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The Pan African Medical Journal 2019We here report the case of a 6-year old female patient with no pathological history, presenting with diffuse abdominal pain and abdominal distension evolving in the last...
We here report the case of a 6-year old female patient with no pathological history, presenting with diffuse abdominal pain and abdominal distension evolving in the last 2 months. The patient had a deterioration in her general condition. Clinical examination showed distended abdomen, average abundance ascites, venous collateral circulation and multiple mobile hard abdominal masses measuring 3-4 cm in diameter at the level of the iliac fossa and of the left hypochondriac region associated with a well circumscribed, hard, rounded umbilical mass measuring 3cm in diameter lifting the skin with inflammatory signs (A). The remainder of the physical examination was normal. Thoraco-abdominal CT scan showed subcutaneous umbilical nodule (B), with homogeneous enhancement measuring 36x29x19mm, associated with mesenteric lymphadenopathy magmas, pelvic mass and extended jejunum thickening. Fine needle aspiration biopsy of the mass showed the presence of several naked nuclei and a few blasts. Biopsy showed Burkitt lymphoma. Therefore, the diagnosis of Burkitt lymphoma revealed by sister Marie-Josèphe nodule was retained and the patient underwent chemotherapy according the LMB01 protocol. Outcome was favorable, marked by the regression of the nodule and of the abdominal masses. Sister Mary Joseph nodule is an umbilical metastasis from a tumor (usually an abdomino pelvic tumor) mainly an adenocarcinoma, exceptionally a lymphoma. It is a rare sign. It accounts for 1-3% of all abdomino-pelvic neoplasms and it is associated with poor prognosis. It is essential to know that this nodule is a lesion secondary to solid tumor in order to avoid delayed management of the underlying neoplasm.
PubMed: 31692734
DOI: 10.11604/pamj.2019.33.228.19636 -
Technology in Cancer Research &... 2022: To identify the dosimetric predictors of lymphocytopenia and retrospectively analyze the changing trend of peripheral lymphocyte counts and lymphocyte-related...
Peripheral Lymphocyte Counts and Lymphocyte-Related Inflammation Indicators During Radiotherapy for Pelvic Malignancies: Temporal Characterization and Dosimetric Predictors.
: To identify the dosimetric predictors of lymphocytopenia and retrospectively analyze the changing trend of peripheral lymphocyte counts and lymphocyte-related inflammatory indicators in patients with simple pelvic radiotherapy. We retrospectively reviewed the clinical data of 188 patients with pelvic malignancies undergoing pelvic radiotherapy. The absolute count of neutrophils, lymphocytes, monocytes, and platelets at each time point was collected, and lymphocyte-related inflammation indicators were obtained, including neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), and the systemic immune-inflammation index (SII). The total pelvic bone (TPB) and the body within the 5 Gy coverage were retrospectively delineated for each patient. Dose-volume histograms corresponding to the delivered volumetric arc therapy plan were used to assess the dose volumes received by the TPB and body. A paired-samples -test or Wilcoxon signed-rank test for matched pairs was applied for pairwise comparisons. We also established a stepwise multiple linear regression model for the peripheral lymphocyte count (PLC) value at the end of radiotherapy. The PLC and lymphocyte-related inflammatory indicators changed significantly after the start of radiotherapy and persisted for 3-6 months after radiotherapy. The nadirs of PLC occurred at RT-End, and the PLC was still significantly lower than the baseline value at RT-3 months and RT-6 months. NLR, PLR, and SII at RT-End are about 3.5 times the value at RT-Baseline, while LMR is one-fourth of the basal value. In a further multiple stepwise linear regression analysis, the basal PLC (β = 0.156, ≤ .001), gender (β = 0.096, = .005), and TPB-V5 (β = -0.016, ≤ .001) turned out to be the predictor of the absolute value of lymphocytes at the end of radiotherapy. The impact of pelvic radiotherapy on PLC and lymphocyte-related inflammatory indicators is considerable and long-lasting. Minimizing pelvic bone radiation exposure dose (5 Gy) may help to avoid severe cases of lymphocytopenia.
Topics: Humans; Inflammation; Lymphocyte Count; Lymphocytes; Lymphopenia; Pelvic Neoplasms; Retrospective Studies
PubMed: 36114641
DOI: 10.1177/15330338221116494 -
International Journal of Molecular... Apr 2023Uterine leiomyosarcoma (uLMS) is the most frequent subtype of uterine sarcoma that presents a poor prognosis and high rates of recurrence and metastasis. The origin and...
