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International Journal of Surgical... Apr 2017Peritoneal metastasis in colorectal carcinoma is associated with a dismal prognosis; however, features that correlate with patterns of metastatic spread are not well...
Peritoneal metastasis in colorectal carcinoma is associated with a dismal prognosis; however, features that correlate with patterns of metastatic spread are not well characterized. We analyzed the clinicopathologic and molecular features of 166 patients with colorectal carcinomas stratified by metastases to the peritoneum or liver. Mucinous and signet ring cell differentiation were more frequently observed in colorectal carcinoma with peritoneal dissemination compared to colorectal carcinoma with liver metastasis (mucinous differentiation: 62% vs 23%, P < .001; signet ring cell differentiation: 21% vs 0%, P < .0001). The significant association of mucinous differentiation with peritoneal dissemination compared with liver metastasis was identified in patients with both synchronous and metachronous development of metastasis ( P < .01). In contrast, colorectal carcinomas with liver metastasis were more frequently low-grade (90% vs 72%, P = .005) and associated with dirty necrosis (81% vs 56%, P = .001) compared with colorectal carcinomas with peritoneal dissemination. No significant differences were identified between colorectal carcinoma with peritoneal metastasis versus liver metastasis with respect to KRAS mutations, BRAF mutation, or high levels of microsatellite instability. Patients with tumors involving the peritoneum had a significantly worse overall survival in comparison to patients with liver metastasis lacking peritoneal involvement ( P = .02). When including only those patients with peritoneal metastasis, the presence of any mucinous or signet ring cell differentiation was associated with a significantly worse overall survival ( P = .006). Our findings indicate that mucinous and signet ring cell differentiation may be histologic features that are associated with an increased risk of peritoneal dissemination and poor overall survival in patients with peritoneal metastasis.
Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aged, 80 and over; Carcinoma, Signet Ring Cell; Cell Differentiation; Colorectal Neoplasms; DNA Mismatch Repair; DNA Mutational Analysis; Female; Humans; Immunohistochemistry; Kaplan-Meier Estimate; Male; Microdissection; Microsatellite Instability; Middle Aged; Neoplasm Metastasis; Polymerase Chain Reaction; Prognosis; Proportional Hazards Models; Young Adult
PubMed: 27571790
DOI: 10.1177/1066896916664990 -
Head and Neck Pathology Jun 2017Primary colonic-type adenocarcinoma involving the tongue (CTAT) is exquisitely rare, with only four cases having been reported in the literature. We report the case of a...
Primary colonic-type adenocarcinoma involving the tongue (CTAT) is exquisitely rare, with only four cases having been reported in the literature. We report the case of a 53-year-old woman with an anterior (oral) tongue mass. A review of literature was performed. Histomorphologic features were evaluated with standard hematoxylin and eosin stained sections. Ancillary testing was performed. The mass consisted of invasive adenocarcinoma associated with "dirty necrosis", akin to the phenotype seen in colorectal adenocarcinoma. By immunohistochemistry, the tumor cells were positive for AE1/3, CDX2, CK20, SATB2 and beta-catenin. This was initially felt to represent a metastatic colorectal adenocarcinoma but subsequent PET/CT and colonoscopy examination were negative for colorectal mass, excluding the possibility of a metastasis and confirming a diagnosis of CTAT. We raise awareness of the existence of this entity and recommend that metastatic disease be excluded before rendering a diagnosis of CTAT.
Topics: Adenocarcinoma; Biomarkers, Tumor; Female; Humans; Middle Aged; Tongue Neoplasms
PubMed: 27357134
DOI: 10.1007/s12105-016-0740-7 -
Journal of Radiological Protection :... Oct 2020This work was undertaken to understand what would happen if a high-activity radioactive fragment became embedded in an individual following the use of a crude...
This work was undertaken to understand what would happen if a high-activity radioactive fragment became embedded in an individual following the use of a crude radiological dispersal device ('dirty bomb'). Two areas were addressed: how would a high-activity fragment be viewed on modern digital x-ray imaging systems; and, what would be the impact on medical management for the patient? A set of experimental trials were undertaken using an iridium-192 source and a DRagon mobile x-ray set equipped with a Canon CXDI-50G portable flat panel digital detector plate. In addition, the potential doses to a surgical team were calculated and potential doses to a patient were assessed using a Monte Carlo code, in which a radioactive point source of nil volume was located within a limb of an anthropomorphic voxel phantom. Three distinct effects on the digital imaging systems were observed, referred to in this paper as a localised 'bloom' effect, a 'discontinuity' effect towards the middle of the image and 'fogging' across the entire image. The first two of these effects were unexpected, and possible reasons for their appearance are discussed. The Monte Carlo modelling showed that the patient exposure can potentially lead to very high localised absorbed doses, which may result in symptoms associated with acute radiation syndrome. While the dose clearly depends upon the activity of the fragment and the length of time that the fragment is present inside the patient, it is clear that radiation necrosis of bone, muscle and other tissues may threaten the medium term viability of the limb. The dose rates associated with high-activity fragments may also restrict the time a surgeon has to operate, leading to challenging ethical and surgical decisions. Low-activity fragments allow for conventional surgical management to be considered with appropriate control measures.
