Evidence Of Local Recurrence Research Articles

Giant-cell tumor of the patella: An uncommon cause of fracture

Primary patellar tumors are highly unusual. Most are benign neoplasms with giant-cell tumors being the most common, followed by chondroblastomas and aneurysmal bone cysts. Intralesional curettage and bone grafting is the treatment of choice for most giant-cell tumors in the patella. The use of adjuvants can reduce the high recurrence rate. This is a case report of a giant-cell tumor in a 61-year-old man who was diagnosed with a pathological fracture in the patella after minimal trauma. Extended curettage through an osteotomy made in the medial cortical of the patella was performed. The tumor cavity was filled with high viscosity bone cement and the medial cortical was repositioned. Histological analysis showed mononuclear cells and numerous multinucleated giant cells, confirming the diagnosis. Twenty-four months after surgery, the patient was asymptomatic and there was no evidence of local recurrence. Epidemiology, symptomatology, imagenology, histopathology, treatment options and prognoses of giant-cell tumors of the patella are discussed herein.

Treatment of lung tumours with high-energy microwave ablation: a single-centre experience.

The purpose of our study is to report safety, technical success, effectiveness, local progression-free survival (LPFS) and overall survival of percutaneous microwave ablation (MWA) to treat lung tumours unsuitable for surgery. Nineteen patients with thirty-one tumours (mean diameter 2.4cm) underwent percutaneous MWA in 28 sessions. Microwave ablation was carried out using a 2450-MHz generator (Emprint/Covidien, Boulder, CO, USA). Procedures were performed under cone-beam CT (CBCT) and under fluoro-CT (one session) guidance. Safety, technical success, effectiveness, LPFS and overall survival (OS) were evaluated. Safety was defined as the frequency of major and minor complications. The efficacy was evaluated on the basis of imaging characteristics, using RECIST criteria. CT follow-up was performed at 1, 3 and 6months and yearly. LPFS was defined as the interval between MWA treatment and evidence of local recurrence, if there was any. OS was defined as the percentage of patients who were still alive. We registered one major complication (purulent hydro-pneumothorax). Minor complications were spontaneously resolved (pneumothorax and perilesional haemorrhagic effusion). Technical success was 100%. Residual disease was registered in two cases, one of whom was retreated. Complete ablation was obtained in the remaining cases (90.3%). During available follow-up (mean 9.6months), 9/31 tumours demonstrated local recurrence. Five tumours were retreated, and none of them presented residual disease during follow-up (LPFS 22.6%). Overall survival was 93.8%. Percutaneous high-energy MWA is a safe, effective and confident technique to treat lung tumours not suitable for surgery.

Primary Intraosseus Xanthoma Involving the Proximal Femur in a Normolipidemic Patient: A Case Report

We report the case of a 25-year-old woman presenting with left hip pain. A lesion was found in the proximal femoral metaphysis. Benign bone tumor, such as intraosseous lipoma or liposclerosing myxofibrous tumor, was suspected based on simple radiographs and magnetic resonance images. Curettage of the lesion and bone grafting was performed. Histologic findings reflected primary intraosseous xanthoma of the proximal femur. Laboratory tests revealed the patient to be normolipidemic, while immunoelectrophoretic fractionation of lipoproteins revealed normal values for alpha, pre-beta, beta, and chylomicrons. At the one-year follow-up, there was no evidence of local recurrence. This is the first reported case of primary intraosseous xanthoma of the proximal femur in a normolipidemic patient.

Diagnostic challenge

A 4-year-old, intact male, African pygmy hedgehog (Atelerix albiventris) was presented for evaluation of a 1.5 × 2.5 cm firm mass on the right ventral neck. The ventral cervical mass was surgically resected and histopathologically diagnosed as a presumptive metastatic C-cell carcinoma. Following surgery, the hedgehog was treated with a total of 32 Gy (8 Gy/fraction for 4 weekly fractions) via external beam radiation therapy. No acute radiation side effects were noted during or 1 week post–radiation therapy. At the time of writing, the hedgehog was 9 months postdiagnosis with no evidence of local recurrence or metastatic disease.

