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Othman MY, Halepota HF, Le Linn Y, Lee YT, Chang KTE, Ahamed SH, Lam JCM, Bhattacharyya R, Tan AM, Loh AHP. Gastrointestinal and oncologic outcomes of pediatric gastrointestinal lymphoma following upfront resection or biopsy of bowel masses. Pediatr Surg Int 2021; 37:1049-1059. [PMID: 33963920 DOI: 10.1007/s00383-021-04915-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Complete upfront resection of pediatric gastrointestinal lymphomas is recommended over biopsy whenever feasible, but either approach may have adverse sequelae. We sought to compare gastrointestinal and oncological outcomes of pediatric gastrointestinal lymphomas who underwent attempted upfront resection or biopsy of the presenting bowel mass. METHODS We retrospectively reviewed charts of children with gastrointestinal lymphomas treated on LMB89 and LMB96 protocols from 2000 to 2019 who underwent upfront gastrointestinal surgery, and compared resection and biopsy groups. RESULTS Of 33 children with abdominal lymphomas, 20 had upfront gastrointestinal surgery-10 each had resection or biopsy. Patients with attempted upfront resections had fewer postoperative gastrointestinal complications compared to biopsies (10% vs. 60%, p = 0.057), but longer time to chemotherapy initiation (median 11.5 vs. 4.5 days, p < 0.001). Three resection patients were surgically down-staged. Second surgeries were required in 30% and 40% of resected and biopsied patients, respectively, at median 4.6 months. Survival was similar in both groups, but better in patients on LMB96 protocol and stage II/III disease. CONCLUSIONS Children with upfront attempted resection had low rates of surgical down-staging, greater delay in chemotherapy initiation, but fewer gastrointestinal complications and subsequent surgeries than biopsies. Survival was similar regardless of upfront surgery, likely reflecting beneficial effects of newer protocols.
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Affiliation(s)
- Mohd Yusran Othman
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric Surgery, Hospital Tunku Azizah (Women's and Children's Hospital), Jalan Raja Muda Abdul Aziz, Kampung Baru, 50300, Kuala Lumpur, Malaysia
| | - Huma Faiz Halepota
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pediatric General Surgery, Indus Hospital, Plot C-76, Sector 31/5, Karachi, Pakistan
| | - Yun Le Linn
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - York Tien Lee
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Kenneth T E Chang
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Summaiyya Hanum Ahamed
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Joyce C M Lam
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Rajat Bhattacharyya
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Ah Moy Tan
- Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore.,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.,Department of Paediatric Subspecialties Haematology/Oncology Service, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore
| | - Amos H P Loh
- Department of Paediatric Surgery, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore. .,Duke NUS Medical School, 8 College Road, Singapore, 169857, Singapore. .,VIVA-KKH Paediatric Brain and Solid Tumour Programme, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899, Singapore.
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Burchard P, Thomay AA. Resection of a colonic mass following trauma: a diagnostic dilemma. J Surg Case Rep 2020; 2020:rjaa226. [PMID: 32728415 PMCID: PMC7378017 DOI: 10.1093/jscr/rjaa226] [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] [Received: 06/01/2020] [Accepted: 06/10/2020] [Indexed: 11/12/2022] Open
Abstract
A 53-year-old Caucasian male presented with a 2-week history of abdominal distension, pain, nausea and lethargy. His symptoms began 1 day after an all-terrain vehicle accident during which he suffered blunt-force trauma to his mid-right abdomen. CT scan demonstrated abnormal thickening of the ascending colon and terminal ilium with surrounding inflammation within the retroperitoneum and colonic mesentery. Given his likely mechanism and symptomatic improvement, he was initially managed conservatively. However, he was readmitted with recurrence of symptoms, and a repeat CT scan demonstrated no interval improvement. An exploratory laparotomy was performed and a firm, fixed mass of the right-colon and colonic mesentery was found. Final histopathology of the mass revealed a diffuse lymphoid infiltrate with numerous mitotic figures and apoptotic cells. Immunohistochemical staining was positive for CD45, CD20, CD10, and BCL-6 and negative for CD3, TdT, and BCL-2, indicating a diagnosis of Burkitt lymphoma.
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Affiliation(s)
- Paul Burchard
- Department of Surgery, University of Rochester, Rochester, NY 14642, USA
| | - Alan A Thomay
- Department of Surgery, West Virginia University, Morgantown, WV 26506, USA
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Vural S, Baskin D, Dogan O, Polat N, Caliskan C, Urganci N, Karaman S. Diagnosis in childhood abdominal Burkitt's lymphoma. Ann Surg Oncol 2010; 17:2476-9. [PMID: 20499283 DOI: 10.1245/s10434-010-1113-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND The role of surgery has changed substantially over the years in abdominal Burkitt's lymphoma. Laparotomy without total excision of the tumor does not have a positive effect on survival, might cause complications, and delays initiation of chemotherapy. Here we present our diagnostic management of patients with abdominal Burkitt's lymphoma. MATERIALS AND METHODS The diagnostic methods of abdominal Burkitt's lymphoma cases treated between January 1999 and December 2009 were evaluated retrospectively. RESULTS Of the 48 abdominal Burkitt's lymphoma patients, 13 also had extra-abdominal site involvement. Diagnosis was made with ultrasound-guided tru-cut needle biopsy of the abdominal mass (n = 11), fluid cytology (n = 7), extra-abdominal site biopsy (n = 4), bone marrow aspiration (n = 2), gastroscopy (n = 1), and laparotomy (n = 23). In patients diagnosed with laparotomy, chemotherapy was started in 4-22 days (median 7) compared with patients diagnosed with other diagnostic interventions in 2-4 days (median 2) (P < .001). CONCLUSION Although the most frequently used technique is laparotomy and open biopsy in our series, other methods provided quicker initiation of chemotherapy and less surgical morbidity. Especially in patients with high stages, cytological evaluation and tru-cut needle biopsy with radiological guidance is a better alternative of laparotomy.
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Affiliation(s)
- Sema Vural
- Pediatric Oncology, Sisli Etfal Education and Research Hospital, Istanbul, Turkey
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Abid M, Frikha MF, Mdhaffar M, Mzali R, Ben Amar M, Beyrouti MI. [Two pelvic tumors which should not be operated, lymphoma of Burkitt and actinomycosis]. ACTA ACUST UNITED AC 2009; 146:297-300. [PMID: 19665710 DOI: 10.1016/j.jchir.2009.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The treatment of the pelvic tumors depends of their histological nature. Some of them require only one medical treatment without recourse to surgery. We report two rare cases of pelvic tumors occurring in young adults. For the first case, actinomycosic nature was related to the histological study of the surgical biopsies. Concerning the second case, the lymphatic nature of a tumor of the low rectum was retained on the immunohistochimic study of the endoscopic biopsies. The evolution was uneventful in the two cases after a medical treatment containing penicillin G or a chemotherapy. We discuss at the time of these two observations the diagnostic difficulties and the therapeutic methods of these rare affections.
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Affiliation(s)
- M Abid
- Service de chirurgie générale, EPS Habib-Bourguiba, 3029 Sfax, Tunisie.
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