evaluation and therapeutic management.
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Affiliation(s)
- Chieko Miyazaki
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Mikio Shiozawa
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan. .,The Department of Surgery, Medical Center Shimotsuga, Ohiramachi Kawazure 420-1, Tochigi, Tochigi, 329-4498, Japan.
| | - Rintaro Koike
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Kasumi Ogihara
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Yumiko Sasaki
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Satomi Shiba
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Saki Nishida
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Masako Sakuragi
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Hirofumi Mizunuma
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Takashi Fujita
- The Department of Breast Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Noriyoshi Fukushima
- The Department of Pathology, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Alan K Lefor
- The Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Joji Kitayama
- The Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
| | - Naohiro Sata
- The Department of Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotuke, Tochigi, 329-0498, Japan
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Bui NQ, Wang DS, Hiniker SM. Contemporary management of metastatic soft tissue sarcoma. Curr Probl Cancer 2019; 43:289-299. [DOI: 10.1016/j.currproblcancer.2019.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 06/08/2019] [Indexed: 01/31/2023]
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Diaz Brito JA, Gatti G, Vento AR, Galimberti V, Intra M, De Almeida RCS, Pruneri G, Luini A. Report on a Case of Breast Sarcoma Metastatic to the Axillary Lymph Nodes. TUMORI JOURNAL 2019; 92:188-90. [PMID: 16724703 DOI: 10.1177/030089160609200219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast sarcoma is a rare entity that accounts for less than 1% of all breast malignancies; it may spread by direct invasion and/or through the blood. Axillary lymph node involvement is extremely rare and usually associated with advanced-stage disease. In the surgical treatment of this neoplasm, complete axillary lymphadenectomy is important for the local clearance of the clinically involved lymph nodes. We report a case of a 65-year-old woman affected by follicular dendritic cell sarcoma of the left breast. Six months after breast surgery she developed an axillary metastasis from the same disease.
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Hu S, Wong K, Ramesh KH, Villanueva-Siles E, Panarelli N, In H. Diffuse, Aggressive Metastatic Progression after Minimally Invasive Local Resection of Primary Gastric Synovial Sarcoma: a Case Report and Systematic Review of the Literature. J Gastrointest Cancer 2019; 50:116-122. [PMID: 28660525 DOI: 10.1007/s12029-017-9979-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Shaomin Hu
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Kristen Wong
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building room 112, Bronx, NY, 10461, USA
| | - K H Ramesh
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Esperanza Villanueva-Siles
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Nicole Panarelli
- Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, NY, 10467, USA
| | - Haejin In
- Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Block Building room 112, Bronx, NY, 10461, USA.
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Wongta K, Tangsirapat V, Chakrapan Na Ayudhya V, Charutragulchai P, Sripreechapattana S, Chakrapan Na Ayudhya K, Poolsavatkitikool R, Sookpotarom P, Vejchapipat P. A giant jejunal gastrointestinal stromal tumor misconceived as pancreatic cystic neoplasm: A case report. Int J Surg Case Rep 2019; 60:253-256. [PMID: 31255936 PMCID: PMC6610676 DOI: 10.1016/j.ijscr.2019.06.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 05/30/2019] [Accepted: 06/12/2019] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs), although not common in gastrointestinal (GI) tumors, constitute the most frequent mesenchymal tumors of the GI tract. This report describes a patient with a large sporadic GIST at proximal jejunum that mimicked the pancreatic cystic neoplasm. CASE PRESENTATION We report a 59-year-old female patient with unexplained weight loss and palpable left upper quadrant abdominal mass for 6 months. Computed tomography (CT) scan demonstrated a heterogeneously mass measuring 10 cm in a maximal diameter at pancreatic body and tail. Laparotomy was done, and the tumor was found at proximal jejunum closed to the ligament of Treitz, so en bloc resection of the tumor was done. The pathological and immunohistochemical study confirmed GISTs. DISCUSSION Although most GISTs are originated from the intestine, they frequently arise from the stomach, the duodenum and rarely from the jejunum. And jejunal GISTs are usually asymptomatic. The misdiagnosis as mucinous cystadenoma of this case might be due to the proximity of the tumor to the body and tail of pancreas, and compressing the adjacent organ due to its large size. CONCLUSION GISTs are most frequently small and arising from the stomach. GISTs are rarely present as a large tumor of the jejunum, and particularly mimicked a pancreatic tumor.
