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Asian Journal of Endoscopic Surgery Jan 2019This case demonstrates successful resection of a rare, recurrent presacral-pelvic lipoblastoma in a 19-year-old female patient. Because of the anatomical location of the...
This case demonstrates successful resection of a rare, recurrent presacral-pelvic lipoblastoma in a 19-year-old female patient. Because of the anatomical location of the mass and its proximity to vital structures, the robotic approach allowed for both optimal visualization and effective debulking of the mass. Furthermore, with the use of an articulating laparoscopic camera, key visualization of the posterior lateral pelvis was possible. Using a wide breadth of technologies and resources is essential to broadening the surgical armamentarium and achieving resectability in otherwise challenging cases.
Topics: Female; Humans; Lipoblastoma; Neoplasm Recurrence, Local; Pelvic Neoplasms; Robotic Surgical Procedures; Young Adult
PubMed: 29747240
DOI: 10.1111/ases.12493 -
American Journal of Orthopedics (Belle... Jun 2010This is the fifth report of the rare lipoma-like variant of hibernoma, the 19th case reported, and the first documented as recurring after excision. Our patient was a...
This is the fifth report of the rare lipoma-like variant of hibernoma, the 19th case reported, and the first documented as recurring after excision. Our patient was a 56-year-old man whose painful lipoma-like hibernoma (LLH) in the pelvis/buttock was initially treated with marginal excision 15 years earlier. Nine years after treatment, the LLH recurred locally. The recurrence was treated with partial excision and embolization, which alleviated symptoms. The disease was stable 26 months after repeat excision and 202 months after initial treatment. LLH is 1 of the 4 histologic variants of hibernomas, which are rare benign lipomatous tumors distinguished from other lipomas by their brown-fat component. Only minimal information is available regarding the clinicopathologic characteristics of the individual variants. Reviewing the literature, we found that LLH predominantly develops in the fifth and sixth decades, and mean age at diagnosis is 41 years (age range, 2-66 years). LLH has a slight male predilection of 10:9. It most commonly develops in the thigh, with other occurrences reported in the hip, trunk, knee, and calf. The magnetic resonance imaging signal of LLH mirrors fat in all sequences. Presence of internal septations and enhancement with contrast are variable. Histologically, LLH is defined as a hibernoma composed predominantly of univacuolated white-fat cells and only scattered granular or pale hibernoma cells. The literature provides only a few treatment details regarding this variant.
Topics: Humans; Lipoma; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Neoplasms; Treatment Outcome
PubMed: 20631936
DOI: No ID Found -
Tumori Nov 2017Paraganglioma, a kind of pheochromocytoma originating from embryonic neural crest, is a rare neuroendocrine neoplasm commonly located at extra-adrenal areas such as... (Review)
Review
PURPOSE
Paraganglioma, a kind of pheochromocytoma originating from embryonic neural crest, is a rare neuroendocrine neoplasm commonly located at extra-adrenal areas such as head, neck, and abdomen. There are a few reports on renal paragangliomas; fewer than 5 reported cases are renal pelvic paragangliomas, including our case.
METHODS
Our patient, who had not experienced headache, hypertension, or palpitation, was founded to have a fixed mass in the left renal pelvis incidentally. Ultrasonography and computed tomography (CT) demonstrated a heterogeneous mass before surgery, and histopathologic test subsequently revealed that the infrequent mass was paraganglioma.
RESULTS
During 6 months follow-up, ultrasonography and CT examinations showed no signs of recurrence or metastasis.
CONCLUSIONS
The present case report confirms surgery as the standard to treat patients with paraganglioma. We present this case to serve as a reminder of suspected paraganglioma when it has occurred in renal pelvis.
Topics: Adult; Humans; Kidney Neoplasms; Kidney Pelvis; Male; Paraganglioma; Pelvic Neoplasms; Prognosis; Young Adult
PubMed: 28799639
DOI: 10.5301/tj.5000677 -
The Australian and New Zealand Journal... Aug 1976Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality...
Our experience of 76 pelvic exenterations for advanced pelvic malignancies is presented, with emphasis on the results and complications. The overall operative mortality rate of 14% is acceptable, and a five-year survival rate of 20% has been achieved. The procedure has a definite role to play in the management of advanced but otherwise localized pelvic malignancies.
Topics: Female; Humans; Leiomyosarcoma; Male; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms
PubMed: 1070292
DOI: 10.1111/j.1445-2197.1976.tb03314.x -
Journal of Cancer Research and Clinical... Jul 2014To analyze prognostic factors and long-term outcomes in patients with locally recurrent pelvic cancer (LRPC) treated with a multidisciplinary approach.
PURPOSE
To analyze prognostic factors and long-term outcomes in patients with locally recurrent pelvic cancer (LRPC) treated with a multidisciplinary approach.
