Giant Tumor Research Articles

Perioperative strategies and management of giant anterior mediastinal tumors: a narrative review.

Giant anterior mediastinal tumors sometimes may cause circulatory collapse and respiratory failure, known as mediastinal mass syndrome (MMS). The prediction and prevention of MMS is challenging. The aim of this study is to summarize the evaluation methods for MMS and formulate treatment strategies for giant anterior mediastinal tumors. We performed a thorough analysis of recent international literature on giant anterior mediastinal tumors (>10 cm in diameter) and MMS published in the PubMed database. The search spanned the duration of the preceding 10 years from August 19, 2023, and only studies published in English were included. Mature teratomas and liposarcomas are the most common giant anterior mediastinal tumors and MMS develops most frequently in case of malignant lymphomas. Here, we propose a new treatment strategy for giant anterior mediastinal tumors. Based on imaging findings, giant anterior mediastinal tumors can be classified as cystic or solid and further blood investigation data are useful for a definitive diagnosis. When malignant lymphoma or malignant germ cell tumor is highly suspected, the first choice of treatment is not surgery but chemotherapy and radiotherapy. Moreover, image-guided drainage may be effective if giant cystic anterior tumors develop into MMS. The risk classification of MMS is important for treating giant anterior mediastinal tumors. If the MMS risk classification is 'unsafe' or 'uncertain', the intraoperative management deserves special attention. The surgical approach should however be based on tumor localization and invasion of surrounding tissues. Multidisciplinary team coordination is indispensable in the treatment of giant anterior mediastinal tumors. When giant anterior mediastinal tumors are encountered, it is important to follow the appropriate treatment strategy, focusing on the development of MMS based on imaging findings and symptoms.

Staged Surgical Treatment of the Giant Pituitary Neuroendocrine Tumors

To investigate the long-term clinical outcomes of staged surgical resection in giant Pituitary Neuroendocrine Tumors(pitNET).Method We performed a retrospective analysis of the clinical data of 16 patients who underwent surgery. The patients were diagnosed and underwent surgery at the Department of Neurosurgery of Shiyan Taihe Hospital from January 2013 to March 2021. Among the cases, 12 patients underwent primarily transsphenoidal surgery followed by secondary transcranial surgery, while 4 patients underwent primarily transsphenoidal surgery followed by secondary transsphenoidal surgery. Before the surgery, all patients underwent a pituitary MRI scan, pituitary hormone level examination, visual acuity, and visual field examination. A pituitary MRI was rechecked within 1 week after the operation. A tumor resection rate of 100% on MRI was considered as a total resection, between 90% to 100% as a subtotal resection, and lower than 90% as a partial resection. After the surgery, regular clinical visits and telephone or internet platform follow-ups were conducted. Outcome In our clinical investigation, after staged surgery 10 patients had a total resection, 5 had a subtotal resection, and 1 had a partial resection depending on the tumor size and invasion. The clinical outcomes showed that 1 case suffered from postoperative intracranial infection, 1 case had decreased visual acuity, and 6 cases experienced decreased pituitary function after surgery.Postoperative complications were cured after symptomatic treatment, except for 1 patient who experienced decreased vision and 1 patient sufferred hypopituitarism required long-term oral levothyroxine tablet treatment. No cases of intracranial hemorrhage or death were caused by intentionally staged resection surgery. Conclusion Staged surgery for giant pitNET is a safe and effective clinical surgery strategy.

A Case of Giant Malignant Peripheral Nerve Sheath Tumor of Neck

Malignant peripheral nerve sheath tumor (MPNST) is an extremely rare sarcoma of soft tissue. It is locally invasive, frequently recurred and metastasizes distantly, therefore has a very poor prognosis. the most involved sites are human body and extremities, and MPNST occurs and involved very rarely in the parapharynx of neck. MPNST does not react to radiotherapy and chemotherapy, therefore complete surgical resection is the most important treatment. Since immunohistochemical staining is essential for the final diagnosis, it is common to be confirmed after surgery. We report a case of giant MPNST without symptom in the head and neck involving the right parapharynx with multiple distant metastases in a 74-year-old patient on a review of the literature.