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Affiliation(s)
- Kitti Wongta
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vorapatu Tangsirapat
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Vichack Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Papot Charutragulchai
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Singha Sripreechapattana
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Kobkool Chakrapan Na Ayudhya
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Rapol Poolsavatkitikool
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paiboon Sookpotarom
- Department of Surgery, Panyananthaphikkhu Chonprathan Medical Center, Srinakharinwirot University, Nonthaburi, 11120, Thailand.
| | - Paisarn Vejchapipat
- Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
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Primary pulmonary sarcoma - treatment outcomes depending on the different types of radical operation. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2019; 16:1-6. [PMID: 31043968 PMCID: PMC6491372 DOI: 10.5114/kitp.2019.83938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/27/2018] [Indexed: 11/30/2022]
Abstract
Introduction Primary pulmonary sarcomas (PPS) are rare types of non-epithelial malignant tumors of the lungs (0.013–1.1% of all malignant lung tumors). The PPS can originate from mesenchymal elements of the bronchial wall, vessels or pulmonary stroma. Since the introduction of immunohistochemical and molecular diagnosis, a significant improvement in description and classification of sarcomas has been achieved. Nonetheless, sarcomas still remain a diagnostic and clinical problem. Aim To estimate factors which could have an influence on the overall survival (OS) and progression-free survival (PFS) of different types of radical operations (R0) for PPS. Material and methods Fourteen patients who underwent surgical radical treatment between 1994 and 2009 with a final diagnosis of PPS were analyzed. Results A group of 14 patients, treated with R0 operations (pneumonectomies, lobectomies, non-anatomical resections), were included in the analysis. Median OS of patients undergoing R0 operations was respectively: for pneumonectomy 7 months, lobectomy 20 months, non-anatomic resections 213 months. Patients subjected to non-anatomical resections had better prognosis than the others treated radically (p < 0.05); however, this group of patients had the most local recurrences (3 patients – 50%). Statistical analysis did not show the influence of prognostic factors characteristic of PPS and soft tissue sarcoma (STS) on OS in the types of surgery performed. Conclusions There are no unambiguous factors affecting OS and PFS of patients who have undergone anatomical and non-anatomical resections. A large number of local recurrences in non-anatomical operations may indicate that PPS spread like lung cancer.
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Brady AC, Picado O, Tashiro J, Sola JE, Perez EA. Lymph Node Sampling and Survival in Child and Adolescent Extremity Soft-Tissue Sarcoma. J Surg Res 2019; 241:205-214. [PMID: 31028942 DOI: 10.1016/j.jss.2019.03.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/26/2019] [Accepted: 03/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND The significance of lymph node sampling (LNS) on disease-specific survival (DSS) of extremity soft tissue sarcomas (STS) is unknown. We investigated the effect of LNS on DSS in child and adolescent extremity STS. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results registry was queried for patients aged <20 y with extremity STS who underwent surgery. Patient demographics were collected and analyzed. RESULTS A total of 1550 patients were included, with findings of 10-y DSS of 74% for all extremity STS and 49% for rhabdoymyosarcoma (RMS) (P < 0.005). LNS was associated with worse DSS in patients with extremity nonrhabdomyosacrcoma soft tissue sarcomas (79% versus 84%, P = 0.036). Conversely, LNS was associated with an improved DSS in patients with extremity RMS (64% versus 49%, P = 0.005). CONCLUSIONS LNS is positively associated with an improved DSS in child and adolescent extremity RMS. Multivariate analysis found no correlation between DSS and LNS in child and adolescent extremity nonrhabdomyosarcoma soft tissue sarcomas.
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Affiliation(s)
- Ann-Christina Brady
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Omar Picado
- Division of Surgical Oncology, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Jun Tashiro
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Juan E Sola
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida
| | - Eduardo A Perez
- Division of Pediatric Surgery, DeWitt-Daughtry Department of Surgery, Leonard M. Miller School of Medicine, University of Miami, Miami, Florida.