Uterine leiomyosarcoma (uLMS) is the most frequent subtype of uterine sarcoma that presents a poor prognosis and high rates of recurrence and metastasis. The origin and molecular mechanism underlying and driving its clinical and biological behavior remain largely unknown. Recently, we and others have revealed the role of microRNAs, DNA methylation, and histone modifications in contributing to the pathogenesis of uLMS. However, the connection between reversible mA RNA methylation and uLMS pathogenesis remains unclear. In this study, we assessed the role and mechanism of FTO mA RNA demethylase in the pathogenesis of uLMS. Immunohistochemistry analysis revealed that the levels of RNA demethylases FTO and ALKBH5 were aberrantly upregulated in uLMS tissues compared to adjacent myometrium with a significant change by histochemical scoring assessment ( < 0.01). Furthermore, the inhibition of FTO demethylase with its small, potent inhibitor (Dac51) significantly decreased the uLMS proliferation dose-dependently via cell cycle arrest. Notably, RNA-seq analysis revealed that the inhibition of FTO with Dac51 exhibited a significant decrease in cell-cycle-related genes, including several CDK members, and a significant increase in the expression of , which correlated with a Dac51-exerted inhibitory effect on cell proliferation. Moreover, Dac51 treatment allowed the rewiring of several critical pathways, including TNFα signaling, KRAS signaling, inflammation response, GM checkpoint, and C-Myc signaling, among others, leading to the suppression of the uLMS phenotype. Moreover, transcription factor (TF) analyses suggested that epitranscriptional alterations by Dac51 may alter the cell cycle-related gene expression via TF-driven pathways and epigenetic networks in uLMS cells. This intersection of RNA methylation and other epigenetic controls and pathways provides a framework to better understand uterine diseases, particularly uLMS pathogenesis with a dysregulation of RNA methylation machinery. Therefore, targeting the vulnerable epitranscriptome may provide an additional regulatory layer for a promising and novel strategy for treating patients with this aggressive uterine cancer.
Topics: Female; Humans; Leiomyosarcoma; Proto-Oncogene Proteins c-myc; Signal Transduction; Uterine Neoplasms; MicroRNAs; Pelvic Neoplasms; Alpha-Ketoglutarate-Dependent Dioxygenase FTO
PubMed: 37175660
DOI: 10.3390/ijms24097957 -
Abdominal Radiology (New York) Jun 2020This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed...
This an interesting case of an asymptomatic 60-year-old postmenopausal patient with an incidental pelvic mass mimicking a pelvic malignancy on imaging. Biopsy revealed findings consistent with polypoid endometriosis. After discontinuation of hormone replacement therapy, the mass showed decrease in size on follow-up imaging. Polypoid endometriosis is a rare but distinct variant of endometriosis with histopathologic features akin to an endometrial polyp. Clinical and imaging features of polypoid endometriosis differ from classic endometriosis. While classic endometriosis predominates in premenopausal women, polypoid endometriosis more commonly affects peri- to postmenopausal women and is associated with the exposure to Tamoxifen or hormone replacement therapy. Imaging features that aid in the diagnosis of polypoid endometriosis are a T2 hyperintense polypoid mass with signal characteristics similar to endometrium, a T2 hypointense peripheral rim, contrast enhancement pattern mirroring the enhancement of the endometrium, and lack of diffusion restriction. Radiologists should be familiar with polypoid endometriosis because this clinically and morphologically distinct variant may mimic malignant neoplasms on imaging.
Topics: Diagnosis, Differential; Endometriosis; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Pelvic Neoplasms; Polyps
PubMed: 31372776
DOI: 10.1007/s00261-019-02143-8 -
International Journal of Environmental... Aug 2022Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a...
Cancer patients experience pain not only in its physical dimension, but also in a broader context that includes psychological, social, and spiritual aspects due to a higher level of anxiety and stress. The present prospective, longitudinal study examined the relationship between total pain and illness acceptance among pelvic cancer patients, taking into consideration the moderated mediation effects of self-efficacy and stress. The study involved a sample of pelvic cancer patients receiving radiotherapy treatment. Assessments were completed at T1 (before radiotherapy), T2 (after 3-4 weeks), and T3 (after radiotherapy) to assess the psychosocial dynamics of illness acceptance ( = 267). The more physical, psychological, social, and spiritual pain symptoms the patients experienced, the less they accepted negative health conditions and the effects of their illness. Stress moderated the indirect effect between total pain dimensions and illness acceptance through self-efficacy, but it did not moderate the relationship between total pain and illness acceptance. The relationships between total pain dimensions and illness acceptance thus depend on both the mediating effect of self-efficacy and the moderating effect of stress. This highlights the need to control one's motivation and behavior and manage emotional strain or tension.