Clinicopathological analysis of giant ovarian tumors

ObjectiveThis study aims to analyze giant ovarian tumors' clinical and pathological characteristics. Material and MethodsThis was an analytical observational study. Medical records of all patients with giant ovarian tumors who underwent surgery between January 2020 and June 2022 at Dr. Soetomo Academic Hospital, Surabaya, Indonesia, were analyzed. ResultsWe analyzed 63 patients with ovarian tumors measuring > 20 cm who underwent surgery at Dr. Soetomo Academic Hospital, Surabaya, Indonesia. The mean tumor size was 25.9 cm (largest size was 41 cm). There was no significant difference in tumor size between benign and malignant giant ovarian tumors (p = 0.261). Based on histopathological results, 66.67 % of giant ovarian tumors were malignant, 26.98 % were benign, and 6.35 % were borderline. Among the malignant tumors, the epithelial type accounted for 69 % of cases. Most giant ovarian tumors originated in the left adnexa (68.25 %). There was no significant difference in patient age (p = 0.511), tumor size (p = 0.168), malignancy (p = 0.303), and histopathological type (p = 0.232) regardless of adnexal side. CA125 levels did not differ significantly between malignant and benign giant ovarian tumors (p = 0.604). There was no correlation between malignant ovarian tumor size and CA125 levels, while there was a significant difference between CA125 levels and the adnexal side (p = 0.010). ConclusionsMost giant ovarian tumors were malignant, diagnosed at an early stage, and predominantly epithelial type. CA125 levels did not correlate with the size of malignant ovarian tumors. Most giant ovarian tumors originate in the left adnexa.

Keratin-Positive Giant Cell-Rich Tumor: A Review and Update.

Keratin-positive giant cell-rich tumor (KPGCT) is an extremely rare and recently described mesenchymal neoplasm that occurs in both soft tissue and bone, frequently found in young women. It has locally recurrent potential if incompletely excised but low risk for metastasis. KPGCT is histologically similar to conventional giant cell tumors of soft tissue but shows the presence of keratin-positive mononuclear cells. Interestingly, KPGCT also shares some morphological features with xanthogranulomatous epithelial tumors. These two tumors have recently been shown to harbor an HMGA2-NCOR2 fusion, arguing in favor of a single entity. Surgery is the treatment of choice for localized KPGCT. Therapeutic options for advanced or metastatic disease are unknown. This review provides an overview of the current knowledge on the clinical presentation, pathogenesis, histopathology, and treatment of KPGCT. In addition, we will discuss the differential diagnosis of this emerging entity.

A radiograph-based deep learning model improves radiologists’ performance for classification of histological types of primary bone tumors: A multicenter study

PurposeTo develop a deep learning (DL) model for classifying histological types of primary bone tumors (PBTs) using radiographs and evaluate its clinical utility in assisting radiologists. MethodsThis retrospective study included 878 patients with pathologically confirmed PBTs from two centers (638, 77, 80, and 83 for the training, validation, internal test, and external test sets, respectively). We classified PBTs into five categories by histological types: chondrogenic tumors, osteogenic tumors, osteoclastic giant cell-rich tumors, other mesenchymal tumors of bone, or other histological types of PBTs. A DL model combining radiographs and clinical features based on the EfficientNet-B3 was developed for five-category classification. The area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, and specificity were calculated to evaluate model performance. The clinical utility of the model was evaluated in an observer study with four radiologists. ResultsThe combined model achieved a macro average AUC of 0.904/0.873, with an accuracy of 67.5 %/68.7 %, a macro average sensitivity of 66.9 %/57.2 %, and a macro average specificity of 92.1 %/91.6 % on the internal/external test set, respectively. Model-assisted analysis improved accuracy, interpretation time, and confidence for junior (50.6 % vs. 72.3 %, 53.07[s] vs. 18.55[s] and 3.10 vs. 3.73 on a 5-point Likert scale [P < 0.05 for each], respectively) and senior radiologists (68.7 % vs. 75.3 %, 32.50[s] vs. 21.42[s] and 4.19 vs. 4.37 [P < 0.05 for each], respectively). ConclusionThe combined DL model effectively classified histological types of PBTs and assisted radiologists in achieving better classification results than their independent visual assessment.