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Mayo Z, Kennedy S, Gao Y, Miller BJ. What Is the Clinical Importance of Incidental Findings on Staging CT Scans in Patients With Sarcoma? Clin Orthop Relat Res 2019; 477:730-737. [PMID: 30601764 PMCID: PMC6437370 DOI: 10.1007/s11999.0000000000000149] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Baseline staging CT scans are performed on nearly every patient after the diagnosis of a sarcoma to evaluate for the presence of metastatic disease. These scans often identify abnormalities that may or may not be related to the known malignancy. Despite the high frequency of incidental findings, there is little guidance for clinicians faced with assessing these radiographic abnormalities. The interpretation of incidental findings is important because it may influence decisions regarding surveillance frequency, prognostic estimation, and surgical and medical intervention. QUESTIONS/PURPOSES The purpose of this study was to determine (1) the frequency of abnormal findings and indeterminate nodules on staging CT scans; (2) the natural history of indeterminate nodules identified at the time of sarcoma diagnosis; and (3) the factors associated with indeterminate nodules representing true metastatic disease. METHODS Between September 2010 and February 2016 we treated 233 patients with bone and soft tissue sarcomas. Of those, 227 (97%) had a staging CT scan of the chest or chest/abdomen/pelvis performed within 2 months of diagnosis. To be eligible for this retrospective study, a patient had to have a minimum of 6 months of radiographic followup after that initial CT scan. A total of 36 (16%) were lost to followup or did not have radiographic surveillance at least 6 months later, and 48 (21%) were excluded for other prespecified reasons, leaving 149 patients for evaluation. We recorded all abnormal findings listed in the official radiology CT report of the lung, bone, liver, and lymph nodes. We assessed progression of indeterminate nodules by reviewing radiology reports, which listed both size and number of findings, and clinical notes outlining the current assessment of disease status and treatment plan. If indeterminate nodules grew in size or number consistent with metastatic disease or were confirmed histologically, they were considered to represent true metastasis. Bivariate methods were used to investigate an association between various clinical factors, which were obtained from chart review, and progression of indeterminate nodules to clear metastatic disease. RESULTS One hundred thirty-five of 149 patients (91%) had at least one abnormal finding on a staging CT scan. Forty-nine patients (33%) presented with indeterminate lung nodules, 15 (10%) with indeterminate liver lesions, four (3%) with indeterminate bone lesions, and 57 (38%) with enlarged lymph nodes. Fifteen of the 49 patients with indeterminate lung nodules (31%), one of 15 liver nodules, zero of four bone lesions, four of 13 lymph nodes 1 to 2 cm in size, and two of 44 subcentimeter lymph nodes (4.5%) were clearly metastatic on followup. A primary tumor size ≥ 14 cm in greatest dimension was more suggestive of indeterminate nodules representing true metastatic disease compared with smaller primary tumors in both lung (eight of 10 compared with seven of 36 [19%]; odds ratio, 16.6; 95% confidence interval, 2.9-95.9; p < 0.001) and lymph nodes (six of 18 compared with zero of 36 [0%], p < 0.001). CONCLUSIONS It is extremely common for abnormal findings and incidental nodules to be present at the time of a staging CT scan in patients with sarcoma. Although patients with indeterminate nodules should have continued surveillance, it appears from this study that the majority of these findings do not represent true metastatic disease. Given a minimum followup of 6 months, it is possible the actual proportion of indeterminate lesions representing true metastatic disease may increase over time. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Zachary Mayo
- Department of Orthopaedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
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Braig D, Becherer C, Bickert C, Braig M, Claus R, Eisenhardt AE, Heinz J, Scholber J, Herget GW, Bronsert P, Fricke A, Follo M, Stark GB, Bannasch H, Eisenhardt SU. Genotyping of circulating cell-free DNA enables noninvasive tumor detection in myxoid liposarcomas. Int J Cancer 2019; 145:1148-1161. [PMID: 30779112 DOI: 10.1002/ijc.32216] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/19/2019] [Accepted: 02/06/2019] [Indexed: 12/16/2022]
Abstract
Soft tissue sarcomas (STS) are rare tumors of mesenchymal origin. About 50% of patients with STS experience relapse and more than 30% will die within 10 years after diagnosis. In this study we investigated circulating free DNA (cfDNA) and tumor-specific genetic alterations therein (circulating tumor DNA, ctDNA) as diagnostic biomarkers. Plasma concentrations and fragmentation of cfDNA was analyzed with quantitative PCR. Patients with STS (n = 64) had significantly higher plasma concentrations and increased fragmentation of cfDNA when compared to patients in complete remission (n = 19) and healthy controls (n = 41) (p < 0.01 and p < 0.001). Due to overlapping values between patients with STS and controls, the sensitivity and specificity of these assays is limited. Sensitive assays to detect genomic alterations in cfDNA of synovial sarcomas (t(X;18)), myxoid liposarcomas (t(12;16) and TERT C228T promoter mutation) and well-differentiated/de-differentiated liposarcomas (MDM2 amplifications) were established. ctDNA was quantified in nine liposarcoma patients during the course of their treatment. Levels of breakpoint t(12;16) and TERT C228T ctDNA correlated with the clinical course and tumor burden in patients with myxoid liposarcomas (n = 4). ctDNA could detect minimal residual disease and tumor recurrence. In contrast, detection of MDM2 amplifications was not sensitive enough to detect tumors in patients with well-differentiated/de-differentiated liposarcomas (n = 5). Genotyping of cfDNA for tumor specific genetic alterations is a feasible and promising approach for monitoring tumor activity in patients with myxoid liposarcomas. Detection of ctDNA during follow-up examinations despite negative standard imaging studies might warrant more sensitive imaging (e.g. PET-CT) or closer follow-up intervals to timely localize and treat recurrences.