Topics: Humans; Nuclear Weapons; Phantoms, Imaging; Radiation Injuries; Radioactivity; Radiographic Image Enhancement
PubMed: 33124602
DOI: 10.1088/1361-6498/abb14c -
Surgical Innovation Dec 2014Implantation of synthetic meshes for reinforcement of abdominal wall hernias can be complicated by mesh infection, which often requires mesh explantation. The risk of... (Clinical Trial)
Clinical Trial Observational Study
BACKGROUND
Implantation of synthetic meshes for reinforcement of abdominal wall hernias can be complicated by mesh infection, which often requires mesh explantation. The risk of mesh infection is increased in a contaminated environment or in patients who have comorbidities such as diabetes or smoking. The use of biological prostheses has been advocated because of their ability to resist infection. Initial results, however, have shown high hernia recurrence rates and wound occurrences. The objective of the present study is to evaluate early and mid-term outcomes in the largest French series that included 43 consecutive complex abdominal hernias repaired with biological prostheses.
MATERIALS AND METHODS
Retrospective observational study of a prospective collected data bank. Patient demographics, history of previous repairs, intraoperative findings and degree of contamination, associated procedures, postoperative prosthetic-related complications, and long-term results were retrospectively reviewed.
RESULTS
There were 25 (58%) incisional, 14 parastomal, and 4 midline hernia repairs. Hernias were considered "clean" (n = 5), "clean-contaminated" (n = 19), "contaminated" (n = 12), or "dirty" (n = 7). Wound-related morbidity occurred in 17 patients; 4 patients needed reoperation for cutaneous necrosis or abscess. Smoking was the only risk factor associated with wound complication (P = .022). No postoperative wound events required removal of the prosthesis. There were 4 hernia recurrences (9%). A previous attempt at repair (P = .018) and no complete fascia closure (P = .033) were associated with hernia recurrence.
CONCLUSIONS
This study demonstrated that the use of bioprothesis in complex hernia repair allowed successful single-stage reconstruction. Wound-related complications were frequent. Cost-benefit analyses are important to establish the validity of these findings.
Topics: Adult; Aged; Aged, 80 and over; Bioprosthesis; Female; France; Hernia, Ventral; Herniorrhaphy; Humans; Male; Middle Aged; Pilot Projects; Postoperative Complications; Retrospective Studies; Risk Factors; Surgical Mesh; Treatment Outcome
PubMed: 24496103
DOI: 10.1177/1553350613520514 -
Clinical Interventions in Aging 2014Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K....
Klebsiella pneumoniae necrotizing fasciitis is a rare infection in regions outside of Asia. Here, we present a case of necrotizing fasciitis of the leg caused by K. pneumoniae in a 92-year-old French woman hospitalized in a geriatric rehabilitation unit. The patient initially presented with dermohypodermitis of the leg that developed from a dirty wound following a fall. A few hours later, this painful injury extended to the entire lower limb, with purplish discoloration of the skin, bullae, and necrosis. Septic shock rapidly appeared and the patient died 9 hours after the onset of symptoms. The patient was Caucasian, with no history of travel to Asia or any underlying disease. Computed tomography revealed no infectious metastatic loci. Blood cultures showed growth of capsular serotype K2 K. pneumoniae strains with virulence factors RmpA, yersiniabactin and aerobactin. This rare and fatal case of necrotizing fasciitis caused by a virulent strain of K. pneumoniae occurred in a hospitalized elderly woman without risk factors. Clinicians and geriatricians in particular should be aware of this important albeit unusual differential diagnosis.
Topics: Aged, 80 and over; Diagnosis, Differential; Fasciitis, Necrotizing; Fatal Outcome; Female; France; Humans; Klebsiella Infections; Klebsiella pneumoniae; Leg
PubMed: 25071368
DOI: 10.2147/CIA.S60812 -
International Journal of Surgery Case... 2017Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of...
INTRODUCTION
Double-layer dermal grafts are used for the management of complicated abdominal wall hernias in obese, high risk patients. The method has not yet been used in case of emergency in septic/dirty environment.