METHODS AND MATERIALS
From January 1995 to December 2011, 81 patients [rectal (47 %); gynecologic (39 %); retroperitoneal sarcoma (14 %)] underwent extended surgery [multiorgan (58 %), bone (35 %), vascular (9 %), soft tissue (63 %)] and intraoperative electron beam radiation therapy (IOERT) to treat recurrent tumors in the pelvic region. Thirty-five patients (43 %) received external beam radiotherapy (EBRT). Survival was estimated using the Kaplan-Meier method, and risk factors were identified using univariate and multivariate analysis.
RESULTS
Median follow-up was 39 months (6-189 months); the 1- 3- and 5-year rates of locoregional control (LRC) were 83, 53, and 41 %, respectively. Univariate Cox proportional hazard analysis revealed worse LRC in patients who did not receive integrated EBRT as rescue treatment of pelvic recurrence (p = 0.003) or underwent non-radical resection (p = 0.01). In the multivariate analysis EBRT, non-radical resection, and tumor fragmentation retained significance (p = 0.002, p = 0.004, and p = 0.05, respectively).
CONCLUSIONS
Radical resection, absence of tumor fragmentation and addition of EBRT for rescue are associated with improved LRC in patients with LRPC. Our results suggest that this group can benefit from EBRT combined with extended surgical resection and IOERT.
Topics: Adolescent; Adult; Aged; Combined Modality Therapy; Digestive System Surgical Procedures; Female; Gynecologic Surgical Procedures; Humans; Interdisciplinary Communication; Intraoperative Care; Male; Middle Aged; Neoplasm Recurrence, Local; Patient Care Team; Pelvic Neoplasms; Radiotherapy Dosage; Radiotherapy, Adjuvant; Treatment Outcome; Young Adult
PubMed: 24718720
DOI: 10.1007/s00432-014-1667-6 -
Journal of Plastic, Reconstructive &... Jun 2012Pelvic extenuative surgery produces good long term outcomes in advanced pelvic malignancies. We evaluate the use and clinical outcomes of the Vertical Rectus Abdominus...
Pelvic extenuative surgery produces good long term outcomes in advanced pelvic malignancies. We evaluate the use and clinical outcomes of the Vertical Rectus Abdominus Myocutaenous (VRAM) flap as a reconstruction technique in a heterogenic cohort of patients with advanced colorectal cancer in whom neo-adjuvant chemo-radiotherapy had been performed pre-operatively. Analysis of patients having VRAM flaps for pelvic reconstruction in a tertiary referral centre from 2001 to 2010 was conducted. 37 patients (23 female, 14 male) underwent pelvic extenuative surgery of which 22 (60%) had recurrent pelvic disease. All surgical and medical complications were analysed. Major flap complications were defined as 'requiring return to the operating theatre at any stage' and these occurred in 6 (16%) patients. There were 7 (19%) minor flap complications defined as 'requiring conservative non surgical treatment' The total global re-intervention rate of patients requiring return to theatre for re-operation as a result of their exenteration and reconstruction was 6 (16%). We highlight the merits and versatility of the VRAM flap in advanced pelvic malignancy in obtaining stable and supple reconstructive cover and the relative low morbidity in this difficult group confirms out strong support for immediate VRAM reconstruction in pelvic exenterative procedures.
Topics: Adult; Aged; Aged, 80 and over; Chemoradiotherapy; Cohort Studies; Colectomy; Colorectal Neoplasms; Female; Graft Rejection; Graft Survival; Humans; Male; Middle Aged; Neoadjuvant Therapy; Neoplasm Invasiveness; Neoplasm Staging; Pelvic Neoplasms; Quality of Life; Plastic Surgery Procedures; Rectus Abdominis; Retrospective Studies; Risk Assessment; Surgical Flaps; Survival Analysis; Treatment Outcome; United Kingdom
PubMed: 22264638
DOI: 10.1016/j.bjps.2011.11.063 -
Radiation Oncology (London, England) Oct 2019There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides...
AIM
There is no general consensus on the optimal treatment for prostate cancer (PC) patients with intrapelvic nodal oligorecurrences after radical prostatectomy. Besides androgen deprivation therapy (ADT) as standard of care, both elective nodal radiotherapy (ENRT) and stereotactic body radiotherapy (SBRT) as well as salvage lymph node dissection (sLND) are common treatment options. The aim of our study was to assess decision making and practice patterns for salvage radiotherapy (RT) in this setting.
METHODS
Treatment recommendations from 14 Swiss radiation oncology centers were collected and converted into decision trees. An iterative process using the objective consensus methodology was applied to assess differences and consensus.
RESULTS
PSMA PET/CT was recommended by 93% of the centers as restaging modality. For unfit patients defined by age, comorbidities or low performance status, androgen deprivation therapy (ADT) alone was recommended by more than 70%. For fit patients with unfavorable tumor characteristics such as short prostate-specific antigen (PSA) doubling time or initial high-risk disease, the majority of the centers (57-71%) recommended ENRT + ADT for 1-4 lesions. For fit patients with favorable tumor characteristics, there were low levels of consensus and a wide variety of recommendations. For 1-4 nodal lesions, focal SBRT was offered by 64% of the centers, most commonly as a 5-fraction course.