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Affiliation(s)
- David Braig
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital, Perth, WA, Australia
| | - Caroline Becherer
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Christiane Bickert
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Moritz Braig
- Department of Radiology, Medical Physics, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Rainer Claus
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Internal Medicine, Augsburg Hospital, Medical Faculty of the University of Augsburg, Augsburg, Germany
| | - Anja E Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Juergen Heinz
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Jutta Scholber
- Department of Radiation Oncology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Georg W Herget
- Department of Orthopaedics and Traumatology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Peter Bronsert
- Institute for Surgical Pathology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Tumorbank Comprehensive Cancer Center Freiburg, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Alba Fricke
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.,Department of Plastic Aesthetic and Hand Surgery, HELIOS Klinikum Emil von Behring, Berlin, Germany
| | - Marie Follo
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - G Bjoern Stark
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Bannasch
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Steffen U Eisenhardt
- Department of Plastic and Hand Surgery, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ezuddin NS, Pretell-Mazzini J, Yechieli RL, Kerr DA, Wilky BA, Subhawong TK. Local recurrence of soft-tissue sarcoma: issues in imaging surveillance strategy. Skeletal Radiol 2018; 47:1595-1606. [PMID: 29785452 DOI: 10.1007/s00256-018-2965-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/16/2018] [Accepted: 04/30/2018] [Indexed: 02/02/2023]
Abstract
Soft-tissue sarcomas pose diagnostic and therapeutic challenges to physicians, owing to the large number of subtypes, aggressive tumor biology, lack of consensus on management, and controversy surrounding interval and duration of surveillance scans. Advances in multidisciplinary management have improved the care of sarcoma patients, but controversy remains regarding strategies for surveillance following definitive local control. This review provides an updated, comprehensive overview of the current understanding of the risk of local recurrence of soft-tissue sarcoma, by examining the literature based on features such as histological type and grade, tumor size, and resection margin status, with the aim of helping clinicians, surgeons, and radiologists to develop a tailored approach to local imaging surveillance.
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Affiliation(s)
- Nisreen S Ezuddin
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA
| | - Juan Pretell-Mazzini
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Raphael L Yechieli
- Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Darcy A Kerr
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Breelyn A Wilky
- Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Ty K Subhawong
- Department of Radiology, University of Miami Miller School of Medicine/Jackson Memorial Hospital, 1611 NW 12th Avenue, JMH WW 279, Miami, FL, 33136, USA.
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Youngwirth LM, Freischlag K, Nussbaum DP, Benrashid E, Blazer DG. Primary sarcomas of the pancreas: A review of 253 patients from the National Cancer Data Base. Surg Oncol 2018; 27:676-680. [PMID: 30449492 DOI: 10.1016/j.suronc.2018.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/16/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Primary sarcomas of the pancreas are rare, and the limited data regarding their presentation, oncologic profile, and survival have been derived from small case series. METHODS The National Cancer Data Base (1998-2012) was queried for patients with primary sarcomas of the pancreas. Demographic and clinical features at the time of diagnosis were evaluated for all patients. Subjects who underwent surgical resection were identified, and logistic regression was used to identify variables associated with resection. A Cox proportional hazards model was developed to identify factors associated with survival. RESULTS In total, 253 patients were identified. The mean age at diagnosis was 63 years, with tumors occurring more frequently in women (57.3%) and those of white race (79.8%). Tumors in the head of the pancreas were most common (63.3%). The mean size was 7.5 cm. Only 100 patients (39.5%) underwent resection, with younger age (OR = 0.763, p = 0.04) and smaller tumor size (OR = 0.978, p < 0.01) associated with resection. Chemotherapy and radiation therapy use were similar in patients who underwent resection and those who did not. Patients who underwent resection had a median survival of 17 months, compared to 6 months for patients who were not resected (p < 0.01). Following adjustment, only older age (HR 1.257, p = 0.03) and higher tumor grade (HR 1.997, p = 0.01) were associated with an increased risk of death in resected patients. CONCLUSIONS Primary pancreatic sarcomas are rare and the majority of patients do not undergo resection; thus, little is known about their oncologic profile or outcomes following pancreatectomy. Patients who undergo resection have markedly improved survival; older age and higher tumor grade are associated with decreased survival.
