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The Journal of International Medical... Jun 2020Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is... (Review)
Review
Primitive neuroectodermal tumours (PNETs) are rare malignant small round cell tumours. Notably, despite widespread reports of PNET in multiple parts of the body, it is extremely rare in the pelvis. Here, a rare case of giant PNET of the pelvis, that was treated with surgical intervention comprising hemipelvectomy and amputation, is reported. A 42-year-old female patient presented with an enlarged mass on the left hip and severe pain in the left lower extremity for the previous 6 months. Preoperative imaging examinations indicated an irregular soft tissue-like signal shadow sized 19 × 15 × 12 cm at the left ilium and sacrum. After surgical intervention involving left hemipelvectomy and amputation, the tumour was diagnosed by pathology as PNET. During the courses of postoperative radiotherapy and chemotherapy, local recurrence and distant metastasis occurred, and the patient died 9 months following surgical treatment. To the best of the authors' knowledge, the current case is the largest pelvic PNET resection reported to date. Pelvic PNET is extremely malignant and has a high mortality rate regardless of surgical treatment, however, surgical resection of the lesion may relieve the symptoms, extend life, and improve quality of life to a certain extent.
Topics: Adult; Biopsy; Female; Humans; Neoplasm Recurrence, Local; Neuroectodermal Tumors, Primitive; Pelvic Neoplasms; Pelvis; Quality of Life
PubMed: 32500784
DOI: 10.1177/0300060520906747 -
Supportive Care in Cancer : Official... Jul 2022Late radiation tissue injuries (LRTIs) after treatment for pelvic cancer may impair health related quality of life (HRQoL). Hyperbaric oxygen therapy is an adjuvant...
PURPOSE
Late radiation tissue injuries (LRTIs) after treatment for pelvic cancer may impair health related quality of life (HRQoL). Hyperbaric oxygen therapy is an adjuvant therapy for LRTIs, but limited studied. The aim of this study was to explore the development and association between symptoms of LRTI and HRQoL following hyperbaric oxygen treatment.
METHODS
A pretest-posttest design was used to evaluate the changes in pelvic LRTIs and HRQoL from baseline (T1), immediately after treatment (T2) and at six-month follow-up (T3). EPIC and EORTC-QLQ-C30 were used to assess LRTIs and HRQoL. Changes were analysed with t-tests, and associations with Pearson's correlation and multiple regression analyses.
RESULTS
Ninety-five participants (mean age 65 years, 52.6% men) were included. Scores for urinary and bowel symptoms, overall HRQoL, all function scales and the symptoms scales sleep, diarrhoea, pain and fatigue were significantly improved six months after treatment (P-range = 0.00-0.04). Changes were present already at T2 and maintained or further improved to T3. Only a weak significant correlation between changes in symptoms and overall HRQoL was found (Pearson r-range 0.20-0.27).
CONCLUSION
The results indicate improvement of pelvic LRTIs and HRQoL following hyperbaric oxygen therapy, corresponding to minimal or moderate important changes. Cancer survivors with pelvic LRTIs and impaired HRQoL may benefit from undergoing hyperbaric oxygen therapy. Especially the reduced symptom-severity and improved social- and role function can influence daily living positively.
TRIAL REGISTRATION
ClinicalTrials.gov: NCT03570229. Released 2. May 2018.
Topics: Aged; Cancer Survivors; Female; Humans; Hyperbaric Oxygenation; Male; Pelvic Neoplasms; Quality of Life; Radiation Injuries
PubMed: 35320424
DOI: 10.1007/s00520-022-06994-8 -
Medicine Jan 2024Cancer of unknown primary (CUP) is a very challenging disease, accounting for 2% to 9% of all new cancer cases. This type of tumor is a heterogeneous tumor whose primary...