Eosinophilic cystitis mimicking muscle-invasive bladder cancer: a case report and literature review

Objective To evaluate the clinical and pathological features of eosinophilic cystitis (EC), and to discuss its diagnosis and treatment. Methods The clinical and pathological data of one case of eosinophilic cystitis were reported. An 86-year-old male with gross hematuria and urinary urgency for 15 days was admitted on 16 March 2015. A computed tomography scan showed uneven thickening of the bladder wall and a nodular soft tissue on the anterior wall protruding into the bladder cavity. Results Cystoscopic examination showed diffuse thickening of the bladder with polypoid red lesions on the anterior wall. Transurethral biopsies revealed infiltrating eosinophils, which was consistent with the diagnosis of EC. The patient was then treated with anti-inflammatory drugs, corticosteroids and anti-histamine drugs. At 6 months of follow-up, the patient was asymptomatic and had no evidence of local recurrence by ultrasonography. Conclusions Eosinophilic cystitis is a rare disease without specific clinical and imaging features, which can mimic bladder tumor. The final diagnosis of this disease depends on the pathology. Transurethral resection of the lesion along with postoperative hormone and antihistamines administration are the main choices of treatment. Key words: Eosinophilic cystitis; Dysuria; Diagnosis; Therapy

Stereotactic body re-irradiation therapy for locally recurrent prostate cancer after external-beam radiation therapy: Initial report

PurposeManagement of prostate cancer relapses after external-beam radiation therapy is still undefined. Re-irradiation schedules have been explored in different tumour sites. In this report, we present our preliminary experience of re-irradiation using stereotactic body radiotherapy for localized prostate cancer failure. Material and methodsBetween March 2011 and October 2014, robotic stereotactic body radiation therapy was administered to patients previously treated with external-beam radiation therapy to a median dose of 71.1Gy (range, 45–76.5Gy) and with biochemical failure corresponding to a local in-field recurrence of prostate cancer. Ten patients had recurrences after postoperative external-beam radiotherapy. Patients underwent a pelvic MRI to confirm the recurrence and a total body staging using a (18F)-fluorocholine PET/CT. The prescription dose consisted of five fractions of 7.25Gy to a total dose of 36.25Gy. Efficacy was evaluated based on biochemical response and toxicity was evaluated according to CTCAE v.4.0 questionnaires and International Prostate Symptom Score. ResultsTwenty-one patients were treated and followed for a median time of 11.7 months (mean: 13.4 months; range: 2.5–46.5 months). Median time between the first external-beam radiation therapy of prostate cancer and the first day of CyberKnife® treatment was 111 months (range: 38–398 months). One-year biochemical recurrence-free survival rate was 83.3%, and only one in-field progression was reported. Two patients had a biochemical failure corresponding to metastatic progression without evidence of local recurrence. Treatment was well tolerated, with only one grade 2 acute genitourinary toxicity, no grade≥2 acute gastrointestinal or late toxicities were reported. ConclusionStereotactic body re-irradiation therapy using CyberKnife® after failed external-beam radiation therapy showed favourable results in terms of in-field local and biochemical control. Toxicity was low and acceptable. Further prospective studies are needed to confirm these results to select patient and to evaluate the introduction of androgen-deprivation therapy.