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Kuruva SP, Bala S, Konatam ML, Karnam AK, Maddali LS, Gundeti S. Clinicopathological features, treatment and survival outcomes of synovial sarcoma. South Asian J Cancer 2018; 7:270-272. [PMID: 30430100 PMCID: PMC6190396 DOI: 10.4103/sajc.sajc_269_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Synovial sarcoma (SS) is a malignant mesenchymal tumor. It is most common among children and adults. The data on SS from India are scarce. In this study, we analyzed the clinicopathological treatment parameters and survival outcomes of SS patients. Materials and Methods: A total of 57 histologically proven SS diagnosed from 2010 to 2016 were retrospectively analyzed. Results: The median age was 23 years with a male-to-female ratio of 1.28:1. Localized disease was seen in 44 patients (77%) and 13 patients (23%) had metastasis. The primary sites of involvement such as lower limb, upper limb, thorax, and abdomen were seen in 60%, 28%, 7%, and 5% patients, respectively. Surgery was done in 39 patients and 18 patients had unresectable disease. Adjuvant chemotherapy with doxorubicin-based regimen was given in 30 patients and adjuvant radiotherapy in 21 patients. Palliative chemotherapy with anthracycline-based or gemcitabine-based regimen was used in 17 and 2 patients, respectively. The median event-free survival (EFS) was 30 months with 3 years and EFS rate was 36%; median progression-free survival (PFS) was 11.5 months and 1 year; and PFS rate was 38%. On univariate analysis, resection and performance status were significantly associated with survival. There is no impact of grade and size of the tumor on survival. In metastatic patients, the lung is the most common site. Conclusion: SS is the most common soft-tissue sarcoma among adults. Resectability and performance status were impacting the survival.
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Affiliation(s)
- Siva Prasad Kuruva
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Stalin Bala
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Meher Lakshmi Konatam
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Ashok Kumar Karnam
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Lakshmi Srinivas Maddali
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sadashuivudu Gundeti
- Department of Medical Oncology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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Aisu Y, Yasukawa D, Kimura Y, Hori T. Laparoscopic and endoscopic cooperative surgery for gastric tumors: Perspective for actual practice and oncological benefits. World J Gastrointest Oncol 2018; 10:381-397. [PMID: 30487950 PMCID: PMC6247108 DOI: 10.4251/wjgo.v10.i11.381] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 09/15/2018] [Accepted: 10/11/2018] [Indexed: 02/05/2023] Open
Abstract
Laparoscopic and endoscopic cooperative surgery (LECS) is a surgical technique that combines laparoscopic partial gastrectomy and endoscopic submucosal dissection. LECS requires close collaboration between skilled laparoscopic surgeons and experienced endoscopists. For successful LECS, experience alone is not sufficient. Instead, familiarity with the characteristics of both laparoscopic surgery and endoscopic intervention is necessary to overcome various technical problems. LECS was developed mainly as a treatment for gastric submucosal tumors without epithelial lesions, including gastrointestinal stromal tumors (GISTs). Local gastric wall dissection without lymphadenectomy is adequate for the treatment of gastric GISTs. Compared with conventional simple wedge resection with a linear stapler, LECS can provide both optimal surgical margins and oncological benefit that result in functional preservation of the residual stomach. As technical characteristics, however, classic LECS involves intentional opening of the gastric wall, resulting in a risk of tumor dissemination with contamination by gastric juice. Therefore, several modified LECS techniques have been developed to avoid even subtle tumor exposure. Furthermore, LECS for early gastric cancer has been attempted according to the concept of sentinel lymph node dissection. LECS is a prospective treatment for GISTs and might become a future therapeutic option even for early gastric cancer. Interventional endoscopists and laparoscopic surgeons collaboratively explore curative resection. Simultaneous intraluminal approach with endoscopy allows surgeons to optimizes the resection area. LECS, not simple wedge resection, achieves minimally invasive treatment and allows for oncologically precise resection. We herein present detailed tips and pitfalls of LECS and discuss various technical considerations.
