-
The Journal of Dermatology Dec 2005A 36-year-old African-American woman presented with an extensive stomatitis and pigmented cutaneous macules on the neck, axillae and hands. Subsequently she developed... (Review)
Review
A 36-year-old African-American woman presented with an extensive stomatitis and pigmented cutaneous macules on the neck, axillae and hands. Subsequently she developed violaceus papules on the dorsa of the hands, histologically consistent with an interface dermatitis. After 18 months of progressive disease, paraneoplastic pemphigus was suspected and a search for an underlying neoplasm was initiated. An exploratory laparotomy revealed a pelvic mass and the histologic examination showed an inflammatory fibrosarcoma. The evidence of acantholysis on new cutaneous lesions and the positivity of indirect immunofluorescence with rodent urinary bladder epithelium reinforced the diagnostic criteria for paraneoplastic pemphigus, which is confirmed by the identification of strong protein bands at 210, 190 and 170 kd by immunoprecipitation. Paraneoplastic pemphigus should be considered when investigating atypical mucocutaneous manifestations of pemphigus vulgaris and lichen planus. Diagnostic screening for paraneoplastic pemphigus and a search for an underlying tumor should be performed.
Topics: Adult; Black or African American; Biopsy, Needle; Female; Fibrosarcoma; Follow-Up Studies; Humans; Immunohistochemistry; Laparotomy; Paraneoplastic Syndromes; Pelvic Neoplasms; Pemphigus; Risk Assessment; Treatment Outcome
PubMed: 16471469
DOI: 10.1111/j.1346-8138.2005.tb00893.x -
European Journal of Surgical Oncology :... Nov 2022Minimally invasive surgical techniques are being successfully used to treat locally advanced and recurrent pelvic malignancy of colorectal origin. This review aims to... (Review)
Review
Application of minimally invasive approaches to pelvic exenteration for locally advanced and locally recurrent pelvic malignancy - A narrative review of outcomes in an evolving field.
INTRODUCTION
Minimally invasive surgical techniques are being successfully used to treat locally advanced and recurrent pelvic malignancy of colorectal origin. This review aims to describe the application of minimally invasive approaches to pelvic exenteration and compare current reported surgical outcomes.
METHODS AND RESULTS
A literature search was performed of PubMed, Google Scholar and EMBASE for studies on pelvic exenteration with locally advanced or recurrent rectal cancer utilising minimally invasive techniques. A total of 22 studies were reviewed, including four case reports describing novel approaches.
DISCUSSION
Laparoscopic, robotic and trans-anal total mesenteric excision (TaTME) aided pelvic exenteration methods have recently demonstrated low post-operative morbidity and mortality trends. Minimally invasive methods also have improved rates of R0 resection in modest cohort studies. Hybrid methods have also been proposed to overcome observed technical difficulties such as the narrow male pelvis and obese habitus. There is still limited data beyond case report and small cohort studies on challenging patient groups such as those with recurrent rectal cancer or bony involvement, as a consequence of patient selection for these novel approaches.
CONCLUSION
International, multicentre studies have provided the best opportunity to explore efficacy of these methods on a larger scale. Further research is required into patient selection, safety and long-term outcomes of these approaches within high volume centres practicing beyond the surgical learning curve.
Topics: Male; Humans; Pelvic Exenteration; Pelvic Neoplasms; Neoplasm Recurrence, Local; Rectal Neoplasms; Pelvis; Carcinoma; Retrospective Studies; Treatment Outcome
PubMed: 36068124
DOI: 10.1016/j.ejso.2022.08.004 -
Korean Journal of Radiology 2015To describe the imaging features of pelvic solitary plasmacytoma and to correlate them with the pathologic grade.
OBJECTIVE
To describe the imaging features of pelvic solitary plasmacytoma and to correlate them with the pathologic grade.
MATERIALS AND METHODS
A retrospective study was performed on the imaging features of 10 patients with a histological diagnosis of pelvic solitary plasmacytoma. The imaging studies were assessed for bone expansion, cortical destruction, signal intensity/density of soft tissue mass and enhancement manifestations, which were then correlated to the pathologic grade.