Epilepsy in Association with Giant Skull Base Tumors: A Retrospective Case Series of Giant Skull Base Tumors in the Anterior and Middle Fossa

Abstract Objective This study aims to investigate the association between giant anterior and middle fossa skull base tumors and epilepsy, and implications for clinical management. Methods A retrospective analysis was conducted on a cohort of patients diagnosed with anterior skull base tumors between 2016 and 2023. Radiologic data were used to identify tumors with major diameter larger than 5 cm involving skull base with intracranial involvement. Relevant demographic information, tumor characteristics, seizure type, seizure frequency, and treatment outcomes were analyzed. Results Among the 236 patients diagnosed and operated with skull base tumors by senior author, 7.63% (n = 18) had giant skull base tumors of anterior and middle fossa, and 2.96% (n = 7) presented with concurrent epilepsy. Overall, in giant anterior and middle fossa skull base tumors, epilepsy was present in 38% of cases. The average age at operation was 47.56 ± 16.96, with 44.4% of cases being male and 55.6% of the cases being female. The majority of these cases exhibited focal epilepsy (71%), characterized by seizures originating from the proximity of the tumor location suggesting a potential correlation between tumor location and seizure generation. Of the remaining, 29% were generalized seizures. Tumors of the anterior fossa included 11 meningiomas, 3 pituitary adenomas, 1 chondrosarcoma, 1 hemangiopericytoma, 1 schwannoma, and 1 adenoid cyst carcinoma; half of which (n = 9) were of low grade. Conclusion Our findings provide evidence of low frequency of epilepsy in skull base tumors in general, with an association among giant anterior and middle fossa skull base tumor and epilepsy.

Surgical management of a giant kidney tumor weighing 9.2 kg

Abstract Giant renal tumors are very rare, and they present with abdominal distension without any other symptoms. Complete resection of the tumor is the only curative treatment if metastasis is excluded. We present a case of a giant kidney tumor weighing 9.2 kg removed surgically in toto.

Clinical case of treatment of giant uterine fibroid

Uterine leiomyomas are the most common type of benign tumor that occurs in the female pelvis. Uterine leiomyoma is a tumor of smooth muscles. Its prevalence is higher in the reproductive age group and decreases after menopause. Giant uterine fibroids are a rare tumor of the uterus. Giant uterine fibroids, especially subcutaneous types, are complicated by malnutrition due to deterioration of their blood supply. The complaints of the patients are non-specific: an increase in the size of the abdomen, aching pains, sometimes difficulty urinating and defecating. A physical examination reveals a giant abdominal and pelvic formation. Ultrasound with Dopplerometry and contrast-enhanced MRI diagnoses a giant tumor next to the uterus with a heterogeneous structure and the presence of cystic cavities, which is difficult to distinguish from a true large ovarian tumor. The article illustrates the complexity of differential diagnosis of giant tumor of the uterus and ovaries. There are no significant differences between these tumors during ultrasound and MRI examinations. The final diagnosis can be made intraoperativery. The article presents a clinical observation of the giant uterine fibroids of a 48-year-old female patient. Ultrasound and contrast-enhanced MRI revealed a giant tumor of the right ovary, which occupied the entire abdominal cavity, of a heterogeneous structure. Intraoperatively, two tumors, intimately adjacent to each other, 31 cm and 28 cm in diameter, emanating from the isthmus of the uterus, were found. The final diagnosis of uterine fibroids was established histologically. Difficulties in differential diagnosis between uterine fibroids and ovarian tumors before surgery are associated with the large size of the tumor and the heterogeneity of the structure due to its malnutrition.