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Affiliation(s)
- Yuki Aisu
- Department of Digestive Surgery, Tenri Hospital, Tenri 632-8552, Nara, Japan
| | - Daiki Yasukawa
- Department of Surgery, Shiga University of Medical Science, Otsu 520-2192, Japan
| | - Yusuke Kimura
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Graduate School of Medicine, Kyoto University, Kyoto 606-8507, Japan
| | - Tomohide Hori
- Department of Surgery, Shiga General Hospital, Moriyama 524-8524, Shiga, Japan
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Bowen CM, Landau MJ, Badash I, Gould DJ, Patel KM. Primary tumors of the hand: Functional and restorative management. J Surg Oncol 2018; 118:873-882. [DOI: 10.1002/jso.25202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/23/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Chase M. Bowen
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Mark J. Landau
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ido Badash
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Daniel J. Gould
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
| | - Ketan M. Patel
- Division of Plastic and Reconstructive Surgery; Keck School of Medicine of the University of Southern California; Los Angeles California
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Crettenand F, Martin D, Cherix S, Demartines N, Matter M. Occurrence and prognosis of lymph node metastases in patients selected for isolated limb perfusion with soft tissue sarcoma. J Cancer 2018; 9:3311-3315. [PMID: 30271491 PMCID: PMC6160681 DOI: 10.7150/jca.25696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 08/03/2018] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives:Extensive surgery is often required for advanced soft tissue sarcoma (STS) of the limb. In the 1980s, a new approach was developed: isolated limb perfusion (ILP). This study aimed to assess incidence and impact on patient survival based on lymph node metastasis with systematic radical lymphadenectomy during ILP. Methods: Retrospective study of 57 consecutive patients treated by ILP for limb STS with simultaneous radical lymph node dissection in our tertiary referral center between 1992 and 2015. Results: Median age was 62 years (19-87) and 30 patients were male (53%). Lymph node involvement was observed in 13 patients (N1, 23%), regarded as metastatic spreading in 4 angiosarcomas, 3 epithelioid sarcomas, 2 leiomyosarcomas, 2 undifferentiated sarcomas and 2 synovial sarcomas. For the N0 patient group, median survival was 73.9 months (CI 95% 41.9-105.9) compared to 15.1 months (CI 95% 7.4-22.6) in case of metastatic lymph node (p=0.002). The median disease-free survival was 33,0 months (CI 95% 12,5-53.5) in N0 group and 8.0 months (CI 95% 4.0-11.9) in N1 (p=0.006). Conclusions: Lymph node metastases of STS patients selected for ILP seemed to have a negative impact on both overall and disease-free survival. Radical lymph node dissection should be included in ILP procedure.
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Affiliation(s)
| | - David Martin
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland
| | - Stéphane Cherix
- Department of Orthopaedics and Traumatology, University Hospital CHUV, Lausanne, Switzerland.,Sarcoma Center, University Hospital CHUV, Lausanne, Switzerland
| | - Nicolas Demartines
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.,Sarcoma Center, University Hospital CHUV, Lausanne, Switzerland
| | - Maurice Matter
- Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.,Sarcoma Center, University Hospital CHUV, Lausanne, Switzerland
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93
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Inaba CS, Dosch A, Koh CY, Sujatha-Bhaskar S, Pejcinovska M, Smith BR, Nguyen NT. Laparoscopic versus open resection of gastrointestinal stromal tumors: survival outcomes from the NCDB. Surg Endosc 2018; 33:923-932. [DOI: 10.1007/s00464-018-6393-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 08/20/2018] [Indexed: 02/07/2023]
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Akahoshi K, Oya M, Koga T, Shiratsuchi Y. Current clinical management of gastrointestinal stromal tumor. World J Gastroenterol 2018; 24:2806-2817. [PMID: 30018476 PMCID: PMC6048423 DOI: 10.3748/wjg.v24.i26.2806] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/03/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are the most common malignant subepithelial lesions (SELs) of the gastrointestinal tract. They originate from the interstitial cells of Cajal located within the muscle layer and are characterized by over-expression of the tyrosine kinase receptor KIT. Pathologically, diagnosis of a GIST relies on morphology and immunohistochemistry [KIT and/or discovered on gastrointestinal stromal tumor 1 (DOG1) is generally positive]. The prognosis of this disease is associated with the tumor size and mitotic index. The standard treatment of a GIST without metastasis is surgical resection. A GIST with metastasis is usually only treated by tyrosine kinase inhibitors without radical cure; thus, early diagnosis is the only way to improve its prognosis. However, a GIST is usually detected as a SEL during endoscopy, and many benign and malignant conditions may manifest as SELs. Conventional endoscopic biopsy is difficult for tumors without ulceration. Most SELs have therefore been managed without a histological diagnosis. However, a favorable prognosis of a GIST is associated with early histological diagnosis and R0 resection. Endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration (EUS-FNA) are critical for an accurate diagnosis of SELs. EUS-FNA is safe and effective in enabling an early histological diagnosis and adequate treatment. This review outlines the current evidence for the diagnosis and management of GISTs, with an emphasis on early management of small SELs.
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Affiliation(s)
- Kazuya Akahoshi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Masafumi Oya
- Department of Pathology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Tadashi Koga
- Department of Surgery, Aso Iizuka Hospital, Iizuka 820-8505, Japan
| | - Yuki Shiratsuchi
- Department of Gastroenterology, Aso Iizuka Hospital, Iizuka 820-8505, Japan
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Abstract
The purpose of staging in orthopaedic oncology is to provide a framework for classifying tumors based on their risk of local recurrence and distant metastasis to guide treatment decisions. Two separate systems are commonly used to categorize bone and soft-tissue sarcomas. The Musculoskeletal Tumor Society system for bone sarcomas and the Enneking system for soft-tissue sarcomas are the original staging systems developed by orthopaedic surgeons. The American Joint Committee on Cancer staging systems for bone and soft-tissue sarcomas are periodically updated based on new data, and they are currently on their eighth edition.