Minimally invasive rib-sparing video-assisted thoracoscopic surgery resections with high-dose-rate intraoperative brachytherapy for selected chest wall tumors

BackgroundBy avoiding chest wall resection, iridium-192 (Ir-192) high-dose-rate (HDR) intraoperative brachytherapy (IOBT) and video-assisted thoracoscopic surgery (VATS) might improve outcomes for high-risk patients requiring surgical resection for pulmonary malignancy with limited pleura and/or chest wall involvement. Methods and materialsSeven patients with non-small cell lung cancer involving the pleura or chest wall underwent VATS pulmonary resections combined with HDR IOBT. After tumor extraction, an Ir-192 source was delivered via a Freiburg applicator to intrathoracic sites with potential for R1-positive surgical margins. The number of catheters, dwell position along each catheter, prescription depth, and dose were customized based on clinical needs. ResultsSix patients had pT3N0M0 non-small cell lung cancers. A seventh case was a recurrent sarcomatoid carcinoma. One case required conversion to open thoracotomy for pneumonectomy with en bloc chest wall resection. There were no intraoperative complications and average operative time was 5.8 hours. Five of seven patients without transmural chest wall involvement underwent rib-sparing resection. Four of the 6 patients treated with VATS and IORT remain alive in follow-up without evidence of local recurrence (median follow-up, 25 months). Noted toxicities were recurrent postoperative pneumothorax, pleural effusion with persistent chest wall pain, avid fibrosis at 2 years of follow-up, and a late traumatic rib fracture. ConclusionsHDR IOBT with Ir-192 via VATS is technically feasible and safe for intrathoracic disease with pleural and/or limited chest wall involvement. Short-term morbidity associated with chest wall resection may be reduced. Additional study is required to define long-term benefits.

Treatment of a Thyroid Tumor in an African Pygmy Hedgehog (Atelerix albiventris)

A 4-year-old, intact male, African pygmy hedgehog (Atelerix albiventris) was presented for evaluation of a 1.5 × 2.5cm firm mass on the right ventral neck. The ventral cervical mass was surgically resected and histopathologically diagnosed as a presumptive metastatic C-cell carcinoma. Following surgery, the hedgehog was treated with a total of 32Gy (8Gy/fraction for 4 weekly fractions) via external beam radiation therapy. No acute radiation side effects were noted during or 1 week post–radiation therapy. At the time of writing, the hedgehog was 9 months postdiagnosis with no evidence of local recurrence or metastatic disease.

Intestinal autotransplantation for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery.

We describe the operative techniques and perioperative morbidity of intestinal autotransplantation (IATx) for neoplasms originating in the pancreatic head with involvement of the superior mesenteric artery (SMA), particularly focusing on oncological outcomes of patients with ductal adenocarcinoma. Six patients with pancreatic head neoplasms aged 20 to 67years underwent IATx in our center from January 2012 to January 2016. The operative procedure involves (1) selection and procurement of a segment of small intestine as the autograft, (2) completion of an en bloc resection of the tumor along with involved organs, and (3) autotransplantation of the autograft. In all six patients, the median operative time was 12.1h (range, 9.5-16.5) with a median blood transfusion of 7 units (range, 4-10). All patients had margin-negative resections. Complications occurred in three of six patients with no perioperative mortality. The median duration of hospital stay was 19days (range, 15-26). These six patients have had a well-functioning autograft and have not required any intravenous fluid hydration since discharge. At 5.9-, 10.9-, and 12.4-month follow-ups, serum levels of CA19-9 remained normal in two and elevated in one of three patients with ductal adenocarcinoma. At a median follow-up of 12.1months (range, 4.9-42.9), all patients have remained alive without evidence of local recurrence and gross metastatic disease. IATx combined with extensive pancreaticoduodenectomy and SMA resection can be performed in highly selected patients with an acceptable morbidity and mortality. Careful preoperative assessment and planning are the keys to the success of this aggressive operation.

Thumb Reconstruction with Arthrodesis to the Second Metacarpal following Sarcoma Excision.