A pulmonary artery was embolized in a patient with an occluded pulmonary vein to manage massive hemoptysis

BackgroundStenosis and obliteration of the pulmonary vein can be developed by multiple diseases and might cause hemoptysis. Traditional therapy including surgical procedure and conservative treatments might be inappropriate choices to manage massive hemoptysis.Case presentationA 64-year-old man, diagnosed with advanced stage IVA lung squamous cell carcinoma, presented with dyspnea and recurrent, massive hemoptysis. An initial contrast-enhanced computed tomography revealed a giant tumor in the left lung hilus and occlusion of the left superior pulmonary vein. Despite immediate selective bronchial artery embolization and simultaneous embolization of an anomalous branch of the internal thoracic artery, the massive hemoptysis continued. Subsequently, embolization of the left superior pulmonary artery was performed, achieving functional pulmonary lobectomy, which successfully treated the hemoptysis without relapse during a six-month follow-up. The patient continues to undergo cancer therapy and remains stable.ConclusionsThis case successfully managed massive hemoptysis associated with lung cancer invasion into the pulmonary vein through functional pulmonary lobectomy via embolization of the corresponding pulmonary artery.

Management Approaches and Patient Outcomes for Giant Pituitary Neuroendocrine Tumors Classified as Knosp Grade 3 and 4.

Background Treatment of patients with a giant pituitary neuroendocrine tumor (GPitNET) is challenging. Here, we present the methods used for the clinical management of patients who underwent GPitNET resection mainly via endoscopic endonasal surgery along with multimodal supportto avoid surgical complications, which can affect the outcomes. Methodology The medical records of 25 patients with a GPitNET who underwent endonasal endoscopic surgery were retrospectively reviewed. Complications were analyzed and factors affecting the extent of resection were evaluated. Results Gross total resection was achieved in six (24%), near-total resection (>90%) in nine (36%), and partial resection in 10 (40%) patients. Multivariate analyses revealed that tumors invading the middle fossa had negative effects on the extent of resection (odds ratio = 0.092, p = 0.047). Postoperative vision improved or normalized in 16 (64%), remained stable in eight (32%), and worsened in one (4%), while a new hormonal deficit was noted in seven (28%) patients. Complications included permanent oculomotor nerve palsy in one (4%) and transient oculomotor palsy in one (4%), apoplexy of the residual tumor resulting in ischemic stroke in one (4%), postoperative cerebrospinal fluid leakage in one (4%), and permanent diabetes insipidus in six (24%) patients. Conclusions For GPitNETs that extend into the middle fossa, our study underscored the difficulties in surgical extraction and the necessity for tailored treatment approaches. To ensure the safest and most complete removal possible, the surgical strategy must be specifically adapted to each case. Additionally, employing a comprehensive support approach is essential to reduce the chance of complications in patients impacted by this condition.

Benign Lipomatous Soft Tissue Tumors in Nigerians: An Analysis of the Clinical and Morphological Features of a Common but Important Entity.