BACKGROUND
Cancer of unknown primary (CUP) is a very challenging disease, accounting for 2% to 9% of all new cancer cases. This type of tumor is a heterogeneous tumor whose primary site cannot be determined by standard examination. It has the characteristics of early metastasis, strong aggressiveness, and unpredictable mode of metastasis. Studies have shown that there is no consensus on the treatment of CUP and that there is a wide range of individual differences. In most cases, surgical removal of tumor is the most typical treatment for pelvic tumors. Herein, we report a case of a large pelvic tumor of unknown origin that had compressed the sigmoid colon and ureter and was completely removed by surgery. Postoperative diagnosis was pelvic metastatic squamous cell carcinoma.
CASE SUMMARY
A 68-year-old man with pelvic tumor who initially complained of recurrent low back pain and painful urination. The mass was initially diagnosed as a pelvic tumor of unknown origin. The patient underwent complete resection of the tumor by laparotomy. The tumor was pathologically diagnosed as squamous cell carcinoma.
CONCLUSION
Based on the treatment experience of this case, surgery alone cannot improve the poor prognosis of CUP. Since chemotherapy and immunotherapy have achieved promising efficacy in various cancers, and immunotherapy has the characteristics of low side effects and good tolerability, we recommend that patients with CUP should receive chemotherapy and/or immunotherapy for better survival outcomes.
Topics: Male; Humans; Aged; Neoplasms, Unknown Primary; Pelvic Neoplasms; Constriction, Pathologic; Carcinoma, Squamous Cell; Hydronephrosis; Ureteral Obstruction
PubMed: 38277516
DOI: 10.1097/MD.0000000000037057 -
Asian Pacific Journal of Cancer... 2015The aim of this study was to compare the tumor-free and overall survival rates between patients with low-risk endometrial cancer who underwent surgical staging and those... (Comparative Study)
Comparative Study
PURPOSE
The aim of this study was to compare the tumor-free and overall survival rates between patients with low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgical staging.
MATERIALS AND METHODS
Data, including demographic characteristics, grade of the tumor, myometrial invasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion, postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, for patients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic and paraaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioid endometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2) endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromal glandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patients at low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaortic LND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND.
RESULTS
There was no statistical significance when the groups were compared in terms of lymphovascular space invasion, cervical involvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher in group 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodes were significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statistically significant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overall survival (p=0.166).
CONCLUSIONS
Total hysterectomy with bilateral salpingo-oophorectomy and stage-adapted postoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficient treatments for low-risk endometrial cancer.
Topics: Adenocarcinoma; Endometrial Neoplasms; Female; Follow-Up Studies; Humans; Hysterectomy; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neoplasm Grading; Neoplasm Invasiveness; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Retrospective Studies; Survival Rate
PubMed: 26225674
DOI: 10.7314/apjcp.2015.16.13.5331 -
Medicine Sep 2019Pelvic tumor had great impact on patients' quality of life. After tumor resection, how to accurately fill bone defect remained challenging for orthopedic surgeons. Due...
RATIONALE
Pelvic tumor had great impact on patients' quality of life. After tumor resection, how to accurately fill bone defect remained challenging for orthopedic surgeons. Due to lack of individual design, high incidence of prosthetic mismatching, and loosening were reported in pelvic reconstruction surgery with conventional modular prostheses. Nowadays, with rapid development of three-dimensional (3D) print technology, pelvic prostheses could be designed according to patients' own anatomy. The objective of this study was to describe the application of 3D printed customized hemi-pelvic prosthesis for patients with pelvic tumor.
PATIENT CONCERNS
A 62-year-old female had developed severe right joint pain without obvious inducement from 5 months before she sought medical advice. Pain, swelling, and limited range of motion of right joint were founded during physical examination.
DIAGNOSIS
The patients were diagnosed as "right acetabulum metastatic carcinoma" INTERVENTION:: 3D printed titanium alloy hemi-pelvic prosthesis was designed according the morphology of unaffected side hemi-pelvis and subsequently implanted in surgery to reconstruct the pelvis. 3D printed osteotomy guide and pelvic model were also manufactured and applied to improve accuracy of osteotomy and reduce operation time. X-Ray of pelvis, Harris score, musculoskeletal tumor society score (MSTS) and The MOS item short from health survey (SF-36) were recorded during the period of preoperation, 1, 3, 6, 12 months follow-up after operation.