Primary sarcomas of the thumb metacarpal are rare malignant lesions. Surgical treatment involves amputation versus tumor resection with thumb reconstruction. If complete tumor resection is possible, thumb preservation may be considered, as the thumb is vital to hand function. Following tumor resection, previous reports have described graft reconstruction with fusion to the trapezium or scaphoid. We present two cases of sarcoma necessitating resection of the thumb metacarpal that were reconstructed with an arthrodesis of the proximal phalanx to the second metacarpal shaft. Arthrodesis to the second metacarpal allows robust bony contact for fusion as well as improved resting position of the thumb. At 2- and 4-year follow-up, both patients have a stable, pain-free thumb without evidence of local recurrence.

A rare case of triple negative synchronous bilateral invasive ductal carcinoma of breast

The occurrence of bilateral breast carcinoma is extremely rare with an incidence of 2-5% of all breast malignancies. We hereby report an unusual and interesting case of triple negative synchronous invasive ductal carcinoma (IDC) of bilateral breasts detected simultaneously in view of its rarity and therapeutic challenge it presented. A 55-year-old postmenopausal female presented with a history of lump bilateral breasts of 4 months duration. Fine needle aspiration cytology of both breast lumps showed IDC. Mammography showed Breast Imaging Reporting and Data System V both breasts. Metastatic workup was negative. She underwent bilateral modified radical mastectomy. Postoperative histopathology revealed IDC Grade III with estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2-neu negative on immunohistochemistry. She received adjuvant chemotherapy followed by locoregional radiotherapy to the right breast in view of nodal positivity. Presently on regular follow-up without any evidence of local recurrence or distant metastasis.

Spinous Process Osteochondroma as a Rare Cause of Lumbar Pain.

We present a case of a 5th Lumbar Vertebra (L5) spinous process osteochondroma as a rare cause of lumbar pain in an old patient. A 70-year-old male presented with progressive and disabling lower lumbar pain. Tenderness over the central and left paraspinal area of the lower lumbar region and a palpable mass were evident. CT scan showed a mass arising from the spinous process of L5. Marginal resection of the tumor was performed through a posterior approach. The histological study revealed an osteochondroma. After surgery, pain was completely relieved. After one year there was no evidence of local recurrence or symptoms. Osteochondromas rarely involve the spine, but when they do symptoms like pain, radiculopathy/myelopathy, or cosmetic deformity may occur. The imagiologic exam of election for diagnosis is CT scan. When symptomatic the treatment of choice is surgical resection. The most concerning complication of osteochondromas is malignant transformation, a rare event.

Incidentally Solitary, Synchronous, Metastatic Left Adrenal Mass From Colon Cancer.

The authors report the case of a 63-year-old man who underwent an open adrenalectomy for a synchronous, malignant, metastatic left adrenal tumor and a total colectomy for T3N0M1 (stage 4) primary, malignant colon cancer. Two polypoid lesions, one measuring 40 mm × 30 mm × 30 mm and the other measuring 20 mm × 10 mm × 10 mm, were found in the ascending colon and rectosigmoid (RS) junction, respectively, and a synchronous, malignant, left adrenal gland lesion measuring 70 mm × 50 mm × 30 mm was incidentally found on abdominal computed tomography scan. Histological examination revealed a metastatic, necrotic adenocarcinoma of the left adrenal mass, an adenocarcinoma of the cecal mass, and an adenomatous polyp (tubulovillous type) of the smallest polypoid lesion in RS junction that had invaded deeply into the submucosal layer. The patient recovered uneventfully, and his condition is now stable, with no evidence of local recurrence or metastatic disease, 2 years after the surgery. To the best of our knowledge, only 25 cases of an adrenalectomy for treating metastatic adrenal gland tumors have been reported to date; physicians should be aware of the possibility of this event.