CONCLUSIONS
As an alternative to ADT, ENRT or SBRT for pelvic nodal oligorecurrences of PC are commonly offered to selected patients, with large treatment variations between centers. The exact number of lymph nodes had a major impact on treatment selection.
Topics: Humans; Male; Neoplasm Recurrence, Local; Patient Selection; Pelvic Neoplasms; Practice Patterns, Physicians'; Prognosis; Prospective Studies; Prostatectomy; Prostatic Neoplasms; Radiotherapy; Salvage Therapy
PubMed: 31619296
DOI: 10.1186/s13014-019-1383-0 -
Annals of Surgery Jan 1974
Topics: Age Factors; Child, Preschool; Female; Follow-Up Studies; Ganglioneuroma; Humans; Infant; Infant, Newborn; Lymphatic Metastasis; Male; Neoplasm Regression, Spontaneous; Neuroblastoma; Pelvic Neoplasms; Prognosis; Vitamin B 12
PubMed: 4817867
DOI: 10.1097/00000658-197401000-00022 -
Diseases of the Colon and Rectum Jan 2021Achieving a negative resection through a pelvic exenteration for a recurrent or an advanced pelvic malignancy offers the potential for cure. Exenterative surgical units...
Preemptive Femoral-Femoral Crossover Grafting of Artery and Vein Before Pelvic Exenterative Surgery for Locally Advanced and Recurrent Pelvic Malignancy Involving the Aortoiliac Axis.
INTRODUCTION
Achieving a negative resection through a pelvic exenteration for a recurrent or an advanced pelvic malignancy offers the potential for cure. Exenterative surgical units have expanded the boundaries and redefined what constitutes resectable disease through improved surgical technique. In selected cases, contiguous tumor involvement of the aortoiliac axis requires en bloc resection and subsequent vessel reconstruction. However, vascular reconstruction can be challenging in a contaminated field during an extended radical resection.
TECHNIQUE
The aim of this Technical Note is to describe a novel method in the management of patients with recurrent or advanced pelvic malignancy involving the aortoiliac axis by performing preemptive femoral-femoral arterial and venous crossover grafts, with adjunctive arteriovenous loop fistula formation before undergoing an extended radical pelvic resection 4 weeks later.
RESULTS
Four patients have undergone preemptive femoral-femoral arterial and venous crossover grafts at our institution (median age = 60 y (range, 47-66 y); 2 women). There were no early complications, and all of the patients subsequently underwent extended radical pelvic resections for a pelvic malignancy.
CONCLUSIONS
Preemptive vascular reconstruction before major pelvic surgery reduces the risk of graft infection because this method avoids the wounds being contaminated by GI or genitourinary organisms. Other advantages to this technique include a reduction in the overall operating time for the pelvic exenteration, a significant reduction in the ischemia time to the lower limbs, and ensuring that the grafts are patent before embarking on major intra-abdominal surgery.
Topics: Aged; Aorta; Arteriovenous Shunt, Surgical; Blood Vessel Prosthesis; Female; Femoral Artery; Femoral Vein; Humans; Iliac Artery; Iliac Vein; Male; Middle Aged; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Vascular Grafting
PubMed: 33306540
DOI: 10.1097/DCR.0000000000001819 -
Archives of Surgery (Chicago, Ill. :... Apr 1994To review a 50-year experience with total pelvic exenteration for treatment of advanced pelvic cancer.
OBJECTIVE
To review a 50-year experience with total pelvic exenteration for treatment of advanced pelvic cancer.
DESIGN
Retrospective study with 100% follow-up.
SETTING
Cancer hospital.
PATIENTS
Two hundred thirty-two patients referred for treatment of advanced pelvic cancer who underwent total pelvic exenteration.
MAIN OUTCOME MEASURES
Rates of operative mortality, complications, recurrence, and 5-year survival.
RESULTS
The morbidity rate was 45%. The operative death rate was 14% during the 50-year period, but decreased from 16.8% in the first three decades to 10% thereafter. Eighty-nine patients (38%) had recurrences. The overall 5-year survival rate was 42%.
CONCLUSIONS
Operative mortality and morbidity have declined over 50 years, largely because of proper patient selection, increasing experience, and advances in perioperative care. Exenteration has a major role in the treatment of advanced pelvic cancer.
Topics: Adult; Aged; Aged, 80 and over; Cancer Care Facilities; Female; Follow-Up Studies; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Missouri; Neoplasm Recurrence, Local; Pelvic Exenteration; Pelvic Neoplasms; Retrospective Studies; Survival Rate
PubMed: 8154965
DOI: 10.1001/archsurg.1994.01420280062008