Introduction Benign lipomatous tumors are soft tissue tumors that exhibit a predominant adipocytic phenotype. Lipomas are the archetype and are the most common benign soft tissue tumors in adults but relatively uncommon in children. Their sex incidence is equivocal. They sometimes occur in combination with other mesenchymal elements, giving rise to variants including fibrolipoma, angiolipoma, myolipoma, spindle cell lipoma, chondroid lipoma, osteolipoma, and chondrolipoma. Their clinical significance is mainly due to the cosmetic disfigurement of patients and the differential diagnosis of malignant soft tissue tumors. Occasionally, due to their large size or presence near vital organs, they may cause life-threatening and/or excruciating pressure symptoms. This study was purposed to address the dearth of local studies on the clinical and morphological characteristics of benign lipomatous tumors in Nigerians, to compare these with those of other populations, and to establish baseline data. Materials and methods This was a retrospective study of all benign lipomatous tumors seen in the anatomic pathology and forensic medicine department of Asokoro District Hospital, Abuja, Federal Capital Territory, Nigeria, over an eight-year period. Surgical pathology reports were retrieved for patients' biodata and clinical information. The appropriate slides were retrieved, and reviewed, and new sections were cut where necessary. The tumors were classified according to the 2020 World Health Organization (WHO) guidelines and categorized based on size as small, medium, or giant. The data obtained were analyzed, and the results were presented as tables, bar charts, ratios, and percentages. Results Four hundred and eighteen cases met the inclusion criteria. Of these, 58.4% (244/418), occurred in females, while 41.6% (174/418) occurred in males. The age range was six to 91 years, while the median age was 42 years. The least number of cases, 0.5% (2/418), were seen in patients aged less than 10 years, while the majority, 35.4% (148/418), occurred in the fifth decade, followed by 27.8% (116/418) in the fourth. Size-wise, the majority of tumors, 60% (253/418), were medium, followed by small, 22.8% (95/418). Giant-sized tumors significantly accounted for 16.7% (70/418) of the cases. The diagnostic spectrum comprised conventional lipoma and variants such as fibrolipoma, spindle cell lipoma, pleomorphic lipoma, angiolipoma, chondrolipoma, intramuscular lipoma, and osteolipoma. Lipoma and fibrolipoma dominated with 87.1% (364/418) and 10.0% (42/418), respectively, while the rest accounted for <3%. The majority, 31.8% (133/418), occurred in the back/shoulder region, followed by the lower limb with 18.2% (76/418). Only two cases occurred in the abdominal/pelvic region. More tumors occurred in females in all the regions except the head and neck, which had a male-to-female ratio of 1.5:1. Multiple site tumors were more common in males in a ratio of 2.5:1. Most, 41.1% (39/95), of the small-sized tumors, occurred in the head/neck region, largely involving the face, 48.7% (19/39). Conclusion Our study showed many similarities in the clinical and morphological features of benign lipomatous tumors between Nigerians and other regions of the world. A notable finding, however, was the significantly higher proportion of giant benign lipomatous tumors when compared tostudies from other regions, a finding that warrants further studies.

Neurofibroma of C2 root

Background: Intra and extradural neurofibromas of C2 root is a challenging pathology, usually with indolent evolution, that is why the onset symptoms are neurologic deficit just like upper cervical myelopathy symptoms and explains the late diagnosis of giant tumours with severe spinal cord compression with involvement and distortion of great vessels anatomy. These facts make surgeries more difficult. The follow-up of this type of surgery must be very close because CSF fistula can often occur. Case description: The present article reports a series of three cases of neurofibromas, two of them are giant dumbbell-shaped C2 neurofibromas and the third one is a case of neurofibromatosis type 1 of C2 roots bilaterally, C3 root unilateral with unusual postoperative course. Dural reconstruction was necessary in all cases. Conclusions: The patients in this series were very symptomatic with good recovery. The surgical procedures were challenging, total tumour removal was possible, and the reconstruction of dural defects was needed in all cases. In the case of NF1, the postoperative period was practically just the follow-up of complications and addressing them. This fact stresses the importance of meticulous preoperative planning and close follow-up. Postoperative quality of life was better than preoperative in all the cases. The purpose of the surgical treatment is the decompression of the spinal cord, tumour removal and prophylaxis of CSF fistula by closing the dural defects. Overall, the surgical C2 root neurofibromas resection is a safe procedure and is associated with good clinical outcomes.

Multiple snares-assisted endoscopic full-thickness resection of a giant submucosal tumor at the esophagogastric junction.

Multiple snares-assisted endoscopic full-thickness resection of a giant submucosal tumor at the esophagogastric junction.

Giant right atrial tumor following catheter ablation.

We report a rare case of a giant right atrial myxoma after catheter ablation. A 74-year-old man presented with a fever of unknown origin three years after laser catheter ablation. Multimodal imaging revealed a giant tumor located in the right atrium, which was suspected to be malignant. Surgical resection was performed, and pathological examination revealed that the tumor was a myxoma. Several cardiac myxoma cases after catheter ablation have been reported, suggesting a potential association between myxoma development and catheter ablation-related tissue injury.