A Painful Groin Pseudotumor Mimicked an Incarcerated Hernia

Incarcerated inguinal hernia is one of the emergency operations for delay diagnosis may cause serious dreadful effects such as bowel obstruction, bacterial translocation with sepsis, intestinal wall necrosis, bowel perforation, or even death. On the other hand, inflammatory pseudotumors (IPTs) were first described by Brunn, but their cause remains unknown. These benign lesions are common in children and young adults, but they can also occur in elderly adults. An 88-year-old Chinese man was referred to our hospital with a painful mass in his right inguinal region for 3 days. The patient complained about abdominal fullness, poor appetite, and right groin painful and an enlarged lesion in his groin site since five days ago. Physical examination revealed a tender, painful, untouchable, and nonpulsatile mass lesion in the right groin area. Non-specific bowel gas and stool impaction in the KUB. Ultrasound and color Doppler images showed a laminated and well-defined mass on the right inguinal region with a hypoechoic center without blood flow signals and increased peripheral vascularity, which was similar to a bowel loop through the inner ring into the inguinal canal. Computed tomography revealed a soft tissue mass-like lesion in right inguinal area. We performed an emergent exploratory laparotomy under a tentative diagnosis of an incarcerated hernia, but just found a mass in the hernia sac during the operation. Histopathologic examination showed typical findings of the IPT. The patient was followed for 6 months without evidence of local recurrence or distant metastasis. As it is nearly impossible to make a correct judgment prior to operation, surgical resection is usually required for diagnosing IPTs.

Low-Grade Fibromyxoid Sarcoma of the Malar Area.

Low-Grade Fibromyxoid Sarcoma of the Malar Area.

Giant plexiform neurofibroma of digital nerves: A case report and review of the literature

Neurofibroma is a benign tumor arising from nerve sheath of peripheral nerves, and may present as an isolated lesion or may present as part of von Recklinghausen's disease. Although plexiform neurofibromas usually affect the face, neck, back, and inguinal region, however other areas may rarely be affected. Plexiform neurofibroma of the palm is a very rare entity, which may affect the fine motor functions of the hand. Surgery is the only treatment option available, but due to diffuse involvement of the nerves and infiltrating nature of the lesions, complete resection may be impossible in many of the cases. We are reporting a case of giant neurofibroma of the palm affecting digital nerves in a 37-year-old patient presenting with features of Von Recklinghausen's disease. He presented with pain and swelling over left palm of 8 years duration. We carried out the surgical excision of the mass, and the individual has been followed-up on out-patient basis for about 3 months without showing any evidence of local recurrence.

Incidental Fallopian Tube Adenocarcinoma Managed using Robotic Staging Surgery

Primary fallopian tube carcinoma is an uncommon gynecological malignancy. Management of primary fallopian tube carcinoma using a robotic-assisted approach is also rare. We have described here two cases of adenocarcinoma located in the fallopian tubes that were managed using robotic-assisted staging surgery, followed by subsequent serial chemotherapy. The surgical procedure consisted of a total hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvi lymph node dissection, para-aortic lymph node dissection, appendectomy, omentectomy, peritoneal biopsies, and ascites cytology. After surgery, a test for CA-125 level and a computed tomography (CT) evaluation were conducted every 3 and 6 months, respectively. In Case I, the patient received 6 cycles of chemotherapy consisting of cisplatin and paclitaxel after surgery, and CA-125 level decreased from 55.9 U/mL to 9.5 U/mL over 6 months. At 16 months after surgery, a follow-up CT scan revealed no evidence of local recurrence. In Case II, the patient received 11 cycles of chemotherapy including cisplatin and paclitaxel, and CA-125 level decreased from 52.1 U/mL to 11.1 U/mL over 12 months. At 20 months after surgery, a follow-up CT scan revealed no evidence of local recurrence. In conclusion, robotic-assisted staging surgery is a feasible approach for treating incidentally located tumors in the fallopian tubes.

Red-Brown Plaques and Papules in a Patient With Breast Cancer.