RESULTS
The imaging features of pelvic solitary plasmacytoma revealed 3 different types: multilocular type (n = 5), unilocular type (n = 2) and complete osteolytic destruction type (n = 3) on computed tomography and MRI. Pathologically, the tumors were classified into low, intermediate and high grades. Features such as multilocular change, perilesional osteosclerosis, slight expansion, local bone cortex disruptions and masses inside bone destruction, often suggest a low-grade solitary plasmacytoma; complete osteolytic destruction, huge soft tissue mass, and osseous defects imply a higher pathologic grade.
CONCLUSION
Pelvic solitary plasmacytoma has various imaging manifestations, while a slight expansile osteolytic feature with multilocular change or homogeneous enhancement highly suggests its diagnosis. The distinctive imaging features of pelvic solitary plasmacytoma are well correlated to the pathologic grade.
Topics: Adult; Aged; Female; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Neoplasm Grading; Pelvic Neoplasms; Plasmacytoma; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 25598683
DOI: 10.3348/kjr.2015.16.1.146 -
Medicine Sep 2016Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis. (Review)
Review
BACKGROUND
Malignant phyllodes tumor (PT) is a rare fibro epithelial neoplasm of the breast, which is poor prognosis due to high risk of recurrence and distant metastasis.
METHODS
We report a case of malignant PT. It had recurred locally five times, and the sixth relapse was occurred 54 months after first diagnosis, presenting a huge pelvic mass (14 cm × 11 cm) by CT scan. Histopathological examination has demonstrated a metastatic phyllodes tumor. After postoperative chemotherapy treatment, a longer survival has been achieved, which is more than 72 months.
RESULTS
Our case report describes a breast PT with several local recurrences and a rare metastasis (pelvic cavity), but long-term overall survival was achieved after surgery and chemotherapy.
CONCLUSION
We conclude that trustworthy prognosticators that identify patients with excessive potential of aggressive clinical course should be explored. Moreover, proper treatment could prolong overall survival of metastatic PT patients.
Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Fatal Outcome; Female; Humans; Immunohistochemistry; Mastectomy; Neoplasm Recurrence, Local; Pelvic Neoplasms; Pelvis; Phyllodes Tumor; Positron Emission Tomography Computed Tomography
PubMed: 27661051
DOI: 10.1097/MD.0000000000004942 -
Revista Espanola de Enfermedades... Jan 2016We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an...
We report a case of a 50-year-old woman who presented to the emergency department with large bowel obstruction and anemia. The initial imaging study suggested an inoperable rectal tumor with involvement of surrounding structures. In this paper we discuss the diagnostic work-up of this patient with a diagnosis of pelvic/perirectal inflammatory myofibroblastic tumor (IMT). IMT is a rare tumor with intermediate malignant potential that frequently mimics clinical and imaging features of malignancy. Additionally, to the best of our knowledge, this is the first case of a pelvic IMT that regressed without surgical excision.
Topics: Anemia; Diagnosis, Differential; Female; Humans; Intestinal Obstruction; Magnetic Resonance Imaging; Middle Aged; Neoplasm Regression, Spontaneous; Neoplasms, Muscle Tissue; Pelvic Neoplasms; Rectal Neoplasms
PubMed: 26765236
DOI: No ID Found -
PloS One 2017Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term...
BACKGROUND AND OBJECTIVES
Treatment of pelvic tumors remains challenging due to complex anatomy, poor oncological outcome and high complication rates. We sought to investigate the long-term oncological and surgical outcome of these patients.
METHODS
Between 1980 and 2012, 147 patients underwent surgical treatment for pelvic sarcoma. Histological diagnosis was Chondrosarcoma in 54, Ewing's Sarcoma/PNET in 37, Osterosarcoma in 32 and others in 24 patients. Statistical analysis for the evaluation of oncological and surgical outcome was performed by applying Cox proportional hazards regression and Fine-Gray regression models for competing risk (CR) endpoints.