OUTCOMES
3D printed hemi-pelvic prosthesis matched precisely with pelvis and implanted successfully. There was no sign of prosthetic loosening within 12 months' follow-up. No sign of peri-prosthetic infection from laboratory examination. Harris score, MSTS, and SF-36 were gradually increasing during follow-up period.
LESSONS
Satisfactory effect of pelvic reconstruction could be achieved by 3D printed hemi-pelvic prostheses. It also provided a promising way to the treatment of pelvic tumor in similar cases.
Topics: Female; Humans; Middle Aged; Neoplasm Metastasis; Pelvic Neoplasms; Printing, Three-Dimensional; Prosthesis Design; Prosthesis Implantation; Plastic Surgery Procedures
PubMed: 31490360
DOI: 10.1097/MD.0000000000016658 -
BMC Surgery Oct 2022Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic...
3D-printed hemipelvic prosthesis combined with a dual mobility bearing in patients with primary malignant neoplasm involving the acetabulum: clinical outcomes and finite element analysis.
BACKGROUND
Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination.
METHODS
Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow-up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint.
RESULTS
By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out.
CONCLUSION
Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable.
Topics: Acetabulum; Bone Neoplasms; Bone Screws; Finite Element Analysis; Humans; Pelvic Neoplasms; Polyethylenes; Printing, Three-Dimensional; Prosthesis Design; Retrospective Studies; Treatment Outcome
PubMed: 36203147
DOI: 10.1186/s12893-022-01804-8 -
Turkish Journal of Urology Mar 2015Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and...
Renal pelvic hematoma (Antopol Goldman lesion) is a rare but significant condition that may clinically mimick a renal or a pelvic neoplasm. Differential diagnosis and optimal treatment are still not known certainly. A 80-year-old male patient admitted to the emergency department with gross hematuria/clot retention and right flank pain. Magnetic resonance imaging (MRI) imaging revealed a filling defect in the right renal pelvis. Diagnostic flexible uretrorenoscopy was performed and a renal pelvic tumor was excluded. A 6 Fr double J (DJ) ureteral catheter was placed for 4 weeks while the patient was under an antifibrinolytic therapy. Filling defect was not detected at 3(rd) month control MRI. During 6 months of the follow-up period, gross hematuria or any abnormal radiological finding was not encountered.
PubMed: 26328199
DOI: 10.5152/tud.2014.48208 -
Trials May 2024Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative...
Educational telerehabilitation program for women with pelvic floor dysfunctions after gynecological pelvic cancer treatment: protocol study for a randomized and controlled clinical trial.
BACKGROUND
Educational and self-care measures are important for women after gynecological pelvic cancer treatment. Pelvic floor muscle training exercises (PFMT) are a conservative treatment for pelvic floor (PF) dysfunction. The purpose is to evaluate the impact of a telerehabilitation and self-care program on PF dysfunctions, reports of urinary incontinence (UI), and physical-emotional factors of participants post-treatment for gynecological pelvic cancer.
METHODS
Two-arm randomized clinical trial: an intervention group (IG) will evaluate the effect of a telerehabilitation program on women undergoing clinical practice of radiotherapy for the treatment of gynecological pelvic cancer and a control group (CG) will maintain the routine. Primary outcome is the prevalence of reports of UI, which will be assessed using the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF). The secondary outcomes will be the severity and impact of UI on quality of life, location and perception of pain intensity, presence and intensity of dyspareunia, vaginal stenosis, fecal incontinence (FI), and levels of physical activity. Statistical analysis will be performed by intention-to-treat, and multivariate mixed effects analysis will be used to compare results.