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96
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Ito S, Tsuchitani Y, Kim Y, Hashimoto S, Miura Y, Uemura T, Katsura K, Abe T, Sato K, Kato H. A gastrointestinal stromal tumor of the jejunum presenting with an intratumoral abscess: A case report and a literature review. Int J Surg Case Rep 2018; 48:65-68. [PMID: 29859449 PMCID: PMC6014644 DOI: 10.1016/j.ijscr.2018.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 05/17/2018] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The small intestine is the second-most frequent location where GISTs occur after the stomach. Attention should be paid to small intestinal GISTs because they infrequently present with acute abdomen, which necessitates emergency surgery. This report describes a patient with a small intestinal GIST developing a giant intratumoral abscess, in whom emergency surgery was performed. PRESENTATION OF CASE A 56-year-old woman presented with worsening abdominal pain. Computed tomography scan showed an approximately 9.5 cm × 9 cm tumor bearing a thick and hypervascularized wall with an internal air-fluid level. Emergency laparotomy revealed the tumor originated from the jejunum, and partial resection of the jejunum was performed. A large amount of pus was contained inside the tumor. Immunohistochemically, the tumor was diagnosed as a high risk GIST of the Cjejunum, and imatinib mesylate was initiated. DISCUSSION AND CONCLUSION When an intratumoral abscess in the abdomen is confirmed, GISTs should be listed as differential diagnosis. Complete surgical resetcion with careful handling and adjuvant chemotherapy with imatinib mesylate are considered to be important for this state.
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Affiliation(s)
- Soichi Ito
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan.
| | - Yuma Tsuchitani
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Yuro Kim
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Souhei Hashimoto
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Yuichi Miura
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Takuji Uemura
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Kazunori Katsura
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Takayuki Abe
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Koichiro Sato
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
| | - Hirotaka Kato
- Department of Surgery, Iwate Prefectural Iwai Hospital, 17 Odaira, Kozenji, Ichinoseki, Iwate, 029-0192, Japan
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97
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Regional Lymph Node Metastases in Groin Sarcomas: A Diagnostic and Therapeutic Challenge. Am J Clin Oncol 2018; 41:1162-1167. [PMID: 29782363 DOI: 10.1097/coc.0000000000000462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The evaluation of lymph nodes and the role of groin dissection for groin sarcomas has been controversial where there have not been previous studies or guidelines published. In this study, we aim to first formulate a clinical approach in the evaluation of regional lymph nodal metastases. Second, we aim to also evaluate the role of regional lymphadenectomy in the setting of pathologically involved regional lymph nodes for groin sarcomas. MATERIALS AND METHODS In total, 43 consecutive patients with groin sarcomas underwent treatment at the National Cancer Centre Singapore between 2002 and 2015. Univariate comparisons were performed using the log-rank test. A Cox multivariate analysis was performed for disease-specific survival to identify independent prognostic factors. RESULTS The median disease-free survival was 18 months (range, 1 to 180 mo). The median overall survival (OS) was 28 months (range, 3 to 180 mo). In total, 28 patients underwent a groin dissection. Of the 28 patients who underwent groin dissections, 15 had negative lymph node involvement, 7 had positive lymph node involvement and 6 had lymphovascular invasion.On univariate analysis, grade (P=0.047) and clinical and/or radiological involvement (P=0.039) were significant for regional lymph nodal metastases.The 5-year OS for patients with positive lymph nodes was 31%. CONCLUSIONS Our study suggests that the evaluation of lymph nodes via groin dissections in groin sarcomas in the Asian population should be based primarily on clinical and radiologic evidence. Regional lymph node dissection seems to confer OS benefit in patients with these high-risk tumors and can improve local control of disease.
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98
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Shoji Y, Takeuchi H, Goto O, Tokizawa K, Nakamura R, Takahashi T, Wada N, Kawakubo H, Yahagi N, Kitagawa Y. Optimal minimally invasive surgical procedure for gastric submucosal tumors. Gastric Cancer 2018; 21:508-515. [PMID: 28744619 DOI: 10.1007/s10120-017-0750-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 07/15/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Laparoscopic wedge resection (LWR) is widely performed for managing gastric submucosal tumors (SMTs). Despite the development of novel procedures such as laparoscopy-endoscopy cooperative surgery (LECS) and nonexposed endoscopic wall-inversion surgery (NEWS), the most appropriate surgical intervention for gastric SMTs remains unclear. METHODS We retrospectively reviewed patient characteristics, surgical outcomes, postoperative courses, results of histopathological examinations, and surgical costs of 71 consecutive patients who underwent LWR, LECS, or NEWS for gastric SMTs from January 2010 to June 2016 in our institute. RESULTS LWR, LECS, and NEWS were performed in 31, 14, and 26 cases, respectively. Patient backgrounds were comparable between groups. LWR was not performed for esophagogastric (E-G) junction tumors to avoid postoperative stricture, and LECS was not performed for ulcerated tumors to prevent tumor dissemination. NEWS was considered for tumors smaller than 3 cm for transoral extraction. Resected specimen area of the LWR group was significantly larger than that of the other groups. Further, the LWR group had a significantly higher complication rate. Compared to the LECS group, postoperative serum C-reactive protein level was significantly lower and postoperative hospitalization was significantly shorter in the NEWS group. Also, operation costs were significantly lower in the NEWS group. CONCLUSIONS The surgical procedure for gastric SMTs must be carefully chosen according to tumor size, location, and presence or absence of ulceration. For selected patients, NEWS is suggested to be an appropriate option for the treatment of gastric SMTs.