A 55-year-old woman diagnosed with invasive ductal carcinoma of the left breast (T3N1M0, stage IIIA) in December 2012 was treated with neoadjuvant chemotherapy comprising docetaxel (75 mg/m) and trastuzumab (8 mg/kg initially, then 6 mg/kg every 3 weeks), followed by 3 courses of epirubicin (90 mg/m) and cyclophosphamide (600 mg/m), prior to modified radical mastectomy of the left breast. In September 2013, she began receiving trastuzumab treatment and received adjuvant radiotherapy (5000Gy in 25 fractions) 1 month later. In June 2014, she developed a generalized nonpruritic, nontender rash, without fevers or other constitutional symptoms. Physical examination showed multiple red-brown plaques and papules of various sizes on the chest, abdomen, back, and limbs (Figure 1). Laboratory evaluation revealed pancytopenia (white blood cells, 1460/μL; hemoglobin, 8.3 g/dL; and platelets, 99 000/μL [leukocyte differential: 0% blasts, 0% promyeloctes, 0%myelocytes, 0%metamyelocytes, 0% banded neutrophils, 30.1% segmented neutrophils, 4.1% eosinophils, 0.7% basophils, 0.7% monocytes, 64.4% lymphocytes]). A follow-up computed tomography scan of the chest and abdomen showed no evidence of local recurrence or distant metastasis. Quiz at jama.com Figure 1.Generalizedmultiple red-brown plaques and papules of various sizes on patient’s torso.

Ewing's sarcoma of the ulna treated with sub-total resection and reconstruction using a non-vascularized, autogenous fibular graft and hernia mesh: A case report.

Ewing's sarcoma of the bone is the second most frequently occurring malignant bone tumor in children and adolescents. Ewing's sarcoma in the ulna are extremely rare. Thus, the surgical options for reconstruction of the elbow are limited and technically challenging. In the current study, a 29-year-old male with Ewing's sarcoma of the ulna was treated with a sub-total resection and reconstruction using a non-vascularized, autogenous fibular graft and hernia mesh. At the 2-year follow-up, the patient had returned to his previous occupation with no evidence of local recurrence or distant metastasis. The functional recovery was satisfactory, and the patient could perform active movement of the elbow from 0° to 135°, forearm pronation to 30°, supination to 85° and had full hand function. The grip power of the left hand was 36 kg, which was 86% of the contralateral side (42 kg).

CT-guided permanent 125I seed interstitial brachytherapy for recurrent retroperitoneal lymph node metastases after external beam radiotherapy

To evaluate the feasibility, efficacy, and safety of permanent (125)I seed interstitial brachytherapy reirradiation in patients with retroperitoneal lymph node recurrence under CT guidance. Seventeen patients with 19 retroperitoneal lymph node recurrence after external beam radiotherapy underwent CT-guided (125)I seed implant brachytherapy from October 2007 to August 2014. Treatment for all patients was preplanned using a three-dimensional radiation therapy planning system 3-5days before brachytherapy; dosimetry verification was performed immediately after brachytherapy. The actuarial D90 (dose delivered to 90% of the target volume) was 100-198Gy (median, 126.5Gy). In 9 patients, pain intensity decreased to mild pain 1-3weeks after brachytherapy. Pain-free survival ranged 2-15months (median, 5months; 95% confidence interval [CI]: 0.1, 9.9). The overall response rate was 19 of 19 (100%). The median local control time was 15months (95% CI: 2.3, 27.7). The 6-, 12-, and 24-month local control rate was 88.0%, 63.2%, and 42.1%, respectively. Twelve patients (70.6%) developed distant metastases and died. Two patients (11.8%) are alive with distant metastases but no evidence of local recurrence. Three patients (17.6%) are alive with no evidence of local recurrence. Median overall survival was 10months (95% CI: 5.7, 14.3); the 1- and 2-year survival rates were 38.1% and 15.3%, respectively. No major complications related to the procedure occurred during or after brachytherapy. Reirradiation with CT-guided permanent (125)I seed interstitial brachytherapy is feasible, safe, and effective as pain relief or salvage treatment for patients with recurrent retroperitoneal lymph nodes.