DISCUSSION
Activities in the context of telerehabilitation using PFMT and self-care can represent a viable and effective solution to minimize the side effects of gynecological cancer treatment and improve women's quality of life.
Topics: Humans; Female; Telerehabilitation; Pelvic Floor; Urinary Incontinence; Quality of Life; Treatment Outcome; Exercise Therapy; Randomized Controlled Trials as Topic; Patient Education as Topic; Pelvic Floor Disorders; Self Care; Surveys and Questionnaires; Time Factors; Recovery of Function; Genital Neoplasms, Female; Pelvic Neoplasms; Health Knowledge, Attitudes, Practice
PubMed: 38802934
DOI: 10.1186/s13063-024-08138-1 -
In Vivo (Athens, Greece) 2020Ovarian cancer presents an aggressive tumor biology, a significant number of patients experiencing recurrent disease. The aim of this study was to examine the...
BACKGROUND/AIM
Ovarian cancer presents an aggressive tumor biology, a significant number of patients experiencing recurrent disease. The aim of this study was to examine the feasibility and effectiveness of secondary debulking surgery for relapsed ovarian cancer.
PATIENTS AND METHODS
Between 2014 and 2018, debulking surgery for relapsed ovarian cancer was performed in 40 cases.
RESULTS
Debulking surgery to no residual disease was achieved in 31 cases; among the remaining cases, an R1 resection was feasible in six cases, while in the remaining three cases an R2 resection was performed. The most commonly performed visceral resections were represented by rectosigmoidian resection, right colon resection, total or partial cystectomy and unilateral or bilateral ureteral resection. The early postoperative morbidity rate was 32.5% while the postoperative mortality rate was 2.5%.
CONCLUSION
Extended pelvic resections are feasible in patients with relapsed ovarian cancer and might be performed with acceptable rates of postoperative complications.
Topics: Adenocarcinoma, Clear Cell; Adenocarcinoma, Mucinous; Adult; Aged; Cystadenocarcinoma, Serous; Cytoreduction Surgical Procedures; Endometrial Neoplasms; Female; Follow-Up Studies; Humans; Middle Aged; Neoplasm Recurrence, Local; Ovarian Neoplasms; Pelvic Neoplasms; Prognosis; Retrospective Studies
PubMed: 31882505
DOI: 10.21873/invivo.11787 -
Medicine Mar 2017Lymphangioleiomyomatosis (LAM) is a rare disease affecting young women caused by abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs and... (Review)
Review
BACKGROUND
Lymphangioleiomyomatosis (LAM) is a rare disease affecting young women caused by abnormal proliferation of smooth muscle-like cells (LAM cells) in the lungs and extrapulmonary sites (extrapulmonary LAM). The objective of this case series is to demonstrate marked regression in 2 cases of retroperitoneal LAM after treatment with everolimus, an mTOR inhibitor.
METHODS
We enrolled 2 cases with large volume, extrapulmonary pelvic LAM, and evaluated them with contrast-enhanced abdominal computed tomographic (CT) scans at presentation and serially during treatment with everolimus. Results were objectively quantified using the Response Evaluation Criteria in Solid Tumors, RECIST, Version 1.1.
RESULTS
After 12 to 18 months of treatment with everolimus, both patients showed substantial reduction in the volume of their tumors. The first had about 50% regression of the pelvic LAM and renal angiomyolipoma (AML). The second patient had extensive abdomino-pelvic LAM which after treatment showed complete remission. Both patients have not demonstrated disease progression after nearly 4 and 2 years of follow-up, respectively.
CONCLUSIONS
This case series demonstrates the enormous value of mTOR inhibitors (specifically everolimus) in the management of extrapulmonary pelvic LAM, of which there is no effective treatment currently available.
Topics: Adult; Antineoplastic Agents; Everolimus; Female; Humans; Lymphangioleiomyomatosis; Middle Aged; Pelvic Neoplasms; Pelvis
PubMed: 28272193
DOI: 10.1097/MD.0000000000004562