RESULTS
The estimated overall survival (OS) to death was 80%, 45% and 37% at 1, 5 and 10 years, respectively. Univariate analyses revealed a statistically significant unadjusted influence of age age (p = 0.038; HR = 1.01), margin (p = 0.043; HR = 0.51) and grade (p = 0.001; HR = 2.27) on OS. Considering the multivariable model, grade (p = 0.005; HR = 3.04) and tumor volume (p = 0.014; HR = 1.18) presented themselves as independent prognostic factors on OS. CR analysis showed a cumulative incidence for major complication of 31% at 5 years. Endoprosthetic reconstruction had a higher risk for experiencing a major complication (p<0.0001) and infection (p = 0.001).
CONCLUSIONS
Pelvic resections are still associated with a high incidence of complications. Patients with pelvic reconstruction and high volume tumors are especially at risk. Consequently, a cautious decision-making process is necessary when indicating pelvic reconstruction, although a restrictive approach to pelvic reconstruction is not necessarily reasonable when the other option is major amputation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Child; Child, Preschool; Disease-Free Survival; Female; Hemipelvectomy; Humans; Infections; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Neoplasms; Postoperative Complications; Prognosis; Proportional Hazards Models; Retrospective Studies; Risk; Sarcoma; Survival Rate; Treatment Outcome; Vascular Diseases; Young Adult
PubMed: 28199377
DOI: 10.1371/journal.pone.0172203 -
In Vivo (Athens, Greece) 2019Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies. (Meta-Analysis)
Meta-Analysis
BACKGROUND/AIM
Although pelvic exenteration is an aggressive surgical procedure, it remains almost the only curative solution for patients diagnosed with large pelvic malignancies.
PATIENTS AND METHODS
We present a series of 100 patients submitted to pelvic exenteration with curative intent.
RESULTS
The origin of the primary tumor was most commonly represented by cervical cancer, followed by, endometrial cancer, rectal cancer, ovarian cancer and vulvo-vaginal cancer. An R0 resection was confirmed in 68 cases, while the remaining 32 cases presented lateral positive resection margins or perineal positive margins. The postoperative morbidity rate was 37% while the mortality rate was 3%. As for the-long term outcomes, the median overall survival time was 38.7 months, being most significantly influenced by the origin of the primary tumor.
CONCLUSION
Although pelvic exenteration is still associated with an increased morbidity, an important improvement in the long-term survival can be achieved, especially if radical resection is feasible.
Topics: Adult; Aged; Disease Management; Female; Humans; Male; Middle Aged; Neoplasm Grading; Neoplasm Recurrence, Local; Neoplasm Staging; Pelvic Exenteration; Pelvic Neoplasms; Prognosis; Treatment Outcome; Tumor Burden
PubMed: 31662557
DOI: 10.21873/invivo.11723 -
Cirugia Espanola Nov 2019Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high...
Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.
Topics: Biopsy; Drug Therapy; Humans; Margins of Excision; Neoplasm Recurrence, Local; Patient Care Team; Pelvic Neoplasms; Preoperative Period; Prognosis; Radiotherapy; Retroperitoneal Neoplasms; Sarcoma; Surgeons; Survival Rate
PubMed: 31521244
DOI: 10.1016/j.ciresp.2019.06.011 -
Techniques in Coloproctology Apr 2002Presacral (retrorectal) tumors are particularly rare in the adult. There is difficulty in the performance of diagnostic biopsy, and specialized imaging is required to... (Review)
Review
Presacral (retrorectal) tumors are particularly rare in the adult. There is difficulty in the performance of diagnostic biopsy, and specialized imaging is required to plan surgical extirpation. This review assesses their incidence and classification as well as the principles involved in their diagnosis and surgical management.
Topics: Biopsy; Diagnostic Imaging; Humans; Incidence; Pelvic Neoplasms; Sacrococcygeal Region
PubMed: 12077641
DOI: 10.1007/s101510200008 -
The British Journal of Surgery Jul 2023
Topics: Humans; Pelvic Exenteration; Pelvic Neoplasms; Robotic Surgical Procedures; Neoplasm Recurrence, Local; Pelvis; Retrospective Studies
PubMed: 36441181
DOI: 10.1093/bjs/znac422