CASE REPORT
A 76-year old female patient (BMI 36.7kg/m) was admitted with mechanical bowel obstruction and sepsis caused by a third time recurred, incarcerated and eventrated abdominal wall hernia. During the emergency surgery perforation of the terminal ileum and the ascending colon was detected, along with a feculent peritonitis and extended abdominal wall necrosis. Extended right hemicolectomy and necrectomy of the abdominal wall were performed. The surgery resulted in an abdominal wall defect measuring 223cm, for the management of which direct closure was not possible. Using a specific method, an autologous dermal graft was prepared from the redundant skin. The first dermal graft was placed under the abdominal wall with 5cm overlap, and the second layer was placed onto the first layer with 3cm overlap in a perforated fashion. The operating time was 250min. No significant intra-abdominal pressure elevation was measured. No reoperation was performed. On the fifth postoperative day, the patient was mobilised. She was discharged in satisfactory general condition on the 18th postoperative day. There is no recurrent hernia 8 months after the surgery.
DISCUSSION
Abdominal wall reconstruction was possible in a necrotic, purulent environment by using a de-epithelised autologous double layer dermal graft, without synthetic or biological graft implantation. The advantage of the procedure was cost-effectivity, and the disadvantage was that only in an obese patient is the sufficient quantity of dermal graft available.
CONCLUSION
A homogeneous internal and perforated outer dermal graft was suitable for bridging the abdominal gap in the case of an obese, high risk patient. Autologous dermal grafts can be a safe and feasible alternative to biological meshes in emergency abdominal wall surgeries. Evaluation of a case series can be the next cornerstone of the method described above.
PubMed: 28012327
DOI: 10.1016/j.ijscr.2016.12.002 -
Acta Cytologica 2015Intracranial chondrosarcoma is rare, and most cases occur in the skull base. Intradural chondrosarcoma is even rarer.
BACKGROUND
Intracranial chondrosarcoma is rare, and most cases occur in the skull base. Intradural chondrosarcoma is even rarer.
CASE
Here, we describe a case of dural chondrosarcoma with a radiation history for nasopharyngeal carcinoma and a radical prostatectomy for prostatic cancer 15 and 8 years earlier, respectively. A 67-year-old man presented with a 3-week memory disturbance and dysarthria. Computed tomography and magnetic resonance images of the brain revealed a dural-based mass in the left temporal area. Under the impression of a glioblastoma, a resection and an intraoperative squash cytology were done. A necrotic dirty background as well as bluish-to-pinkish myxoid stroma were characteristic; the nuclei of highly pleomorphic tumor cells were hyperchromatic to vesicular with an occasional ground-glass appearance. The cytoplasm was of an eosinophilic hyalinized condensed morphology with an occasional granular appearance. Histologically, the lobulated mass was composed of hypercellular lobules of well-differentiated chondrocytes intermixed with anaplastic pleomorphic cells and diagnosed as a conventional grade III chondrosarcoma. These cells were immunoreactive for D2-40, S-100 protein and vimentin. Brain invasion was also found.
CONCLUSION
Albeit rare, dural-based chondrosarcomas should be considered in the differential diagnosis for meningeal tumors, especially in the case of previous radiation therapy.
Topics: Aged; Biomarkers, Tumor; Biopsy; Chondrosarcoma; Cytodiagnosis; Diagnosis, Differential; Dura Mater; Glioblastoma; Humans; Immunohistochemistry; Magnetic Resonance Imaging; Male; Meningeal Neoplasms; Microscopy, Electron, Transmission; Necrosis; Neoplasm Grading; Neoplasm Invasiveness; Predictive Value of Tests
PubMed: 25997403
DOI: 10.1159/000380901 -
Meditsina Truda I Promyshlennaia... 2015The work was aimed to find new screeding parameters (biomarkers) for evaluation of health state of workers engaged into enterprises with hazardous work conditions, as...
The work was aimed to find new screeding parameters (biomarkers) for evaluation of health state of workers engaged into enterprises with hazardous work conditions, as exemplified by "Maradykovskyi" object of chemical weapons extinction. Analysis of 27 serum cytokines was conducted in donors and the object personnel with various work conditions. Findings are statistically significant increase of serum eotaxin in the personnel of "dirty" zone, who are regularly exposed to toxic agents in individual filter protective means over the working day. For screening detection of health disorders in the object personnel, the authors suggested new complex biomarker--ratio Eotaxin* IFNγ/TNFα that demonstrates 67.9% sensitivity and 87.5% specificity in differentiating the "dirty" zone personnel and other staffers.
Topics: Adult; Biomarkers; Chemical Warfare; Chemical Warfare Agents; Decontamination; Female; Humans; Interleukin-18; Male; Mass Screening; Occupational Diseases; Occupational Exposure; Russia; Sensitivity and Specificity; Tumor Necrosis Factor-alpha
PubMed: 26036023
DOI: No ID Found