Topics: Humans; Longitudinal Studies; Pain; Pelvic Neoplasms; Prospective Studies; Self Efficacy; Stress, Psychological; Surveys and Questionnaires
PubMed: 35954987
DOI: 10.3390/ijerph19159631 -
Cancer Reports (Hoboken, N.J.) Dec 2021Previous population-based studies on second primary cancers (SPCs) in urothelial cancers have focused on known risk factors in bladder cancer patients without data on...
BACKGROUND
Previous population-based studies on second primary cancers (SPCs) in urothelial cancers have focused on known risk factors in bladder cancer patients without data on other urothelial sites of the renal pelvis or ureter.
AIMS
To estimate sex-specific risks for any SPCs after urothelial cancers, and in reverse order, for urothelial cancers as SPCs after any cancer. Such two-way analysis may help interpret the results.
METHODS
We employed standardized incidence ratios (SIRs) to estimate bidirectional relative risks of subsequent cancer associated with urothelial cancers. Patient data were obtained from the Swedish Cancer Registry from years 1990 through 2015.
RESULTS
We identified 46 234 urinary bladder cancers (75% male), 940 ureteral cancers (60% male), and 2410 renal pelvic cancers (57% male). After male bladder cancer, SIRs significantly increased for 9 SPCs, most for ureteral (SIR 41.9) and renal pelvic (17.2) cancers. In the reversed order (bladder cancer as SPC), 10 individual FPCs were associated with an increased risk; highest associations were noted after renal pelvic (21.0) and ureteral (20.9) cancers. After female bladder cancer, SIRs of four SPCs were significantly increased, most for ureteral (87.8) and pelvic (35.7) cancers. Female bladder, ureteral, and pelvic cancers associated are with endometrial cancer.
CONCLUSIONS
The risks of recurrent urothelial cancers were very high, and, at most sites, female risks were twice over the male risks. Risks persisted often to follow-up periods of >5 years, motivating an extended patient follow-up. Lynch syndrome-related cancers were associated with particularly female urothelial cancers, calling for clinical vigilance.
Topics: Aged; Aged, 80 and over; Female; Follow-Up Studies; Humans; Incidence; Male; Middle Aged; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Prognosis; Registries; Sweden; Ureteral Neoplasms; Urinary Bladder Neoplasms
PubMed: 34114732
DOI: 10.1002/cnr2.1406 -
Gynecologic Oncology Nov 2022To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.
OBJECTIVE
To evaluate postoperative and oncologic outcomes associated with pelvic exenteration for non-ovarian gynecologic malignancies.
METHODS
This was a retrospective review of patients who underwent pelvic exenteration for non-ovarian gynecologic malignancies at our institution from 1/1/2010-12/31/2019. Palliative exenteration cases were excluded from survival analysis. Postoperative complications were early (≤30 days) or late (31-180 days). Complications were graded using a validated institutional scale. Major complications were considered grade ≥ 3. Categorical variables were compared using the chi-square test, and the Kaplan-Meier method was used for survival analysis.
RESULTS
Of 100 patients identified, 89 underwent pelvic exenteration for recurrent disease, 5 for palliation, 5 for primary disease, and 1 for persistent disease. Thirty percent had cervical, 27% vulvar, 24% uterine, and 19% vaginal cancer. Sixty-two percent underwent total, 30% anterior, and 8% posterior exenteration. No deaths occurred intraoperatively or within 30 days of surgery. Six patients died after 30 days. Ninety-seven experienced a perioperative complication-49 early, 1 late, and 47 both. Fifty experienced a major complication-22 (44%) early, 19 (38%) late, and 9 (18%) both. No variables were statistically associated with complication development. The 3-year progression-free survival rate was 61.0%; the 3-year overall survival rate was 61.6%. Of 58 surviving patients, 16 (28%) and 4 (7%) were alive after 5 and 10 years, respectively.
CONCLUSION
The overall complication rate for pelvic exenteration remains high. No variables demonstrated association with complication development as the rate was nearly 100%. The low rate of perioperative mortality is likely due to improved perioperative care.
Topics: Humans; Female; Genital Neoplasms, Female; Pelvic Exenteration; Survival Analysis; Retrospective Studies; Vaginal Neoplasms; Neoplasm Recurrence, Local
PubMed: 36064678
DOI: 10.1016/j.ygyno.2022.08.017 -
Archives of Gynecology and Obstetrics Feb 2023Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Uterine leiomyosarcoma (uLMS) may show loss of expression of B-cell lymphoma-2 (Bcl-2) protein. It has been suggested that Bcl-2 loss may both be a diagnostic marker and an unfavorable prognostic marker in uLMS.
OBJECTIVE
To define the diagnostic and prognostic value of Bcl-2 loss in uLMS through a systematic review and meta-analysis.