Anaesthesia Management for Giant Intraabdominal Tumours: A Case Series Study.

Due to a lack of randomised controlled trials and guidelines, and only case reports being available in the literature, there is no consensus on how to approach anaesthetic management in patients with giant intraabdominal tumours. This study aimed to evaluate the literature and explore the current status of evidence, by undertaking an observational research design with a descriptive account of characteristics observed in a case series referring to patients with giant intraabdominal tumours who underwent anaesthesia. Twenty patients diagnosed with giant intraabdominal tumours were included in the study, most of them women, with the overall pathology being ovarian-related and sarcomas. Most of the patients were unable to lie supine and assumed a lateral decubitus position. Pulmonary function tests, chest X-rays, and thoracoabdominal CT were the most often performed preoperative evaluation methods, with the overall findings that there was no atelectasis or pleural effusion present, but there was bilateral diaphragm elevation. The removal of the intraabdominal tumour was performed under general anaesthesia in all cases. Awake fiberoptic intubation or awake videolaryngoscopy was performed in five cases, while the rest were performed with general anaesthesia with rapid sequence induction. Only one patient was ventilated with pressure support ventilation while maintaining spontaneous ventilation, while the rest were ventilated with controlled ventilation. Hypoxemia was the most reported respiratory complication during surgery. In more than 50% of cases, there was hypotension present during surgery, especially after the induction of anaesthesia and after tumour removal, which required vasopressor support. Most cases involved blood loss with subsequent transfusion requirements. The removal of the tumor requires prolonged surgical and anaesthesia times. Fluid drainage from cystic tumour ranged from 15.7 L to 107 L, with a fluid extraction rate of 0.5-2.5 L/min, and there was no re-expansion pulmonary oedema reported. Following surgery, all the patients required intensive care unit admission. One patient died during hospitalization. This study contributes to the creation of a certain standard of care when dealing with patients presenting with giant intraabdominal tumour. More research is needed to define the proper way to administer anaesthesia and create practice guidelines.

A Recurrent Giant Phyllodes Tumor with Review of Literatures

Phyllodes tumors are rare breast tumors accounting for less than 1% Unlike breast cancers where they started from ducts and glands, phyllodes tumors start in the connective tissue of the breast. They are fast growing tumors with a large spectrum of behavior and most of them are benign with resemble of fibroadenoma with small number of borderline and malignant tumors. The correct diagnosis is mostly through core needle biopsy and it is also important to decide whether surgical management has to be done. Here we had a case of 38 year-old woman having recurrent fast growing lump to her right breast with distorted nipple with irregular border. MRI showed mass lesion measuring 9.5cm×14cm×20cm at right breast with few cystic areas with subtle chest wall infiltration especially underling muscles. After diagnosed to have phyllodes tumor total mastectomy involving partially the pectorals’ major with latissimus Dorsi myocutaneous flap reconstruction was done.

The effect of albumin to alkaline phosphatase ratio on survival in patients with metastatic bone sarcomas

Objective: To investigate the effect of albumin to alkaline phosphatase ratio (AALPR) at survival in patients with metastatic bone sarcomas.&#x0D; Patients and Methods: 60 patients with metastatic bone sarcomas were included in the study. The relationship between AALPR before chemotherapy and overal survival (OS) and progression free survival (PFS) was evaluated with Cox regression multivariate analysis.&#x0D; Results: Of the patients in the study, 25 (58.3%) were osteosarcoma, 16 (26.7%) Ewing's sarcoma, 5 (8.3%) chondrosarcoma and 4 (6.7%) giant cell bone tumor. AALPR was 0.039 obtained in ROC analysis. The median PFS and OS at AALPR ≥ 0.039 group was statistically significantly higher than the group with

Clinicopathological features of SMARCA4-deficient lung adenocarcinoma: a study of 42 cases