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Affiliation(s)
- Yoshiaki Shoji
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu-shi, Shizuoka, 431-3192, Japan.
| | - Osamu Goto
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazunori Tokizawa
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Rieko Nakamura
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tsunehiro Takahashi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Norihito Wada
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hirofumi Kawakubo
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Naohisa Yahagi
- Division of Research and Development for Minimally Invasive Treatment, Cancer Center, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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99
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Chellakhi M, Benchakroun N, Bouchbika Z, Jouhadi H, Tawfiq N, Sahraoui S, Benider A. [Radiotherapy of primary breast sarcomas: Retrospective study]. Cancer Radiother 2018; 22:211-215. [PMID: 29680464 DOI: 10.1016/j.canrad.2017.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 12/07/2017] [Accepted: 12/20/2017] [Indexed: 11/28/2022]
Abstract
PURPOSE Primary breast sarcomas are heterogeneous tumours derived from non-epithelial mammary gland structures. Although they represent a rare entity, their incidence may increase in the coming years owing to conservative approach considered in the treatment of breast cancer. The aim of this work was to highlight the effect of postoperative irradiation in the treatment of these tumours. MATERIALS AND METHODS This is a retrospective study conducted at the Mohammed-VI centre for cancer treatment between 2004 and 2011. Survival rates were calculated by the Kaplan-Meier method. RESULTS Fifteen cases were collected. The median age was 41.9years. Phyllode sarcoma accounted for 66% of this series. Surgical treatment was performed in 93% of the patients with negative margins in 33.33% of the cases. Neoadjuvant chemotherapy was indicated in 46% of the patients with locally advanced tumours and 66% of the patients received postoperative radiotherapy for positive or close margins. Five years overall survival and relapse free survival was not significantly different with the use of adjuvant radiotherapy. CONCLUSION Due to the rarity of this entity and the absence of randomized trials, evidence based management is still lacking. However, a multidisciplinary approach is to be required including surgical excision followed by radiotherapy, depending on the tumour characteristics.
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Affiliation(s)
- M Chellakhi
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc.
| | - N Benchakroun
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - Z Bouchbika
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - H Jouhadi
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - N Tawfiq
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - S Sahraoui
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
| | - A Benider
- Centre Mohammed-VI de traitement des cancers, CHU Ibn-Rochd, rue Lahcen-El Arjoun, Casablanca, Maroc
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100
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Hayashi T, Horiuchi A, Sano K, Hiraoka N, Ichimura T, Sudo T, Ishiko O, Yaegashi N, Aburatani H, Konishi I. Potential Diagnostic Biomarkers: Differential Expression of LMP2/β1i and Cyclin B1 in Human Uterine Leiomyosarcoma. TUMORI JOURNAL 2018. [DOI: 10.1177/1636.17918] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Takuma Hayashi
- Department of Immunology and Infectious Disease, Shinshu University Graduate School of Medicine, Matsumoto
- Promoting Business Using Advanced Technology, Japan Science and Technology Agency (JST), Tokyo, Japan
- SIGMA-Aldrich Collaboration Laboratory, Rehovot, Israel
| | | | - Kenji Sano
- Department of Laboratory Medicine, Shinshu University Hospital, Matsumoto
| | - Nobuyoshi Hiraoka
- Pathology Division, National Cancer Center Research Institute, Tokyo
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka
| | - Tamotsu Sudo
- Department of Gynecology, Hyogo Cancer Center, Hyogo
| | - Osamu Ishiko
- Department of Obstetrics and Gynecology, Osaka City University Graduate School of Medicine, Osaka
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai
| | - Hiroyuki Aburatani
- The Cancer System Laboratory, Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo
| | - Ikuo Konishi
- Department of Obstetrics and Gynecology, Kyoto University Graduate School of Medicine, Kyoto
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