METHODS
Electronic databases were searched from their inception to May 2020 for all studies assessing the diagnostic and prognostic value of Bcl-2 loss of immunohistochemical expression in uLMS. Data were extracted to calculate odds ratio (OR) for the association of Bcl-2 with uLMS vs leiomyoma variants and smooth-muscle tumors of uncertain malignant potential (STUMP), and hazard ratio (HR) for overall survival; a p value < 0.05 was considered significant.
RESULTS
Eight studies with 388 patients were included. Loss of Bcl-2 expression in uLMS was not significantly associated with a diagnosis of uLMS vs leiomyoma variants and STUMP (OR = 2.981; p = 0.48). Bcl-2 loss was significantly associated with shorter overall survival in uLMS (HR = 3.722; p = 0.006). High statistical heterogeneity was observed in both analyses.
CONCLUSION
Loss of Bcl-2 expression appears as a significant prognostic but not diagnostic marker in uLMS. The high heterogeneity observed highlights the need for further research and larger studies.
Topics: Female; Humans; Leiomyosarcoma; Prognosis; Uterine Neoplasms; Leiomyoma; Pelvic Neoplasms
PubMed: 35344084
DOI: 10.1007/s00404-022-06531-2 -
International Journal of Gynecological... Aug 2020To determine surveillance patterns of stage I cervical cancer after cervical conization.
OBJECTIVES
To determine surveillance patterns of stage I cervical cancer after cervical conization.
METHODS
A 25-question electronic survey was sent to members of the Society of Gynecologic Oncology. Provider demographics, surveillance during year 1, years 1-3, and >3 years after cervical conization, use of pelvic examination, cytology, Human papillomavirus testing, colposcopy, and endocervical curettage were queried. Data were analyzed.
RESULTS
239/1175 (20.1%) responses were collected over a 5-week study period. All providers identified as gynecologic oncologists. During year 1, 66.7% of providers perform pelvic examination and 37.1% perform cytology every 3 months. During years 1-3, 61.6% perform pelvic examination and 46% perform cytology every 6 months. At >3 years, 54.4% perform pelvic examination every 6 months and 43% perform annual pelvic examination. 66.7% of respondents perform cytology annually, and 51.9% perform annual Human papilloma virus testing. 85% of providers do not offer routine colposcopy and 60% do not offer endocervical curettage at any point during 5-year follow-up. 76.3% of respondents screen patients for Human papilloma virus vaccination.
CONCLUSIONS
To date, there are no specific surveillance guidelines for patients with stage I cervical cancer treated with cervical conization. The most common surveillance practice reported is pelvic examination with or without cytology every 3 months in year 1 and every 6 months thereafter. However, wide variation exists in visit frequency, cytology, and Human papillomavirus testing, and there is a clear trend away from using colposcopy and endocervical curettage. These disparate surveillance practices indicate a need for well-defined, uniform surveillance guidelines.
Topics: Adult; Age Factors; Cervix Uteri; Colposcopy; Conization; Cytodiagnosis; Female; Fertility Preservation; Gynecological Examination; Humans; Hysterectomy; Institutional Practice; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Papillomavirus Infections; Population Surveillance; Practice Patterns, Physicians'; Private Practice; Surveys and Questionnaires; Time Factors; Uterine Cervical Neoplasms; Vaccination
PubMed: 32499392
DOI: 10.1136/ijgc-2020-001338 -
Journal of Cancer Research and Clinical... Dec 2020Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to... (Review)
Review
PURPOSE
Penile cancer is highly prevalent in low- and middle-income countries, with significant morbidity and mortality rates. The first Brazilian consensus provides support to improve penile cancer patients' outcomes, based on expert's opinion and evidence from medical literature.
METHODS
Fifty-one Brazilian experts (clinical oncologists, radiation oncologists, urologists, and pathologists) assembled and voted 104 multiple-choice questions, confronted the results with the literature, and ranked the levels of evidence.
RESULTS
Healthcare professionals need to deliver more effective communication about the risk factors for penile cancer. Staging and follow-up of patients include physical examination, computed tomography, and magnetic resonance imaging. Close monitoring is crucial, because most recurrences occur in the first 2-5 years. Lymph-node involvement is the most important predictive factor for survival, and management depends on the location (inguinal or pelvic) and the number of lymph nodes involved. Conservative treatment may be helpful in selected patients without compromising oncological outcomes; however, surgery yields the lowest rate of local recurrence.
CONCLUSION
This consensus provides an essential decision-making orientation regarding this challenging disease.
Topics: Brazil; Developing Countries; Humans; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Recurrence, Local; Penile Neoplasms; Risk Factors
PubMed: 33104884
DOI: 10.1007/s00432-020-03417-1