Objective: To investigate the clinicopathological characteristics and genetic mutations of SMARCA4-deficient lung adenocarcinoma. Methods: From January 2021 to April 2023 in the First Affiliated Hospital of Zhengzhou University, 42 cases of SMARCA4-deficienct lung adenocarcinoma were diagnosed and now analyzed. All cases were retrospectively studied using hematoxylin-eosin staining and immunohistochemistry. The clinicopathological features were reviewed. Next-generation sequencing (NGS) was performed to investigate the mutations of related genes. Results: Among the 42 cases, there were 35 biopsy and 7 surgical specimens. There were 38 males and 4 females. The male to female ratio was 9.5∶1.0, with an age range from 42 to 78 years. Thirty-three patients were smokers. Overall, 4 cases (9.5%), 2 cases (4.7%), 18 cases (42.9%) and 18 cases (42.9%) were at stages Ⅰ, Ⅱ, Ⅲ, and Ⅳ, respectively. Microscopically, all the cases were non-mucinous adenocarcinoma, without lepidic pattern. The morphology was diverse. Rhabdomyoid cells, tumor giant cells and tumor necrosis were present. Most of the tumor cells had eosinophilic cytoplasm and occasionally clear cytoplasm. Defined cell borders and variable cytoplasmic hyaline secretory globules could be found. Inflammatory cells infiltrated the tumor stroma. Immunohistochemistry showed 29 cases (69.0%, 29/42) expressed TTF1, 10 cases (40.0%, 10/25) expressed Napsin A, and 20 cases (100.0%, 20/20) expressed INI1. Forty cases (95.2%, 40/42) showed BRG1 loss in all tumor cells, while 2 cases (4.8%, 2/42) had partial BRG1 loss. PD-L1 (22C3) was positive in 59.2% of the cases (16/27). NGS revealed mutations in EGFR, ROS1, MET, RET and KRAS. Six cases (6/8) showed SMARCA4 mutation, while some cases were accompanied by mutations of TP53 (7/15), STK11 (4/8), and KEAP1 (1/8). Driver gene mutations were more common in women (P<0.05). Patients were followed up for 1-25 months. Four patients died and 20 patients' diseases progressed. Conclusions: SMARCA4-deficient lung adenocarcinoma lacks characteristic morphology. Most of them express TTF1 and harbor driver gene mutations. It is necessary to identify this subset of lung adenocarcinoma by carrying out BRG1 stain routinely on lung adenocarcinoma. These patients can then be identified and benefit from targeted therapies.

Soft-tissue reconstruction with pedicled vertical rectus abdominis myocutaneous flap after total or high sacrectomy for giant sacral tumor

BackgroundThe large soft tissue defect after total or high sacrectomy for giant sacral tumor induces high incidence of wound complications. It remains a huge challenge to reconstruct the soft tissue defect with a preferred clinical outcome. MethodsA total of 27 patients undergoing one-stage total or high sacrectomy for giant sacral tumor between 2016 and 2021 in a tertiary university hospital were retrospectively reviewed. Thirteen patients underwent a pedicled vertical rectus abdominis myocutaneous (VRAM) flap reconstruction while 14 patients underwent a conventional wound closure. Patient’s clinical characteristics, surgical duration, postoperative complications and outcomes were compared between the two groups. ResultsPatients in VRAM and Non-VRAM group were similar in baseline characteristics. The mean tumor size was 12.85cm (range: 10~17cm) in VRAM group and 11.79cm (range: 10~14.5cm) in Non-VRAM group (P=0.139). The most common giant sacral tumor is chordoma. Patients in VRAM group had shorter length of drainage (9.85 vs 17.14 days), postoperative time in bed (5.54 vs 17.14 days), and total length of stay (19.46 vs 33.36 days) compared to patients in Non-VRAM group. Patients in VRAM group had less wound infection and debridement than patients in Non-VRAM group (15.4 vs 57.1%, P<0.001). ConclusionThis study demonstrates the advantages of pedicled VRAM flap reconstruction of large soft tissue defects after high or total sacrectomy when using the anterior-posterior approach. This choice of reconstruction is better than direct wound closure in terms of wound infection, length of drainage, and total length of stay.